Public Health Commons^™

Changing Hearts And Minds: Results From A Multi-Country Gender And Sexual Diversity Training, Tonia Poteat, Chulwoo Park, Diego Solares, John K. Williams, R. Cameron Wolf, Noah Metheny, Andrea Vazzano, Juan Dent, Ashley Gibbs, Bareng Aletta Sanny Nonyane, Nora Toiv

Faculty Publications

Engaging key populations, including gender and sexual minorities, is essential to meeting global targets for reducing new HIV infections and improving the HIV continuum of care. Negative attitudes toward gender and sexual minorities serve as a barrier to political will and effective programming for HIV health services. The President’s Emergency Plan for AIDS Relief (PEPFAR), established in 2003, provided Gender and Sexual Diversity Trainings for 2,825 participants including PEPFAR staff and program implementers, U.S. government staff, and local stakeholders in 38 countries. The outcomes of these one-day trainings were evaluated among a subset of participants using a mixed methods pre- …

Training Us Health Care Professionals On Human Trafficking: Where Do We Go From Here?, Clydette Powell, Kirsten Dickins, Hanni Stoklosa

Pediatrics Faculty Publications

Some 21 million adults and children are labor-trafficked or sex-trafficked through force, fraud, or coercion. In recognition of the interface between trafficking victims and the healthcare setting, over the last 10 years there has been a notable increase in training of health care professionals (HCPs) on human trafficking (HT) and its health implications. Many organizations have developed curricula and offered training in various clinical settings. However, methods and content of this education on trafficking vary widely, and there is little evaluation of the impact of the training. The goal of this study was to assess the gaps and strengths in …

Assessing Very Early Infant Diagnosis Turnaround Times: Findings From A Birth Testing Pilot In Lesotho, Michelle Gill, Heather J. Hoffman, Majoalane Mokone, Vincent Tukei, Matsepeli Nchephe, +Several Additional Authors

Epidemiology Faculty Publications

Very early infant diagnosis (VEID) (testing within two weeks of life), combined with rapid treatment initiation, could reduce early infant mortality. Our study evaluated turnaround time (TAT) to receipt of infants’ HIV test results and ART initiation if HIV-infected, with and without birth testing availability. Data from facility records and national databases were collected for 12 facilities offering VEID, as part of an observational prospective cohort study, and 10 noncohort facilities. HIV-exposed infants born in January–June 2016 and any cohort infant diagnosed as HIV-infected at birth or six weeks were included. The median TAT from blood draw to caregiver result …

Regulatory Elements On Marijuana, For The Effective Population Health Protection, C Santos-Burgoa

Global Health Faculty Publications

When discussing the public health approach to the use of marijuana, the complexity of rigorous regulatory interventions for population protection is omitted. Using the experience of governments where these practices already exist, regulation is introduced as an essential public health function, spelling out seven purposes for controlling marijuana. The technical elements of institutional capacity -including the technical and financial capacity- and of governance that must be covered by any rigorous regulation of its use are detailed below. The difficulty of regulating psychoactive substances is addressed when considering the capacity to control other legal substances manifested with their increased consumption. It …

Risk Of Gastrointestinal Bleeding Among Dabigatran Users – A Self Controlled Case Series Analysis, Wenze Tang, Hsien-Yen Chang, Meijia Zhou, Sonal Singh

Epidemiology Faculty Publications

This article aims to evaluate the real world risk of gastrointestinal bleeding among users naïve to dabigatran. We adopted a self-controlled case series design. We sampled 1215 eligible adult participants who were continuous insured users between July 1, 2010 and March 31, 2012 with use of dabigatran and at least one gastrointestinal bleeding episode. We used a conditional Poisson regression to estimate incidence rate ratios. The population consisted of 64.69% of male and 60.25% patients equal to or greater than age 65 at start of observation. After adjustment for time-variant confounders, the incidence rate of gastrointestinal bleeding was similar during …

