Public Health Commons^™

Surgical Delay Of Thoracodorsal Artery Perforator Flaps For Bilateral Autologous Breast Reconstruction, Ryan D. Hoffman, Mark A. Maier, Hugo St. Hilaire, Robert J. Allen

School of Medicine Faculty Publications

Summary; Autologous reconstruction accounts for nearly one-quarter of all breast reconstruction cases in the United States, with the abdomen functioning as the most popular donor site. This case describes a 62-year-old woman who presented to our clinic with a remote history of estrogen receptor+/progesterone+ breast cancer and bilateral implant-based reconstruction. After grade IV capsular contracture of her left breast, she presented for autologous reconstruction. Due to her body habitus and prior belt lipectomy, deep inferior epigastric perforator flap reconstruction was contra-indicated. The thoracodorsal artery perforator (TDAP) flap is well described in the literature, and was chosen as an alternative salvage …

Genome-Wide Association Studies And Fine-Mapping Identify Genomic Loci For N-3 And N-6 Polyunsaturated Fatty Acids In Hispanic American And African American Cohorts, Chaojie Yang, Jenna Veenstra, Traci M Bartz, Matthew C Pahl, Brian Hallmark, Yii-Der Ida Chen, Jason Westra, Lyn M Steffen, Christopher D Brown, David Siscovick, Michael Y Tsai, Alexis C Wood, Stephen S Rich, Caren E Smith, Timothy D O'Connor, Dariush Mozaffarian, Struan F A Grant, Floyd H Chilton, Nathan L Tintle, Rozenn N Lemaitre, Ani Manichaikul

Faculty, Staff and Students Publications

Omega-3 (n-3) and omega-6 (n-6) polyunsaturated fatty acids (PUFAs) play critical roles in human health. Prior genome-wide association studies (GWAS) of n-3 and n-6 PUFAs in European Americans from the CHARGE Consortium have documented strong genetic signals in/near the FADS locus on chromosome 11. We performed a GWAS of four n-3 and four n-6 PUFAs in Hispanic American (n = 1454) and African American (n = 2278) participants from three CHARGE cohorts. Applying a genome-wide significance threshold of P < 5 × 10

The Grindr Complex: The Behavioral Health Impact Of Sexual Racism On Latinx Men Who Have Sex With Men, Luisalfredo Plascencia

Doctoral Dissertations

Given the social history surrounding the issue of HIV/AIDS in the LGBTQ+ community and the unique and intersectional experiences that Latinx Men who have Sex Men (MSM) have in their community, this dissertation’s research will contribute to the growing work on sexual racism and how it correlates with various elements of behavioral health. The study investigated the moderation impact of Latinx cultural values of caballerismo and familismo on the relationship between experiences sexual racism to mental health symptoms. The study also examined the moderation of caballerismo and familismo and psychological flexibility on the relationship between experiences of sexual racism to …

Indoor Airborne Microbiome And Endotoxin: Meteorological Events And Occupant Characteristics Are Important Determinants, Hesham Amin, Tina Šantl-Temkiv, Christine Cramer, Kai Finster, Francisco Gomez Real, Thorarinn Gislason, Mathias Holm, Christer Janson, Nils Oskar Jögi, Rain Jogi, Andrei Malinovschi, Ian P G Marshall, Lars Modig, Dan Norbäck, Rajesh Shigdel, Torben Sigsgaard, Cecilie Svanes, Hulda Thorarinsdottir, Inge M Wouters, Vivi Schlünssen, Randi J Bertelsen

Faculty, Staff and Student Publications

Airborne bacteria and endotoxin may affect asthma and allergies. However, there is limited understanding of the environmental determinants that influence them. This study investigated the airborne microbiomes in the homes of 1038 participants from five cities in Northern Europe: Aarhus, Bergen, Reykjavik, Tartu, and Uppsala. Airborne dust particles were sampled with electrostatic dust fall collectors (EDCs) from the participants’ bedrooms. The dust washed from the EDCs’ clothes was used to extract DNA and endotoxin. The DNA extracts were used for quantitative polymerase chain (qPCR) measurement and 16S rRNA gene sequencing, while endotoxin was measured using the kinetic chromogenic limulus amoebocyte …

Food Insecurity And Risky Sexual Behaviors Among College Students During The Covid-19 Pandemic, Bertille Assoumou, Jennifer Pharr, Courtney Coughenour

Environmental & Global Health Faculty Research

Background

Sexually transmitted infections (STIs) and food insecurity are public health concerns in the United States (US) due to their growing prevalence and incidence among young people, and particularly in college students. Studies have reported that college students are at higher risk of STIs due to the high rates of risky sexual behavior (RSB). Most studies report a food insecurity prevalence of more than 30% among college students, which was more than twice the overall national food insecurity rate of 10.5% in 2020. This study aims to assess the relationship between food insecurity and RSB among college students during the …

