Public Health Commons^™

Distribution Of Healthcare Resources In Peninsular Malaysia : An Examination Of Equity With Respect To Geography And Allocative Processes, Saw Chien Gan

Student Works (2020-2029)

On a country’s pathway to Universal Health Coverage, it is important to ensure equitable healthcare provision and financing. There was a lack of evidence in equity of healthcare provision and financing across geographic areas in Peninsular Malaysia. This was despite the evidence that geographic factors directly and indirectly affect population health and healthcare services are mostly delivered at immobile healthcare facilities. In Malaysia’s mixed public-private healthcare system, Ministry of Health Malaysia (MOH) has a geographically comprehensive provision network and the MOH resources are distributed through geographic-bound MOH administrative structures. The private sector, which concentrated on more affluent geographic areas, also …

Access To Renal Transplantation And Post-Transplantation Prognosis (Retrapp) Study Of Adults In Malaysia, Kim Soon Peter Gan

Student Works (2020-2029)

Introduction Renal transplantation (RT) is recognised as the preferred treatment modality for end-stage renal disease. However, Malaysian transplantation rates have been low compared to other countries. Numerous clinical determinants have been associated with renal transplant recipient' (RTRs) health, which is the main focus of the healthcare fraternity. Coincident with the rising interest for equitable healthcare, many studies in the high-income countries have examined the disparities in RT. On the contrary, little is known about the association of socioeconomic gradient of RTRs on the access and outcome of RT in Malaysia, a low- and middle-income country. ReTRAPP was designed to explore …

Development And Evaluation Of Hearing Conservation Program Among Vector Control Workers, Supramanian Rama Krishna

Student Works (2020-2029)

Noise-induced hearing loss (NIHL) is one of the highest recorded occupational disease despite being preventable. In 2018, occupational noise-induced hearing loss was the highest reported occupational disease experienced by workers in Malaysia accounting for 87.7% of all occupational diseases. The aim of this study is to develop, implement and evaluate the effectiveness of a Hearing Conservation Program (HCP) in preventing noise�induced hearing loss among vector control workers. This study is divided into two phases: development of HCP (phase 1) and implementation and evaluation of HCP (phase 2). The development phase (phase 1) included a review, interview with key stakeholders and …

Association Of Mental Health Literacy And Depression Symptoms Among Young Adolescents In Selangor, Lakha Singh Sarbhan Singh

Student Works (2020-2029)

Mental health literacy (MHL) relating to depression (depression literacy) is a multifaceted concept comprising of knowledge of depression, help seeking and stigma components, that plays an important role in depression outcomes. The aim of this study was to examine the association of depression literacy components namely knowledge of depression, help seeking, stigmatising attitudes and adequacy of depression literacy with depression symptoms among adolescent in Malaysia. This study reports on the common tools used to examine depression literacy, validation of the MHL and Stigma questionnaire and Centre for Epidemiological Studies Depression scale (CES-D) Malay version questionnaire, findings of the depression literacy …

Evaluation Of A Concussion Management And Discharge Education Training Module For Emergency Department Nurses, Carmen Frede

DNP Projects

Purpose: The purpose of this project was to improve the Emergency Department (ED) nurses’ knowledge on identifying patients at risk for concussions and delivering effective concussion discharge education using an educational training intervention.

Methods: This project used a descriptive, non-randomized pre-post survey design. Participation involved three stages: a pre-education survey to assess baseline concussion education knowledge, an educational intervention consisting of a narrated PowerPoint presentation, and a post-education survey to evaluate knowledge on concussion discharge education. The intervention was delivered online via the UK Canvas educational platform.

Results: The majority of nursing staff participants were female (97%) and had a …

Evaluating Providers’ Perceptions On Preconception Care For Women With Sud, Corinna Hughes

DNP Projects

Background: Substance use disorders (SUDs) has become an epidemic. Women of reproductive age with SUDs have particularly complex healthcare needs including an increased risk of having an unintended pregnancy and associated sequela of negative birth outcomes (NBO). Little is known about how medication assisted treatment (MAT) providers are adequately addressing their unique needs. Identifying provider barriers and tools to address the reproductive needs of women with SUDs can optimize their health outcomes and prevent NBOs.