Post-Diagnosis Body Mass Index And Mortality Among Women Diagnosed With Endometrial Cancer: Results From The Women's Health Initiative., Hannah Arem, Ruth M Pfeiffer, Steven C Moore, Melinda L Irwin, Michael J Lamonte, Gloria E Sarto, Rami Nassir, Juhua Luo, Rowan T Chlebowski, Louise A Brinton, Charles E Matthews

Epidemiology Faculty Publications

Higher body mass index (BMI) measured before endometrial cancer diagnosis has been associated with greater risk of developing endometrial cancer and higher mortality, but the association between BMI measured after diagnosis and mortality risk is unclear. We identified 467 women (91 deaths) in the Women's Health Initiative (WHI) with information on BMI measured after diagnosis and used Cox proportional hazards regression to generate hazard ratios (HR) and 95% confidence intervals (CI) for all-cause mortality. Comparing BMI 35+ with/m2, we observed no association with all-cause mortality (HR = 1.02, 95% CI 0.55-1.91). Our study does not support the hypothesis that higher …

Baltimore, Md: Creating A Coalition To Improve School Climate In Inner City Baltimore, The Center And Health Care In Schools

Center for Health and Health Care in Schools

Serving one of the largest, and poorest, inner city school districts in the country, grant makers and service organizations have been helping children in Baltimore City Public Schools (City Schools) for years. In 2014, a diverse group of grant makers, government organizations, school personnel, and community groups started meeting to learn more about existing mental health programs, structures, and challenges in the schools. Still developing at the time of this study in spring 2015, the group has coalesced and grown under the umbrella term School Climate Network and, as of February 2016, is creating strategic plans and work groups to …

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

Imagine an America where children arrive at their school desks, ready to learn and succeed. They have coping skills to address their everyday worries, concerns and stressors, as well as the more difficult challenges life may present. They have social skills to establish positive relationships with their peers, teachers and parents. They make healthy choices that allow them to focus on their education and prepare for future success. And if a problem arises, they have access to early intervention and treatment. Now, imagine having sustainable funding to make all of this a reality.

Currently, however, barriers, particularly financing issues, restrict …

Pressure Thresholds And Stiffness On The Plantar Surface Of The Human Foot, Thilina W. Weerasinghe, Ravindra S. Goonetilleke, Uwe Reischl

Public and Population Health Faculty Publications and Presentations

The objective was to develop a methodology to assess Pressure Discomfort Thresholds (PDT), Pressure Pain Thresholds (PPT), and tissue stiffness on the plantar surface of the foot. Ten male and ten female participants volunteered for the study. Foot landmarks were used to create a standardized grid-type template of 95 points. For each test point, PPT and PDT values were obtained, and stiffness was calculated for each of the twenty participants. Cluster analyses were performed to determine the regions of similarity for the three dependent variables, PPT, PDT and stiffness. Moran’s-I-index was used to determine the spatial auto correlations. The use …

Identifying Factors Associated With Participation In T1d Support Program For Young Adults, Taylor L. Neher, Samuel D. Towne Jr., Sarah E. Toevs

Public and Population Health Faculty Publications and Presentations

Objective: Type 1 diabetes (T1D) has been shown to have a significant and stressful impact on an individual’s transition into young adulthood. Young adults are often experiencing new levels of independence and decision-making at this time. Insufficient research has been conducted on the use and impact of T1D support programs tailored to young adults in relation to the emotional impacts of the disease, access to programming, and desired outcomes of programs. his study assesses awareness, utilization, and emotional needs of T1D support programs tailored to young adults.

Research Design and Methods: A cross-sectional analysis was performed on surveys collected through …

Spatiotemporal Dynamics Of The Southern California Asian Citrus Psyllid (Diaphorina Citri) Invasion., Brett R. Bayles, Shyam M. Thomas, Gregory S. Simmons, Elizabeth E. Grafton-Cardwell, Mathew P. Daugherty

Global Public Health | Faculty Scholarship

Biological invasions are governed by spatial processes that tend to be distributed in non-random ways across landscapes. Characterizing the spatial and temporal heterogeneities of the introduction, establishment, and spread of non-native insect species is a key aspect of effectively managing their geographic expansion. The Asian citrus psyllid (Diaphorina citri), a vector of the bacterium associated with huanglongbing (HLB), poses a serious threat to commercial and residential citrus trees. In 2008, D. citri first began expanding northward from Mexico into parts of Southern California. Using georeferenced D. citri occurrence data from 2008-2014, we sought to better understand the extent of the …

