Public Health Commons^™

Public Perceptions Of Opioid Use Disorder (Oud) In Rural Pennsylvania: Opportunities, Challenges, And Barriers, Josiah Miller, Duane Donmoyer, Md, James Plumb, Md, Mph

Phase 1

Introduction:

Opioid Use Disorder (OUD) has significantly impacted rural communities nation-wide. This study adds information to what is currently known about OUD and its effects on small towns through examining how OUD has, and is currently, affecting a rural community (~7,000 population) in central Pennsylvania. The main aim of this study was to better understand how OUD affects this small town through interviewing individuals involved in local public health.

Methods:

This qualitative study consisted of key stakeholder interviews with ten individuals involved in local government, law enforcement, or healthcare. Questions centered around how OUD affects the local area, how current …

Improving The Implementation Of Home Blood Pressure Monitoring, Joshua Mairose, Geoffrey Mills, Md

Phase 1

Introduction: Home blood pressure monitoring (HBPM) has been shown to outperform traditional office readings in its association with cardiovascular disease (CVD) risk and ability to identify patients with white coat or masked hypertension. For these reasons, the 2017 ACC/AHA Guidelines included HBPM as part of its recommendations for hypertension management. Our project focused on improving the implementation of HBPM in an urban primary care practice with an end goal of increasing the number of patients that actively use home blood pressure cuffs and have access to them for future telemedicine visits.

Methods: A patient outreach process to increase HBPM uptake …

Medicaid Expansion’S Importance To Mental Health Care, Cameron Blazoski, Vittorio Maio, Pharmd, Ms, Msph

Phase 1

Introduction: The 2010 Patient Protection and Affordable Care Act established the Medicaid expansion, which incentivized states to expand their Medicaid programs to include individuals with incomes up to 138% of the federal poverty level. A significant population that stood to benefit from this health care expansion were Americans who suffer from a mental health disorder. This study was conducted to analyze the impact of Medicaid expansion on individuals with mental health and substance abuse disorders.

Methods: This political commentary was based on statistics on mental health in the United States derived from research studies and publications from federal …

Attitudes And Practices Of Providers Towards Continuity Of Care With Patients Prescribed Contraception, Jennifer Sachs, Grace Styklunas, Caroline King, Rebecca Mercier, Md

Phase 1

Introduction: The primary objective of this study is to evaluate provider attitudes and practices for follow-up counseling regarding patients prescribed contraception at women's health and primary care offices. As prescription contraception (oral contraceptive pills (OCPs), the patch, NuvaRing) are the most widely used reversible form of birth control in the United States, understanding provider practices and attitudes towards the necessity of follow-up for prescription contraception management is crucial.

Methods: An anonymous 16-item cross-sectional online Qualtrics survey queries providers for specialty and position, years in practice, as well as attitudes and practices regarding follow-up counseling for prescription contraception. The study cohort …

Differences In Hypertension And Obesity Levels Between High School Students In Philadelphia Urban And Suburban Areas, Joseph Gonnella, Jeremy Close, Md, Michael Bozzi, Md, Peri Levey, Kyle Prochno

Phase 1

Introduction: The prevalence of childhood obesity remains high, putting millions of children at risk of developing certain illnesses, such as diabetes and cardiovascular diseases. Therefore, it is vital to determine the true scope of the issue and reveal the risk factors associated with this condition. Since the objective of this study is to compare the obesity and hypertension levels between adolescents in Philadelphia urban and suburban high schools, these risk factors can be highlighted and analyzed.

Methods: Biometric and demographic data of Philadelphia urban students was collected from the Athlete Health Organization (AHO) pre-participation evaluations (PPEs) from 2016-2018. It was …

Comparing The Quality Of An In-Person Versus Virtual Diabetes Education Course Due To Covid 19 Pandemic, Allie Hamilton, Rickie Brawer, Phd

Phase 1

Introduction: Group diabetes education courses are proven to improve patients’ diabetes knowledge and metabolic control. Due to the COVID19 pandemic, Stephen Klein Wellness Center (SKWC) shifted their diabetes education course to an online format over Zoom. This study aimed to investigate difference in patient experience and course effectiveness between the in-person and online courses.