Purpose: The purpose of this study was to evaluate MAT Nurse Practitioners’ (NPs) knowledge and perceptions of providing preconception care to women with …

Improving First Dose Administration Of The Hpv Vaccine For Adolescents In A Pediatric Primary Care Clinic, Scarlett Mikesell-Pierce

DNP Projects

BACKGROUND: Nationwide more than 90% of cervical cancer cases are caused by the human papilloma virus (HPV). Cervical cancer can be largely prevented by administration of the HPV vaccine for children before becoming sexually active. However, vaccination rates in the United States, remain low at 60%, and only 39.7% through series of completion, despite the strong evidence to support the effectiveness of the HPV vaccine. Research indicates a clinician’s recommendation, providing information and opportunity for discussion about the vaccine are strong motivators for parents to vaccinate their children, regardless of ethnicity. This study addresses the barriers to parent/caregiver intent to …

Investigating Chronic Illness In Pathways To Housing Clients, Joshua Malerich, Lara Weinstein, Md, Dph

Phase 1

Approximately 553,000 individuals were homeless in the US each night in 2017, each at significant risk for substance use disorder, severe mental illness, and untreated chronic disease. Housing First (HF) is an evidence-based model for reaching high risk homeless individuals by providing a personal home to clients without the requirement for abstinence. HF has been shown as effective as other frameworks in remission of substance use, connectedness in the community, and client perceived quality of life, but there is a gap in the literature regarding the impact of HF services on clinical measures of chronic health, which could help further …

Examining The Associations Between Addiction Severity And Prior Adverse Childhood Experiences In Pregnant Women Receiving Treatment For Opioid Addiction, Julia Gong, Diane Abatemarco, Phd, Msw

Phase 1

Introduction: Opioid use during pregnancy poses risk to both the mother and fetus, including fetal loss and pre-term birth. Prior research suggests that adverse childhood experiences (ACEs) are a plausible antecedent to opioid abuse. However, there is insufficient understanding of the association between prior ACEs, familial history of substance use, and treatment outcomes in pregnant women receiving treatment for opioid addiction.

Methods: A retrospective chart review will be used to review data from 167 MATER patients who entered treatment between 1997 and 2017. Descriptive statistics will be utilized to characterize the study population. Regression and chi-square analyses will be conducted …

Analyzing The Attitudes, Beliefs, And Practices Of Breastfeeding Women At Maternity Care Coalition, Angela Heysel, Conor Bradley, Naima Black, Galissa Jones

Phase 1

Introduction: It is recommended that women breastfeed for twelve months because breastfeeding is an important part of infant development and maternal bonding. Research shows that despite high overall breastfeeding rates, discrepancies exist in breastfeeding rates across zip codes and race in Philadelphia. The research goal is to develop a community resource to promote breastfeeding in Philadelphia and to understand the impact race and zip code have on breastfeeding attitudes and practices.

Methods: Data was collected from residents of Philadelphia and neighboring counties through an online general population survey and focus group survey. Both surveys addressed demographics and the women’s attitudes …

High Retention In An Fqhc Moud Program Despite Substantial Vulnerabilities In Population, Qais Iqbal, Lara Weinstein, Md, Mph, Drph

Phase 1

Background: Seventy-thousand people in Philadelphia use heroin, and another 50,000 misuse prescription opioids. Philadelphia has increased its capacity for medication for opioid use disorder (MOUD) with buprenorphine from 100 slots in 2017 to 2,906 as of December 2018, but clearly there is still a need for thousands of more treatment slots. Additionally, recent evaluations reveal people from vulnerable populations, including homeless, non-white, and those with chronic medical diseases, have compounded difficulty accessing MOUD, even if there is sufficient capacity. Our objective was to describe and report initial outcomes of a low-threshold MOUD program at our Federally Qualified Health Center (FQHC) …

Increasing Food Access: Evaluation Of A Food Buying Club In Philadelphia, Kimberly Hoover, Rickie Brawer, Mph, Phd, Mches

Phase 1

Introduction: Children living in food insecure homes are at higher risk of developing a variety of negative health outcomes, including cardiovascular disease, obesity, and cognitive, emotional and behavioral problems. In order to combat these outcomes, Mercy Neighborhood Ministries of Philadelphia (MNMOP) established a Food Buying Club to increase accessibility and affordability of fresh produce. However, the satisfaction with this program among participants needs to be determined in order to strengthen the program.

