Public Health Commons^™

Sex Differences In Morbidity And Care-Seeking During The Neonatal Period In Rural Southern Nepal, Summer Rosenstock, Joanne Katz, Luke C. Mullany, Subarna K. Khatry, Steven C. Leclerq, James M. Tielsch, Et Al.

Global Health Faculty Publications

Background

South Asian studies, including those from Nepal, have documented increased risk of neonatal mortality among girls, despite their early biologic survival advantage. We examined sex differences in neonatal morbidity and care-seeking behavior to determine whether such differences could help explain previously observed excess late neonatal mortality among girls in Nepal.

Methods

A secondary analysis of data from a trial of chlorhexidine use among neonates in rural Nepal was conducted. The objective was to examine sex differences in neonatal morbidity and care-seeking behavior for ill newborns. Girls were used as the reference group.

Results

Referral for care was higher during …

Revising The International Health Regulations: Call For A 2017 Review Conference., Rebecca Katz, Scott F. Dowell

Health Policy and Management Faculty Publications

No abstract provided.

Emergence Of Multidrug Resistant Influenza A(H1n1)Pdm09 Virus Variants In An Immunocompromised Child Treated With Oseltamivir And Zanamivir., Daisuke Tamura, Roberta L. Debiasi, Margaret Okomo-Adhiambo, Vasiliy P. Mishin, Angela P. Campbell, Brett Loechelt, Bernhard L. Wiedermann, Alicia M. Fry, Larisa V. Gubareva

Pediatrics Faculty Publications

Prolonged treatment of an immunocompromised child with oseltamivir and zanamivir for A(H1N1)pdm09 virus infection led to the emergence of viruses carrying H275Y and/or E119G in the neuraminidase. When phenotypically evaluated by neuraminidase inhibition, the dual H275Y-E119G substitution caused highly reduced inhibition by four neuraminidase inhibitors including oseltamivir, zanamivir, peramivir and laninamivir.

The Star Rating System And Medicare Advantage Plans, Lisa Sprague

National Health Policy Forum

With nearly 30 percent of Medicare beneficiaries opting to enroll in Medicare Advantage (MA) plans instead of fee-for-service Medicare, it’s safe to say the MA program is quite popular. The Centers for Medicare & Medicaid Services (CMS) administers a Star Ratings program for MA plans, which offers measures of quality and service among the plans that are used not only to help beneficiaries choose plans but also to award additional payments to plans that meet high standards. These additional payments, in turn, are used by plans to provide additional benefits to beneficiaries or to reduce cost sharing—added features that are …

Race And Ethnicity, Obesity, Metabolic Health, And Risk Of Cardiovascular Disease In Postmenopausal Women, Michelle D. Schmiegelow, Haley Hedlin, Rachel H. Mackey, Lisa W. Martin, Mara Z. Vitolins, Marcia L. Stefanick, Marco V. Perez, Matthew Allison, Mark A. Hlatky

Medicine Faculty Publications

Background It is unclear whether obesity unaccompanied by metabolic abnormalities is associated with increased cardiovascular disease risk across racial and ethnic subgroups.

Methods and Results We identified 14 364 postmenopausal women from the Women's Health Initiative who had data on fasting serum lipids and serum glucose and no history of cardiovascular disease or diabetes at baseline. We categorized women by body mass index (in kg/m²) as normal weight (body mass index 18.5 to P=0.05). Obese black women without metabolic syndrome had higher adjusted risk (HR 1.95) than obese white women (HR 1.07; interaction P=0.02). Among women with …

Occupational Health Risk Factors For Schistosomiasis: Systematic Review And Analysis, Sarah Grace Sawyer, Amira Roess, Gisela Butera

GW Research Days 2015

Schistosomiasis is a neglected tropical disease caused by a parasitic flatworm which afflicts over 200 million people in the poorest regions of Africa. Carried by snails living in fresh, stagnant water, the parasite penetrates human skin upon contact, causing the victim to suffer a range of symptoms including diarrhea, blood in the urine, and eventual death. Despite its prevalence, schistosomiasis is preventable, treatable, and curable once a control program is implemented. Substantial reduction of schistosomiasis would relieve suffering and produce many socio-economic benefits, including higher productivity and higher school attendance rates. Disease transmission is directly tied to the environment, and …

Can Electronic Health Records Systems Support New Payment Methods For Health Centers?, Peter Shin, Feygele Jacobs, Jeffrey Barnes, James B. Welsh, Lisa Perry, Scott D. Morgan

