Public Health Commons^™

Persistent Infection Or Successive Reinfection Of Deer Mice With Bartonella Vinsonii Subsp. Arupensis, Ying Bai, Charles H. Calisher, Michael Y. Kosoy, J. Jeffrey Root, Jeffrey B. Doty

United States Public Health Resources

Bartonella infections are common in rodents. From 1994 to 2006, longitudinal studies of a rodent community, consisting mainly of deer mice (Peromyscus maniculatus), were conducted in southwestern Colorado to study hantaviruses. Blood samples from deer mice captured one or more times during the period 2003 to 2006 (n = 737) were selected to study bartonellae in deer mice. Bartonellae were found to be widely distributed in that population, with an overall prevalence of 82.4% (607/737 mice). No correlation was found between bartonella prevalence and deer mouse weight or sex. Persistent or successive infections with bartonellae were observed …

Long Term Depleted Uranium Exposure In Gulf War I Veterans Does Not Cause Elevated Numbers Of Micronuclei In Peripheral Blood Lymphocytes, M. V. Bakhmutskya, M. S. Oliver, M. A. Mcdiarmid, K. S. Squibb, J. D. Tucker

United States Public Health Resources

Depleted uranium (DU) is a high density heavy metal that has been used in military munitions since the 1991 Gulf War. DU is weakly radioactive and chemically toxic. Long term exposure can cause adverse health effects. This study assessed genotoxic effects in DU exposed Gulf War I veterans as a function of uranium (U) body burden. Levels of urine U were used to categorize the cohort into low and high exposure groups. Exposure to DU occurred during friendly fire incidents in 1991 involving DU munitions resulting in inhalation and ingestion exposure to small particles of DU and soft tissue DU …

The Department Of Veterans Affairs Nursing Academy (Vana): Forging Strategic Alliances With Schools Of Nursing To Address Nursing’S Workforce Needs, Candice C. Bowman, Linda Johnson, Malcolm Cox, Catherine Rick, Mary Dougherty, Anna C. Alt-White, Tamar Wyte, Jack Needleman, Aram Dobalian

United States Public Health Resources

In 2007, the Department of Veterans Affairs (VA) established the VA Nursing Academy (VANA), a 5-year, $60-million pilot program funding 15 partnerships between schools of nursing and local VA health care facilities nationwide, to expand nursing faculty, enhance clinical faculty development, increase nursing student enrollment, and promote educational innovations. VA is an ideal setting for educating nursing students owing to a well-educated registered nurse staff, an array of traditional and nontraditional settings, a state-of-the-art computerized electronic health record system, and a unique patient population. Challenges related to the complex nature of VANA partnerships, conceptualized as strategic alliances created between disparate …

Receptor Specificity Of Subtype H1 Influenza A Viruses Isolated From Swine And Humans In The United States, Li-Mei Chen, Pierre Rivailler, Jaber Hossain, Paul Carney, Amanda Balish, Ijeoma Perry, C. Todd Davis, Rebecca Garten, Bo Shu, Xiyan Xu, Alexander Klimov, James C. Paulson, Nancy J. Cox, Sabrina L. Swenson, James Stevens, Amy Vincent, Marie Gramer, Ruben O. Donis

United States Public Health Resources

The evolution of classical swine influenza viruses receptor specificity preceding the emergence of the 2009 H1N1 pandemic virus was analyzed in glycan microarrays. Classical swine influenza viruses from the α, β, and γ antigenic clusters isolated between 1945 and 2009 revealed a binding profile very similar to that of 2009 pandemic H1N1 viruses, with selectivity for α2-6-linked sialosides and very limited binding to α2-3 sialosides. Despite considerable genetic divergence, the ‘human-like’ H1N1 viruses circulating in swine retained strong binding preference for α2-6 sialylated glycans. Interspecies transmission of H1N1 influenza viruses from swine to humans or …

