Public Health Commons^™

The Conceptual Relevance Of Assessment Measures In Patients With Mild/Mild-Moderate Alzheimer's Disease, Ann Hartry, Natalie V.J. Aldhouse, Tamara Al-Zubeidi, Myrlene Sanon, Richard G. Stefanacci, Sarah L. Knight

College of Population Health Faculty Papers

Introduction: This study aims to evaluate the conceptual relevance of four measures of disease activity in patients with mild/mild-moderate Alzheimer's disease (AD): (1) the Alzheimer's Disease Assessment Scale–Cognitive Subscale; (2) the Alzheimer's Disease Cooperative Study–Activities of Daily Living Inventory; (3) the Neuropsychiatry Inventory; and (4) the Dependence Scale. Methods: A conceptual model depicting patient experience of mild AD was developed via literature review; concepts were compared with the items of the four measures. Relevance of the concepts included in the four measures was evaluated by patients with mild AD in a survey and follow-up interviews. Results: The four measures assessed …

Determinants Of Successful Weight Loss In Low-Income African American Women: A Positive Deviance Analysis., Elaine Seaton Banerjee, Sharon J. Herring, Katelyn Hurley, Katherine Puskarz, Kyle Yebernetsky, Marianna Lanoue

College of Population Health Faculty Papers

OBJECTIVE: We set out to investigate the behaviors of low-income African American women who successfully lost weight.

METHODS: From an urban, academic, family medicine practice, we used a mixed methods positive deviance approach to evaluate 35 low-income African American women who were obese and lost at least 10% of their maximum weight, and maintained this loss for 6 months, comparing them with 36 demographically similar control participants who had not lost weight. Survey outcomes included demographics and behaviors that were hypothesized to be related to successful weight loss. Interviews focused on motivations, barriers, and what made weight loss successful. Survey …

Co-Use Of Tobacco And Marijuana During Pregnancy: Pathways To Externalizing Behavior Problems In Early Childhood., Stephanie A. Godleski, Shannon Shisler, Rina D. Eiden, Marilyn A. Huestis

Institute of Emerging Health Professions Faculty Papers

Use and co-use of tobacco and marijuana during pregnancy are associated with the development of social, cognitive, and behavioral problems for infants and children. However, less is known about the potential developmental impact of the use of tobacco and marijuana in tandem. The present study examined an etiological model for the development of externalizing behavior problems (EBP) in early childhood in a high risk sample (N = 247) of mother-infant dyads with prospective data from pregnancy to 36 months of child age. Co-use during pregnancy and continued maternal tobacco and marijuana use from infancy through early childhood were investigated. Although …

Use Of International Classification Of Diseases, Ninth Revision Codes For Obesity: Trends In The United States From An Electronic Health Record-Derived Database., Michelle Mocarski, Ye Tian, B. Gabriel Smolarz, John Mcana, Albert Crawford

College of Population Health Faculty Papers

Obesity is a potentially modifiable risk factor for many diseases, and a better understanding of its impact on health care utilization, costs, and medical outcomes is needed. The ability to accurately evaluate obesity outcomes depends on a correct identification of the population with obesity. The primary objective of this study was to determine the prevalence and accuracy of International Classification of Diseases, Ninth Revision (ICD-9) coding for overweight and obesity within a US primary care electronic health record (EHR) database compared against actual body mass index (BMI) values from recorded clinical patient data; characteristics of patients with obesity who did …

Internet And Social Media Access Among Youth Experiencing Homelessness: Mixed-Methods Study., Lauren A. Houdek Vonholtz, Rosemary Frasso, Jesse M. Golinkoff, Alicia J. Lozano, Alexandra Hanlon, Nadia Dowshen

College of Population Health Faculty Papers

BACKGROUND: Youth experiencing homelessness are at a risk for a variety of adverse outcomes. Given the widespread use of the internet and social media, these new technologies may be used to address their needs and for outreach purposes. However, little is known about how this group uses these resources.

