Public Health Commons^™

Influence Of The Patient Protection And Affordable Care Act On The Development Of The Patient Centered Medical Home, Anjali Rao

Master of Public Health Program Student Publications

The Patient Centered Medical Home (PCMH) model of care incorporates many public health concepts. Some supporters of PCMH regard the Affordable Care Act (ACA) as legislation that will invigorate PCMH progress across the country. This policy analysis intends to understand the influence of the ACA on the development of PCMH. The policy analysis compares relevant sections of the ACA with core PCMH concepts agreed upon by major medical professional organizations. The evaluative framework uses a “traffic light” system to rate each section of the ACA based on the accuracy of the section as compared to PCMH criteria, and denotes whether …

Elevated Serum C-Reactive Protein And Markers Of Sleep Disordered Breathing, R Constance Wiener

Faculty & Staff Scholarship

Background. Previous studies indicated sleep-disordered breathing (SDB) is associated with cardiovascular disease (CVD). Systemic inflammation is recognized as a risk factor for CVD. Studies examining SDB and inflammation are limited. Methods. We studied sleep duration, snoring, snorting, and daytime sleepiness, and an additive SDB score. The main outcome was a C-reactive protein (CRP) of >1 mg/dL. Results. Snoring, snorting, daytime sleepiness, and sleeping >7 or <7 hours, and the additive score were significantly associated with high CRP. The additive score was not associated in men but moderately associated in women in a multivariable model adjusting for age, gender, race/ethnicity, education, smoking, hypertension, alcohol intake, physical activity, body mass index, depression, diabetes, hypertension, and total cholesterol (P-interaction ). For race/ethnicity, the association was strongest in Mexican Americans/others, modest in Non-Hispanic whites, and absent in Non-Hispanic blacks (P-interaction ). Conclusions. The association between SDB and high CRP was present mainly in women and Mexican Americans, implying SDB has a residual, independent association with inflammation after controlling for lifestyle and metabolic risk factors like BMI, physical activity, depression, diabetes, and cholesterol.

Association Between Serum Uric Acid Levels And Sleep Variables: Results From The National Health And Nutrition Survey 2005–2008, R Constance Wiener

Faculty & Staff Scholarship

Sleep disordered breathing as well as high serum uric acid levels are independent risk factors for cardiovascular disease. However, studies evaluating the relationship between sleep-disordered breathing and hyperuricemia are limited. We examined the 2005–2008 National Health and Nutrition Examination survey's sleep variables and high serum uric acid among 6491 participants aged ≥ 2 0 years. The sleep variables included sleep duration, snoring, snorting, and daytime sleepiness. The main outcome was high serum uric acid level, defined as levels of serum uric acid > 6 . 8 mg/dL in males and > 6 . 0 mg/dL in females. We found that snoring more …

Aspirin But Not Ibuprofen Use Is Associated With Reduced Risk Of Prostate Cancer: A Plco Study, F. M. Shebl, L. C. Sakoda, A. Black, J. Koziol, G. L. Andriole, R. Grubb, T. R. Church, D. Chia, Cindy Zhou, +8 Additional Authors

GW Biostatistics Center

Background:

Although most epidemiological studies suggest that non-steroidal anti-inflammatory drug use is inversely associated with prostate cancer risk, the magnitude and specificity of this association remain unclear.

Methods:

We examined self-reported aspirin and ibuprofen use in relation to prostate cancer risk among 29 450 men ages 55–74 who were initially screened for prostate cancer from 1993 to 2001 in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Men were followed from their first screening exam until 31 December 2009, during which 3575 cases of prostate cancer were identified.

Results:

After adjusting for potential confounders, the hazard ratios (HRs) of …

Child, Parent, And Healthcare Professionals' Perspectives On Hiv Infection Status Disclosure To Children, Grace Gachanja

Presidential Alumni Research Dissemination Award

HIV infected parents face great challenges when contemplating and performing disclosure of theirs and their children's illnesses to their infected and noninfected children. HIV disclosure guidelines for a parent's and child's illness do not exist in resource-poor nations. This hinders and impedes the delivery of disclosure from parent to child. This qualitative phenomenological study, based on the disease progression theory and the consequence theory of HIV disclosure, was conducted to understand the lived experiences of HIV-infected parents and their children living in Kenya before, during, and after disclosure of a parent's and child's HIV infection status. Thirty four participants consisting …

Developing A Business Plan For Sustaining School Mental Health Services: Three Success Storiess, Donna Behrens, Julia Graham Lear, Olga Acosta Price

Center for Health and Health Care in Schools

No abstract provided.