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This study assessed the feasibility and usefulness of combining electronic health record (EHR) data with federal cost report data for the purposes of: 1) quantifying the provision of enabling services; and 2) for use as the basis of community health center payment rate-setting. The study used EHR data derived from the Center for Primary Care Informatics to isolate enabling services and perform the end-to-end analysis that might be required to develop or evaluate reimbursement rates. The study revealed that data extracted from federal cost reports combined with data from the EHR fall short of providing the information required to reasonably …

Fast Food: A Source Of Exposure To Phthalates And Bisphenol A In A Nationally Representative Sample, Cassandra Phillips, Susanna Mitro, Ami R. Zota

GW Research Days 2015

Background: Certain phthalates and bisphenol A (BPA) are industrial chemicals widely used in consumer products that can adversely impact human health. Diet is hypothesized to be a major source of exposure but little is known about the impact of specific food sources. This study aims to investigate the association between fast food consumption with human exposure to high-molecular weight phthalates (di(2-ethylhexyl) phthalate (DEHP) and diisononyl phthalate (DINP)) and BPA, in 8876 participants, aged 6 to 85 years old, from the National Health and Nutrition Examination Survey (NHANES), 2003-2010.

Methodology: During the NHANES mobile exam, participants: 1) provided a spot urine …

Annual Report 2014, Forum Staff

National Health Policy Forum

This annual report describes the activities of the Forum during the 2014 calendar year, and provides a snapshot of our audience and resources.

Using Neuroscience To Create A Paradigm Shift In Addiction Treatment And Theory, Tabitha E.H. Moses

Student Works

Drug abuse has long fascinated philosophers and scientists. Many different models have attempted to elucidate the mechanism behind drug addiction and analyze whether an addict has a choice in his behavior. The problem with these models is that they seem to suggest only two ways of viewing addiction. These models suggest either that a person cannot control his addiction and is therefore deserving of treatment, or that suggest a person can control their addictions and is not deserving of treatment, and instead needs threats of punishment to stop their behavior. I believe these approaches are too simplistic and do not …

The Role Of Zinc And Iron-Folic Acid Supplementation On Early Child Temperament And Eating Behaviors In Rural Nepal: A Randomized Controlled Trial, Pamela J. Surkan, Mary Katherine Charles, Joanne Katz, Emily H. Siegel, Subarna K. Khatry, Steven C. Leclerq, Rebecca J. Stoltzfus, James M. Tielsch

Global Health Faculty Publications

Child eating behaviors play an important role in nutrient intake, ultimately affecting child growth and later outcomes in adulthood. The study assessed the effects of iron-folic acid and zinc supplementation on child temperament and child eating behaviors in rural Nepal. Children (N = 569) aged 4–17 months in Sarlahi district, southern Nepal were randomized to receive daily supplements of placebo, iron-folic acid, zinc, or zinc plus iron-folic acid and followed for approximately 1 year. At baseline and four follow-up visits mothers completed questionnaires including information on demographic characteristics and child temperament and eating behaviors. The main effects of zinc and …

Alternate Payment Models For Ryan White Hiv/Aids Program Funded Services: Strategies Used By Nine Grantees, Naomi Seiler, Scott Dafflitto, Rosalind Fennell, Julia Hidalgo, Katie Horton, Mary-Beth Malcarney

Health Policy and Management Faculty Publications

The Health Resources and Services Administration (HRSA) HIV/AIDS Bureau (HAB) offers Ryan White HIV/AIDS Program (RWHAP) Part A and Part B grantees some flexibility in determining the method used for paying subgrantees for core medical and support services. Many Part A and Part B grantees use a traditional “cost-based reimbursement” approach, in which subgrantees submit budgets that include personnel costs, other direct costs related to the provision of funded services, and capped indirect costs (IDCs). Some grantees, however, have developed alternative reimbursement models for core medical and/or support services. This report summarizes the reimbursement approaches taken by nine RWHAP grantees. …

Teaching Health Centers: A Promising Approach For Building Primary Care Work Force For The 21 St Century, Leighton Ku, Fitzhugh Mullan, Christine Cerrano, Zoe Barber, Peter Shin

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

No abstract provided.

How Far Will They Go?: Assessing The Travel Distance Of Current And Former Drug Users To Access Harm Reduction Services, Sean Allen, Monica S. Ruiz, Allison O'Rourke

Prevention and Community Health Faculty Publications

Background

Prior research has explored spatial access to syringe exchange programs (SEPs) among people who inject drugs (PWID), but little is known about service utilization by former PWID who continue to access services (e.g., HIV screenings and referrals for social services) at harm reduction providers. The purpose of this research is to examine differences in access to SEPs between current and former PWID seeking services at a mobile SEP in Washington, DC.

