Public Health Commons^™

Hyperandrogenism And Obesity: Ominous Co-Morbidities, Amit M. Deokar, Shawn J. Smith, Amanda J. Goodwin, Hatim A. Omar

Pediatrics Faculty Publications

This review has a two-fold objective. One, it addresses the association of hyperandrogenism and obesity and the complex metabolic derangements that are part of the problem. Clinical management of these co-morbidities is challenging and complex. Second, this article will aid health care providers with the key features to an early diagnosis and intervention to decrease the morbidities in the short as well as long term. Method: Systematic review of articles and information on the topic of interest that were published in the last 15 years. Conclusion: Obesity and hyperandrogenism are integral parts of Metabolic Syndrome/Polycystic Ovarian Syndrome (PCOS)/Hyperandrogenism, Insulin resistance, …

Violence Against Women Raises Risk Of Cervical Cancer, Ann L. Coker, Claudia Hopenhayn, Christopher P. Desimone, Heather M. Bush, Leslie Crofford

CRVAW Faculty Journal Articles

Background: An emerging literature suggests that violence against women (VAW), particularly sexual violence, may increase the risk of acquiring a sexually transmitted infection (STI) and, therefore, may be associated with cervical cancer development. The purpose of this cross-sectional analysis was to determine if women who had experienced violence had higher prevalence rates of invasive cervical cancer.

Methods: Women aged 18–88 who joined the Kentucky Women’s Health Registry (2006–2007) and completed a questionnaire were included in the sample. Multivariate logistic regression analyses were used to adjust odds ratio (OR) for confounders (e.g., age, education, current marital status, lifetime illegal drug use, …

Hpv Vaccine Acceptance Among Latina Mothers By Hpv Status, Maureen Sanderson, Ann L. Coker, Katherine S. Eggleston, Maria E. Fernandez, Concepcion D. Arrastia, Mary Kay Fadden

CRVAW Faculty Journal Articles

Objective: We investigated whether Latina mothers who were and were not human papillomavirus (HPV) positive differed in their knowledge and acceptance of the HPV vaccine for their children.

Methods: We conducted a cross–sectional survey among women aged 18–64 years between April 2007 and April 2008. Data collectors conducted in-person interviews in community clinics with 215 HPV-negative women and 190 HPV-positive women (with respective response rates of 64% and 84%). Most (83%) HPV-positive women were recruited at dysplasia clinics. Although no HPV-negative women were recruited at dysplasia clinics, they were recruited at other low-income public and private clinics.

Results: After adjustment …

Breast Cancer Screening In Women Exposed In Utero To Diethylstilbestrol, Elizabeth A. Camp, Ann L. Coker, Stanley J. Robboy, Kenneth L. Noller, Karen J. Goodman, Linda T. Titus-Ernstoff, Elizabeth E. Hatch, Arthur L. Herbst, Rebecca Troisi, Raymond H. Kaufman, Ervin Adam

CRVAW Faculty Journal Articles

Purpose: To determine if women exposed in utero to diethylstilbestrol (DES) are more likely than unexposed women to receive recommended or additional breast cancer screening examinations.

Methods: 1994 Diethylstilbestrol-Adenosis (DESAD) cohort data are used to assess the degree of recommended compliance of breast cancer screenings found in 3140 DES-exposed and 826 unexposed women. Participants were enrolled at four sites: Houston, Boston, Rochester, and Los Angeles. Logistic regression modeling was used to analyze mailed questionnaire data that included reported frequency over the preceding 5 years (1990–1994) of breast-self examinations (BSEs), clinical breast examinations (CBEs), and mammograms.

Results: DES-exposed women exceeded annual …

Ethnic Disparities In Cervical Cancer Survival Among Medicare Eligible Women In A Multiethnic Population, Ann L. Coker, Katherine S. Eggleston, Xianglin L. Du, Lois Ramondetta

CRVAW Faculty Journal Articles

To determine predictors of cervical cancer survival by socioeconomic status (SES), urbanization, race/ethnicity, comorbid conditions, and treatment among elderly Medicare-eligible women whose conditions were diagnosed with cervical cancer in a multiethnic population.

