Public Health Commons^™

Clinician Perspectives On Factors Affecting Shared Decision Making About Lung Cancer Screening, Mohammad Abubaker-Sharif, Melissa Dicarlo, Mph, Ms, Ronald E. Myers, Phd, Dsw

Phase 1

Background/Objective. In 2015, the Centers for Medicare and Medicaid Services (CMS) announced coverage for annual lung cancer screening (LCS) with low dose computed tomography (LDCT) for individuals who are 55 to 77 years of age, have > 30 pack years of smoking history, and undergo shared decision making (SDM) prior to screening. Most referrals for LCS are initiated in primary care. Currently, little is known about how primary care physicians view SDM and barriers in practice to SDM about LCS. This study aimed to gather information to help fill these knowledge gaps.

Methods. I worked with senior leadership in …

Knowledge, Attitudes, And Beliefs About Sexual Health And Behavior In Huye, Rwanda, Sara Charles, Lianna Drobatz, Ryan Dorey

Phase 1

Introduction: Pregnancy and its associated complication is the leading cause of death for women aged 15-19 worldwide. Teenage pregnancy is correlated with increased health complications, death, poverty, and societal stigma. Pregnancy in Rwanda has been documented at rates of 7% among teen women.

Objective: The objectives of this research study include assessing the attitudes, knowledge, and beliefs of adolescents in the Huye District of Rwanda regarding sexual health and behavior. We hypothesize that gaps in sexual health knowledge may exist and that differing beliefs among male and female adolescents affect adolescent sexual decision making, and, therefore, teenage pregnancy prevalence.

Methods: …

Impact Of Physical Activity On Stress Levels And Methadone Maintenance Treatment Outcomes, Praneeja Matta, Robert Sterling, Phd

Phase 1

Introduction: While the opioid epidemic has continued to intensify over the last decade, unfortunately the likelihood of achieving stable long-term abstinence using methadone maintenance treatment (MMT) remains as low as 60 percent. Perceived stress has been identified as a factor predictive of premature termination and relapse, making stress reduction an important area of study in MMT. However, little research is available on the effects of active stress-coping mechanisms on MMT outcomes.

Objective: To address this gap, the current study was conducted to examine the impact of physical activity on stress reduction and treatment outcomes.

Methods: This was a retrospective cohort …

Peer Assessments May Predict Objective Long-Term Academic Performance, Noah Christian, Yousif Hanna, John Spandorfer, Md

Phase 1

Introduction: A common challenge in medical education is to create a curriculum that both teaches the required material but still delivers a personable physician. In this data study, 673 Sidney Kimmel Medical College (SKMC) students were given a required survey to judge their group members on personal attributes ranging from preparedness to affability. These scores were used to aid students and hopefully prevent unfortunate habits from settling. We hypothesize that peer assessments will predict academic performance.

Methods: A five-question, Likert scale, peer assessment was given to each first-year medical student at SKMC. The electronic survey was given twice during the …

Medication Assisted Treatment For Opioid Use Disorder In The Primary Care Setting In Philadelphia: A Retrospective Review, Denis Ostick, Lara Weinstein, Md, Mph

Phase 1

Introduction:

The opioid crisis continues to be a growing public health concern across the United States. Americans struggling with Opioid Use Disorder (OUD) can seek different resources to help curtail their addiction. These include abstinence -based programs such as Narcotics Anonymous and Specialty treatment facilities including methadone and suboxone clinics. It has been shown that increased availability of drugs to treat opioid use addiction, such as methadone and buprenorphine, is linked to a lower likelihood of relapse and fatal overdoses. Therefore, medication assisted treatment (MAT) is a valuable asset because it combines behavioral therapy and medications to treat opioid use …

Screening, Brief Intervention, And Referral To Treatment (Sbirt) For Substance Use Disorders In Title X Facilities: Assessing Barriers, Change Of Provider Behavior, And Patient Outcomes, Christian Iversen, Ms, Holly Ireland, Lcsw-C, Dickie Lynn Gronseth, Mph

Phase 1

Introduction: Substance use disorders, specifically opioids, are an increasing problem in the US. Screening, brief intervention, and referral to treatment (SBIRT) is a method to identify and treat patients at risk, or currently using illicit substances. Integrating SBIRT into Title X facilities, which provide reproductive healthcare to lower income populations, may allow identification and treatment of individuals that do not seek healthcare elsewhere. Objective: We aim to assess the efficacy of a longitudinal training program in Title X facilities. The program provides a structured approach to implementing new protocols, including an educational session on SBIRT and motivational interviewing (MI).