Urban Governance Of Disease, Rebecca Katz, Sangeeta Mookherji, Morgan Kaminski, Vibhuti Haté, Julie E. Fischer

Global Health Faculty Publications

Rapid population growth, urbanization, and the growing challenges faced by the urban poor require redefining the paradigm for public health interventions in the 21st century, creating new approaches that take urban determinants of health into consideration. The widening disparity between the urban poor and the urban rich further exacerbates health inequities. Existing tools for global governance of urban health risks fall short, particularly in the lack of formal mechanisms to strengthen collaboration and communication among national and municipal agencies and between their local and international non-governmental partners. There is also a clear disconnect between governance strategies crafted at the international …

Smoking Susceptibility And Its Predictors Among Adolescents In China: Evidence From Ningbo City, Cheng Huang, Jeffrey Koplan, Jing Liu, Changwei Li, Jessica Silvaggio, Amanda K. Macgurn, Tao Zhang, Michael P. Erikson, Pam Redmon

Global Health Faculty Publications

Susceptibility to smoking is a risk factor of actual adolescent smoking behaviors. This study aimed to estimate the rate of smoking susceptibility and its predictors in China with a sample of 4,695 junior high school students in Ningbo, China. Core questions from the Global Youth Tobacco Survey (GYTS) were adapted to the China context and administered to these students. The rate of smoking susceptibility, measured by “Do you foresee yourself taking up smoking in the next 12 months”, is 6.1%. Results from logistic regression suggested that among boys, adolescents’ health knowledge that smoking can cause lung cancer (OR=2.73), the belief …

Health Effects Associated With Foreclosure: A Secondary Analysis Of Hospital Discharge Data, Nancy Menzel, Sheniz Moonie, Melva V. Thompson-Robinson

Nursing Faculty Research

Objectives. The purpose of this study was to assess the health effects of high home foreclosure rates in an area of the United States of America and the utility of hospital discharge data for this purpose. Methods. We analyzed hospital discharge data from three postal zip codes using the principal diagnosis for 25 Diagnostic Related Groups associated with stress. Descriptive statistics were used to characterize hospital discharge rates for each condition by year and zip code. To test for differences across time, the Cochran-Armitage trend test was performed. Results. Most conditions did not demonstrate a statistical change between …

Erlin2 Promotes Breast Cancer Cell Survival By Modulating Endoplasmic Reticulum Stress Pathways, Guohui Wang, Gang Liu, Xiaogang Wang, Seema Sethi, Rouba Ali-Fehmi, Judith Abrams, Ze Zheng, Kezhong Zhang, Stephen Ethier, Zeng-Quan Yang

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

Amplification of the 8p11-12 region has been found in approximately 15% of human breast cancer and is associated with poor prognosis. Previous genomic analysis has led us to identify the endoplasmic reticulum (ER) lipid raft-associated 2 (ERLIN2) gene as one of the candidate oncogenes within the 8p11-12 amplicon in human breast cancer, particularly in the luminal subtype. ERLIN2, an ER membrane protein, has recently been identified as a novel mediator of ER-associated degradation. Yet, the biological roles of ERLIN2 and molecular mechanisms by which ERLIN2 coordinates ER pathways in breast carcinogenesis remain unclear.

Methods

We established the MCF10A-ERLIN2 …

Association Between Acculturation And Breastfeeding Among Hispanic Women: Data From The Pregnancy Risk Assessment And Monitoring System, Indu B. Ahluwalia, Denise D’Angelo, Brian Morrow, Jill A. Mcdonald

United States Public Health Resources

Background: Breastfeeding rates are typically higher among Hispanic women; however, they vary by acculturation status in that those more acculturated are less likely to breastfeed than those who are less acculturated. This study examined the association between acculturation and breastfeeding behaviors using population-based data.