Methods: A total of 538 women with cervical cancer aged 65 years or older were identified from 1999 to 2001 from the Texas Cancer Registry and were linked with the state Medicare data and Texas Vital Records to determine survival times. All women had similar access to care through Medicare fee-for-services insurance. A composite measure of SES was created using census tract-level data as was urbanization. Treatment and …

Obesity And Contraception, Donald E. Greydanus, Hatim A. Omar, Artemis Tsitsika

Pediatrics Faculty Publications

All sexually active youth, whether obese or normal weight, should be offered counseling regarding contraception and appropriate contraceptive methods. However, obese youth who are sexually active may be less likely than their normal weight peers to use contraceptives correctly. Methods of contraception for obese adolescents are reviewed in this discussion. Combined oral contraceptives (COCs) and the contraceptive patch have higher failure rates in obese versus normal weight females, though failure rates are lower than noted with barrier contraceptives. The risk for venous thrombosis is higher in obese youth on COCs. Progestin-only pills and the levonorgestrel intrauterine system appear to be …

Retrofitting Tractors With Rollover Protective Structures: Perspective Of Equipment Dealers, Shalome M. Tonelli, Kelley J. Donham, Kerry Leedom-Larson, Wayne Sanderson, Mark A. Purschwitz

Biosystems and Agricultural Engineering Faculty Publications

This study was one of a cluster of studies that originated via requests for proposals from the NIOSH National Agricultural Tractor Safety Initiative. The present study design consisted of several steps: (1) formation of an advisory group, (2) development and testing of a standard paper self-responding survey instrument, (3) sample selection of farm equipment dealers, (4) administration of the survey, (5) assessment and analysis of the survey, and (6) in-person response panel of dealers (n = 80) to review results of the questionnaire for further definition and sharpening of the recommendations from the survey. A key finding is that most …

Concepts Of Contraception For Adolescents With Obesity: Pathways Of Judicial Moderation, Donald E. Greydanus, Hatim A. Omar, Artemis Tsitsika

Pediatrics Faculty Publications

All sexually active youth, whether obese or normal weight, should be offered counseling regarding contraception and appropriate contraceptive methods. However, obese youth who are sexually active may be less likely than their normal weight peers to use contraceptives correctly. Methods of contraception for obese adolescents are reviewed in this discussion. Combined oral contraceptives (COCs) and the contraceptive patch have higher failure rates in obese versus normal weight females, though failure rates are lower than noted with barrier contraceptives. The risk for venous thrombosis is higher in obese youth on COCs. Progestin-only pills and the levonorgestrel intrauterine system appear to be …

Obesity And Hyperandrogenism, Amit M. Deokar, Shawn J. Smith, Amanda J. Goodwin, Hatim A. Omar

Pediatrics Faculty Publications

This chapter has a two-fold objective. One, it addresses the association of hyperandrogenism and obesity and the complex metabolic derangements that are part of the problem. Clinical management of these co-morbidities is challenging and complex. Second, this article will aid health care providers with the key features to an early diagnosis and intervention to decrease the morbidities in the short as well as long term. Method: Systematic review of articles and information on the topic of interest that were published in the last 15 years. Conclusion: Obesity and hyperandrogenism are integral parts of Metabolic Syndrome/Polycystic Ovarian Syndrome (PCOS)/Hyperandrogenism, Insulin resistance, …

Obesity And Lack Of Physical Activity, Hatim A. Omar, Efrat Merrick-Kenig, Joav Merrick

Pediatrics Faculty Publications

Lack of physical activity and overweight status continues to be a significant health problem in the United States. To assess the actual prevalence of these problems, we reviewed data from the School-based Health Promotion Centers in one middle school, and one high school in central Kentucky. A total of 232 6th graders and 607 9th graders were included. A total of 92% of 6th graders and 45% of 9th graders reported complete lack of regular exercise. 37% of 9th graders and 59% of 6th graders had inappropriate nutrition, 47% of 9th graders and 33% of 6th graders had Body Mass …

The Implementation Of The Kentucky Transitions: A Money Follows The Person Demonstration Grant Program, Amie Goodin

MPA/MPP/MPFM Capstone Projects

Kentucky Transitions is a Kentucky Medicaid program that is funded primarily by a grant from the Centers for Medicare and Medicaid Services. The purpose of this program is to transition individuals residing in long-term care facilities back into the community, where they will continue to receive health, social, and other benefits but do so in an approved residential setting. Individuals living in the community may experience higher quality of life and the increased ability to choose how and when they receive services, while Medicaid reaps the projected financial benefit of providing less-expensive community alternatives for care.