OBJECTIVE: This study investigated how homeless adolescents use these technologies for general and health-related purposes, whether the scope of their use changes with housing status, and their interest in a website dedicated to youth experiencing homelessness.

METHODS: A convenience sample of youth aged 18 to 21 years was recruited from a …

Predicting Risk Of Hospitalisation: A Retrospective Population-Based Analysis In A Paediatric Population In Emilia-Romagna, Italy., Daniel Z. Louis, Clara A. Callahan, Mary Robeson, Mengdan Liu, Jacquelyn Mcrae, Joseph S. Gonnella, Marco Lombardi, Vittorio Maio

College of Population Health Faculty Papers

OBJECTIVES: Develop predictive models for a paediatric population that provide information for paediatricians and health authorities to identify children at risk of hospitalisation for conditions that may be impacted through improved patient care.

DESIGN: Retrospective healthcare utilisation analysis with multivariable logistic regression models.

DATA: Demographic information linked with utilisation of health services in the years 2006-2014 was used to predict risk of hospitalisation or death in 2015 using a longitudinal administrative database of 527 458 children aged 1-13 years residing in the Regione Emilia-Romagna (RER), Italy, in 2014.

OUTCOME MEASURES: Models designed to predict risk of hospitalisation or death in …

Drug Abuse Manifesting As Persistent Hypoglycemia: A Case Report Of Hidden Sulfonylurea Poisoning, Frederick B. Peng, Sharon Li, Md

Department of Medicine Posters

Background

• Prescription drug abuse is on the rise. According to the Philadelphia Department of Health data in 2017, up to 26% of adults may be using benzodiazepines and/or opioids (Table 1).
• 12% or 1/8 Philadelphians are estimated to be current benzodiazepine users and have taken one in the last 7 days. Benzodiazepine use is most common among people with household incomes below $25,000 and among the 45-54 years old age group (17.7%) [1].
• Most current users (84%) obtain benzodiazepines from health care providers [1]. However, with new policies to closely monitor controlled substances, those with dependence on benzodiazepines may turn …

Success And Limitations Of Hepatitis C Screening In The Inpatient Setting, Madalene Zale, Mphc, Priya Mammen, Md, Mph

College of Population Health Posters

This study evaluates the outcomes that a state level mandate for HCV screening with HCV-Antibody-only has on linkage to care and access to treatment, compared to a specific programmatic effort, which includes HCV confirmation.

Differences In Work Environment For Staff As An Explanation For Variation In Central Line Bundle Compliance In Intensive Care Units., Yuna S.H. Lee, Patricia W. Stone, Monika Pogorzelska-Maziarz, Ingrid M. Nembhard

College of Nursing Faculty Papers & Presentations

BACKGROUND: Central line-associated bloodstream infections (CLABSIs) are a common and costly quality problem, and their prevention is a national priority. A decade ago, researchers identified an evidence-based bundle of practices that reduce CLABSIs. Compliance with this bundle remains low in many hospitals.

PURPOSE: The aim of this study was to assess whether differences in core aspects of work environments-workload, quality of relationships, and prioritization of quality-are associated with variation in maximal CLABSI bundle compliance, that is, compliance 95%-100% of the time in intensive care units (ICUs).

METHODOLOGY/APPROACH: A cross-sectional study of hospital medical-surgical ICUs in the United States was done. …

Readmission Rates In Not-For-Profit Vs. Proprietary Hospitals Before And After The Hospital Readmission Reduction Program Implementation., Lauren E. Birmingham, Willie H. Oglesby Phd, Msph, Fache

College of Population Health Faculty Papers

BACKGROUND: The Patient Protection and Affordable Care Act established the Hospital Readmission Reduction Program (HRRP) to penalize hospitals with excessive 30-day hospital readmissions of Medicare enrollees for specific conditions. This policy was aimed at increasing the quality of care delivered to patients and decreasing the amount of money paid for potentially preventable hospital readmissions. While it has been established that the number of 30-day hospital readmissions decreased after program implementation, it is unknown whether this effect occurred equally between not-for-profit and proprietary hospitals. The aim of this study was to determine whether or not the HRRP decreased readmission rates equally …

