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2017 Community Benefit Summary, Children's Mercy Hospital

Community Benefits

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

The Effect Of Urinary Triclosan On Serumthyroxine In Us Population: 2011-2012 Nhanes Data, Katie M. Clark

Master of Public Health Program Student Publications

Background: Triclosan is an antibacterial agent that is added to personal care products to prevent bacterial growth. The FDA banned the use of triclosan in soap in 2016 due to safety concerns. Triclosan is considered an endocrine disruptor and had reported effects on the body, including changes in thyroid function.

Purpose: The purpose of this study was to assess the relationship between urinary triclosan and serum thyroxine in U.S adults. Methods: Data from the 2013-2014 National Health and Nutrition Examination Survey (NHANES) were analyzed (N =1,476). Linear regression analyses were performed to assess the relationship between log transformed triclosan and …

Poor Sleep Health In American Adults: Implications For Screening In Civil Aviation, Melissa E. Gear

Master of Public Health Program Student Publications

Background: Poor sleep health is increasingly prevalent in the United States (US) adult population and contributes to fatigue. Fatigue is a significant safety hazard within civilian aviation, yet data regarding the prevalence of inadequate sleep in this population is sparse. Are there demographic characteristics which put individual at risk of not obtaining adequate sleep which should trigger screening during the medical certification process?

Methods: This cross-sectional study used National Health Interview Survey 2014-2016 data from US adults aged 18 to 65 to observe the relationship of demographic, socioeconomic, health, and behavioral characteristics with reported inadequate sleep duration and quality (trouble …

How Household Healthcare Expenditures Redistribute Disposable Income? An Analysis Using Bangladesh Household Income And Expenditure Survey, 2010., Azahar Molla Md, Phd, Mph, Msc, Chunhuei Chi Mph, Sc.D.

Faculty & Staff Research and Creative Activity

Essential healthcare is a civil right. Payments toward healthcare is a moral compulsion, and no less strong than legal compulsion like income tax. Healthcare payments can redistribute disposable income. Redistribution may be vertical (from rich to poor or opposite) and horizontal (from men to women or from households without children to households with children). Health planners are interested in degrees to which redistribution occurs. In this paper, we aim to analyze how well different forms of healthcare payments in Bangladesh redistribute disposable income. Our data comes from Bangladesh Household Income and Expenditure Survey, 2010. Using the methods developed by Aronson …

Better Bone Health: Health Community Clinic, Naijah Hughes, Dakota Turnage, Kintara Williams, Christopher Fangna

DC Health and Academic Prep Program (DC HAPP)

Osteoporosis affects the quality of life, the ability to work, and basic activities of daily living. Osteoporosis is a disease marked by reduced bone strength leading to an increase in fractures. Every day, our body breaks down old bone and puts new bone in its place. As we get older, our bones break down more bone than they put back. If you do not take the steps to keep your bones healthy, you may lose too much bone and osteoporosis may develop. Men and women are both affected by osteoporosis. In the United States, an estimated 5.3 million people aged …

Teen Pregnancy Prevention: Nine Minutes To Avoid Nine Months, Natalie Custodio, Ronaldo Gomez, Katherine Mejicanos-Portillo, Jalen Templeman

DC Health and Academic Prep Program (DC HAPP)

The United States is one of the most developed nations with one of the highest rates of teen pregnancy. Although there has been a reduction in teen pregnancy nationally, areas in DC such as Wards 5, 7 and 8 still have teen birth rates above the national rate. The objective for our project is to provide a targeted-intervention to decrease teen pregnancy rates by increasing awareness of safe sex practices, contraceptive methods and STIs/HIV. Our program will provide a 9-minute session on sexual health at chosen schools and youth organizations in Wards 5, 7 and 8 to target 11 to …

Project Anacostia, Lapoldeon Williams, Abenezer Lemma, Janae Thomas, Kafoued Ouedraogo

DC Health and Academic Prep Program (DC HAPP)

Objectives Project Anacostia aims to [1] help meet the Healthy People 2020 goal of reducing the disease burden of diabetes mellitus (DM) and improving the quality of life for all persons who have, or are at risk for, DM as outlined by the U.S. Department of Health and Human Services. [2] To increase community awareness of the social determinants of health related to obesity and diabetes. [3] Increase access to recreational facilities and healthy food options in Wards 7 &8 and [4] promote healthy lifestyle choices among youth in the Anacostia community.