Characterizing Binge Drinking Among U.S. Military Veterans Receiving A Brief Alcohol Intervention, Michael A. Cucciare, Maura Darrow, Kenneth R. Weingardt

United States Public Health Resources

Background: Brief web-based alcohol interventions (BAIs) are effective for reducing binge drinking in college students and civilian adults, and are increasingly being applied to U.S. military populations. However, little is known about factors associated with binge drinking in Veteran populations and therefore some concern remains on the generalizability of studies supporting BAIs for addressing binge drinking in this population. This study sought to better understand the characteristics (e.g., demographic, coping related mental health factors, prior exposure to traumatic events, and factors assessing motivation to change alcohol use) of a predominantly male sample of binge drinking Veterans receiving a BAI …

Prevalence Of Liver Disease In Veterans With Bipolar Disorder Or Schizophrenia, Bret E. Fuller, Veronica L. Rodriguez, Alex Linke, Mirko Sikirica, Riad Dirani, Peter Hauser

United States Public Health Resources

Objective: To assess the prevalence of three liver diseases [hepatitis C virus (HCV), nonalcoholic fatty liver disease and alcohol-induced cirrhosis] in patients (veterans) with/without schizophrenia/schizoaffective disorder and bipolar disorder.

Methods: A retrospective electronic chart review of Veterans Integrated Services Network 20 facilities from January 1, 2001 to December 21, 2006 selected patients to one of two groups: schizophrenia/schizoaffective disorder or bipolar disorder. Patients in both groups were compared with veterans in an equal-sized random sample from the same data set of veterans without psychiatric diagnoses. Logistic regression models evaluated risk for overall liver diseases as well as HCV, …

Factors Associated With Suicidal Ideation In Oef/Oif Veterans, Chad M. Lemaire, David P. Graham

United States Public Health Resources

Background: The purpose of this projectwas to examine factors associated with suicidal ideation in returning Iraq and Afghanistan war veterans.

Methods: A cross-sectional review of 1740 veterans' initial mental health screening evaluations. One-hundred and thirteen (6.5%) OEF/OIF veterans reported active suicidal ideation at the time of the interview.

Results: Prior exposures of physical or sexual abuse and having a history of a prior suicide attempt(s) were associated with the presence of current suicidal ideation, as were having a diagnosis of a psychotic disorder, a depressive disorder, or posttraumatic stress disorder (PTSD). Deployment concerns related to training (protective), …

Imagery Rescripting And Exposure Group Treatment Of Posttraumatic Nightmares In Veterans With Ptsd, Mary E. Long, Mary E. Hammons, Joanne L. Davis, B. Christopher Frueh, Myrna M. Khan, Jon D. Elhai, Ellen J. Teng

United States Public Health Resources

This study details results of an open trial of a group psychological treatment for Veterans with posttraumatic stress disorder (PTSD) and chronic posttraumatic nightmares called “Imagery Rescripting and Exposure Therapy” (IRET). IRET is a variant of a successful imagery rescripting treatment for civilian trauma-related nightmares that was modified to address the needs of the Veteran population. Thirtyseven male U.S. Veterans with PTSD and nightmares attended 6 multicomponent group sessions. Findings indicated that the intervention significantly reduced frequency of nightmares and PTSD severity, as well as increased hours of sleep. Unlike the few open trials examining treatment of nightmares in Veterans, …

The Impact Of Endorsing Spitzer’S Proposed Criteria For Ptsd In The Forthcoming Dsm-V On Male And Female Veterans, Lyndsey N. Miller, Kathleen M. Chard, Jeremiah A. Schumm, Carol O’Brien

United States Public Health Resources

This study explored differences between Spitzer’s proposed model of posttraumatic stress disorder (PTSD) and the current DSM-IV diagnostic classification scheme in 353 Veterans. The majority of Veterans (89%) diagnosed with PTSD as specified in the DSM-IV also met Spitzer’s proposed criteria. Veterans who met both DSM-IV and Spitzer’s proposed criteria had significantly higher Clinician Administered PTSD Scale severity scores than Veterans only meeting DSM-IV criteria. Logistic regression indicated that being African American and having no comorbid diagnosis of major depressive disorder or history of a substance use disorder were found to predict those Veterans who met current, but not proposed …