Though Kentucky Transitions operates …

Medication Therapy Management: Is It Worth Medicare’S Time?, Jennifer White

MPA/MPP/MPFM Capstone Projects

Problem:

Medication Therapy Management (MTM) is a service that a pharmacist can provide to any of their patients, but mostly to those who are either high risk patients for adverse events or those who are new to chronic medication therapy. As Medicare Part D has begun to cover MTM services, more and more pharmacists and other clinicians are becoming providers of MTM.

The intent of MTM is to decrease adverse events and healthcare costs to both the patient and the third party payer. In realizing the benefits of MTM, it is important to assess these outcomes to see if clinical, …

Gender Specific Differences In The Pros And Cons Of Smoking Among Current Smokers In Eastern Kentucky: Implications For Future Smoking Cessation Interventions, Dana A. Hazen, David M. Mannino, Richard Clayton

Preventive Medicine and Environmental Health Faculty Publications

This study investigated gender differences in the perceived “pros” and “cons” of smoking using the constructs of decisional balance (DB) and stage of change from the Transtheoretical Model. The population distribution for stage of change among a population-based, cross-sectional survey of 155 current smokers over 40 years was: precontemplation (22.6%), contemplation (41.9%), preparation (35.5%). Results of stepwise regression models indicated significant gender differences in DB were in the preparation stage of change; scores on the DB measure increased 3.94 points (95% CI: 1.94, 5.93) for male smokers. Interventions targeting the “pros” and “cons” of smoking may need to be gender …

Young People's Blood Alcohol Concentration And The Alcohol Consumption City Law, Brazil, Raquel De Boni, Carl G. Leukefeld, Flavio Pechansky

Center on Drug and Alcohol Research Faculty Publications

The paper assesses blood alcohol concentration and risk behaviors for traffic accidents before and after the implementation of a law which prohibits the use of alcoholic beverages on city gas stations. In Porto Alegre, Southern Brazil, young people go out at night and drive to gas station convenience stores to buy alcoholic beverages which are consumed on the premises of parking lots in gas stations. Data were obtained from self-administered questionnaires and breath analyzers in two cross-sectional collections with purposive samples of youngsters in May and July 2006 (n=62, and n=50, respectively). There were no significant differences between the groups …

Childhood Lymphohematopoietic Cancer Incidence And Hazardous Air Pollutants In Southeast Texas, 1995–2004, Kristina W. Whitworth, Elaine Symanski, Ann L. Coker

CRVAW Faculty Journal Articles

BACKGROUND: Cancer is the second leading cause of death among U.S. children with few known risk factors. There is increasing interest in the role of air pollutants, including benzene and 1,3-butadiene, in the etiology of childhood cancers.

OBJECTIVE: Our goal was to assess whether census tracts with the highest benzene or 1,3-butadiene ambient air levels have increased childhood lymphohematopoietic cancer incidence.

METHODS: Our ecologic analysis included 977 cases of childhood lymphohematopoietic cancer diagnosed from 1995–2004. We obtained the U.S. Environmental Protection Agency’s 1999 modeled estimates of benzene and 1,3-butadiene for 886 census tracts surrounding Houston, Texas. We ran Poisson regression …

Roofing Foreman Dies From Telescopic Boom Lift Fall, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Falls

On a winter day in 2008, a male roofer/ foreman died after falling from a telescopic boom lift. He and four other roofing crew members were installing a new roof at a residence undergoing restoration. They had arrived at the job site at approximately 7:45 AM.

At approximately 8:00 AM, the foreman and two roofers were installing flashing on the roof of an alcove on the south side of the house while two other roofers were in a pickup truck putting on coveralls. The crew on the roof needed red rosin underlayment (paper) which was in the pickup truck. Using …

A 53-Year-Old Male Iron Foreman Dies After Fall From Steel Decking, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Falls

During the fall of 2007, a 53-year-old male iron foreman died when he fell approximately 18 feet from roofing being installed on a retail building under new construction. Two work crews were installing metal decking for a roof by laying corrugated metal sheets to the joists of a retail building being constructed. All workers wore personal fall arrest systems complete with lanyards on the roof; none of the workers were tied off to the building. The foreman had accessed the work site via a 32-foot extension ladder to check on the progress of the work. After speaking to the first …

Truck Drivers In Fatal Crashes After Substance Use, Kentucky Injury Prevention And Research Center

Kentucky Haz Alerts--Motor Vehicle

To prevent truck crashes due to substance use:

• Employers should implement and enforce a policy that prohibits commercial drivers who are ill or taking over-the-counter medications with potential side effects for impaired driving from operating a commercial vehicle.
• Employers should implement and enforce a “reasonable suspicion” drug testing policy if a driver is suspected to be under the influence of drugs.
• Companies should conduct comprehensive new-hire prescreening and after-hire random drug testing for substance abuse.
• A nationwide data- base containing a record of all commercial driver positive drug tests in the last two years should be developed.