Methods Our intervention is comprised of three progressive …

Widening The Disparity Gap: Differences In Outcomes For Racial And Ethnic Groups In Youth Substance Abuse Prevention Programming, Changsoo Song, Jennifer N. Rutt, Mindy Anderson-Knott

UNL Office of Research and Innovation, Social/Behavioral Sciences Research Consortium

This study examined racial and ethnic differences in the outcomes of a universal evidence-based program targeted to children and adolescents. Using data collected in 2015 and 2016 from the Alcohol: True Stories Hosted by Matt Damon program (N = 925), the study found the outcome of perceptions on risk of harm from alcohol use significantly different between the group of White respondents and the group of non-White respondents, and between the group of Hispanic respondents and the group of non-Hispanic respondents. Program effectiveness was found only among White and non-Hispanic respondents, widening the already existing gap between these populations.

Pre- And Post-Diagnosis Physical Activity, Television Viewing, And Mortality Among Hematologic Cancer Survivors., Daniela Schmid, Gundula Behrens, Hannah Arem, Christina Hart, Wolfgang Herr, Carmen Jochem, Charles E Matthews, Michael F Leitzmann

Epidemiology Faculty Publications

PURPOSE: The associations of physical activity and television (TV) viewing with mortality risk among individuals with hematologic malignancies remain unclear.

METHODS: We examined the relations of physical activity and TV viewing time before and after diagnosis with mortality among 5182 U.S. adults aged 50-71 years from the NIH-AARP Diet and Health Study cohort who survived a first primary hematologic cancer between 1995-1996 and 2011.

RESULTS: For the pre- and post-diagnosis analyses, we confirmed 2606 and 613 deaths respectively. In multivariable-adjusted Cox proportional hazard regression models, comparing high (≥4 hrs/wk) versus low (/wk) activity levels, pre-diagnosis physical activity was associated with …

Impact Of Chronic Sexual Abuse And Depression On Inflammation And Wound Healing In The Female Reproductive Tract Of Hiv-Uninfected And Hiv-Infected Women., Mimi Ghosh, Jason Daniels, Maria Pyra, Monika Juzumaite, Mariel Jais, Kerry Murphy, Tonya N Taylor, Seble Kassaye, Lorie Benning, Mardge Cohen, Kathleen Weber

Epidemiology Faculty Publications

Sexual violence is associated with increased risk of HIV acquisition/transmission in women. Forced sex can result in physical trauma to the reproductive tract as well as severe psychological distress. However, immuno-biological mechanisms linking sexual violence and HIV susceptibility are incompletely understood. Using the Women's Interagency HIV Study repository, a total of 77 women were selected to form 4 groups, stratified by HIV serostatus, in the following categories: 1) no sexual abuse history and low depressive symptom score (below clinically significant cut-off, scores

Characterizing Performance Improvement In Primary Care Systems In Mesoamerica: A Realist Evaluation Protocol [Version 1; Referees: 1 Approved], Wolfgang Munar

Global Health Faculty Publications

Background. Improving performance of primary care systems in low- and middle-income countries (LMICs) may be a necessary condition for achievement of universal health coverage in the age of Sustainable Development Goals. The Salud Mesoamerica Initiative (SMI), a large-scale, multi-country program that uses supply-side financial incentives directed at the central-level of governments, and continuous, external evaluation of public, health sector performance to induce improvements in primary care performance in eight LMICs. This study protocol seeks to explain whether and how these interventions generate program effects in El Salvador and Honduras.

Methods. This study presents the protocol for a study …

Youth Paying For Sex: What Are The Associated Factors? Findings From A Cross-Sectional Study In Cambodia, Soaman Dizechi, Carinne M. Brody, Sovannary Tuot, Chhorvann Chhea, Vonthanak Saphonn, Kunthearith Yung, Siyan Yi

BACKGROUND: At-risk male youth in Cambodia who purchase sex are at greater risk for HIV compared to the general population. Factors associated with paying for sex among youth are poorly studied, both globally and in Cambodia. This study aimed to identify specific factors associated with transactional sex with women among most-at-risk male youth in Cambodia.

METHODS: This cross-sectional questionnaire survey was conducted with 405 sexually active male youth aged 16-24 recruited at 'hotspots' in the capital city of Phnom Penh and seven provinces. We collected data on demographic factors, sexual behaviors, HIV testing and other potential factors. Multivariable logistic regression …

An Epidemiological Study Of Invasive Pneumococcal Disease In A South Texas-Mexico Border Metropolitan Community, Steven Daniel Hinojosa