Two Sessions Of Sleep-Focused Mind–Body Bridging Improve Self-Reported Symptoms Of Sleep And Ptsd In Veterans: A Pilot Randomized Controlled Trial, Yoshio Nakamura, David L. Lipschitz, Richard Landward, Renee Kuhn, Gavin West

United States Public Health Resources

Objective: Sleep disturbance is highly prevalent among veterans. As an alternative to sleep medications with their undesirable side effects, nonpharmacological mind–body interventions may be beneficial for sleep management in primary care. The aim of this pilot study was to investigate whether a novel mind–body intervention, mind–body bridging (MBB), focusing on sleep, could improve self-reported sleep disturbance and comorbid symptoms in veterans.

Methods: This pilot study was a randomized controlled trial at the Veterans Affairs Salt Lake City Health Care System in which 63 veterans with self-reported sleep disturbance received MBB or an active sleep education control. Both interventions …

Cerebrocerebellar Hypometabolism Associated With Repetitive Blast Exposure Mild Traumatic Brain Injury In 12 Iraq War Veterans With Persistent Post-Concussive Symptoms, Elaine R. Peskind, Eric C. Petrie, Donna J. Cross, Kathleen Pagulayan, Kathleen Mccraw, David Hoff, Kim Hart, Chang-En Yu, Murray A. Raskind, David G. Cook, Satoshi Minoshima

United States Public Health Resources

Disagreement exists regarding the extent to which persistent post-concussive symptoms (PCS) reported by Iraq combat Veterans with repeated episodes of mild traumatic brain injury (mTBI) from explosive blasts represent structural or functional brain damage or an epiphenomenon of comorbid depression or posttraumatic stress disorder (PTSD). Objective assessment of brain function in this population may clarify the issue. To this end, twelve Iraq war Veterans (32.0±8.5 [mean±standard deviation (SD)] years of age) reporting one or more blast exposures meeting American Congress of Rehabilitation Medicine criteria for mTBI and persistent PCS and 12 cognitively normal community volunteers (53.0±4.6 years of age) without …

Electroconvulsive Therapy For Major Depression Within The Veterans Health Administration, Paul N. Pfeiffer, Marcia Valenstein, Katherine J. Hoggatt, Dara Ganoczy, Dan Maixner, Erin M. Miller, Kara Zivin

United States Public Health Resources

Objectives: Electroconvulsive therapy (ECT) is the most effective treatment for severe or treatment resistant depression; however, the lack of widely accepted methods for determining when ECT is indicated may contribute to disparities and variation in use. We examined receipt of ECT among depressed patients in the largest coordinated health system in the US, the Veterans Health Administration.

Methods: Using administrative data, we conducted a multivariable logistic regression to identify individual clinical and sociodemographic predictors of receiving ECT, including variables of geographic accessibility to ECT, among patients diagnosed with major depressive disorder between 1999 and 2004.

Results: 307 (0.16%) …

Veterans Affairs General Surgery Service: The Last Bastion Of Integrated Specialty Care, Stephen Poteet, Margaret Tarpley, John L. Tarpley, A. Scott Pearson

United States Public Health Resources

BACKGROUND: In a time of increasing specialization, academic training institutions provide a compartmentalized learning environment that often does not reflect the broad clinical experience of general surgery practice. This study aimed to evaluate the contribution of the Veterans Affairs (VA) general surgery surgical experience to both index Accreditation Council for Graduate Medical Education (ACGME) requirements and as a unique integrated model in which residents provide concurrent care of multiple specialty patients.

