Public Health Commons^™

Time To Clinical Stability In Patients With Ventilator-Associated Pneumonia Due To Methicillin-Resistant Staphylococcus Aureus Treated With Linezolid Versus Vancomycin: Results From The Impact-Hap Study, Paula Peyrani, Timothy L. Wiemken, Marcus J. Zervos, Daniel H. Kett, Thomas M. File Jr., Gary E. Stein, Kimbal D. Ford, Julio A. Ramirez

The University of Louisville Journal of Respiratory Infections

Background: Time to clinical stability is a well-defined early clinical outcome in hospitalized patients with community-acquired pneumonia, but it has not been evaluated in patients with ventilator-associated pneumonia (VAP). The objective of this study was to compare time to clinical stability in patients with MRSA VAP treated with linezolid versus vancomycin.

Methods: This was a secondary analysis of the IMPACT-HAP study database. VAP was defined according to CDC criteria. MRSA VAP was considered when MRSA was isolated from a tracheal aspirate or bronchoalveolar lavage. A patient was considered to reach clinical stability the day that the following four criteria were …

Neutrophil Function In Elderly Patients Hospitalized With Community- Acquired Pneumonia, Jorge Perez San Juan, Lisandra Rodriguez Hernandez, Timothy L. Wiemken, Robert R. Kelley, Rafael Fernandez-Botran, Martin Gnoni, Paula Peyrani, Madhavi J. Rane, Forest W. Arnold, Julio A. Ramirez, Silvia Uriarte, Jose Bordon

The University of Louisville Journal of Respiratory Infections

Background: Advanced age is associated with immunosenescence as well as increased risk for poor outcomes during episodes of community-acquired pneumonia (CAP). Data on neutrophil function in hospitalized elderly patients with CAP is lacking. In this study we compared neutrophil function in elderly and non-elderly hospitalized patients with CAP.

Methods: Prospective study of healthy controls (HC) and patients hospitalized with CAP nonelderly (NE-CAP) and elderly (E-CAP). Blood samples were obtained on the day of hospitalization. The following neutrophil functional assays were performed: degranulation of secretory vesicles (CD35), degranulation of specific granules (CD66b), phagocytosis, and hydrogen peroxide (H₂O₂) …

A Review Of Macrolide Based Regimens For Community-Acquired Pneumonia, Forest W. Arnold, Leslie A. Beavin

The University of Louisville Journal of Respiratory Infections

Community-acquired pneumonia (CAP) has significant morbidity and mortality. The Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) guidelines recommend two antimicrobial regimens for hospitalized patients with CAP, one of which includes a macrolide, and one of which does not. Both regimens have antimicrobial properties, but macrolides also possess immunomodulatory properties. Macrolides, however, may also have potential arrhythmia adverse effects. The purpose of this review is to provide an update of studies evaluating outcomes for patients with CAP treated with or without a macrolide-based regimen. Two recent randomized controlled trials conflict with each other regarding the benefit versus noninferiority of including …

Effects Of A Text Message-Based Motivational Interviewing Intervention On Cigarette Smoking In College Students., Anna Jorayeva

Electronic Theses and Dissertations

Purpose: The purpose of this dissertation was to examine the effects of a novel text message-based motivational interviewing intervention on cigarette smoking behavior in college students. Three manuscripts comprised this dissertation and included: a state of the science review of motivational interviewing and text message-based smoking behavior interventions in adolescents and young adults; a critical review and analysis of instruments used to measure nicotine dependence in young adults; and a quasi-experimental study testing the effects of a novel text message-based motivational interviewing intervention on cigarette smoking behavior in college students. Background: Cigarette smoking is the number one preventable cause of …

Cost Of Care For Hospitalized Patients With Pulmonary Mycobacterial Diseases In The United States., Mary Beth Wells Allen

Electronic Theses and Dissertations

Background: Pulmonary mycobacterial diseases describe both tuberculosis (TB) and nontuberculous mycobacteria (NTM). Few data are available measuring the cost burden of mycobacterial diseases on the national level. The purpose of this study was to evaluate the cost burden and measure emerging trends in hospitalization of pulmonary TB and NTM in the US from 2001 through 2012. Methods: This study was a retrospective community based cost analysis of hospitalized patients with a principal diagnosis of pulmonary mycobacterial diseases from 2001 through 2012. Data for pulmonary TB and NTM were retrieved from the Healthcare Cost and Utilization Project (HCUP), US Department of …