Graduate Research Theses & Dissertations

This research study examines the epidemiology of invasive pneumococcal disease in Hidalgo County, Texas. Invasive pneumococcal disease is a bacterial infection, causing severe types of clinical manifestations, including bacteremia and meningitis. Hidalgo County is the largest metropolitan statistical area along the Texas-Mexico border. Supporting a 2016 census population estimate of nearly 850,000, this community facilitates frequent bi-national travel, providing unique attributes towards disease transmission. This study aims to identify if population characteristics for infection aligned with current Advisory Committee for Immunization Practice recommendations for vaccination against pneumococcal disease. This includes identifying if the general healthy adult healthy population has an …

Work-Related Values, Preferences, And Expectations Of Millennials: Implications For Long-Term Care Administrators, Cheryl K. Derynck

All Graduate Theses, Dissertations, and Other Capstone Projects

The purpose of this research is to examine millennials’ work-related values, preferences, and expectations and to understand the impact for administrators in long-term care (LTC) facilities. Supervisors at LTC facilities must understand millennials’ work behavior, and strive to meet their needs, so as to effectively recruit, train, and retain these millennial employees. Allowing for management understanding of millennials work-related values, preferences, and expectations and how these support or detract from employment within LTC settings may pinpoint how facilities may retain these workers. This study will also provide information about work satisfaction of millennial employees and how employers can improve to …

Examining Jordanians' Attitudes Towards Five Types Of Developmental Disabilities, Najah Zaaeed, Mohammad Mohammad, Peter Gleason, Khaled A. Bahjri, Naomi Modeste

Public Health, Food Studies, and Nutrition

Background: The diagnosis and reported rates of persons with developmental disabilities (PWDDs) in Jordan is steadily increasing. Although initiatives have been implemented to improve the lives of PWDDs, attitudes towards PWDDs hinder successful inclusion in the Jordanian society.

Objectives: To examine the relationship between Jordanians socio-economic status and attitudes towards persons with developmental disabilities: autism, blindness, cerebral palsy, Down syndrome and muscular dystrophy.

Methods: Jordanians (N=259), ages 18-65 were recruited for this convergent parallel, mixed-methods study. Participants completed the modified 40-item Community Living Attitude Scale-developmental disability (CLAS-DD) and the modified Intellectual Disability Literacy Scale consisting of five vignettes, representing each …

Therapeutic And Immunological Interventions In Primary Biliary Cholangitis: From Mouse Models To Humans, Atsushi Tanaka, Patrick S.C. Leung, Howard A. Young, M. Eric Gershwin

United States Public Health Resources

Primary biliary cholangitis (PBC) is a chronic cholestatic liver disease that predominantly affects women in their fifth and sixth decades. The diagnostic hallmarks of PBC are detection of anti-mitochondrial antibodies (AMAs) and chronic non-suppurative destructive cholangitis (CNSDC) of small- and medium-sized intrahepatic bile ducts in liver histological examination [1, 2]. A significant amount of data suggests that immunological activity against small biliary epithelial cells (BECs), found histologically as portal inflammation, leads to clinical disease. In PBC, as with other autoimmune diseases, both genetic and environmental factors contribute to the development of pathology [3–8]. The first-line therapy of PBC is ursodeoxycholic …

Genomic Differences Between Nasal Staphylococcus Aureus From Hog Slaughterhouse Workers And Their Communities., Yaqi You, Li Song, Bareng A S Nonyane, Lance B Price, Ellen K Silbergeld

Environmental and Occupational Health Faculty Publications

New human pathogens can emerge from the livestock-human interface and spread into human populations through many pathways including livestock products. Occupational contact with livestock is a risk factor for exposure to those pathogens and may cause further spreading of those pathogens in the community. The current study used whole genome sequencing to explore nasal Staphylococcus aureus obtained from hog slaughterhouse workers and their community members, all of whom resided in a livestock-dense region in rural North Carolina. Sequence data were analyzed for lineage distribution, pathogenicity-related genomic features, and mobile genetic elements. We observed evidence of nasal S. aureus differences between …

Gender-Transformative Bandebereho Couples' Intervention To Promote Male Engagement In Reproductive And Maternal Health And Violence Prevention In Rwanda: Findings From A Randomized Controlled Trial., Kate Doyle, Ruti G Levtov, Gary Barker, Gautam G Bastian, Jeffrey B Bingenheimer, Shamsi Kazimbaya, Anicet Nzabonimpa, Julie Pulerwitz, Felix Sayinzoga, Vandana Sharma, Dominick Shattuck

Prevention and Community Health Faculty Publications

BACKGROUND: Rigorous evidence of the effectiveness of male engagement interventions, particularly on how these interventions impact relationship power dynamics and women's decision-making, remains limited. This study assessed the impact of the Bandebereho gender-transformative couples' intervention on impact on multiple behavioral and health-related outcomes influenced by gender norms and power relations.