METHODS: Institutional review board approval was obtained for retrospective analysis of electronic medical records involving all surgical cases performed by the general surgery service from 2005 to …

Substance Use Disorders In Iraq And Afghanistan Veterans In Va Healthcare, 2001–2010: Implications For Screening, Diagnosis And Treatment, Karen H. Seal, Greg Cohen, Angela Waldrop, Beth E. Cohen, Shira Maguen, Li Ren

United States Public Health Resources

Background: The prevalence and correlates of alcohol use disorder (AUD) and drug use disorder (DUD) diagnoses in Iraq and Afghanistan veterans who are new users of Department of Veterans Affairs (VA) healthcare nationwide has not been evaluated.

Methods: VA administrative data were used in retrospective cross-sectional descriptive and multivariable analyses to determine the prevalence and independent correlates of AUD and DUD in 456,502 Iraq and Afghanistan veterans who were first-time users of VA healthcare between October 15, 2001 and September 30, 2009 and followed through January 1, 2010.

Results: Over 11% received substance use disorder diagnoses: AUD, …

Motivational Interview Improves Treatment Entry In Homeless Veterans, R. Morgan Wain, Paula L. Wilbourne, Keith W. Harris, Heather Pierson, Jasmine Teleki, Thomas A. Burling, Steven Lovett

United States Public Health Resources

Motivational Interviewing (MI) has successfully been used to facilitate entry and compliance in drug and alcohol treatment programs. Some questions have been raised as to the effectiveness of MI in severely distressed populations. This study aims to assess the effectiveness of MI in a population of homeless, unemployed, and substance dependent veterans who are being wait-listed for entry into a residential treatment program. Seventy-five veterans placed on a wait-list were randomized to receive a single MI or standard (Std) intake interview. Outcomes assessed were entry, and length of stay (LOS). Secondary outcomes assessed included program completion and rates of graduation. …

Insomnia Characteristics And Clinical Correlates In Operation Enduring Freedom/Operation Iraqi Freedom Veterans With Post-Traumatic Stress Disorder And Mild Traumatic Brain Injury: An Exploratory Study, D. M. Wallace, S. Shafazand, A.R. Ramos, D.Z. Carvalho, H. Gardener, D. Lorenzo, W.K. Wohlgemuth

United States Public Health Resources

Background: There is limited data on chronic insomnia in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans, in whom post-traumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) often co-exist. Our aim was to compare sleep characteristics of three groups of OEF/OIF veterans: (1) healthy sleepers (HS), (2) those with insomnia associated with PTSD and mTBI (PTSD–mTBI), and (3) those with insomnia associated with PTSD alone.

Methods: Consecutive veterans with insomnia complaints (>6 months) were recruited over 6 months from the Miami VA Post Deployment clinic. Participants completed a sleep disorders clinical interview, medical history, and questionnaires …

Factors Influencing Receipt Of Outpatient Rehabilitation Services Among Veterans Following Lower Extremity Amputation, Jianxun Zhou, Barbara E. Bates, Jibby E. Kurichi, Pui L. Kwong, Dawei Xie, Margaret G. Stineman

United States Public Health Resources

Objective: To determine patient-, treatment-, and facilitylevel characteristics associated with receiving outpatient rehabilitation services after lower extremity amputation within the Veterans Affairs (VA) system.

Design: Observational study.

Setting: All Veterans Affairs Medical Centers (VAMCs).

Participants: Veterans (N=4165) with lower extremity amputation discharged from VAMCs between October 1, 2002, and September 20, 2004. Interventions: Not applicable.

Main Outcome Measures: Receipt of outpatient rehabilitation services up to 1 year postdischarge. A Cox proportional hazards model was used to determine the adjusted hazard ratio and 95% confidence interval of veterans to receive outpatient services.