Memory And Fine Motor Skill Test Performance Among Children Living Near Coal Ash Storage Sites., Lindsay Koloff Tompkins

Electronic Theses and Dissertations

Coal ash, a byproduct of coal combustion,is reduced in 47 U.S. states andfrequently contains heavy metals, some of which are known neurotoxins. An estimated 1.5 million children live near sites where coal ash is produced andstored, yet there have been no studies assessing coal ash exposure and children’s neuro behavioral health. This study is part of a larger cross-sectional study, Coal Ash and Neuro behavioral Symptoms in Children Aged 6- 14 Years Old, and aimed to determine the relationship between children’s memory and fine motor skill test performance and the proximity of the home to coal ash storage sites, the …

Type 2 Diabetes Mellitus (T2dm) Onset And "Remission"., Srikanth Tangelloju

Electronic Theses and Dissertations

Background: Type 2 diabetes mellitus (T2DM) is a progressive disease condition. As the disease progresses the function of beta (β) cells (cells which regulate insulin) decline, thereby increasing the circulating blood glucose levels. If left unmanaged the disease progresses from onset to development of T2DM related complications and eventually death. When managed, in certain individuals, T2DM onset can be prevented and/or slowed down and in certain T2DM individuals, remission is observed. There are some known modifiable risk factors such as diet and physical activities that are associated with the speed and direction of progression, but much is still unknown. In …

The Impact Of The Patient Protection And Affordable Care Act’S Risk Adjustment Program On Adverse Selection : First Year Case Study., Steven K. Zimmerman

Electronic Theses and Dissertations

In 2014 the Patient Protection and Affordable Care Act (ACA) implemented a risk adjustment program to stabilize premiums and neutralize premiums in the individual health insurance marketplace. This dissertation will examine the impact of the ACA risk adjustment program on adverse selection for one insurer during 2014. This study utilized enrollment and claims data for one insurer and employs graphical analysis to test for adverse selection. Previous studies have been unable to utilize actual insurer data to test for adverse selection in under the ACA risk adjustment program. Until the implementation of the ACA, insurers relied on underwriting methods to …

Air Pollution, Pulmonary Oxidative Stress, And The Endothelin System In The Development Of Cardiovascular Injury., Jordan B. Finch

Electronic Theses and Dissertations

The goal of this project was to examine the role of endothelin-1 (ET-1) as a mediator in the pathway between air pollution exposure and the development of vascular injury. A human cohort and male mice (C57BL/6 and ecSOD-Tg) were used to evaluate changes in the ET-1 system in response to exposures of fine particulate matter (PM2.5). Human ET-1 levels were significantly associated with environmental factors and markers of vascular change, but were decreased with increased PM2.5. No association was seen between ET-1 and endothelial progenitor cells (EPCs) except for EPC-4, possibly indicating a regulatory relationship with this specific population. In …

Leveling The Playing Field Through Partnerships And Collaboration : Neighborhood Revitalizations And The Influence Of Social Determinants Of Health And Institutional Logics., J. M. Bohn

Electronic Theses and Dissertations

A qualitative study guided by grounded theory was on a Midwest US city (population > 50,000 people), three of its inner city neighborhoods, and community coalition and partnership efforts in neighborhood revitalizations. A two-phase semi-structured interview methodology assessed interviewees’ experiences in initiatives focused on improving social determinants of health in the neighborhoods. Phase I interviews (n= 11) identified the spectrum of partnerships and initiatives while Phase II interviews (n=28) captured detailed experiences of interviewees. Inter-institutional systems and institutional logics theory were applied in the post-data collection analysis. Interviewees were from public and private sectors including: built environment, economic development, residential/commercial property …

Environmental Vegetation : A Possible Association With Cardiovascular Disease Risk., Ray Anthony Yeager Ii