Methods: Data (N = 8942) from the Pregnancy Risk Assessment Monitoring System (PRAMS) were used for analysis. Acculturation status was determined using self-reported Hispanic ethnicity and the language in which the women responded to the PRAMS survey, either English or Spanish. Hispanic women who responded to the survey in Spanish were categorized as less acculturated than …

Most Physicians Were Eligible For Federal Incentives In 2011, But Few Had Ehr Systems That Met Meaningful-Use Criteria, Chun-Ju Hsiao, Sandra Decker, Esther Hing, Jane Sisk

United States Public Health Resources

As more physicians adopt electronic health record systems in their practices, policy interest is focusing on whether physicians are ready to meet the federal “meaningful use” criteria—a vital threshold to qualify for financial incentives. In our analysis of a 2011 nationally representative survey of office-based physicians, we found that 91 percent of physicians were eligible for Medicare or Medicaid meaningful-use incentives. About half of all physicians intended to apply. However, only 11 percent both intended to apply for the incentives and had electronic health record systems with the capabilities to support even two-thirds of the stage 1 core objectives required …

United States Registered Nurse Workforce Report Card And Shortage Forecast, Stephen P. Juraschek, Xiaoming Zhang, Vinoth K. Ranganathan, Vernon Lin

United States Public Health Resources

Registered nurses (RNs) play a critical role in health care delivery. With an aging US population, health care demand

is growing at an unprecedented pace. Using projected changes in population size and age, the authors developed

demand and supply models to forecast the RN job shortage in each of the 50 states. Letter grades were assigned

based on projected RN job shortage ratios. The number of states receiving a grade of “D” or “F” for their RN

shortage ratio will increase from 5 in 2009 to 30 by 2030, for a total national deficit of 918 232 (725 619 - …

Improving Outpatient Diabetes Care, Susan Kirsh, Michael Hein, Leonard Pogach, Gordon Schectman, Lauren Stevenson, Sharon Watts, Archana Radhakrishnan, John Chardos, David Aron

United States Public Health Resources

More than 20% of patients in the Veterans Health Administration (VHA) have diabetes; therefore, disseminating “best practices” in outpatient diabetes care is paramount. The authors’ goal was to identify such practices and the factors associated with their development. First, a national VHA diabetes registry with 2008 data identified clinical performance based on the percentage of patients with an A1c >9%. Facilities (n = 140) and community-based outpatient clinics (n = 582) were included and stratified into high, mid, and low performers. Semistructured telephone interviews (31) and site visits (5) were conducted. Low performers cited lack of teamwork between physicians and …

Clinical Research And Development Of Tuberculosis Diagnostics: Moving From Silos To Synergy, Payam Nahid, Peter S. Kim, Carlton A. Evans, David Alland, Michael Barer, Jane Diefenbach, Jerrold Ellner, Richard Hafner, Carol Dukes Hamilton, Michael F. Iademarco, Gregory Ireton, Michael E. Kimerling, Christian Lienhardt, William R. Mackenzie, Megan Murray, Mark D. Perkins, Jamie E. Posey, Teri Roberts, Christine Sizemore, Wendy S. Stevens, Laura Via, Sharon D. Williams, Wing Yew, Susan Swindells

United States Public Health Resources

The development, evaluation, and implementation of new and improved diagnostics have been identified as critical needs by human immunodeficiency virus (HIV) and tuberculosis researchers and clinicians alike. These needs exist in international and domestic settings and in adult and pediatric populations. Experts in tuberculosis and HIV care, researchers, healthcare providers, public health experts, and industry representatives, as well as representatives of pertinent US federal agencies (Centers for Disease Control and Prevention, Food and Drug Administration, National Institutes of Health, United States Agency for International Development) assembled at a workshop proposed by the Diagnostics Working Group of the Federal Tuberculosis Taskforce …

The Use Of Low-Calorie Sweeteners By Children: Implications For Weight Management, John Foreyt, Ronald Kleinman, Rebecca Brown, Rachel Lindstrom

United States Public Health Resources

The rise in pediatric obesity since the 1970s has been well established in the United States and is becoming a major concern worldwide. As a potential means to help slow the obesity epidemic, low-calorie sweeteners (LCS) have gained attention as dietary tools to assist in adherence to weight loss plans or prevention of excess weight gain. Observational studies tend to show positive correlations between LCS consumption and weight gain in children and adolescents. Although the data are intriguing, these epidemiologic studies do not establish that LCS cause weight gain, because there are likely many lifestyle and genetic differences between children …