Methods: …

Advocating For Support For Families Of Pregnant And Parenting Women Impacted By The Opioid Crisis In Pennsylvania, Caitlin Weiss, Rosemarie Halt, Rph, Mph

Phase 1

Introduction:

The perinatal period is a key opportunity for intervention for families impacted by opioid use disorder (OUD). However, in 2016 only 7.6% of treatment facilities in PA offered childcare for parents receiving treatment and only 2.8% of residential facilities offered beds for clients’ children.

Objective:

The purpose of this project was to understand the magnitude of the opioid crisis as it affects pregnant women and their children in PA as well as what avenues exist to advocate for policy changes to better support their recovery.

Methods:

1. A policy brief was prepared for the Maternity Care Coalition (MCC) using …

Quality Improvement For The Jeffmd Clinical Experience Program, Chloe Virgil, Emily Romano, Sara Goldstein, Msw, Lsw, Rhea E. Powell, Md, Mph

Phase 1

Introduction: The JeffMD curriculum at Sidney Kimmel Medical College, which completed its inaugural year in the spring of 2018, aims to prepare future physicians to “thrive in the landscape of modern healthcare.” The curriculum is based upon the knowledge that human health exists interdependently with all aspects of life, including but not limited to social, health care system, behavioral, and biological factors. The JeffMD Clinical Experience Program (CE) is a mandatory, experiential, value-added component of the curriculum. Through the CE course, which spans the 21-month preclinical period, students work with a Community Health Worker to screen patients for social …

A Longitudinal Assessment Of Change In Blood Pressure Among Participants In The Heart Smarts Program, Kathryn Haskins, Susana Suzrez, Rickie Brawer, Phd, Mph, Sandra Sherman, Edd, Michelle Abel, Msph, James Plumb, Md, Mph

Phase 1

Many low-income areas of the United States are considered food deserts because people living in those communities have limited access to fresh fruits and vegetables (FFV); lack of FFV is tied to numerous health issues, including cardiovascular disease and obesity. The Heart Smarts Program (HSP) provides increased access to FFV in food deserts, as well as providing participants with nutrition education courses and health screenings, including blood pressure. The purpose of this study is to examine HSP participants who have been with the program for differing lengths of time in order to determine if length of participation has an impact …

Medical Respite Care Services For Homeless Patients Discharged From Thomas Jefferson University Hospital: A Needs Based Assessment, Taylor Treacy, Lara Weinstein, Md

Phase 1

Introduction: Medical respite programs have been proposed as a temporary solution to address the increased hospital readmission rates and lack of appropriate discharge options that exist for homeless patients.

Objective: This study examines the 90-day readmission rate and discharge locations of patients experiencing homelessness.

Methods: We conducted a retrospective chart review of homeless patients discharged from Thomas Jefferson University Hospital (TJUH) between April 30^th 2017 to April 30^th 2018. Homelessness was identified as any patient with 1 of the following locations listed for residency: 833 Chestnut Street, Broad Street Ministry, St. John’s Hospice, shelter as address, no address …

Health Needs Of Philadelphia’S Latinos Through Photovoice, Martin Hehir, Rickie Brawer, Phd, Mph, Mches, Caleb Dafilou

Phase 1

Introduction: The Patient Protection and Affordable Care Act requires non-profit hospitals to complete a Community Health Needs Assessment (CHNA) every three years that provides insight into the health and social needs of the community served and develop a plan to address priority needs. Community engagement and collaborative participation are essential to the process. For the 2019 CHNA, Thomas Jefferson University Hospitals is conducting a more in-depth assessment of the Philadelphia Latino community in North Philadelphia in order to better understand the specific issues faced by this population.

Objective: To conduct a CHNA in North Philadelphia’s Latino community that identifies priority …

Patient Perceptions And Expectations About Postoperative Analgesia, Carrie Mok, Nirmal Shah, Do, Stephen F. Goldberg, Md, Amir C. Dayan, Md, Marc Torjman, Phd, Jaime L. Baratta, Md

Phase 1

Introduction

Opioid overdose deaths have nearly quadrupled since 1999. Nearly 2 out of 3 persons being prescribed medications are prescribed an opioid. Physicians may be prescribing opioids for more than what is required for postoperative pain control, leading to increased risk for opioid abuse and addiction. Patient perceptions of perioperative pain medications are poorly understood.

Objective

This survey aims to understand patient expectations of perioperative analgesics.