Home-Based Self-Sampling Vs Clinician Sampling For Anal Precancer Screening: The Prevent Anal Cancer Self-Swab Study, Alan G Nyitray, Jenna Nitkowski, Timothy L Mcauliffe, Bridgett Brzezinski, Michael D Swartz, María E Fernandez, Ashish A Deshmukh, Timothy J Ridolfi, Sarah J Lundeen, Leslie Cockerham, Dave Wenten, Andrew Petroll, Brian Hilgeman, Jennifer S Smith, Elizabeth Y Chiao, Anna R Giuliano, Vanessa Schick, Prevent Anal Cancer Self-Swab Study Team

Faculty, Staff and Student Publications

Sexual minority men are at increased risk for anal squamous cell carcinoma. Our objective was to compare screening engagement among individuals randomized to self-collect an anal canal specimen at home or to attend a clinic appointment. Specimen adequacy was then assessed for human papillomavirus (HPV) DNA genotyping. A randomized trial recruited cisgendered sexual minority men and transgender people in the community and assigned them to use a home-based self-collection swabbing kit or attend a clinic-based swabbing. Swabs were sent for HPV genotyping. The proportions of participants completing screening in each study arm and the adequacy of their specimens for HPV …

Utilization And Costs Of Home Hemodialysis, In-Center Hemodialysis, And Peritoneal Dialysis Among Patients With End-Stage Renal Disease (Esrd) In The United States, Andres Mauricio Garcia Sierra

Electronic Theses and Dissertations, 2020-2023

Chronic kidney disease (CKD) is a condition that requires access to renal replacement therapies (RRTs) to enable patients to live. The use of such therapies has been continuously researched due to the high cost to payers and their patients. This dissertation aimed to analyze the incidence, prevalence, and mortality of renal replacement therapies in patients with end-stage renal disease (ESRD), and document cost trends and analyze possible inequalities in access to these therapies. Based on an integrated health risk management (IHRM) model, this study examined patient characteristics associated with renal replacement therapies in ESRD patients through a pooled cross-sectional study …

Court Decisions Demonstrate Need For Public Health Economy: A Position Statement Of Public Health Liberation, Christopher Williams, Public Health Liberation Board Of Directors

Advances in Clinical Medical Research and Healthcare Delivery

The recent decisions of the Supreme Court of the United States have major implications for public health. The position statement of Public Health Liberation, a membership nonprofit, underscores the importance of a disciplinary shift in public health toward study and effectuation of the Public Health Economy.

Community Members’ Experiences Training As Medical Journal Reviewers, Jeri Jewett-Tennant, Kurt C. Stange, Ashwini R. Sehgal

Faculty Scholarship

Purpose: Although medical research dissemination is intended to benefit members of society, few members of society actually participate in the process of publishing findings. This study shares findings from community members’ (including patients and the public) experiences being trained as medical journal reviewers. Methods: We analyzed findings from two focus group interviews of community reviewers (N = 29) to identify themes in their experiences with the training program. Results: Community members trained as journal reviewers appreciated learning the context under which manuscript development and review occur from authors and funders, the value of the community member perspectives to science, and …

Environmental Toxins And Their Impact On Neurological Health, Maria Allesandra Elsasser

Master's Projects and Capstones

This paper evaluates the impact of environmental toxins on neurological health from a public health perspective. Employing a comprehensive review of literature across various databases, the study sheds light on the mechanisms through which environmental neurotoxicity influences health, highlighting key correlations between toxin exposure and the onset of neurodegenerative disorders. The research identifies significant gaps in current approaches to managing these risks, particularly concerning policy regulations and public awareness. Based on these findings, strategic recommendations are proposed to address and mitigate the identified challenges, with implications emphasizing the broader benefits for public health.

Predicting Pediatric Tuberculosis: The Need For Age-Specific Host Biosignatures, Sara Suliman, Devan Jaganath, Andrew Dinardo

Faculty, Staff and Students Publications

No abstract provided.

Chronic Lower Back Pain Among Women In India: Evidence-Based Approach To Risk Factors And Interventions, Aelita Matosova

Master's Projects and Capstones

Chronic lower back pain (CLBP) is a prevalent issue worldwide, affecting about 1.71 billion people, with a significant proportion being women. CLBP is a major health concern in India, particularly among women, which were 80% reported experiencing this condition. Several factors, such as personal beliefs, sociocultural norms, restricted healthcare access, repetitive movements, and psychological aspects, contribute to this high prevalence leading to severe health and economic implications, including reduced work productivity and income. Although there have been several reports on prevalence and risk factors of CLBP, to our knowledge, there has not been enough work focusing on evidence-based interventions to …

Acceptability, Appropriateness, And Feasibility Of Rural School Support Strategies For Behavioral Interventions: A Mixed Methods Evaluation Over Two Years Of A Hybrid Type 3 Implementation-Effectiveness Trial, Hannah G. Calvert, Michaela Mcquilkin, Ashley Havlicak, Teri Lewis, Lindsey Turner