METHODS: We conducted a multi-site randomised controlled trial in four Rwandan districts with expectant/current fathers and their partners, who were randomised to the intervention (n = 575 couples) or control group (n = 624 couples). Primary outcomes include women's experience of physical and sexual IPV, women's attendance and men's accompaniment …

Piloting Very Early Infant Diagnosis Of Hiv In Lesotho: Acceptability And Feasibility Among Mothers, Health Workers And Laboratory Personnel., Michelle M Gill, Lynne M Mofenson, Mamakhetha Phalatse, Vincent Tukei, Laura Guay, Matsepeli Nchephe

Epidemiology Faculty Publications

INTRODUCTION: Mortality associated with in-utero HIV infection rises rapidly within weeks after birth. Very early infant diagnosis of HIV (VEID)-testing within 2 weeks of birth-followed by immediate initiation of antiretroviral therapy has potential to avert mortality associated with in-utero transmission. However, our understanding of acceptability and feasibility of VEID is limited.

METHODS: VEID was piloted in an observational prospective cohort of HIV-positive pregnant women and their infants in 13 Lesotho health facilities. Between March-July 2016, semi-structured interviews were conducted with HIV-positive women attending 6-week or 14-week postnatal visits and health workers (HWs) in 8 study facilities in 3 districts as …

Sexually Transmitted Infections Among Hiv-Infected Individuals In The District Of Columbia And Estimated Hiv Transmission Risk: Data From The Dc Cohort, Jose Lucar, Rachel Hart, Nabil Rayeed, Arpi Terzian, Amy Weintrob, Amanda D. Castel, Debra A. Benator, Dc Cohort Executive Committee

Epidemiology Faculty Publications

Background

Washington, DC, has one of the highest rates of HIV infection in the United States. Sexual intercourse is the leading mode of HIV transmission, and sexually transmitted infections (STIs) are a risk factor for HIV acquisition and transmission.

Methods

We evaluated the incidence and demographic factors associated with chlamydia, gonorrhea, and syphilis among HIV-infected persons enrolled at 13 DC Cohort sites from 2011 to 2015. Using Poisson regression, we assessed covariates of risk for incident STIs. We also examined HIV viral loads (VLs) at the time of STI diagnosis as a proxy for HIV transmission risk.

Results

Six point …

Why It Worked: Participants' Insights Into An Mhealth Antiretroviral Therapy Adherence Intervention In China., Lora L Sabin, Lauren Mansfield, Mary Bachman Desilva, Taryn Vian, Zhong Li, Xie Wubin, Allen L Gifford, Yiyao Barnoon, Christopher J Gill

Global Health Faculty Publications

Background: Few Antiretroviral Therapy (ART) adherence trials investigate the reasons for intervention success or failure among HIV-positive individuals.

Objectives: To conduct qualitative research to explore the reasons for effectiveness of a 6-month mHealth (mobile health) trial that improved adherence among ART patients in China. The intervention utilized Wireless Pill Containers (WPCs) to provide, real-time SMS reminders, WPC-generated adherence reports, and report-informed counseling.

Methods: We conducted in-depth interviews with 20 intervention-arm participants immediately following the trial. Sampling was purposeful to ensure inclusion of participants with varied adherence histories. Questions covered adherence barriers and facilitators, and intervention experiences. We analyzed data in …

Modeling The Relationship Between Women’S Perceptions And Future Intention To Use Institutional Maternity Care In The Western Highlands Of Guatemala, Emily Peca, John Sandberg

Global Health Faculty Publications

Background

Despite global gains, women in hard-to-reach areas are at a relatively higher risk of death and disability related to childbirth. Traditional methods of measuring satisfaction may mask negative experiences (such as disrespect and abuse) that can drive down demand for institutional care. Better measurement of women’s perceptions of care quality, especially among marginalized populations with historically low utilization of institutional care, are needed to inform how to improve services and foster greater utilization of (potentially life-saving) clinical care.

Methods

A population-based household survey was conducted in 15 purposively selected villages in the rural Western Highlands of Guatemala among women …

Nobody Likes Flies, Zachary Mattson

Theses and Graduate Projects

Leishmaniasis is a protozoan disease that is common in tropical areas of the globe. Around the world this disease is transmitted from different hosts by various sand-fly species. The most prevalent countries for any type of leishmaniasis are Brazil, India, and Ethiopia. There are three presentations of the disease seen around the world: visceral, mucosal, and cutaneous. Overall cutaneous leishmaniasis is a disease that can be disfiguring and disrupting to individuals across the world. Though it may be difficult to access information for those in rural communities in Central America it is important for providers to provide information in an …