Long-Term Survival After Radical Prostatectomy Compared To Other Treatments In Older Men With Local Or Regional Prostate Cancer, Liqian Liu, Ann L. Coker, Xianglin L. Du, Janice N. Cormier, Charles E. Ford, Shenying Fang

CRVAW Faculty Journal Articles

Background

This study aimed to address long-term survival in a large population-based cohort of men with prostate cancer receiving radical prostatectomy compared to other treatments.

Methods

We studied 5,845 patients diagnosed with local/regional stage prostate cancer at age 65–74 in 1992 with comorbidity score

Results

Of 5,845 patients, 10-year all-cause survival rates were the highest for patients receiving radical prostatectomy (81.0%; 95% CI: 79.4–82.4%), followed by radical prostatectomy in combination with radiotherapy (67.6%; 62.0–72.5%), radiotherapy (60.5%; 58.3–62.6%), and were the lowest for watchful-waiting (50.7%; 47.5–53.8%). A similar pattern was found for 10-year prostate cancer-specific survivals by treatments. After adjusting for …

Designing A Successful Practice-Based Research Network In Public Health: Key Concepts, Glen P. Mays, Sharla A. Smith

Health Management and Policy Reports

Successful public health practice-based research networks (PBRNs) will require organizational, financial, and intellectual resources that allow practitioners and researchers to mount relevant studies in real-world public health settings. This brief outlines characteristics likely to be important to the success of public health PBRNs, based on the experience of PBRNs in other practice settings

Cervical Screening And General Physical Examination Behaviors Of Women Exposed In Utero To Diethylstilbestrol, Elizabeth A. Camp, Ann L. Coker, Rebecca Troisi, Stanley J. Robboy, Kenneth L. Noeller, Karen J. Goodman, Linda T. Titus-Ernstoff, Elizabeth E. Hatch, Arthur L. Herbst, Raymond H. Kaufman, Ervin Adam

CRVAW Faculty Journal Articles

Objective. To estimate whether women exposed in utero to diethylstilbestrol (DES) report receiving more cervical and general physical examinations compared to unexposed women.

Materials and Methods. 1994 Diethylstilbestrol Adenosis cohort data are used to assess the degree of recommended compliance of cervical screenings found in 3,140 DES-exposed and 826 unexposed women. Participants were enrolled at 4 sites: Houston, Boston, Rochester, and Los Angeles. Logistic regression modeling was used to analyze mailed questionnaire data, which included reported frequency over the preceding 5 years (1990-1994) of Papanicolaou smears and general physical examinations.

Results. Diethylstilbestrol-exposed women exceeded the recommended frequency of Papanicolaou smear …

Preventing Cardiovascular Disease In Kentucky: Epidemiology, Trends, And Strategies For The Future, Sarah Sartini Rugg, Alison L. Bailey, Steven R. Browning

Internal Medicine Faculty Publications

Cardiovascular disease (CVD) is the leading cause of death in the United States despite dramatic improvements in the treatment of heart disease in recent years. Kentucky leads the nation in the prevalence of several individual risk factors for cardiovascular disease, the prevalence of multiple risk factors, and in cardiovascular mortality. While trends in the prevalence of some of these cardiac risk factors have shown improvement, others have remained unchanged or have worsened. The increased prevalence of obesity and diabetes, especially among young persons, is one of the most worrisome trends. The prevalence of smoking in Kentucky remains high, and has …

Semi-Tractor Trailer Driver Hauling Chicken Dies After Striking A Rock Wall, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Motor Vehicle

On a sunny fall day in 2007, a 50-year old semi truck driver hauling processed frozen chicken in a refrigerated trailer, died when his semi crashed into a rock wall. The driver was north bound on an interstate highway when witnesses saw the semi in the left lane contact the concrete median barrier then veer over to the right across one traffic lane and the shoulder, then strike a rock wall. The impact caused the cab to overturn onto the driver’s door while the refrigerated trailer remained standing upright. An exhaust pipe located on the back of the cab was …

Semi Owner-Operator Dies In Rollover After Speeding Through A Curve, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Motor Vehicle

On a Fall day in 2005 at 3:00 PM, a 46 year-old male semi-tractor trailer owner-operator was hauling logs when he rounded a curve, drove off the right side of a two lane state highway, struck a tree and rolled over. Emergency medical services were called to the scene. When they arrived, they found the driver without vital signs and contacted the local coroner. Kentucky State Police arrived and called Kentucky Vehicle Enforcement to the scene. The driver had not been wearing his seatbelt. Toxicology detected methamphetamine and doxylamine in his system at the time of the crash.