Salmonella Enterica Serotype Enteritidis: Increasing Incidence Of Domestically Acquired Infections, Shua J. Chai, Patricia L. White, Sarah L. Lathrop, Suzanne M. Solghan, Carlota Medus, Beth Mcglinchey, Melissa Tobin-D'Angelo, Ruthanne Marcus, Barbara Mahon

United States Public Health Resources

Background. Salmonella enterica causes an estimated 1 million cases of domestically acquired foodborne illness in humans annually in the United States; Enteritidis (SE) is the most common serotype. Public health authorities, regulatory agencies, food producers, and food processors need accurate information about rates and changes in SE infection to implement and evaluate evidence-based control policies and practices.

Methods. We analyzed the incidence of human SE infection during 1996–2009 in the Foodborne Diseases Active Surveillance Network (FoodNet), an active, population-based surveillance system for laboratory-confirmed infections. We compared FoodNet incidence with passively collected data from complementary surveillance systems and with …

The Structure Of Posttraumatic Psychopathology In Veterans Attending Primary Care, David Forbes, Jon D. Elhai, Emma Lockwood, Mark Creamer, B. Christopher Frueh, Kathryn M. Magruder

United States Public Health Resources

This study attempted to extend research indicating that posttraumatic stress disorder (PTSD) factors of Re-experiencing, Avoidance and Hyperarousal are more related to Fear/phobic disorders, while PTSD Dysphoria is more related to Anxious-Misery disorders. Trauma exposure, PTSD and comorbidity data for 668 veteran patients were analysed using confirmatory factor analyses and relative strengths of the relationships between PTSD factors and the Fear and Anxious-Misery factors were assessed. Combining Simms, Watson, and Doebbeling’s (2002) model of PTSD symptoms and Krueger’s (1999) Fear/Anxious Misery model of mood and anxiety disorders fit the data well. Contrary to previous research, PTSD Reexperiencing, Avoidance and Hyperarousal …

Trends In Total Laryngectomy In The Era Of Organ Preservation: A Population- Based Study, Patrick Tate Maddox, Louise Davies

United States Public Health Resources

Objective. To describe time trends in total laryngectomy health services utilization across the United States, such as rates of surgery, cost, length of stay, and insurance payer, and to compare this to important milestones in recommendations for laryngeal cancer treatment.

Study Design. Population-based cohort study

Setting. Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) 1997-2008: stratified sample of all US hospital discharges.

Subjects and Methods. All patients with the principal procedure of complete laryngectomy. The unit of analysis was the discharge.

Results. Between 1997 and 2008, the number of laryngectomies done in the United States …

Women At War: Understanding How Women Veterans Cope With Combat And Military Sexual Trauma, Kristin M. Mattocks, Sally G. Haskell, Erin E. Krebs, Amy C. Justice, Elizabeth M. Yano, Cynthia Brandt

United States Public Health Resources

The wars in Iraq (Operation Iraqi Freedom, OIF) and Afghanistan (Operation Enduring Freedom, OEF) have engendered a growing population of US female veterans, with women now comprising 15% of active US duty military personnel. Women serving in the military come under direct fire and experience combatrelated injuries and trauma, and are also often subject to in-service sexual assaults and sexual harassment. However, little is known regarding howwomen veterans cope with these combat and military sexual trauma experiences once they return from deployment. To better understand their experiences, we conducted semi-structured interviews with nineteen OEF/OIF women veterans between JanuaryeNovember 2009. Women …

Factors Associated With Screening Or Treatment Initiation Among Male United States Veterans At Risk For Osteoporosis Fracture, Richard E. Nelson, Jonathan R. Nebeker, Brian C. Sauer, Joanne Lafleur