Electronic Theses and Dissertations

The built environment affects numerous aspects of human health and wellbeing, including risk of cardiovascular disease (CVD), the leading cause of morbidity and mortality in both the U.S. and worldwide. The amount and quality of environmental vegetation, is an important aspect of the built environment that affects known CVD risk factors, including psychosocial stress, health behaviors, and exposure to air pollutants. Nevertheless, little evidence on the role of potential mechanisms and geographic scale in these relationships exists. Of previous studies that describe associations between vegetation and CVD outcomes, limited investigation has been performed to assess these observed relationships in differing …

The Influence Of Nutrition Education And Self-Efficacy On Fruit And Vegetable Consumption For Low-Income Women In Rural West Kentucky., Lewatis Darnell Mcneal

Electronic Theses and Dissertations

Objective: To examine how participation in nutrition education programs, self-efficacy to consume fruit and vegetables and predictor of behavior to eat health foods (POB) influences the consumption of fruit and vegetables for low-income women in west Kentucky eligible or participating in federal supplemental nutrition assistance programs. Methods: A comparative study was conducted between low-income women participating in Special Supplemental Nutrition Assistant Program for Women and Children (WIC) and those eligible for SNAP but were not participating. The study examined consumption in six categories of fruit and vegetables, self-efficacy to consume fruit and vegetables, predictor of behavior to eat healthy foods …

The Impact Of Medicaid Expansion On Utilization Of Mental Health Services In West Louisville, Kentucky., Susan Theresa Buchino

Electronic Theses and Dissertations

Mental health is an essential component of overall health status, and mental illnesses are a leading cause of disability. In addition to expanding insurance coverage, the Affordable Care Act (ACA) reinforced parity for mental health services in insurance plans. This mixed-methods study assessed mental health service utilization by an urban and predominately African-American population following the successful implementation of the ACA and Medicaid expansion in Louisville, KY. Claims data from one Medicaid Managed Care Organization were analyzed to assess mental health care utilization patterns pre- and post- Medicaid expansion and determine differences in utilization rates between the Medicaid expansion population …

Parent Perceptions Of A Child Physical Activity Initiative In A Rural Community., Katie F. Leslie, Kristi M. King, Richard W. Wilson, Patricia Gagne, V. Faye Jones

Faculty and Staff Scholarship

This study assessed the extent to which a community-based intervention developed for children impacted parent perceptions and behaviors toward physical activity in a rural community. Focus groups and individual interviews were conducted with parents of children who participated in physical activity programs. Analysis revealed an increased community awareness surrounding physical activity following program implementation. Parents and children encouraged each other to be physically active. Ecological barriers and enabling factors to adult physical activity were identified these findings indicate a bidirectional influence between parent and child physical activity and the need for community facilities where families can be active together.

Delivering Health Care To Women Who Use Crack : A Brazilian Example., Kristen Connors

College of Arts & Sciences Senior Theses

No abstract provided.

The Effect Of The Patient Protection And Affordable Care Act On The Medicare Part D Coverage Gap As Reflected In Diabetes Medication Adherence., Jennifer A. Forristal

Electronic Theses and Dissertations

This dissertation involves an evaluation of the effect of the Patient Protection and Affordable Care Act (ACA) on diabetic medication adherence for mail order utilizers over 6 years as the Medicare Part D coverage gap begins to close. The study had 3 objectives: 1) to evaluate diabetes medication adherence of health plan members before they reach the coverage gap and then while they are in the coverage gap, 2) to compare diabetes medication adherence between two similar groups with differing benefit structures, one group with a gap in coverage as opposed to a group with no benefit changes within the …

Evaluation Of Liver Transplant Prioritization Methods For Hepatocellular Carcinoma Patients Using Multistate Models., Sarah Katharine Alver

Electronic Theses and Dissertations

The Model for End Stage Liver Disease (MELD), used for prioritizing liver transplantation, predicts mortality from liver disease. Patients with hepatocellular carcinoma (HCC) risk disease progression not reflected in their MELD score. Exception scores prioritize HCC patients higher than their MELD scores, but advantage them over non-HCC patients. To address this, a delay of six months for using exception scores has been implemented, and alternative HCC-specific scores have been developed. Using multistate models, this study projects waitlist dropout and transplant probabilities under the delay and under two alternative scores. The delay improves equity between HCC and non-HCC patients for the …