To prevent …

Social Factors Affecting Treatment Of Cervical Cancer: Ethical Issues And Policy Implications, Shannon N. Westin, Dan Bustillos, Jacalyn B. Gano, Margaret M. Fields, Ann L. Coker, Charlotte C. Sun, Lois M. Ramondetta

CRVAW Faculty Journal Articles

Health care in the United States has become a privilege rather than a right. Patients who have the greatest need are the ones most likely to be denied this privilege. Despite recent advances in disease detection and treatment, many patients do not receive even the bare minimum of care. The high complexity of the health care system in the setting of patients with low levels of health literacy significantly affects the ability to seek and receive treatment in a timely fashion. In addition, lack of insurance, transportation, and social support further complicate access to care. To truly provide a standard …

Finding Order In Complexity: A Typology Of Local Public Health Delivery Systems, Glen P. Mays, F. Douglas Scutchfield, Michelyn Bhandari, Sharla A. Smith

Health Management and Policy Reports

Public health decision-makers and researchers currently lack an evidence-based framework for describing, classifying, and comparing public health delivery systems based on their organizational components, operational characteristics, and division of responsibility. Related typologies developed in the health services sector have proven extremely valuable for policy and administrative decision-making as well as for ongoing research. Performance assessment, quality improvement, and accreditation activities are now blossoming in public health—adding urgency to the need for classification and comparison frameworks. This brief describes a newly-developed empirical typology for local public health systems and highlights its policy and managerial applications.

Male Semi-Truck Driver Killed In Rollover Crash On County Road, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Motor Vehicle

Early in the morning during the winter of 2005, a 31-year-old male semi-truck driver died when the semi-tractor trailer he was driving left the roadway and rolled over into a ditch. He had just picked up a load of raw lumber from a lumber yard and pulled out of the gate onto a county road and driven about a mile when the incident occurred. His destination was a lumber mill approximately 150 miles away. He was driving on a straight stretch of the road when the right tires left the pavement and dropped onto the sloped grassy area next to …

Coal Truck Driver Fatally Injured In Collision With Another Coal Tractor-Trailer, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Motor Vehicle

During the winter of 2008, a 39 –year-old tractor-trailer driver died after striking the right rear of a coal tractor-trailer with his vehicle, then veering into an embankment, rolling over and catching fire. The driver of a coal tractor-trailer (Truck 1) and the decedent driver of a second coal tractor-trailer (Truck 2) had descended a hill in the lane next to one another on a four-lane undivided highway. Truck 1 stopped at a traffic light at an intersection at the bottom of a hill while Truck 2 approached the intersection from behind in the left lane. The light turned green …

Hispanic Carpenter Dies After Falling From Homemade Platform, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Falls

In the Spring of 2007, a 32-year-old Hispanic male carpenter (decedent) died when he fell from a homemade platform (extended approximately seven feet in the air) after it detached from a telehandler (forklift). The decedent and two other carpenters were framing a new construction, single-family residence located on a hillside which was rough and steep. The three carpenters were framing the wall at the rear corner of the house which was high because of the sloping terrain. To reach the area, the crew decided to use a homemade platform as a makeshift scaffold. A fourth worker operated a rough-terrain forklift …

Dump Truck Driver Dies After Being Entangled In Power-Take-Off Drive Shaft, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Motor Vehicle

During the fall of 2006, a 25-year-old male company dump truck driver (decedent) died when he became entangled in the drive shaft of the power-take-off pump (PTO) underneath a dump truck. He and four other dump truck drivers were waiting to have their trucks filled with asphalt when one of the other drivers (Driver 1) began having difficulty with the bed of his truck raising and lowering properly. Another driver (Driver 2) attempted to assist Driver 1 with the problem, but was unsuccessful. Driver 1 decided to inform the plant manager (Owner 1) of the situation and request assistance from …