10 Years Of Progress In Population Health: Connecting Health And Healthcare, David B. Nash, Md, Mba, Willie H. Oglesby, Phd, Mba, Msph, Frsph, Fache, Alexandria Skoufalos, Edd

College of Population Health Annual Reports

Table of Contents

• 6 - A City of Firsts, A College of Firsts
• 8 - Upstream & Downstream
• 14 - Innovations in Education
• 16 - Equipped with the Tools
• 17 - Working Towards Community Health at a Population Level
• 18 - Community Health Requires Community Partnership
• 19 - Bridging the Academic-Industry Divide
• 20 - The Center for Population Health Innovation Supports Lifelong Learning
• 22 - Investing in Research, Investing in Health
• 23 - 1989 Jefferson Center for Population Health
• 24 - Research in Action

Successes And Limitations Of Hepatitis C Screening In The Inpatient Setting: Initial Impact Of Pa Act Of 87 (Apha Roundtable Discussion), Madalene Zale, Mph Candidate, Ashley Park, Mph, Francis Nelson, Ms, Priya Mammen, Md, Mph

College of Population Health Lectures, Presentations, Workshops

The Problem:

• Estimated 3.2 million in US with chronic HCV; Baby Boomers 5 times more likely to be infected compared to other cohorts
• Complex nature of HCV requires confirmation of HCV Ab screens to determine management and treatment needs.

Round table held at 2017 Annual APHA meeting in Atlanta, Georgia

Reaching High-Risk Patient Populations Through Emergency Department Opt-Out Hiv Testing: A Retrospective Chart Review, Tyler G. Boyce, Ba, Priya Mammen, Md, Mph

CwiC Posters

Specific Aims and Hypotheses:

This study aimed to identify socioeconomic (SE), sexual, and other risk factors (RFs), among patients diagnosed with HIV infection through an emergency department-based opt-out HIV screening program, and to examine trends in intravenous drug use (IVDU) as a RF.

• H1: Unsafe sexual practices are the most commonly reported RF.
• H2: Role of IVDU as a RF has increased over the time period studied.

Poster presented at 2017 APHA conference in Atlanta Georgia.

Global Health Nursing Imperative: Using Competency-Based Analysis To Strengthen Accountability For Population Based Practice, Education And Research, Lucille B. Pilling, Edd,Mph, Bsn, Rn, M. Harmon, B. Joyce, R. Johnson, V. Hicks, N. Brown-Scott

College of Population Health Lectures, Presentations, Workshops

Learning Objectives:

Discuss the unique challenges of developing a collaborative global nursing workforce.

Compare three sets of competencies for public health nursing.

Analyze the results of the comparison of the three sets of competencies.

Discuss how the analysis can be used to guide community/public health nursing education, practice and research to encompass local, national and global emphasis.

Presentation presented at 2017 AHPA conference in Atlanta Georgia.

Borders And Blood Pressure: Understanding The Role Of Acculturation In A Hypertension Diagnosis Among Hispanic Americans: 2014 California Health Interview Survey, Lia Scalzo, Mph, Hee-Soon Juon, Phd, Msn, Russell K. Mcintire, Phd, Mph

College of Population Health Posters

Background:

In the U.S. Hispanic population overall, heart disease is the leading cause of death. The prevalence of hypertension among Mexican American immigrants is lower than the general population, yet it is on the rise. Health risks among Hispanics vary depending on their length of stay in the US (as proxy measure of acculturation). The purpose of this study was to examine the association between acculturation and the individual's likelihood of being diagnosed with hypertension among Hispanic Americans.