Methods: The population for this study includes 89 patients at SKWC that completed either the in-person or online diabetes education course. Participant satisfaction was measured with phone interviews and a survey. Course effectiveness was measured using surveys to assess the change in patients’ weight, amount of …

The Impact Of Doula-Supported Care On Stress Levels Of Women Receiving Opioid Addiction Treatment, Mariel Becker, Meghan Gannon, Phd, Msph

Phase 1

Introduction: Mothers suffering from opioid addiction are at high risk for experiencing extreme stress levels which prevents them from providing a healthy and nurturing environment for their family. The aim of this project is to explore if a doula-supported care team alleviates the parenting stress of new mothers participating in opioid addiction rehabilitation.

Methods: A total of 35-40 women in treatment at the Montair program for substance use disorder rehabilitation were recruited to participate in the City of Philadelphia’s Community Doula project. The Parenting Stress Index Score (PSI) was recorded and compared to a control group composed of women …

An Assessment Of Quality Improvement Strategies For The Implementation Of Certified Recovery Specialists In Treating Opioid Use Disorder At The Emergency Department At Jefferson, A. Cosmo Annese, Rickie Brawer, Phd, Mph, Ches

Phase 1

Introduction: Opioid overdose mortality rate in the U.S. has seen a staggering upward trend lately, more than tripling between the years 2000-2017. Although the use of Certified Recovery Specialists (CRSs) has been shown to improve overdose rates, relapse rates, and treatment completion rates for people with opioid use disorder (OUD), the optimal specialization of CRSs in healthcare settings has yet to be clearly defined. This project seeks the perspectives of CRSs and healthcare workers to gain insight into how CRSs can be most effectively implemented in the ED at Jefferson to treat OUD.

Methods: The study population includes CRSs and …

Pediatric Group Well Care Within The Maternal Treatment Education & Research (Mater) Program, Elizabeth Franko, Neera Goyal, Vanessa Short, Aditi Kale

Phase 1

Introduction:

This project aims to develop and implement group well care for mothers and infants receiving care for opioid use disorder (OUD). Groups would be composed of 5-7 mothers and infants of similar age with extension of sessions to allow group activities and parenting discussions. To evaluate acceptability and feasibility of this care model, we sought to examine attitudes and beliefs from these mothers, in particular the impacts of the COVID-19 pandemic.

Methods:

A qualitative interview study of women receiving treatment for OUD at Maternal Addiction Treatment Education and Research at Thomas Jefferson University from October – December 2020 was …

Impact Of Long-Term Doula Services On Maternal And Fetal Health Outcomes In Women In Treatment For Opioid Use Disorder, Saloni Parikh, Meghan Gannon, Phd, Msph

Phase 1

This study analyzed the impact of doula services on maternal and fetal health outcomes in pregnant women seeking treatment for opioid use disorder. Understanding the impact of doula services is critical in reducing inequities in health outcomes experienced by this vulnerable population. Retrospective and prospective data was collected from surveys, focus groups, and maternal and infant birth data from 100 women in treatment for opioid use disorder, with fifty utilizing doulas and fifty not utilizing doulas. Standardized data abstraction of quantitative and qualitative measures were collected into an SPSS database and Nvivo, respectively, and analyzed using SPSS. Measures of importance …

Race And Disordered Eating: A Narrative Review Of Current Literature, Casey Swann, Msed, Lee Pachter, Do, Elizabeth Liveright, Md, Meghan Gannon, Phd, Msph

Phase 1

Research Problem: Eating disorder literature has well-established a correlation between childhood trauma and development of eating disorder symptomology. One type of trauma that is often overlooked in eating disorder research is that of racial stress faced by ethnic minorities. The literature on racism and eating disorders tends to focus on the transdiagnostic construct of disordered eating behavior rather than specific DSM-5 diagnoses. As such, the current literature review examined the findings regarding associations between racial stressors and disordered eating behavior.