The Impact Of Sexual Education On Decreasing Adolescent Pregnancy In Nicaragua, Allison Greenwood

Theses and Graduate Projects

Half of the females of Nicaragua will have given birth by their 20th birthday.1 Nicaragua has one of the highest fertility rates in the world and exceeds the fertility rate average in Latin America with 109 (births per 1000 females aged 15-19) compared to the average of 79 births.1,2 Young maternal age is linked to higher incidences of pregnancy complications such as preterm birth, low birth weight, and neonatal mortality.2 Nicaragua’s high adolescent pregnancy rate is a result of a multifactorial social and political climate. The initiation of a teen's sexual debut is complex and hinges on multiple factors from …

Climate Change: Human Health, The Developing World And The Global Response, Cole James Kriett

Theses and Graduate Projects

Changes to the Earth’s biophysical system will extend and exacerbate the rates of vector-borne infectious disease, non-communicable diseases such as cardiovascular disease and lung disease, and mental health disorders. Developing nations face the greatest burden of climate sensitive human health impacts while also having the lowest capacity to adapt to these changes. Addressing these global ethical challenges cannot be accomplished without supporting organizations like UNEP or the IPCC. However, these organizations cannot achieve global sustainability alone. Human beings collectively taking responsibility for climate change will be vital to this process.

Local Attitudes And Prevention Around The Nicaraguan Sugarcane Worker With Chronic Renal Disease, Matt Cyr

Theses and Graduate Projects

An epidemic of chronic kidney disease (CKD) in Central America and Nicaragua is referred to as Mesoamerican nephropathy (MeN). It’s estimated that the death toll for MeN over the past two decades has reached at least 20,000. Nicaragua is included in the 10 highest overall mortality rate from kidney disease in the world. MeN disproportionately affects young, male agricultural workers who do not exhibit traditional risk factors for CKD such as hypertension and diabetes. A consistent risk factor for MeN is heavy manual labor in the heat, often temperatures over 35 °C with high humidity. Many reasons have been proposed …

Barriers To Contraceptive Use In Nicaragua, Ellen Motley

Theses and Graduate Projects

Many barriers to contraceptive use exist in sexually active Nicaraguan women, leading to increasingly high rates of unintended pregnancies among these women. Higher rates of depression, domestic abuse, and unemployment are also seen in this group of women. These women face more complications during pregnancy and receive higher rates of unsafe abortions, impacting the mom and the infant, as well as the community in which they live. Some of the barriers to contraceptive use include lack of access to healthcare, lack of knowledge about contraceptive methods, negative attitudes about contraceptives, providers’ fear of criticism, previous dissatisfaction or contraceptive failure, family …

In Developing Countries, Does The Implementation Of Basic Cardio-Pulmonary Resuscitation Education In The Community Improve Patient Outcomes?, Ashley Gross

Theses and Graduate Projects

Circulatory shock and cardiovascular diseases contribute to significant mortality globally, with an increased burden in developing countries. The compilation of these studies and anecdotal support gathered while in Nicaragua supports the impact education on high-quality CPR among the community can have on out-of- hospital cardiac arrest patient outcomes. Even though some studies showed guideline-compliant CPR does not improve all patient outcomes, we cannot estimate the time it will take a patient to achieve ROSC. Therefore, educating the public and refining the skills of health care professionals can have a significant positive impact on out-of-hospital cardiac arrest patient outcomes if there …

Hpv Screening In Nicaragua, Claire Maccani

Theses and Graduate Projects

Cervical cancer is the leading cause of mortality due to a malignant neoplasm for young women in Latin America and the leading cause of cancer among women of any age in Nicaragua. Additionally, cervical cancer is the third most common cause of cancer death in females worldwide. This paper will focus on just the screening aspect of prevention. There are also vaccines now available for preventing certain oncologic strains of HPV which ultimately leads to prevention of cervical cancer. There is not yet an organized program offering HPV vaccination in Nicaragua due to the high cost of the vaccine. The …

Smallpox Bioterrorism Preparedness: The Importance Of Technology And Education For Early Detection And Response, D Taylor Jorgenson-Rathke

Theses and Graduate Projects

The use of biological agents as weapons has been prevalent throughout history. Only when the US experienced a bioterrorist attack in 2001 did additional funding begin to invest in preparing for other potential attacks. These initial investments, along with others, have funded preventative measures such as mass surveillance through biosensor technology and the development of preparedness programs such as the Laboratory Response Network and Hospital Preparedness Program. Based on learnings from previous outbreak events, in the event of a bioterrorist attack involving smallpox early detection will be the key to initiating a rapid and effective response. Additionally, further measures need …