Findings

A geometric point distance estimation technique was applied to data collected as part of a PWID population estimation study that took place in Washington, DC, in March …

Community Health Centers: A 2013 Profile And Prospects As Aca Implementation Proceeds, Peter Shin, Jessica Sharac, Zoe Barber, Sara J. Rosenbaum, Julia Paradise

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

In 2013, more than 1,200 federally funded community health centers provided access to care for low-income populations living in medically underserved communities throughout the country. The Affordable Care Act made expansion of health centers a key part of its strategy for ensuring that these communities would realize the benefits of increased health insurance coverage for their residents. As health insurance coverage expands under the Affordable Care Act (ACA) and the demand for primary care increases, the role of health centers is likely to increase. A key question going forward is whether health centers’ expanded capacity, developed over the past five …

Evaluation Of The Benefits And Risks Of Introducing Ebola Community Care Centers, Sierra Leone, Adam J. Kucharski, Anton Camacho, Francesco Checchi, Ronald J. Waldman, Rebecca F. Grais, Jean-Clement Cabrol, Sylvie Briand, Marc Baguelin, Stefan Flasche, Sebastian Funk, W. John Edmunds

Global Health Faculty Publications

In some parts of western Africa, Ebola treatment centers (ETCs) have reached capacity. Unless capacity is rapidly scaled up, the chance to avoid a generalized Ebola epidemic will soon diminish. The World Health Organization and partners are considering additional Ebola patient care options, including community care centers (CCCs), small, lightly staffed units that could be used to isolate patients outside the home and get them into care sooner than otherwise possible. Using a transmission model, we evaluated the benefits and risks of introducing CCCs into Sierra Leone’s Western Area, where most ETCs are at capacity. We found that use of …

The Public Health Service, Jennifer Jenson

National Health Policy Forum

This document provides an overview of the Public Health Service (PHS) within the U.S. Department of Health and Human Services, including a brief history and discussion of the agencies and offices that constitute the PHS today. Information on the mission, key programs, and budgets of PHS agencies and offices is also included.

Salud Mesoamérica 2015 Initiative: Design, Implementation, And Baseline Findings, Ali H. Mokdad, Katherine Elliott Colson, Paola Zuniga-Brenes, Diego Rios-Zertuche, Erin B. Palmisano, Catherine W. Gillespie, +27 Additional Authors

Pediatrics Faculty Publications

Background

Health has improved markedly in Mesoamerica, the region consisting of southern Mexico and Central America, over the past decade. Despite this progress, there remain substantial inequalities in health outcomes, access, and quality of medical care between and within countries. Poor, indigenous, and rural populations have considerably worse health indicators than national or regional averages. In an effort to address these health inequalities, the Salud Mesoamérica 2015 Initiative (SM2015), a results-based financing initiative, was established.

Methods

For each of the eight participating countries, health targets were set to measure the progress of improvements in maternal and child health produced by …

Health Policy Essentials: Common Health Care Acronyms, National Health Policy Forum

National Health Policy Forum

No abstract provided.

Designs Of Two Randomized, Community-Based Trials To Assess The Impact Of Influenza Immunization During Pregnancy On Respiratory Illness Among Pregnant Women And Their Infants And Reproductive Outcomes In Rural Nepal, James M. Tielsch, Mark Steinhoff, Joanne Katz, Janet A. Englund, Jane Kuypers, Subarna K. Khatry, Laxman Shrestha, Steven C. Leclerq

Global Health Faculty Publications

Background: Among the most important causes of illness and death in both pregnant women and their newborn infants are respiratory infections including influenza. Pregnant women in North America have a 4 to 5 fold excess rate of hospitalization compared to non-pregnant women. Rates of infant hospitalization associated with influenza are much higher than in their mothers. Fully half of children hospitalized for influenza in the US are in the age group 0–5 months, a group where no vaccine is licensed. Data on influenza are much fewer in low income countries where the risks of serious morbidity and mortality are …

Risk Of Gastrointestinal Bleeding Associated With Oral Anticoagulants: Population Based Retrospective Cohort Study, Hsien-Yen Chang, Meijia Zhou, Wenze Tang, G. Caleb Alexander, Sonal Singh

Epidemiology Faculty Publications

Objectives To determine the real world safety of dabigatran or rivaroxaban compared with warfarin in terms of gastrointestinal bleeding.

Design Retrospective cohort study.

Setting Large administrative database of commercially insured people in United States from 1 October 2010 through 31 March 2012.