Comparing Views About Evidence In Ontario Public Health Units: A Qualitative Descriptive Study, Sara Masood, Anita Kothari, Sandra Regan

Health and Rehabilitation Sciences Publications

Background: Ways of perceiving evidence by public health managers, practitioners and policy makers is one of the key determinants of evidence uptake. Recent public policy in Ontario requires programs to be based on evidence. Therefore, understanding views about evidence in both practice and policy contexts is important to bridge the research-policy-practice gap in public health.

Objective and Methods: This qualitative descriptive study examined understandings about evidence in Ontario public health units by comparing perspectives from managers and frontline staff across six geographically-diverse units. A secondary qualitative content analysis was used to re-analyze transcripts of focus groups from the Renewal of …

Discrete Event Simulation Model For Planning Level 2 “Step-Down” Bed Needs Using Nems, Felipe F. Rodrigues, Gregory S. Zaric, David Stanford

Business Publications

In highly congested hospitals it may be common for patients to overstay at Intensive Care Units (ICU) due to blockages and imbalances in capacity. This is inadequate clinically, as patients occupy a service they no longer need; operationally, as it disrupts flow from upstream units; and financially as ICU beds are more expensive than ward beds. Step-down beds, also known as Level 2 beds, have become an increasingly popular and less expensive alternative to ICU beds to deal with this issue. We developed a discrete event simulation model that estimates Level 2 bed needs for a large university hospital. The …

High Prevalence Of Non-Communicable Diseases And Associated Risk Factors Amongst Adults Living With Hiv In Cambodia, Pheak Chhoun, Sovannary Tuot, Anthony D. Harries, Nang Thu Thu Kyaw, Khuondyla Pal, Carinne M. Brody, Siyan Yi

BACKGROUND:

With rapid expansion of antiretroviral therapy for HIV, there are rising life expectancies among people living with HIV. As a result, co-morbidity from non-communicable diseases in those living and aging with HIV is increasingly being reported. Published data on this issue have been limited in Cambodia. The aim of this study was to determine the prevalence of diabetes mellitus, hypertension and hypercholesterolemia and associated risk factors in adults living with HIV in Cambodia.

METHODS:

This cross-sectional study was conducted in five provinces of Cambodia from May-June 2015. Information was obtained on socio-demographic and clinical characteristics through face-to-face interviews using …

How Harm Reduction Programs Work In The Context Of Village And Commune Safety Policy: Lessons Learned From A National Non-Governmental Organization In Cambodia, Sovannary Tuot, Sopheab Heng, Chhorvann Chhea, Eunice Salonga, Siyan Yi

This paper aims to examine the challenges and implications of the Village and Commune Safety Policy (VCSP) on harm-reduction programs and describe lessons learned from a harm-reduction program within the context of the VCSP in Cambodia. Data were collected from a monitoring and evaluation database and reports of a drop-in center that provides a wide range of harm-reduction services. In addition, qualitative data were collected through key informant interviews and focus group discussions with 38 participants including people who use drugs (PWUD) and people who inject drugs (PWID). Desk reviews and consultative meetings with key stakeholders were also conducted. In …

Developing A Peer-To-Peer Mhealth Application To Connect Hispanic Cancer Patients, Jennifer R. Banas, David Victorson, Sandra Gutierrez, Evelyn Cordero, Judy Guitleman, Niina Haas

Health Sciences and Physical Education Faculty Publications

Purpose: Cancer and its treatment can significantly impact health-related quality of life (HRQOL) [29, 4], particularly for Hispanics [8, 17]. Moreover, providers of cancer support for this population may encounter unique challenges. Grounded in social capital theory, this study identified Spanish-speaking, Hispanic breast cancer survivor support needs and preferences for a mHealth intervention. Methods: A user-centered, community-engaged research design was employed, consisting of focus groups made up of constituents from a local Hispanic-serving, cancer support organization. Focus group audio-recordings, translated into English, were coded using a grounded theory analytic approach. First, lead researchers read the complete transcripts to obtain a …