Results: …

Angiogenic Biomarkers For Risk Stratification In Women With Suspected Preeclampsia, Andreea Balan, Heather Young, Linda Ojo, Jennifer Keller, Sharon Maynard

Epidemiology Faculty Posters and Presentations

This poster presents the results of a single-center prospective cohort study of 315 pregnant women who presented to George Washington University Hospital Labor and Delivery service with a clinical suspicion of preeclampsia between February 2007 and November 2011. Informed consent was obtained. Baseline demographic information and medical history was collected on each patient including maternal age, ethnicity, body mass index, tobacco and other substance use, gestational age, medical problems and obstetric history. Serum samples were obtained from each enrolled subject within 24 hours of admission, and sFlt1, PlGF and sEng ELISA assays were performed in duplicate by a blinded laboratory …

Situation Assessment Of The Hiv Response Among Young People In Zambia, Sam Kalibala, Drosin Mulenga

HIV and AIDS

The main objective of this situational assessment is to compile and synthesize existing recent information on HIV and young people together with the current AIDS response for young people in Zambia—including programs, policies, and key partners—and to document gaps and challenges in the response. The assessment aims to further strengthen this response by all stakeholders including the Government of the Republic of Zambia, the UN, faith-based organizations, civil society organizations, donors, young people, and youth-led organizations. Recommendations include: amending and strengthening laws related to HIV programming for young people and involving them in design and implementation; offering health services, life …

Migration And Hiv In India: Study Of Select Districts, Niranjan Saggurti, Bidhubhusan Mahapatra, Suvakanta N. Swain, Madhusudana Battala, Alka Narang, Umesh Chawla

HIV and AIDS

Report of a study assessing the important role of migration in the spread of HIV in districts with high out-migration in India. The study suggests a considerable spread of HIV linked to migrants’ extramarital sexual behaviors, and subsequent delay in treatment for infected spouses. In order to control the spread of HIV, the study provides programmatic recommendations made by the study participants and the counselors from ICTCs and ART centers. These suggestions include village-level mapping of at-risk persons, mainstreaming HIV prevention interventions within current health resources, improving various village level HIV prevention programs, and involving women left behind by migrant …

Hiv Transmission Among Married Men And Women In Districts With High Out-Migration In India: Study Brief, Niranjan Saggurti, Bidhubhusan Mahapatra, Suvakanta N. Swain, Madhusudana Battala, Umesh Chawla, Alka Narang

HIV and AIDS

This brief describes a study examining the links between male out-migration and HIV transmission among married men and women and other mechanisms by which HIV is transmitted within marital relationships in districts with high out-migration.

Facilitating Regulatory Approval Of Multipurpose Prevention Technologies For Sexual And Reproductive Health, Martha Brady

HIV and AIDS

This brief describes multipurpose prevention technologies (MPTs) that address women's sexual and reproductive health (SRH) needs, and how to go about facilitating regulatory approval of this technology. It outlines a strategic framework to examine current regulatory guidance, as well a product development pathway to bring MPTs to market.

What Regulatory Guidance Exists For Multipurpose Prevention Technologies (Mpts)? A Review Of Key Guidance Documents And Their Applicability To Mpts, Martha Brady, Heeyoung Park

HIV and AIDS

This brief reviews regulatory guidance documents and how they may apply to multi-purpose technologies (MPTs). It examines guidance documents from the Food and Drug Administration (FDA), the European Medicines Agency (EMA) and the International Conference on Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH). The brief concludes by anticipating increased interactions with US regulatory agencies in hopes of finding new regulatory pathways that address MPTs specifically.

Evaluation Of The Informed Consent Process For Male Circumcision Scale-Up In Swaziland, Barbara Friedland, Louis Apicella, Katie D. Schenk, Meredith Sheehy, Paul C. Hewett

HIV and AIDS

This report evaluates the informed consent process for male circumcision conducted through the Male Circumcision Partnership for Swaziland, led by Population Services International, in partnership with Jhpiego, Marie Stopes International, and the Population Council. The study assesses participants' comprehension of the circumcision process, the informed consent process, as well as the affect of male circumcision counseling on their experience.