Objective: The objective of this quality improvement study was to evaluate parental satisfaction with the MNMOP program, specifically regarding produce options, cost, and variety.

Methods: An online survey …

Perspectives On Lung Cancer Screening In The Philadelphia Lgbtq Community, Kaitlin Demarest, Kristine Pham, Mph, Rickie Brawer, Phd

Phase 1

Introduction: Lung cancer is the leading cause of cancer deaths in the United States, but there are low screening rates across the country. While the prevalence of smoking in the LGBTQ population is disproportionately high, the LGBTQ community may have decreased access to screening, since they are reported to be less likely to have health insurance, more likely to receive inferior care or be denied care. The objective of this project was to better understand the knowledge, beliefs, and attitudes toward lung cancer screening in the LGBTQ community in Philadelphia in order to develop appropriate, community-focused educational materials to increase …

Thomas Jefferson Health System Medical Legal Partnership, Theresa Clark Rihn, Ema, Jd, Martha Romney, Rn, Ms, Jd, Mph, Rickie Brawer, Mph, Phd, Mches, Jennifer Roman, Bsn, Rn, Ccm

Phase 1

Introduction: Medical-legal partnerships (MLPs) provide civil legal services in concert with healthcare services to mitigate complex social conditions with health-harming effects. Currently, there are 333 MLPs in 46 states. Thomas Jefferson Health System (TJHS) does not have a systemwide MLP. (Magee Rehabilitation Hospital does have an MLP used by qualifying Magee patients). This project sought to identify the core components of an MLP and to demonstrate the value an MLP would provide TJHS.

Methods: Assessed existing literature. Interviewed an existing MLP director. Patients from the Jefferson Hospital Ambulatory Practice (JHAP) clinic completed a written survey regarding health-harming social-legal …

Building Connections: Skmc – Ces Medellín International Exchange Program Development, Elias Borne, Kaitlin Demarest, Rosemary Frasso, Phd, Andres Fernandez, Md, Msed

Phase 1

Introduction: To date, there has been no formal evaluation of the exchange program that sends medical students from Sydney Kimmel Medical College (SKMC) to CES University, Colombia. While many medical schools have international exchange partnerships, little is known about what makes a successful global training experience. This project aims to evaluate the SKMC-CES student exchange program with the goal of improving collaboration between the two universities and creating a logic model backbone for the program going forward.

Methods: Surveys and interviews were done with program participants from the 2018 and 2019 academic years (6 students interviewed and 4 surveyed) exploring …

Characteristics Of A Food Insecure Population In North Philadelphia, Galicano Kai Inguito, James Gardner, Laura Layer, Karen Fritz

Phase 1

Introduction: A 2018 report by Hunger Free America showed that food insecurity increased in Philadelphia by 22%, even though it decreased nationally. The objectives of this study were to perform food insecurity screens, and to describe the demographic characteristics in terms of age, gender, primary language, body mass index (BMI), and zip code. We hypothesized that older, overweight, Hispanic females would be more likely to be food insecure.

Methods: After obtaining consent, the validated Hunger Vital Sign screening tool was used in the Summer of 2019 in North Philadelphia by teams of trained students in the Summer Medical Institute program. …

Needs Assessment: Northeast Philly Opioid Epidemic, Davis Witt, Ms, Christopher Chambers, Md

Phase 1

Introduction: Philadelphia has the 3rd highest rate of opioid-related overdoses in the nation. This crisis is worsening in Northeast Philadelphia and the Department of Public Health lacks necessary information to intervene in an informed manner.

Objective: This study aims to better understand the crisis in this community and to provide key information to guide future harm reduction interventions in the Northeast Philadelphia region.

Methods: Using a designed discussion guide, qualitative interviews were completed with key stakeholders and community members. Information regarding personal experiences and opinions about the epidemic was gathered and interviews were analyzed using narrative analysis. In addition, needle …

Adolescent Hiv Pre-Exposure Prophylaxis Prescribing Practices Among Family Medicine Physicians: Limited Immediate Uptake, Emma T. Cooper, Steven A. Elsesser, Md, Amy Cunningham, Phd, Mph, Marshal Miller, Md

Phase 1

Introduction: In the United States, individuals aged 13-24 made up 21% of new HIV infections in 2016. In 2018, the FDA approved tenofovir/emtricitabine as HIV pre-exposure prophylaxis (PrEP) for adolescents aged 15-17. In 2019, we examined adolescent PrEP prescribing practices among family medicine physicians at an academic family medicine practice.