Methods: The current literature review between Nov 2007 and August 2020 searched 3 databases, PubMed, CINAHL, and PsycInfo for …

Early Stages Of Alzheimer's Disease: Evolving The Care Team For Optimal Patient Management., James E Galvin, Paul Aisen, Jessica B Langbaum, Eric Rodriguez, Marwan Sabbagh, Richard G. Stefanacci Do,Mgh,Mba,Agsf,Cmd, Robert A Stern, Elizabeth A Vassey, Arno De Wilde, Neva West, Ivana Rubino

College of Population Health Faculty Papers

Alzheimer's disease (AD) is a progressive, neurodegenerative disease that creates complex challenges and a significant burden for patients and caregivers. Although underlying pathological changes due to AD may be detected in research studies decades prior to symptom onset, many patients in the early stages of AD remain undiagnosed in clinical practice. Increasing evidence points to the importance of an early and accurate AD diagnosis to optimize outcomes for patients and their families, yet many barriers remain along the diagnostic journey. Through a series of international working group meetings, a diverse group of experts contributed their perspectives to create a blueprint …

The Health-Related Quality Of Life, Work Productivity, Healthcare Resource Utilization, And Economic Burden Associated With Levels Of Suicidal Ideation Among Patients Self-Reporting Moderately Severe Or Severe Major Depressive Disorder In A National Survey., Carmela Benson, David Singer, Colleen M Carpinella, May Shawi, Larry Alphs

College of Population Health Faculty Papers

Background: Suicidal ideation (SI) is a cardinal aspect of major depressive disorder (MDD); however, patient-reported outcomes data from large-scale surveys are limited concerning SI in the context of MDD. This study aims to understand the association between varying levels of SI and health-related quality of life (HRQoL), work productivity, healthcare resource utilization (HRU), and associated costs in patients with moderately severe/severe MDD.

Methods: This was a retrospective, cross-sectional analysis of 2013 national survey data. Patients who self-reported moderately severe or severe MDD and completed the Short Form Survey Version 2 (SF-36v2), Work Productivity Loss and Activity Impairment questionnaire (WPAI), and …

Practical Guidance For Studies Using Freelisting Interviews., Shimrit Keddem, Frances K. Barg, Rosemary Frasso

College of Population Health Faculty Papers

Freelisting is a qualitative interviewing technique that has recently grown in popularity. It is an excellent tool for rapidly exploring how groups of people think about and define a particular health-related domain and is well suited for engaging communities and identifying shared priorities. In this article, we outline 7 practical considerations for conducting freelisting studies summarized from 16 articles conducted by the authors at the University of Pennsylvania and Thomas Jefferson University in partnership with community-based organizations and students. Our recommendations can inform study design, data collection, and data analysis for investigators who are interested in using freelisting interviews in …

Risk Factors For Poor Outcomes Among Patients With Extensively Drug-Resistant Tuberculosis (Xdr-Tb): A Scoping Review., Karan Varshney, Beverly Anaele, Matthew Molaei, Rosemary Frasso, Vittorio Maio

College of Population Health Faculty Papers

In recent years, there has been an upsurge in cases of drug-resistant TB, and strains of TB resistant to all forms of treatment have begun to emerge; the highest level of resistance is classified as extensively drug-resistant tuberculosis (XDR-TB). There is an urgent need to prevent poor outcomes (death/default/failed treatment) of XDR-TB, and knowing the risk factors can inform such efforts. The objective of this scoping review was to therefore identify risk factors for poor outcomes among XDR-TB patients. We searched three scientific databases, PubMed, Scopus, and ProQuest, and identified 25 articles that examined relevant risk factors. Across the included …

Epidemiology Of Non-Alcoholic Fatty Liver Disease And Risk Of Hepatocellular Carcinoma Progression, Krishna Chaitanya Thandra, Adam Barsouk, Kalyan Saginala, John Sukumar Aluru, Prashanth Rawla, Alexander Barsouk

Kimmel Cancer Center Faculty Papers

Non-alcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease worldwide. Its incidence has grown alongside the increasing global prevalence of type 2 diabetes, obesity, and metabolic syndrome. The risk of progression to hepatocellular carcinoma for nonalcoholic steatohepatitis patients over 5 years is 8%, and despite targeted and immunotherapy treatment advances, HCC maintains a bleak 5-year survival of 19%. NAFLD’s primary risk factors are components of metabolic syndrome as well as possible sleep disturbances. NAFLD is most common among men 50-60 years of age, though incidence in women catches up after menopause. In the US, Hispanics are …