United States Public Health Resources

Male osteoporosis continues to be under-recognized and undertreated in men. An understanding of which factors cue clinicians about osteoporosis risk in men, and which do not, is needed to identify areas for improvement. This study sought to measure the association of a provider's recognition of osteoporosis with patient information constructs that are available at the time of each encounter. Using clinical and administrative data from the Veterans Health Administration system, we used a stepwise procedure to construct prognostic models for a combined outcome of osteoporosis diagnosis, treatment, or a bone mineral density (BMD) test order using time-varying covariates and Cox …

Β2 Adrenergic Receptor Agonists And Steroids Inhibit Cafo Dust-Mediated Bronchial Epithelial Inflammation In Vitro, D. J. Romberger, K. Palm, A. J. Heires, T. M. Nordgren, M. L. Toews, T. A. Wyatt

United States Public Health Resources

Rationale: Agricultural workers employed in concentrated animal feeding operations (CAFOs) are repeatedly exposed to aerosolized dust, and are susceptible to inflammatory lung diseases including COPD. Aqueous extracts of agricultural dust collected from swine CAFOs (HDE) have been shown to be potent inflammatory stimulators in human cells and in vivo mouse models. HDE exposure augments proinflammatory cytokine release, ICAM-1 expression, PKC activation, and lymphocyte and neutrophil adhesion to airway epithelial cells. Because ₂ adrenergic receptor agonists (β-agonists) alone, and in combination with corticosteroids, have been used to treat COPD, we examined the ability of these agents to diminish the inflammatory …

Cytokine Responses In Whole Blood Assay In Veterans With Agriculture Work Exposures, J. D. J. Romberger, J. L. Meza, E.C. Chickris, A. J. Heires, R. M. Zotti-Pierce, T. D. Levan

United States Public Health Resources

RATIONALE: Agriculture exposures are associated with increased risk of chronic obstructive pulmonary disease (COPD). Endotoxin exposure in agricultural environments is associated with lung disease. Our objective was to evaluate responsiveness to endotoxin stimulation in an in vitro whole blood assay and its association with COPD in an agriculturally exposed cohort.

METHODS: Veterans with ≥ two years agricultural work exposure participated in this case-control study. Cases are veterans with COPD defined as FEV1/FVC ratio < 70% on spirometry post-bronchodilator. Controls did not have COPD as assessed by spirometry nor other significant lung conditions. Whole blood assay (WBA) was done with 2 ml heparinized blood mixed with 2 ml of media and stimulated with increasing doses of LPS (0 – 1 ng/ml). Samples were incubated at 37°C for 24 hours, centrifuged, supernatants harvested and frozen until assayed for cytokines by ELISA. Cytokine values were log transformed. Repeated measures ANOVA was used to examine the association between LPS dose and group (case or control) and the interaction of dose with group. All p values were adjusted for age.

RESULTS: There were 272 participants, 110 cases with COPD and 158 controls. Baseline demographics (gender, age, race) were similar between cases and controls. LPS-stimulated …

Scavenger Receptor A Activation Enhances Peptidoglycan-Stimulated Interleukin-8 Release In Bronchial Epithelium, J. P. Berger, K. L. Bailey, J. M. Devasure, D. J. Romberger, T. A. Wyatt

United States Public Health Resources

INTRODUCTION: The immune response to certain pathogens or cellular stressors is initiated and regulated by pattern recognition receptors of the innate immune system. Pattern recognition receptors are effective by utilizing either endocytic (Scavenger Receptors) or signaling receptors (Toll-like Receptors). It has been previously demonstrated that mouse dendritic cells deficient in scavenger receptor A (SRA) negatively regulated the immune response produced by Toll-like receptors when exposed to modified lipid proteins. Previously, we have shown that peptidoglycan contained in organic dust from swine barns stimulates pro-inflammatory cytokine release in bronchial epithelium. We hypothesized bronchial epithelial SRA would also have a regulatory …

Fish Oil And Indomethacin In Combination Potently Reduce Dyslipidemia And Hepatic Steatosis In Ldlr-/- Mice, Ganesan Murali, Ginger L. Milne, Corey Webb, Ann B. Stewart, Ryan P. Mcmillan, Brandon C. Lyle, Matthew W. Hulver, Viswanathan Saraswathi