Network Participation In Public Health : The Development Of Instruments And Adapted Theory To Predict Stakeholder Participation In A Public Health Network., David Johnson

Electronic Theses and Dissertations

Background: Participation in public health networks is important to achieve the goals of public health. This dissertation addresses a common problem in public health management—of how to measure support and predict participation by individuals and organizations in network level collaboratives—through testing an adapted theory producing a newly developed instrument. Purpose: Community health collaboratives have grown in popularity and in funding opportunities in the past couple decades, but they notoriously fail to achieve measureable results. By adapting theory and relevant instruments to a specific public health network context, factors that enable and inhibit participation are identified. Method: A prospective, theory-driven, sequential …

Refugee Health And The Kentucky Global Health Center, Rahel Bosson, Ruth M. Carrico

Journal of Refugee & Global Health

In this University of Louisville Grand Rounds lecture, Drs. Rahel Bosson and Ruth Carrico give an overview of the real struggle of the refugee population and provide an update of the current state of refugee health in Kentucky.

They also provide an overview of the Global Health Initiative at University of Louisville, which includes the follow programs: HIV/AIDs, Refugee Health and Immunization, Vaccine and International Travel and Global Health Research Support.

The talk concludes looking to the future with a comprehensive Global Health Center composed of improving refugee orientation and EMR, healthcare worker education, developing guidelines, and bettering our surveillance …

Impact Of Numeracy On Parental Self-Efficacy And Treatment Outcome Of Children On Complex Diets., Diana Cardina Pantalos

Electronic Theses and Dissertations

Health numeracy, a counterpart to health literacy, can be a mediator of health disparities. This study analyzed the impact of both cognitive and affective numeracy on the pathway linking health behavior to health outcomes, and the role of self-efficacy in this relationship, based on the Health Belief Model. The context was parental management of children's complex diets that require numerical calculations. Parents of children ages 12 months to 12 years with type 1 diabetes (T1D) or phenylketonuria (PKU) were recruited at clinics or community events in east-central states. Ninety-eight participants completed a standardized test of math skills, an instrument to …

The Association Of Medical Student Debt On Choice Of Primary Care Specialty And Rural Practice Location., Craig Ziegler

Electronic Theses and Dissertations

A shortage of primary care physicians (PCP) is present nationally and within Kentucky. The shortage is expected to worsen, unless a dramatic increase occurs in the generation of additional primary care clinicians. Geographical maldistributions of PCP also exist. Whereas 20% of the US population resides in rural areas, only 10% of physicians practice in these areas. This study explores factors that influence medical students’ decisions to select primary care residency training programs, and to practice in rural areas. Specifically, the levels of debt among 1391 graduates from University of Louisville School of Medicine (ULSOM) during 2001-2010 were examined in association …

The Relationship Between Financial Empowerment And Health Related Quality Of Life In Family Scholar House Participants., Chelsey Erbaugh Franz

Electronic Theses and Dissertations

The Family Scholar House program was a unique intervention designed to stop the cycle of poverty by providing college education and support to single parents. The different aspects of the Family Scholar House program addressed each of the five social determinants of health (economic stability, education, social and community context, health care, and neighborhood and built environment). Results of the studies showed that participant’s mental health and general health rating, as measured by a health-related quality of life survey, improved during the time in the Family Scholar House program. Upon graduation from the program, the mental health and the health …

Implementation Of Break Time For Employee Nursing Mothers At The University Of Louisville : A Case Study., Robin Elise Weiss, 1971-

Electronic Theses and Dissertations

This dissertation is a mixed methods look at the barriers to successful implementation of the Break Time for Nursing Mothers provisions of the Affordable Care Act (ACA) at an upper southern-midwestern university. As public health and medical officials push the desire for an increase in breastfeeding initiation and duration, many mothers must overcome barriers within the employment arena. Previous work has failed to look at how the university setting presents unique challenges with a diverse workforce, varied jobs, and differing space availability. In other settings, barriers have been identified; the goal of this dissertation was to identify what the specific …

The Influence Of Child Physical Activity Programs On Parent Physical Activity In A Rural Community., Katie F. Leslie