Methods: Physicians were invited to complete an online questionnaire assessing PrEP knowledge, attitudes, and prescribing practices. Differences in PrEP knowledge and attitudes among providers who prescribe PrEP to adolescents versus those who do not were examined using independent samples t-tests.

Results: 50 out of 99 surveys were completed. Respondents were …

Perceptions Of Centering Pregnancy At Jefferson’S Maternal Addiction Treatment, Education & Research (Mater) Program, Lindsay Caldarone, Ms, Vanessa Short, Phd, Mph

Phase 1

Introduction: Opioid use and misuse, including during pregnancy, is prevalent across the United States. Many women with opioid use disorder (OUD) face multiple barriers to care, including prenatal care. Group prenatal care, as compared to individual prenatal care, may lead to beneficial outcomes such as reduced odds of preterm birth.

Objective: This study aimed to assess the perceptions of Centering Pregnancy (CP), a group prenatal care program, among women in treatment for OUD.

Methods: The target population included women who participated in the CP program at MATER. Participants (N=6) completed a survey after the last CP session. Survey questions assessed …

The Problem With Relying On Profit-Driven Models To Produce Pandemic Drugs, Ana Santos Rutschman

All Faculty Scholarship

The longstanding problems of relying on a market response to a pandemic are becoming readily apparent in the United States, which has quickly become the epicenter of the COVID-19 outbreak. The problems are particularly pronounced in pharmaceutical markets, where we are pinning our hopes for both cures and vaccines. In previous work we have shown how characteristics of healthcare markets in the United States create a divergence between the private incentives of for-profit companies and public health needs, leading to sub-optimal health outcomes in what is a uniquely market-driven healthcare system. In this Essay, written as the COVID-19 pandemic unfolds, …

Mapping Misinformation In The Coronavirus Outbreak, Ana Santos Rutschman

All Faculty Scholarship

The coronavirus outbreak has sent ripples of fear and confusion across the world. These sentiments—and our collective responses to the outbreak—are made worse by rampant misinformation surrounding the new strain of the virus, COVID-2019. In this post, I survey some of the most pervasive areas of tentacular coronavirus-related misinformation that has proliferated online -- as well as the responses of social media companies like YouTube, Facebook, Pinterest and TikTok that may ultimately prove inadequate given the magnitude of the problem.

The Reemergence Of Vaccine Nationalism, Ana Santos Rutschman

All Faculty Scholarship

This short essay explores the reemergence of vaccine nationalism during the COVID-19 pandemic. The essay traces the pre-COVID origins of vaccine nationalism and explains how it can have detrimental effects on equitable access to newly developed vaccines.

Protecting The Rights Of People With Disabilities, Elizabeth Pendo

All Faculty Scholarship

One in four Americans — a diverse group of 61 million people — experience some form of disability (Okoro, 2018). On average, people with disabilities experience significant disparities in education, employment, poverty, access to health care, food security, housing, transportation, and exposure to crime and domestic violence (Pendo & Iezzoni, 2019). Intersections with demographic characteristics such as race, ethnicity, gender, and LGBT status, may intensify certain inequities. For example, women with disability experience greater disparities in income, education, and employment (Nosek, 2016), and members of under-served racial and ethnic groups with disabilities experience greater disparities in health status and access …

Medicaid's Vital Role In Addressing Health And Economic Emergencies, Nicole Huberfeld, Sidney Watson

All Faculty Scholarship

Medicaid plays an essential role in helping states respond to crises. Medicaid guarantees federal matching funds to states, which helps with unanticipated costs associated with public health emergencies, like COVID-19, and increases in enrollment that inevitably occur during times of economic downturn. Medicaid’s joint federal/state structure, called cooperative federalism, gives states significant flexibility within federal rules that allows states to streamline eligibility and expand benefits, which is especially important during emergencies. Federal emergency declarations give the secretary of Health and Human Services temporary authority to exercise regulatory flexibility to ensure that sufficient health care is available to meet the needs …

Center For Progressive Reform Report: Protecting Workers In A Pandemic--What The Federal Government Should Be Doing, Thomas Mcgarity, Michael C. Duff, Sidney A. Shapiro