The Adolescent Health Care Broker – Adolescents Interpreting For Family Members And Themselves In Health Care, Jennifer R. Banas, James W. Ball, Lisa C. Wallis, Sarah Gershon

Health Sciences and Physical Education Faculty Publications

Parents with limited English proficiency might rely on their adolescent children to interpret health information. We call this adolescent healthcare brokering. Using a mixed-methods, transformative research approach rooted in grounded theory, we sought to answer these questions: (a) “What is happening? What are people doing?” and (b) “What do these stories indicate? What might they suggest about social justice?” High school students from a community in which 53.4% speak another language at home were invited to participate in a survey and focus groups. Of 238 survey participants, 57.5% (n=137) indicated they assisted with healthcare tasks. When doing so, 81.7% …

Sudan : Malaria, Olivia Jilek

Global Public Health

Sudan faces a great number of public health issues, however one of the most prevalent diseases within the country is Malaria. An estimated nine million cases were reported in 2002, with the total number of deaths at 44,000, in a country that has a population of 37,345,935. The research done on Malaria in Sudan looks at the basic epidemiology of the region, how to identify the disease, and major risks factors present. Other major challenges that Sudan faces are included, as well as suggestions for preventing further illness from the disease.

Israel : Translocation Of Rabies, Sarah Baker

Global Public Health

Israel is now faced with a steady growing public health threat as canine rabies has reemerged in the northern region of Israel. While the steady increase in cases is of notable alarm, moreover the close contact most often shared between dog and human populations is of much more concern from a public health prospective. Rabies is a vaccine-preventable disease. Vaccinating dogs has proven to be the most cost-effective strategy for preventing rabies in people. Additionally, education on bite prevention and rabid animal behaviors for both children and adults is an essential extension of the long term rabies vaccination program that …

Madagascar : Plague In Madagascar, Matthew Donald Hesch

Global Public Health

This public health brief calls attention to a disease issue in the country Madagascar. We show reasons as to why Madagascar has such a problem with the plague and what they should do to solve the issue. Madagascar has many areas that are high poverty because of a political crisis and this results in the easy spread of the plague. We show that Madagascar needs an increase in funds so that they can get out of the political crisis and begin fixing the plague issue. I offer ideas on how Madagascar could use the extra funds to overcome the plague …

Visualizing The Diffusion Of Digital Mammography In New York State, Francis P. Boscoe, Xiuling Zhang

Epidemiology & Biostatistics Faculty Scholarship

Digital mammography saw rapid adoption during the first decade of the 2000s. According to data maintained by the Food and Drug Administration, which regulates mammography machines, fewer than 1 percent of the machines in 2001 were digital. By 2014, this figure had risen to 94%. We were interested in identifying the times and locations where the technology was introduced within the state of New York as a way of illustrating the uneven introduction of this technology. While the diffusion of medical innovation has been well-studied, there have not been many instances where maps or geographic information science methods have been …

Environmental Influence On Hypertension In San Francisco, California, Corinna Louise Venturina Villar

Student Research Posters

Hypertension, or high blood pressure, occurs when there is long-term force of force of blood against one’s artery walls. When uncontrolled, hypertension may increase the risk of heart attack and stroke. More than 1 in 3 adults live with 1 or more types of cardiovascular disease in the United States alone- with stroke being the fifth leading cause of death. The purpose of my study is to evaluate the environmental influence on hypertension by comparing various factors in cities with high prevalence rates of heart disease to those with lower rates of heart disease. Conducting an environmental scan will serve …

Burnout Or Depression: Both Individual And Social Issue, Renzo Bianchi, Irvin Sam Schonfeld, Éric Laurent

Publications and Research

In view of the profound problems attached to the construct of burnout, we recommended in our that occupational health specialists focus on (job-related) depression rather than burnout to help workers more effectively. The phenomena of interest (burnout or depression) should not be confused with the perspectives (individual or social) adopted to elucidate those phenomena. Both burnout and depression are best explained through the interaction of social or external conditions with individual or internal dispositions.