United States Public Health Resources

Fish oil (FO) is a potent anti-inflammatory and lipid-lowering agent. Because inflammation can modulate lipid metabolism and vice versa, we hypothesized that combining FO with cyclooxygenase inhibitors (COXIBs), well-known anti-inflammatory drugs, can enhance the anti-inflammatory and lipid-lowering effect of FO. LDLR-/- mice were fed a high fat diet supplemented with 6% olive oil or FO for 12 wk in the presence or absence of indomethacin (Indo, 6mg/liter drinking water). FO reduced plasma total cholesterol by 30% but in combination with Indo, exerted a greater decrease (44%). The reduction of liver cholesterol ester (CE) and triglycerides (TG) by FO (63% …

Annual Report To The Nation On The Status Of Cancer, 1975-2008, Featuring Cancers Associated With Excess Weight And Lack Of Sufficient Physical Activity, Christie Eheman, S. Jane Henley, Rachel Ballard-Barbash, Eric J. Jacobs, Maria J. Schymura, Anne-Michelle Noone, Liping Pan, Robert N. Anderson, Janet E. Fulton, Betsy A. Kohler, Ahmedin Jemal, Elizabeth Ward, Marcus Plescia, Lynn A. G. Ries, Brenda K. Edwards

United States Public Health Resources

BACKGROUND: Annual updates on cancer occurrence and trends in the United States are provided through collaboration between the American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR). This year’s report highlights the increased cancer risk associated with excess weight (overweight or obesity) and lack of sufficient physical activity (<150 minutes of physical activity per week).

METHODS: Data on cancer incidence were obtained from the CDC, NCI, and NAACCR; data on cancer deaths were obtained from the CDC’s National Center for Health Statistics. Annual percent changes in …

The Association Between Depression And Anxiety And Use Of Oral Health Services And Tooth Loss, Catherine A. Okoro, Tara W. Strine, Paul I. Eke, Satvinder S. Dhingra, Lina S. Balluz

United States Public Health Resources

Objective: The purpose of this study is to examine the associations among depression, anxiety, use of oral health services, and tooth loss.

Methods: Data were analysed for 80 486 noninstitutionalized adults in 16 states who participated in the 2008 Behavioral Risk Factor Surveillance System. Binomial and multinomial logistic regression analyses were used to estimate predicted marginals, adjusted prevalence ratios, adjusted odds ratios (AOR) and their 95% confidence intervals (CI).

Results: The unadjusted prevalence for use of oral health services in the past year was 73.1% [standard error (SE), 0.3%]. The unadjusted prevalence by level of tooth loss …

Measuring Discrimination In South Korea: Underestimating The Prevalence Of Discriminatory Experiences Among Female And Less Educated Workers?., Seung-Sup Kim, Yeonseung Chung, David R. Williams

Environmental and Occupational Health Faculty Publications

Objectives

To investigate the possibility that Koreans show different patterns in reporting discriminatory experiences based on their gender and education level, we analyzed the participants who answered “Not Applicable” for the questions of discriminatory experiences that they were eligible to answer.

Methods

Discriminatory experiences in eight social situations were assessed using the 7th wave of Korean Labor and Income Panel Study. After restricting the study population to waged workers, a logistic regression model was constructed to predict the probability that an individual has experienced discrimination based on the observed covariates for each of eight situations, using the data of participants …

Nonclinical Development Needs And Regulatory Requirements For Multipurpose Prevention Technologies: A Primer, Joseph W. Romano, Martha Brady, Judy Manning

HIV and AIDS

This summary outlines key development elements that will be necessary for various configurations of multipurpose prevention products for the simultaneous prevention of HIV, sexually transmitted infections, and/or pregnancy.

Assessing And Improving Self-Reporting Of Male Circumcision In Zambia And Swaziland, Paul C. Hewett, Nicole Haberland, Barbara Mensch, Louis Apicella

HIV and AIDS

The Male Circumcision (MC) Partnership was established with the support of the Gates Foundation and PEPFAR to scale up MC services in Zambia, in collaboration with the Zambian government. The MC Partnership is a five-year project led by Population Services International (Society for Family Health, Zambia), in partnership with Jhpiego, Marie Stopes International (MSI), and the Population Council. The ultimate objective of this study is to provide researchers and program managers with evidence-based recommendations for the collection of self-reported data on MC status through an assessment of different methods to describe and explain MC. Specifically, the study assessed tools for …