All Faculty Scholarship

The "re-opening" of the American economy while the coronavirus that causes COVID-19 is still circulating puts workers at heightened risk of contracting the deadly virus. In some blue-collar industries, the risk is particularly acute because of the inherent nature of the work itself and of the workplaces in which it is conducted. And the risk, for a variety of reasons, falls disproportionately on people of color and low-income workers. With governors stay-at-home orders and other pandemic safety restrictions, Center for Progressive Reform Member Scholars Thomas McGarity, Michael Duff, and Sidney Shapiro examine the federal government's many missed opportunities to stem …

Diploma Privilege And The Constitution, Claudia Angelos, Sara Berman, Mary Lu Bilek, Carol L. Chomsky, Andrea Anne Curcio, Marsha Griggs, Joan W. Howarth, Eileen R. Kaufman, Deborah Jones Merritt, Patricia Salkin, Judith W. Wegner

All Faculty Scholarship

The COVID-19 pandemic and resulting shutdowns are affecting every aspect of society. The legal profession and the justice system have been profoundly disrupted at precisely the time when there is an unprecedented need for legal services to deal with a host of legal issues generated by the pandemic, including disaster relief, health law, insurance, labor law, criminal justice, domestic violence, and civil rights. The need for lawyers to address these issues is great but the prospect of licensing new lawyers is challenging due to the serious health consequences of administering the bar examination during the pandemic.

State Supreme Courts are …

Covid-19 And The Conundrum Of Mask Requirements, Robert Gatter, Seema Mohapatra

All Faculty Scholarship

As states begin to loosen their COVID-19 restrictions, public debate is underway about what public health measures are appropriate. Many states have some form of mask-wearing orders to prevent the spread of COVID-19 infection. Public health guidance from the Centers for Disease Control and Prevention and the World Health Organization has conflicted. From a public health point of view, it is not clear what the right answer is. In the absence of directives, individuals are also making their own choices about mask use. At a time when public health measures, like shelter-in-place orders and social distancing, are being used to …

Distribution Of Human Exposure To Ozone During Commuting Hours In Connecticut Using The Cellular Device Network, Owais Gilani, Simon Urbanek, Michael J. Kane

Faculty Journal Articles

Epidemiologic studies have established associations between various air pollutants and adverse health outcomes for adults and children. Due to high costs of monitoring air pollutant concentrations for subjects enrolled in a study, statisticians predict exposure concentrations from spatial models that are developed using concentrations monitored at a few sites. In the absence of detailed information on when and where subjects move during the study window, researchers typically assume that the subjects spend their entire day at home, school, or work. This assumption can potentially lead to large exposure assignment bias. In this study, we aim to determine the distribution of …

Association Between Smartphone Addiction And Mental Health During The Covid-19 Pandemic 2021 Among Inner Mongolia Medical University Students, The People's Republic Of China, Longlong Zhao

Chulalongkorn University Theses and Dissertations (Chula ETD)

Smartphone is currently playing a crucial role; consequently, many smartphone users have become addicted and eventually resulted in psychological problems. This study intends to assess an association between smartphone addition and mental health among students of Inner Mongolia Medical University. The researcher employed random sampling technique in data collection by having 500 students of Inner Mongolia Medical University. The questionnaires distributed cover such topics as demographic characteristics; smartphone use behaviors; smartphone addiction scale (SAS-SV) questionnaire; life experience during COVID-19 questionnaire and depression anxiety and stress Scale (DASS-21) questionnaire. As for data analysis, binary logistic regression and multivariable logistic regression for …

Factors Related To Behavior Of Mothers In Child Care Influencing On Diarrhea Among Children Aged Under 2 Years In Myanmar, Yair Naing Oo

Chulalongkorn University Theses and Dissertations (Chula ETD)

Diarrhea among children aged under 2 years remains a huge challenge for Myanmar because it is the fourth leading cause of death among children aged under 5 years. This study aimed to find the association between maternal behavior in childcare and diarrhea among children aged under 2 years in Myanmar. Cross-sectional data was obtained from the 2015 Myanmar Demographic and Health Survey used for the study. A total of 1655 children, aged 0–23 months and who are the youngest and lived with their mothers, were selected for this study. The prevalence of diarrhea among Myanmar children under two years old …