For All Children Everywhere: Community Benefit Report 2016, Children's Mercy Hospital

Community Benefits

Fiscal year report on the community benefit provided by Children's Mercy Kansas City to the communities in the Kansas City region.

2016 Community Benefit Summary, Children's Mercy Hospital

Community Benefits

Infographic of the community benefit provided by Children's Mercy Kansas City

Stress: Effects And Management, Breanna Buscher

Nebraska College Preparatory Academy: Senior Capstone Projects

Stress is how the body reacts to any change in a person's life, as well as how it reacts in life or death situations. It is important everyone knows how to manage stress and what will happen if they do not. While there are an abundance of terrifying things that can happen when stress goes unmanaged, there are also plenty of easy ways everyone can keep their stress in check.

Stress can feel overwhelming and often cause health problems if gone unmanaged but luckily there are a plethora of ways to manage it.

Future Research: I would like to research …

The Opioid Epidemic In The United States With A Focus On Ohio, Timothy A. Netters Jr.

Master of Public Health Program Student Publications

The rate of deaths due to opioid drug overdoses has increased substantially in the 21st-century United States and shows no signs of slowing down. Goleman (1987) stated that opioid drugs are not inherently dangerous when used for their specified purpose of relief of moderate to severe acute pain. However, when they are abused, mixed with other drugs, or their stronger counterparts, used for chronic pain or are used without understanding of their increased strength the effects can be devastating. Ohio is unfortunately no stranger to the problem of opiate abuse and overdose. Counties throughout Ohio have had to add additional …

Association Of Cadmium Exposure With Bone Mineral Density In U.S. Adults, Joseph P. Taggart

Master of Public Health Program Student Publications

Background: Cadmium is a toxic heavy metal and environmental pollutant; general population exposure is through occupation, diet, and smoking. Cadmium is associated with lower bone mineral density (BMD) and higher risk of fractures in women. This association is not fully known in men.

Objective: Given the toxicity and global dispersion of cadmium, we explored its association with BMD in U.S. men and women.

Methods: Data from 914 participants from the National Health and Nutrition Examination Survey 2013-2014 was utilized. Multivariable regression analysis was used to determine the independent association between cadmium exposure and BMD controlling for age, body mass index, …

Statin Use And Risk Of Developing Diabetes: Results From The Diabetes Prevention Program, Diabetes Prevention Program(Dpp) Research Group, Marinella G. Temprosa

GW Biostatistics Center

Objective Several clinical trials of cardiovascular disease prevention with statins have reported increased risk of type 2 diabetes (T2DM) with statin therapy. However, participants in these studies were at relatively low risk for diabetes. Further, diabetes was often based on self-report and was not the primary outcome. It is unknown whether statins similarly modify diabetes risk in higher risk populations.

Research design and methods During the Diabetes Prevention Program Outcomes Study (n=3234), the long-term follow-up to a randomized clinical trial of interventions to prevent T2DM, incident diabetes was assessed by annual 75 g oral glucose tolerance testing and semiannual fasting …

Anti-Müllerian Hormone And Its Relationships With Subclinical Cardiovascular Disease And Renal Disease In A Longitudinal Cohort Study Of Women With Type 1 Diabetes, Catherine Kim, Yuanyuan Pan, Barbara Braffett, Valerie Arends, Michael Steffes, Hunter Wessells, Aruna V. Sarma

GW Biostatistics Center

Background

Reproductive age may be a risk factor for vascular disease. Anti-Müllerian hormone (AMH) is produced by viable ovarian follicles and reflects reproductive age. We examined whether AMH concentrations were associated with markers of subclinical cardiovascular disease (CVD) and kidney disease among women with type 1 diabetes.

Methods

We performed a cross-sectional analysis of the Epidemiology of Diabetes Interventions and Complications Study. Participants included women with type 1 diabetes and ≥1 AMH measurement (n = 390). In multivariable regression models which adjusted for repeated measures, we examined the associations between AMH with CVD risk factors, estimated glomerular filtration rate, …