Methods

Following IRB approval, patients 18 years of age or older, were given a 13-question survey prior to their surgery at Thomas Jefferson University Hospital, to evaluate the perception of pain medications, medication efficacy, …

A Comparison Of Screening, Prevention, And Management For Hepatitis B Patients Between The Us And Chinese Healthcare Systems, Thomas Chen, James D. Plumb, Md

Phase 1

Introduction: Hepatitis B (HBV) is a complex disease entity with potentially serious outcomes, including developing hepatocellular carcinoma (HCC). HBV is estimated to be responsible for about 50-80% of HCC cases worldwide, and 75-95% of HCC cases in HBV endemic regions.¹ HBV and HCC are great concerns especially in East Asian countries like China. In China, HCC ranks as the 2^nd most common cancer and 2^nd in cancer mortality, both behind only lung cancer.¹ China is considered an endemic HBV region, with about 100-150 million people infected. In comparison, only an estimated 550,000-2 million people are chronically …

Opioid-Prescribing Practices For Post-Operative Patients In Otolaryngology: A Multiphasic Quality Improvement Project In A Single Large Institution, Zachary Gandee, Sophia Dang, Alexander N. Duffy, Jonathan C. Li, Tanvi Rana, Brittany Gunville, Tingting Zhan, Elizabeth Cottrill, Md, David Cognetti, Md

Phase 1

Objectives:

In otolaryngology, postoperative pain management lacks evidence-based guidelines. We investigated opioid prescription and consumption for common procedures to develop prescribing guidelines at our institution.

Study Design:

Prospective, survey study.

Methods:

Patients who underwent surgery between July and September were given surveys upon discharge and at first follow-up visit. We assessed opioid usage and pain using the visual analog scale and opioid consumption throughout the postoperative period. Opioid prescriptions were converted to a standardized unit of 5 mg Oxycodone pills for reporting. Four procedures (transoral robotic surgery resection [TORS], sialendoscopy, parathyroidectomy/thyroidectomy, and parotidectomy) were selected for isolated analysis.

Results: …

The Impact Of Mental Health On Cancer Preventative Screenings, Chelsea Edirisuriya, Amy Leader, Phd

Phase 1

Among the mental health population of the United States, overall preventative health services, such as cancer screening rates, are remarkably low. Additionally, there is a significant 30% higher mortality rate due to cancer in psychiatric patients. This project established if there are disparities in cancer screening rates between the general population and the mental health population of Southeastern Pennsylvania. The project analyzed and compared the differences in cancer screenings for colorectal, breast, and cervical cancer among those currently diagnosed with a mental condition and the general population. Through p-value and Pearson chi-square statistical analysis of the Community Health Data Base …

Assessing The Accessibility And Integration Of Community Resources For Autism In Sri Lanka, Bryce Eng, Krys Foster, Md, Mph

Phase 1

Introduction: Similar to many other developing countries, Sri Lanka also has challenges meeting the needs of autistic individuals. While progress has been made in evaluating autism screening tools and home-based therapy, limited data exists on the utilization of community resources.

Objective: The objective of this study is to assess the accessibility and integration of community resources for autistic individuals in Sri Lanka. Questions to explore will center on how different sectors work with families and each other to address an autistic individual’s needs.

Methods: Informal interviews were conducted with professionals who have direct experience working with individuals with autism and …

More Social Needs Endorsed By Caregivers Of Young Children Experiencing Everyday Discrimination, Elizabeth Critchlow, Jennifer Robbins, Md, Mph, George Datto, Md, Tirzah Spencer, Phd, Diane Abatemarco, Phd, Msw, Thao-Ly Phan, Md, Mph

Phase 1

Background: Both discrimination and social needs are underlying risk factors for poor health outcomes; however, there are no studies looking at how feelings of discrimination impact reporting of social needs in the pediatric health care setting.

Objective: To compare caregiver report of social needs and desire for help addressing social needs in the pediatric primary care setting based on respondents’ experiences with discrimination.

Methods: We conducted a cross-sectional study of caregivers of children aged 2-5 in an urban primary care setting. Caregivers completed a tool to screen for 15 social needs and desire for help to address these needs, with …

Demographics, Support Opportunities, And Self-Reported Well-Being Of Patients Presenting For Hepatitis C Treatment At A Federally Qualified Health Center In Philadelphia, Dina Zaret, C. Coleman, M. Dorshimer, J. Kostman, L. Magaldi, T. Preston, R. Rivera, S. Trooskin

Phase 1

Introduction: As the opioid epidemic develops and evolves, the number of people who inject drugs is rising. A growing number of new Hepatitis C Virus (HCV) infections have been identified in people who inject drugs.