Participants Enrollees with a prescription of warfarin, dabigatran, or rivaroxaban between 1 October 2010 and 31 March 2012, who were aged 18 years or older, had continuous enrollment and no oral anticoagulant use during the six months before the entry date, with known age and sex, and with no gastrointestinal bleeding for at least six months before the …

Undergraduate Public Health Education: Is There An Ideal Curriculum?, Leonard H. Friedman, Joel M. Lee

Health Policy and Management Faculty Publications

No abstract provided.

Relative Value Units (Rvus), Sally Coberly

National Health Policy Forum

This publication reviews Medicare's relative value units (RVUs), which are assigned to each physician service to represent the resources required to provide the service relative to all other physician services. Three types of resources are included: physician work, that is, the physician time and effort; practice expenses, such as clinical staff and equipment; and professional liability insurance. Each service's RVUs are multiplied by a common dollar conversion factor to determine the Medicare payment.

Evaluating Obesity Prevention Efforts: What Have We Learned? Highlights From A Conversation Of Funders And Evaluators, Sumner M. Redstone Global Center For Prevention And Wellness

Sumner M. Redstone Global Center for Prevention and Wellness

Table of contents:

Executive Summary

Introduction

State of the Obesity Epidemic

The Community Context for Interventions and Evaluations

Investments to Date: Where Is the Strongest Agreement About What Works?

Early Care and Education Environments

Schools/Learning Environments

Parks, Trails, Open Spaces, and Recreation

Land Use and Transportation

The Next Tier: Mixed or Promising Results for Healthy Food Retail Interventions

Implementing Interventions: The Crucial Role of "How"

Other Topics

Summary and Next Steps

Appendix A: Citations and Resources for Key Elements/Components

Using Payment Reform Strategies To Strengthen Family Planning Services At Community Health Centers, Sara J. Rosenbaum, Peter Shin, Susan F. Wood, Jessica Sharac

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

No abstract provided.

A Framework For Assessing The Impact Of Pharmaceutical Reimbursement Policies On Incentives To Innovate, Elizabeth Docteur, Joshua Cohen, Brian K. Bruen, Ruth Lopert, Avi Dor, Chuck Shih

Health Policy and Management Faculty Posters and Presentations

No abstract provided.

A Systematic Review Of Community-To-Facility Neonatal Referral Completion Rates In Africa And Asia, Naoko Kozuki, Tanya Guenther, Lara Vaz, Sajid B. Soofi, Christine Nalwadda Kayemba, James M. Tielsch, Et Al.

Global Health Faculty Publications

Background

An estimated 2.8 million neonatal deaths occur annually worldwide. The vulnerability of newborns makes the timeliness of seeking and receiving care critical for neonatal survival and prevention of long-term sequelae. To better understand the role active referrals by community health workers play in neonatal careseeking, we synthesize data on referral completion rates for neonates with danger signs predictive of mortality or major morbidity in low- and middle-income countries.

Methods

A systematic review was conducted in May 2014 of the following databases: Medline-PubMed, Embase, and WHO databases. We also searched grey literature. In addition, an investigator group was established to …

Fusion, 2015, George Washington University, William H. Beaumont Medical Research Honor Society

Fusion

No abstract provided.

Impact Of Condition Specific Camps On Resiliency And Adaptive Behavior In Children With Heart Conditions, Jeanette Fong, Sandra Cushner-Weinstein

GW Research Days 2015

Objectives: Resilience is the ability to adapt in stressful situations and overcome adversity through the use of effective coping strategies. Previous studies have demonstrated that condition-specific camps designed for children with epilepsy can increase adaptive coping skills including social interactions, cooperation, initiative, and communication in participants over a three-year period ^[1,2]. Additionally, research indicates that as a group, individuals who live with chronic health disorders exhibit less hope and have worse health outcomes when compared to their normative peers. The aim of this study was to determine the impact of condition-specific camps on children with heart conditions.

Methods: 39 …

Evaluation Of Social Media Utilization By Latino Adolescents: Implications For Mobile Health Interventions, Megan Landry, Amita Vyas, Monique Turner, Sara Nelson Glick, Susan Wood

Health Policy and Management Faculty Publications

Background: Trends in social media use, including sending/receiving short message service (SMS) and social networking, are constantly changing, yet little is known about adolescent’s utilization and behaviors. This longitudinal study examines social media utilization among Latino youths, and differences by sex and acculturation.

Objectives: The purpose of this study was to examine Latino adolescents’ social media utilization and behavior over a 16-month period, and to assess whether changes in use differed by sex and acculturation.

Methods: This study included 555 Latino youths aged 13-19 who completed baseline and 16-month follow-up surveys. Prevalence of social media utilization and frequency, by sex …