Methods:

We used data from the 2014 California Health Interview Survey (CHIS) and performed univariate analysis to examine racial differences in prevalence …

Climate Change And Resulting Floods: Using Social Capital To Strengthen Community Resilience In Eastwick, Philadelphia A Known Floodplain, Natasha Bagwe, Md, Mph, Richard Pepino, Phd, Mss, Erin Johnson, Mph, Msn, Rn, Julie Becker, Phd, Mph

College of Population Health Posters

• Climate change will produce intense weather events like increased precipitation and flooding

• Based on climate projections, Philadelphia will be hotter and wetter, and will experience more frequent and intense weather events (OOS, 2016)

•Floods are the second most common hazards in our city (OEM, 2017)

• Vulnerable population such as children, people of color, elderly population and people with disability are severely impacted by climate change

Poster presented at AHPA conference in Atlanta Georgia, United States.

Lessons From The Field: The Conduct Of Randomized Controlled Trials In Botswana., Janice M. Bonsu, Rosemary Frasso, Allison E. Curry

College of Population Health Faculty Papers

BACKGROUND: The conduct of randomized controlled trials (RCTs) in low-resource settings may present unique financial, logistic, and process-related challenges. Middle-income countries that have comparable disease burdens to low-income countries, but greater availability of resources, may be conducive settings for RCTs. Indeed, the country of Botswana is experiencing a rapid increase in the conduct of RCTs. Our objective was to explore the experiences of individuals conducting RCTs in Botswana to gain an understanding of the challenges and adaptive strategies to their work.

METHODS: We conducted in-depth interviews with 14 national and international individuals working on RCTs in Botswana. Participants included principal …

Initiating C.H.E.W. At Maternity Care Coalition, Haley Wicklum, Rickie Brawer, Mph, Phd

CwiC Posters

The purpose of this project is to provide access to healthy and affordable foods to the families involved in Maternity Care Coalition’s Early Head Start program as means to reduce obesity in the 0-3 year old children. Implementing the C.H.E.W. (Cultivating Healthy Eating and Wellness) program, which includes a new food buying club where families can access healthy food at whole sale prices as well as nutrition education workshops throughout the year, will provide access to the healthy and affordable foods needed. The program is focused on pregnant women and young families with children 0-3 years of age to attempt …

Leading Causes Of Death In Vietnam, Lindsey Roth

CwiC Posters

Vietnam is currently facing a public health crisis. Rates of chronic and preventable diseases are climbing, in addition to mortality rates from these diseases. If nothing is done to halt these rising rates, the health of the Vietnamese people will only continue to decline. Although there may be many factors contributing to these high death rates due to chronic diseases, risky health behaviors, such as smoking, and the state of the healthcare system can be considered two main contributors to the leading causes of death in Vietnam. The high smoking rates and high costs of healthcare are hindering the health …

Delaware Health Sciences Alliance Global Health Symposium: Refugee And Immigrant Access To Care Locally And Globally

Global Health Events

Welcome to the 6th annual Global Health Symposium! As always, we are pleased to highlight the latest in our growing Global Health interests across the DHSA. The Delaware Health Sciences Alliance is a partnership of:

• Christiana Care Health System
• Jefferson Philadelphia University & Thomas Jefferson University
• Nemours / Alfred I. duPont Institute for Children
• University of Delaware

Population Health Research: Early Description Of The Organizational Shift Toward Population Health Management And Defining A Vision For Leadership., Kristi L. Caldararo, David B. Nash

College of Population Health Faculty Papers

As health care delivery systems adapt to the changing marketplace, many struggle to define a clear strategy that will prove successful in managing the health of entire populations. The federal government continues to put increasing pressure on organizations to shift away from the traditional way of delivering episodic care and move toward managing populations as a whole-before, during, and after a patient presents in a health care facility. Private payers have begun to follow suit as risk-based payer contracts and bundled payment models become increasingly popular. For organizations to adequately influence the health outcomes of a population, they must be …