Objective: This study aims to better understand the demographics, well-being, and satisfaction with medical care of patients presenting for HCV treatment at a Federally Qualified Health Center (FQHC) in an urban setting. The study also looks to assess the impact of continued connection to holistic medical care.

Methods: Surveys were administered to 51 unique patients at their first visit for HCV treatment. Along with demographic …

Legal Principles And Seminal Legal Cases In Oocyte Donation, Jody L. Madeira, Susan L. Crockin

Articles by Maurer Faculty

Oocyte donation has played an increasingly important role in assisted reproductive technologies since the early 1980s. Over the past 30 years, unique legal standards have evolved to address issues in the oocyte donation procedure itself as well as the disputes over issues, such as parentage, that inevitably arise with new technologies, particularly for individuals seeking to build nontraditional families. This essay will explore oocyte donation's legal aspects as well as seminal law concerning the procedure, including statutory law (uniform and model provisions and enacted state laws) and selected judicial opinions concerning surrogacy and parentage, testing of oocyte donors, mix-ups of …

Evaluation Of The Predictive Ability Of A Screening Instrument Used To Diagnose Co-Occurrence Of Anxiety In Children With High-Functioning Autism., Austin Zachary

Electronic Theses and Dissertations

Anxiety has shown to have a high co-occurrence in children with Autism Spectrum Disorder (ASD), but has been difficult to co-diagnose. This study analyzed the ability of the Screen for Child Anxiety-Related Emotional Disorders (SCARED) to predict positive ASD screenings of the Social Responsiveness Scale (SRS). Parents and children ages 8 to 18 years (N = 100) were screened for anxiety using the SCARED and autism using the SRS. Moderate correlation was found between parent-reported SCARED and positive screening of the SRS (r = .579), with weak correlation found in the child-reported SCARED (r = .105). LASSO regression was conducted …

Adolescent Sexual And Reproductive Health In The Gambia., Sandhya Lohani

Electronic Theses and Dissertations

Adolescence is a crucial period in human development. Knowledge and awareness about when to have children, when to have sex, and use of contraceptives impacts the chances of teenage pregnancy and risk of sexually transmitted diseases. The objective of this study is to determine the prevalence and associated risk factors related to age of sexual debut, teenage pregnancy, and use of contraceptives in the Gambia. This study also compares the data with 2014 survey research conducted in the Gambia. The total study population were 50 adolescents aged 13-21 years from Bafuluto and surrounding communities in the Gambia. Among 50 respondents, …

Noise Induced Hearing Loss Accountability On Jobsites Within The Construction Industry, Joseph O. Lamphere

Construction Management

Noise induced hearing loss is a major issue on jobsites within the construction industry. Every day workers are exposed to hazardous levels of noise, but they are not being properly managed to mitigate this issue. Workers have misconceptions about the topic, but more surprisingly are sometimes indifferent to the effects; believing hearing loss is inevitable, or it can be cured with a hearing aide. Construction has inherent dangers that workers have to deal with every day. Hearing loss might not be on the top of their lists, but the effects are permanent, and they cannot be cured with a hearing …

Stress Management In The Kitchen, Haley Rosano

Capstone Projects and Master's Theses

Catholic Charities - Diocese of Monterey has implemented Stress Management in the Kitchen though the Family Support Services department of the Seaside office. Stress Management in the Kitchen was implemented to address the knowledge gap between nutrition and healthy living.The purpose of the workshop series was to give clients a fun and digestible way to increase their knowledge on how their health and nutritional habits can or should be applied to how they deal with stress. These workshops were implemented through presentation and a series of activities.The measurement of these workshops will be obtained through an exit survey from participants. …

Analyzing Policies Through A Dohad Lens: What Can We Learn?, Julia M. Goodman, Janne Boone-Heinonen, Dawn M. Richardson, Sarah B. Andrea, Lynne C. Messer

OHSU-PSU School of Public Health Faculty Publications and Presentations

Social, health, and environmental policies are critical tools for providing the conditions needed for healthy populations. However, current policy analyses fall short of capturing their full potential impacts across the life course and from generation to generation. We argue that the field of Developmental Origins of Health and Disease (DOHaD), a conceptual and research framework positing that early life experiences significantly affect health trajectories across the lifespan and into future generations, provides an important lens through which to analyze social policies. To illustrate this point, we synthesized evidence related to policies from three domains—family leave, nutrition, and housing—to examine the …

Pilot Study Of The Physiological Effects Of An Integrative Medicine Approach In Irritable Bowel Syndrome, Gigi Constable, Eleanor Lewis, Andrew B. Newberg, Md

Phase 1

Introduction: Irritable Bowel Syndrome (IBS) is the most common GI functional disease in the US, affecting 10-25% of the population and costing ~$1.6B in annual healthcare spending. Defined by varied GI symptoms, IBS is associated with gut inflammation from many factors, including diet, microbiome imbalances, and stress. However, the disease lacks a treatment algorithm, especially within integrative medicine.