Looking Beyond The Numbers: Quality Assurance Procedures In The Global Network For Women's And Children's Health Research Maternal Newborn Health Registry., Ana Garces, Emily Macguire, Holly L Franklin, Norma Alfaro, Gustavo Arroyo, Lester Figueroa, Shivaprasad S Goudar, Sarah Saleem, Fabian Esamai, Archana Patel, Elwyn Chomba, Antoinette Tshefu, Rashidul Haque, Jacquelyn K Patterson, Edward A Liechty, Richard J Derman, Waldemar A Carlo, William Petri, Marion Elizabeth M Koso-Thomasmcclure, Robert L Goldenberg, Patricia Hibberd, Nancy F Krebs

Global Health Articles

BACKGROUND: Quality assurance (QA) is a process that should be an integral part of research to protect the rights and safety of study participants and to reduce the likelihood that the results are affected by bias in data collection. Most QA plans include processes related to study preparation and regulatory compliance, data collection, data analysis and publication of study results. However, little detailed information is available on the specific procedures associated with QA processes to ensure high-quality data in multi-site studies.

METHODS: The Global Network for Women's and Children's Health Maternal Newborn Health Registy (MNHR) is a prospective population-based registry …

What Is Population Health? Ten Years On…., Mitchell Kaminski

College of Population Health Faculty Papers

No abstract provided.

Mental Health And Wellbeing Of First Year Jefferson University Students During The Covid-19 Pandemic: A Photo-Elicitation Study, Olusegun Bakare, Lyena Birkenstock, Morgan Bush, Lizzie Critchlow, Marisa Felsher, Cari Picciano, Alex Reibstein, Olivia Siciliano

Qualitative Research Methods - Presentations

Research Question

How do first year Thomas Jefferson University students perceive their mental health and wellbeing in the context of the COVID-19 pandemic?

Effectiveness Of The Care Of Persons With Dementia In Their Environments Intervention When Embedded In A Publicly Funded Home- And Community-Based Service Program., Richard H Fortinsky, Laura N Gitlin, Laura T Pizzi, Catherine V. Piersol, James Grady, Julie T Robison, Sheila Molony, Dorothy Wakefield

College of Health Professions Faculty Papers

Background and Objectives: In the absence of effective pharmacotherapy, there is an urgent need to test evidence-based dementia care interventions using pragmatic trial approaches. We present results from a study in which an evidence-based, nonpharmacologic intervention for persons living with Alzheimer's disease and related dementia (ADRD) and their informal caregivers, Care of Persons with Dementia in their Environments (COPE), was tested in a Medicaid and state revenue-funded home and community-based service (HCBS) program.

Research Design and Methods: Using pragmatic trial design strategies, persons living with ADRD and their caregivers were randomly assigned as dyads to receive COPE plus usual HCBS …

New Normal For Medical Practice Post Covid-19?, David B. Nash

College of Population Health Faculty Papers

No abstract provided.

Population Health And The Pandemic: Emerging Stronger Next Time., David B. Nash

College of Population Health Faculty Papers

No abstract provided.

Reflections On A Post-Covid World: Lessons From The Surge., David B. Nash, Mark D Smith, Anand K Parekh, Byron C Scott, Kavita Patel, Karen Murphy, Karen B Desalvo

College of Population Health Faculty Papers

This conversation was held on June 16, 2020, and the resulting transcript reflects the events that were current as of the time of the original discussion. Changes to policies, events, and data may have changed between the time of the discussion and its publication.

Changes In Health Care Following Covid-19., David B. Nash, Thomas H Lee, Leana Wen, Bruce A Meyer, Judd E Hollander, Susan Skochelak

College of Population Health Faculty Papers

This conversation was held on June 17, 2020, and the resulting transcript reflects the events that were current as of the time of the original discussion. Changes to policies, events, and data may have changed between the time of the discussion and its publication.