Electronic Theses and Dissertations

Introduction: In 2008, a coalition of community leaders and parents sought to increase access to physical activity opportunities for residents of Meade County, a rural Kentucky community. To date, the Meade Activity Center has implemented a variety of year-round programs conducted at borrowed spaces from local schools that have targeted children, utilizing the strategy to first engage children as a way to extend behavior change to other members of the community. This study assessed the influence of child participation in physical activity programs on parent physical activity, and determined potential methods of intervention to increase adult physical activity in a …

An Examination Of The Relationship Between Sense Of Coherence, Engagement In Health Behaviors, And Individual Coping Style., Dean Todd Misener 1973-

Electronic Theses and Dissertations

Stress is a pervasive issue among traditional college students; affecting their choice in health behaviors, and overall academic performance. What is not clear is why some students, despite the pervasiveness of stressors are able to do well in school and maintain/improve their health, while other students struggle to maintain their health and do poorly in school. Aaron Antonovsky theorized that when confronted with a stressor a person with a high sense of coherence (SOC) will be motivated to cope, believe the challenge is understood and that the necessary resources to cope with the stressor are available. Overall, Antonovsky theorized that …

Health Advocacy Intervention For Youth : A Case Study Of Metro Youth Advocates., Tiffany Monyhan, Sasha Belenky, Kristi Mcclary King

Faculty and Staff Scholarship

No abstract provided.

The Impact Of Preconception Maternal Stress On Fecundability And Adverse Pregnancy Outcomes., Shekufe Akhter

Electronic Theses and Dissertations

It has been commonly hypothesized (and widely believed) that maternal stress either prior to or during pregnancy can adversely affect fertility and pregnancy outcomes. However, surprisingly few epidemiologic studies have rigorously tested these hypotheses. The current study evaluated the effects of pre-conception self-reported stress on fecundability and spontaneous abortion. The study population was derived from the Mount Sinai Study of Woman Office Workers with 487 women included. Women recorded stress (scale from 1 to 4) and covariate information in a daily diary for 12 cycles or until pregnant. Results indicated a significantly increased risk of spontaneous abortion for women with …

Racial Classifications, Biomarkers, And The Challenges Of Health Disparities Research In The African Diaspora., Latrica E. Best, John Chenault

Faculty and Staff Scholarship

Current scholarly research, both sociologically and biologically based, continues to be inundated with notions of race operating as a biological construct and as a proxy for poor health outcomes. Medical research and practice have fostered an environment where diagnostics, treatment, and the creation and dissemination of drug regimens often are influenced by a patient’s skin color and ethnicity. The emergence of biological markers in social science-based surveys has fueled recent health disparities research that is shaping the meaning, interpretation, and policy of the health of people of color. Using hypertension as an example, this paper focuses on ways in which …

Cognitive Decline And Polypharmacy In An Elderly Population., Ximena A. Oyarzun Gonzalez

Electronic Theses and Dissertations

Aging is associated with increased risk of chronic disease, comorbidities, and greater medication use. Polypharmacy, the concomitant use of 5 or more medications, has been associated with adverse health effects, and potentially cognitive decline. The proposed hypothesis is that polypharmacy increases the risk of cognitive decline in elderly people. Using longitudinal data from 572 participants from the New Mexico Aging Process Study cohort, the impact of polypharmacy on the Mini Mental State Examination (MMSE) scores and Mild Cognitive Impairment (MCI) was studied. The statistical analyses were performed using mixed linear regression multivariable models and generalized estimating equations, adjusting for important …

Coal Ash And Children's Sleep : A Community-Based Study., Clara G. Sears

Electronic Theses and Dissertations

Kentucky is the fifth largest producer of coal ash, a by-product of coal combustion. The small spherical coal ash particles contain heavy metals like arsenic, lead, mercury, and cadmium. Coal ash is currently classified as nonhazardous by the EPA, which allows it to be stored in open-air impoundments near low-income communities. The primary object of the study is to determine the prevalence of sleep disruptive behaviors in children exposed to coal ash, compared to a group of demographically similar non-exposed children. Parents or guardians from five neighborhoods surrounding a coal ash storage facility, and one non-exposed community, participated in a …