Objective: This research explores integrative medicine approaches to IBS, including diet and supplements, to identify microbiome and symptom patterns before and after intervention.

Methods: Patients first complete surveys on diet and symptoms, the Beck depression inventory, the SF-36 questionnaire, PET-MRI imaging, and …

Experiences Following Previous Sexual Trauma Of Female Skmc Students, Haritha Reddy, Rickie Brawer, Phd

Phase 1

Introduction:

Sexual trauma is one of the greatest contributors to post-traumatic stress disorder (PTSD) and women are more likely to develop PTSD than men. In focusing on these long-lasting negative mental health outcomes, many study populations involving sexual trauma consist of college-educated females since this demographic is vulnerable to various stressors. However, information regarding methods of resilience employed by these individuals is lacking.

Objective:

The purpose of this project is to identify key elements of resilience in female Sidney Kimmel Medical College (SKMC) students who have experienced sexual trauma prior to entering medical school.

Methods:

Given the perseverance necessary for …

Common Practice For Behavioral Health Screening In Pediatric Primary Care Settings, Joseph A. Menand, Mario Cruz, Md

Phase 1

Mental health disorders in the United States are highly prevalent, affecting 14-20% of children yearly. Only 25-35% receive treatment after on average a six-plus year delay from symptom onset. Current recommendations suggest primary care physicians/providers (PCP) manage mental health conditions, however, PCPs are wary, citing lack of time, training and resources.This study evaluated pediatric/adolescent PCPs using a self-report questionnaire assessing knowledge/skill, clinical practice (e.g. screening tool) and perceived barriers when managing attention deficit hyperactivity disorder (ADHD), anxiety and depression (N = 11). Self-reported knowledge/skill diagnosing, treating and referring each disorder were recorded on a 5-point Likert scale and evaluated using …

Perspectives Of Asian/Pacific Islanders On Lung Cancer Screening In Philadelphia: A Qualitative Study, Melissa Chai, Kristine Pham, Mph, Rickie Brawer, Phd, Mph, Mches

Phase 1

Introduction: Even though rates of smoking, the leading cause of cancer, are lower in Asian/Pacific Islanders (API), the rates of lung cancer deaths are still one of the highest compared to those of other minority groups in the US. However, little is known about the beliefs and attitudes that influence lung cancer screening behaviors of APIs.

Objective: The objective of this study is to better understand the current beliefs, attitudes, and knowledge of APIs in Philadelphia towards lung cancer and lung cancer screening.

Methods: Six in-depth interviews were conducted with key informants, who all had extensive experience working with the …

Total Body Skin Exams: Sensitivity, Specificity, And Number Needed To Screen, Shayan Waseh, Michael Bui, Audra Hugo, Alexander Sherban, Elizabeth Jones, Md

Phase 1

Introduction: Skin cancer, the most common form of cancer worldwide, has one of the highest cure rates among cancers if diagnosed and treated early in its course. The Total Body Skin Exam (TBSE) is the primary modality used to screen for skin cancers. Currently, few studies have characterized the effectiveness of the TBSE in contemporary populations.

Objective: Characterizing the number-needed-to-screen (NNS) to diagnose a case of skin cancer through TBSEs will make it possible to better understand its effectiveness as a screening modality and its utility in an increasingly population health-based healthcare system.

Methods: A retrospective chart review of 3155 …

Economic Impact And Health Disparities Of Firearm Injuries Treated Within The Thomas Jefferson University Health System, Christina Wohler, Stanton Miller, Md

Phase 1

Introduction:

Firearms are a significant cause of morbidity and mortality in the United States. In 2015, firearms killed over 36,000 Americans (CDC, 2017), and in 2013 were responsible for $229 billion in healthcare and other costs (Cerdá 2016). On an average day in Philadelphia, 4 people are injured or killed by firearms (Beard 2017). This purpose of this project is to further investigate these trends in the context of the Thomas Jefferson University Health System.

Objective:

To date, no research exists to examine firearm violence within the Thomas Jefferson University Hospital (TJUH) System. The purpose of this study is to …