Education During Humanitarian Emergencies: The Situation Of Displaced Children And Youth In Darfur, Sudan, Safaa El-Kogali

Poverty, Gender, and Youth

More than 39 million children and youth who live in conflict-affected fragile states do not have access to education. With an increase in the average duration of refugee displacement from 9 years in the early 1990s to 17 years today, whole generations of children have little chance to recoup the potential educational investment lost during their years living in the midst of a humanitarian emergency. The Population Council and the Women’s Refugee Commission launched a research project to identify the link between education and children’s protection and well-being in Darfur, Sudan. The objective was to document the educational environment in …

Female Wages In The Egyptian Textiles And Clothing Industry: Low Pay Or Discrimination?, Amirah El-Haddad

Poverty, Gender, and Youth

This Population Council working paper analyzes data collected from a survey of firms and workers in the textiles and clothing sector in Egypt. These data allow for the explanation of the sector’s gender wage gap by poorer endowments, and relegation of women to low-paying firms and occupations; and by within-firm and within-occupation differential in returns. There is a pay gap in this sector, with men receiving an hourly wage 29 percent higher than that of women, partly because women are concentrated in the lower paid occupations, with a clear glass ceiling in effect, and outright discrimination occurs. The largest of …

The Effects Of Racially-Motivated Emotional Arousal On The Eating Behaviors Of African American Women, Lenwood W. Hayman

Wayne State University Dissertations

Disparities between African Americans and Caucasians remain vast across a wide variety of health indicators. Chronic stress has been identified as a risk factor for a variety of chronic illnesses and poor health outcomes. One type of chronic stress that has been linked to health disparities is the stress associated with experiences of racial discrimination. The stress African Americans encounter as a result of their racist experiences contributes to a chronic elevation of their physiological stress response. In addition to stress, a major risk factor for coronary heart disease and diabetes is obesity, which has been established as a major …

An Investigation On Hiv Related Stigma To Improve Hiv Prevention Efforts In North Dakota, Krissie Lynn Mayer-Guerard

All Graduate Theses, Dissertations, and Other Capstone Projects

This study examines HIV stigma to improve HIV prevention in North Dakota. A survey was administered to North Dakotan adults between January 15 and February 15, 2011, in eight selected towns. The study focused on North Dakotan perceptions of HIV in their state. Research found that most North Dakotans do not view HIV as a problem in their state. There is, however, a belief that there is stigma associated with HIV in North Dakota, as 65 percent of survey respondents believe that. The study also shows that there is a need for education regarding the transmission of HIV. Sixty percent …

Evaluation Of Health Newsletter Effectiveness On Dietary Habits In Low-Income Middle-Aged Women, Nichole Jennifer Hassebroek

All Graduate Theses, Dissertations, and Other Capstone Projects

There is little known about the effectiveness of the SagePlus newsletters at motivating dietary habit changes. The purpose of this study was to determine the effectiveness of the SagePlus newsletter in motivating low-income, middle-aged women who are participating in the SagePlus program to adopt healthier eating habits, specifically to eat more fruits and vegetables. A nonexperimental, descriptive correlational design was used in this study. Phone calls were placed to current SagePlus participants who had been enrolled in the program between six and 12 months. Forty English-speaking participants were contacted and agreed to participate in the telephone survey from a potential …

Barriers To Using Motivational Interviewing For Lifestyle Counseling, Heidi June Sannes

All Graduate Theses, Dissertations, and Other Capstone Projects

The Minnesota Department of Health has sponsored Motivational Interviewing Continuing Education sessions for SagePlus providers to increase their knowledge and skill in the utilization of MI in their clinical practice. The impact of these educational sessions on skill development as well as utilization of MI by these providers is unknown. The purpose of this study was to determine if healthcare providers perceive any barriers in utilizing MI techniques to do lifestyle counseling with SagePlus program particiants. A descriptive quantitative design was used for this study. Of the 22 healthcare providers that were doing lifestyle counseling 16 completed the questionnaires. The …