Health Literacy: Cancer Prevention Strategies For Early Adults., Robert Simmons, Susan C. Cosgrove, Martha C. Romney, James D. Plumb, Rickie O. Brawer, Evelyn T. Gonzalez, Linda G. Fleisher, Bradley S Moore

College of Population Health Faculty Papers

Health literacy, the degree to which individuals have the capacity to obtain, process, and understand health information and services needed to make health decisions, is an essential element for early adults (aged 18-44 years) to make informed decisions about cancer. Low health literacy is one of the social determinants of health associated with cancer-related disparities. Over the past several years, a nonprofit organization, a university, and a cancer center in a major urban environment have developed and implemented health literacy programs within healthcare systems and in the community. Health system personnel received extensive health literacy training to reduce medical jargon …

Adverse Events In Veterans Affairs Inpatient Psychiatric Units: Staff Perspectives On Contributing And Protective Factors., Gala True, Rosemary Frasso, Sara W. Cullen, Richard C. Hermann, Steven C. Marcus

College of Population Health Faculty Papers

OBJECTIVES: This study sought to identify risk factors and protective factors in hospital-based mental health settings in the Veterans Health Administration (VHA), with the goal of informing interventions to improve care of persons with serious mental illness.

METHODS: Twenty key informants from a stratified sample of 7 VHA inpatient psychiatric units were interviewed to gain their insights on causes of patient safety events and the factors that constrain or facilitate patient safety efforts.

RESULTS: Respondents identified threats to patient safety at the system-, provider-, and patient-levels. Protective factors that, when in place, made patient safety events less likely to occur …

Anthropometric Indices For Non-Pregnant Women Of Childbearing Age Differ Widely Among Four Low-Middle Income Populations., K. Michael Hambidge, Nancy F. Krebs, Ana Garcés, Jamie E. Westcott, Lester Figueroa, Shivaprasad S. Goudar, Sangappa Dhaded, Omrana Pasha, Sumera Aziz Ali, Antoinette Tshefu, Adrien Lokangaka, Vanessa R. Thorsten, Abhik Das, Kristen Stolka, Elizabeth M. Mcclure, Rebecca L. Lander, Carl L. Bose, Richard J. Derman, Robert L. Goldenberg, Melissa Bauserman

Global Health Articles

BACKGROUND: Maternal stature and body mass indices (BMI) of non-pregnant women (NPW) of child bearing age are relevant to maternal and offspring health. The objective was to compare anthropometric indices of NPW in four rural communities in low- to low-middle income countries (LMIC).

METHODS: Anthropometry and maternal characteristics/household wealth questionnaires were obtained for NPW enrolled in the Women First Preconception Maternal Nutrition Trial. Body mass index (BMI, kg/m(2)) was calculated. Z-scores were determined using WHO reference data.

RESULTS: A total of 7268 NPW participated in Equateur, DRC (n = 1741); Chimaltenango, Guatemala (n = 1695); North Karnataka, India (n = …

Aboriginal Urban Design For Health, Kate Clark, Mpa, Kirby Broadnax, Antionette Carroll, Jonathan Cha, Naomi Doerner, Allie Kast, Matthew Kennedy, Michael Mendez, Pascale C. Annoual, Carrie Martin, Wendall Nicholas

College of Population Health Lectures, Presentations, Workshops

Montreal’s Aboriginal population is growing rapidly, yet the community lacks a culturally safe and holistic health service center that is accessible to all Aboriginal people. On Friday, June 2, 2017 The Montreal Urban Aboriginal Health Centre (MUAHC) joined forces with Next City & Concordia University to co-create a 7-minute pitch for a $7,000 prize through the Vangaurd Conference Big Idea Challenge. An interdisciplinary team of 8 conference attendees worked with MUAHC leadership to design a short-term solution that would be a step in the right direction towards MUAHC’s goal to build a fully functioning and independent health center dedicated …