We Know Health Is Not Elective: Impacts Of Covid-19., David B. Nash, Mark Angelo, Esther J Nash, Jonathan L Gleason, Bruce A Meyer

College of Population Health Faculty Papers

Several months into the impact of the global COVID-19 pandemic, the authors use the framework of "radical uncertainty" and specific regional health care data to understand current and future health and economic impacts. Four key areas of discussion included are: (1) How did structural health care inequality manifest itself during the closure of all elective surgeries and visits?; (2) How can we really calculate the so-called untold burden that resulted from the closure, with a special emphasis on primary care?; (3) The Pennsylvania experience - using observations from the population of one major delivery ecosystem (Jefferson Health), a major accountable …

Credible Practice Of Modeling And Simulation In Healthcare: Ten Rules From A Multidisciplinary Perspective, Ahmet Erdemir, Lealem Mulugeta, Joy P Ku, Andrew Drach, Marc Horner, Tina M Morrison, Grace C Y Peng, Rajanikanth Vadigepalli, William W Lytton, Jerry G Myers

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

The complexities of modern biomedicine are rapidly increasing. Thus, modeling and simulation have become increasingly important as a strategy to understand and predict the trajectory of pathophysiology, disease genesis, and disease spread in support of clinical and policy decisions. In such cases, inappropriate or ill-placed trust in the model and simulation outcomes may result in negative outcomes, and hence illustrate the need to formalize the execution and communication of modeling and simulation practices. Although verification and validation have been generally accepted as significant components of a model's credibility, they cannot be assumed to equate to a holistic credible practice, which …

Contrasting Cumulative Risk And Multiple Individual Risk Models Of The Relationship Between Adverse Childhood Experiences (Aces) And Adult Health Outcomes, Marianna Lanoue, Brandon George, Deborah L Helitzer, Scott W Keith

College of Population Health Faculty Papers

BACKGROUND: A very large body of research documents relationships between self-reported Adverse Childhood Experiences (srACEs) and adult health outcomes. Despite multiple assessment tools that use the same or similar questions, there is a great deal of inconsistency in the operationalization of self-reported childhood adversity for use as a predictor variable. Alternative conceptual models are rarely used and very limited evidence directly contrasts conceptual models to each other. Also, while a cumulative numeric 'ACE Score' is normative, there are differences in the way it is calculated and used in statistical models. We investigated differences in model fit and performance between the …

Health Design Thinking: An Innovative Approach In Public Health To Defining Problems And Finding Solutions, Sylvie Abookire, Colin Plover, Phd, Rosemary Frasso Phd, Msc, Cph, Bon Ku

College of Population Health Faculty Papers

No abstract provided.

Anticoagulation And Bleeding Risk In Patients With Covid-19, Nancy Musoke, Kevin Bryan Lo, Jeri Albano, Eric Peterson, Ruchika Bhargav, Fahad Gul, Robert Dejoy, Grace Salacup, Jerald Pelayo, Padmavathi Tipparaju, Zurab Azmaiparashvili, Gabriel Patarroyo-Aponte, Janani Rangaswami

Department of Medicine Faculty Papers

BACKGROUND: There is no current standardized approach to anticoagulation in patients with Coronavirus Disease 2019 (COVID-19) while potential bleeding risks remain. Our study characterizes the patterns of anticoagulation use in COVID-19 patients and the risk of related bleeding.

METHODS: This is a single center retrospective analysis of 355 adult patients with confirmed diagnosis of COVID-19 from March 1 to May 31, 2020. Chi-square was used to analyze the relationship between degree of anticoagulant dose and bleeding events by site. Multivariable logistic regression was used to look at factors associated with inpatient death.

RESULTS: 61% of patients were being treated with …

Where There's Smoke, There's Fire: What Current And Future Providers Do And Do Not Know About Electronic Cigarettes., Josephine Hwang, Mdc, Mphc, Crystal Lee, Eric Mastrolonardo, Rosemary Frasso Phd, Msc, Cph

College of Population Health Faculty Papers

BACKGROUND: Health care providers play a pivotal role as educators on health-related matters ranging from vaccination to smoking cessation. With the rising popularity of electronic cigarettes (e-cigarettes), providers face a new challenge. To date, studies have identified a general lack of knowledge among providers regarding e-cigarettes and discomfort with counseling patients on e-cigarette use. This study aims to systematically explore the perspectives of different health care providers on e-cigarettes and their health implications. With a growing availability of research on the health consequences of e-cigarette use, our study also aims to assess the familiarity of our participants with this literature. …