Substance Use, Treatment, And Demographic Characteristics Of Pregnant Women Entering Treatment For Opioid Use Disorder Differ By United States Census Region., Dennis J Hand, Vanessa L Short, Diane J Abatemarco

Department of Obstetrics and Gynecology Faculty Papers

Opioid use disorder (OUD) among pregnant women increased substantially between 1992 and 2012 across the United States, with the greatest increases occurring in the southern states. We analyzed the 2013 Treatment Episodes Database-Admissions to determine how substances used, characteristics of treatment, and demographics of pregnant women entering treatment for opioid use disorder vary between geographical regions. Analyses were restricted to cases where women reported being pregnant at the time of admission and reported opioids as the primary substance problem leading to the treatment admission. Characteristics were compared between U.S. census regions using Chi-square tests and logistic regression with the South …

Predictors Of Hpv Vaccination Series Completion In Philadelphia Adolescents, Karie Youngdahl, Mph, Ami S. Patel, Phd, Mph, Amy E. Leader, Drph, Mph

JCPH Alumni

Research Aim:

This study analyzed data from the Philadelphia KidsPlus Immunization information System (IIS) to look at factors associated with HPV vaccine series completion.

Note:

Student capstone presentation also available at: http://jdc.jefferson.edu/mphcapstone_presentation/190/

Building Interprofessional Global Health Infrastructure At A University And Health System: Navigating Challenges And Scaling Successes, Lucille B. Pilling, Edd,Mph, Bsn, Rn, Janice Bogen, Ma, Louis N. Hunter, Pt, Dpt, Robert Simmons, Drph, Mph, Mches, Cph, Nicholas Leon, Pharmd, Bcps, Bcacp, James D. Plumb, Md, Mph, Richard J. Derman, Md, Mph, Facog

Global Health Posters

Mission:

Global Jefferson will create sustainable programs of global distinction through collaboration that position Jefferson as a local and international destination and resource for education, research, and clinical activities.

Global Jefferson is supported by the Associate Provost for Global Affairs, part of the Office of the Provost.

Global activity at Jefferson includes:

• Global Health Initiatives Committee (GHIC)
• Service Learning
• Global Research & Exchange between institutions
• Pre-clinical, translational, clinical, and applied research

Poster presented at: 8^th Annual Global Health Conference of the Consortium of Universities for Global Health (CUGH)

Evaluating Value-Based Frameworks Used For Relapsed Or Refractory Multiple Myeloma Regimens: Icer Report, Asco Value Framework, And Nccn Evidence Blocks, Laurence M. Djatche, Pharmd, Joseph Goble, Pharmd, Grace Chun, Pharmd, Stefan Varga, Pharmd

College of Population Health Posters

BACKGROUND: With the continuous rise in costs for oncology drugs, the Institute for Clinical and Economic Review (ICER), the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) have developed value-based frameworks (VBFs) to assist stakeholders in formulary and treatment decisionmaking. While emerging VBFs have the potential to significantly impact therapeutic options for patients, it is important to understand the differences associated with those VBFs within a therapeutic area. OBJECTIVE: To compare ICER, ASCO, and NCCN VBFs across three therapeutic options for relapsed or refractory multiple myeloma (RRMM).

METHODS: The values of carfilzomib (CFZ), elotuzumab (ELO), …

Effects Of Evidence-Based Fall Reduction Programing On The Functional Wellness Of Older Adults In A Senior Living Community: A Clinical Case Study., Andrew Harnish, William Dieter, Albert G. Crawford, Tiffany E E. Shubert

College of Population Health Faculty Papers

BACKGROUND: Older adults at a high risk of falls may be referred to a physical therapist. A physical therapy episode of care is designed for the transition of an older adult from a high fall risk to a moderate to low fall risk. However, these episodes of care are limited in time and duration. There is compelling evidence for the efficacy of group-based exercise classes to address risk, and transitioning an older adult from physical therapy to a group-based program may be an effective way to manage risk through the continuum of care.

OBJECTIVES: The purpose of this study was …