Public and Population Health Faculty Publications and Presentations

Background: Positive Behavioral Interventions and Supports (PBIS) is a framework for implementing evidence-based interventions for preventing behavioral issues and improving climate in schools. The implementation of school-wide PBIS with fidelity is complex, requiring leadership commitment, teaming, and coordination of systems for tracking behaviors and consequences. Putting these components in place while ensuring alignment with the values and needs of the school community can be difficult for schools with fewer resources, such as rural schools. Implementation supports are needed, including strategies such as technical assistance, but it is unclear whether lower-cost modalities such as virtual support are acceptable, appropriate, and feasible …

Prevalence Of Symptoms ≤12 Months After Acute Illness, By Covid-19 Testing Status Among Adults — United States, December 2020–March 2023, Juan Carlos C Montoy, James Ford, Huihui Yu, Michael Gottlieb, Dana Morse, Michelle Santangelo, Kelli N O'Laughlin, Kevin Schaeffer, Pamela Logan, Kristin Rising, Mandy J Hill, Lauren E Wisk, Wafah Salah, Ahamed H Idris, Ryan M Huebinger, Erica S Spatz, Robert M Rodriguez, Robin E Klabbers, Kristyn Gatling, Ralph C Wang, Joann G Elmore, Samuel A Mcdonald, Kari A Stephens, Robert A Weinstein, Arjun K Venkatesh, Sharon Saydah, Innovative Support For Patients With Sars-Cov-2 Infections Registry (Inspire) Group

Faculty, Staff and Student Publications

To further the understanding of post-COVID conditions, and provide a more nuanced description of symptom progression, resolution, emergence, and reemergence after SARS-CoV-2 infection or COVID-like illness, analysts examined data from the Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE), a prospective multicenter cohort study. This report includes analysis of data on self-reported symptoms collected from 1,296 adults with COVID-like illness who were tested for SARS-CoV-2 using a Food and Drug Administration-approved polymerase chain reaction or antigen test at the time of enrollment and reported symptoms at 3-month intervals for 12 months. Prevalence of any symptom decreased substantially between baseline …

Genome-Scale Methylation Analysis In Blood And Tumor Identifies Immune Profile, Age Acceleration, And Dna Methylation Alterations Associated With Bladder Cancer Outcomes, Ji-Qing Chen

Dartmouth College Ph.D Dissertations

Bladder cancer patients receive frequent screening due to the high tumor recurrence rate (more than 60%). Nowadays, the conventional monitoring method relies on cystoscopy which is highly invasive and increases patient morbidity and burden to the health care system with frequent follow-up. As a result, it is urgent to explore novel markers related to the outcomes of bladder cancer. Immune profiles have been associated with cancer outcomes and may have the potential to be biomarkers for outcomes management. However, little work has been conducted to investigate the associations of immune cell profiles with bladder cancer outcomes. Here, I utilized the …

Inclusive Education Is Power: Revising Sexual Health Education For People With Disabilities, Carly M. Tsuruda

Master's Projects and Capstones

For people with disabilities in the United States, comprehensive sexual health education is not always available. There are a number of reasons for the lack of comprehensive sexual health education, including excessive censorship and curriculum that is not representative of people with disabilities. Sexual health education and disability are both topics that have several preconceived notions attached to them, yet there is a dearth in resources that could provide accurate information to those both with and without disabilities. These preconceived notions that have been associated with these identity labels lead to negative health outcomes for people with disabilities such as …

Changes In Medicaid Fee-For-Service Benefit Design For Substance Use Disorder Treatment During The Opioid Crisis, 2014 To 2021, Angela Shoulders, Christina Andrews, Melissa A. Westlake, Amanda J. Abraham, Colleen M. Grogan

Faculty Publications

Importance: Medicaid is the largest payer of substance use disorder treatment in the US and plays a key role in responding to the opioid epidemic. However, as recently as 2017, many state Medicaid programs still did not cover the full continuum of clinically recommended care. Objective: To determine whether state Medicaid fee-for-service (FFS) programs have expanded coverage and loosened restrictions on access to substance use disorder treatment in recent years. Design, Setting, and Participants: In 2014, 2017, and 2021, a survey on coverage for substance use disorder treatment was conducted among state Medicaid programs and the District of Columbia with …

The Impact Of Access And Quality Of Antenatal Care On Maternal Mortality Rates Among Women In Pakistan, Fauzia Waqar

Master's Projects and Capstones

This paper focuses on the factors contributing to high maternal mortality rates in Pakistan, emphasizing the crucial role of inadequate antenatal care (ANC) and limited access to quality health services. Prominent risk factors include poverty and financial constraints, healthcare workforce shortages, lack of women empowerment, and low socioeconomic conditions. The cultural and traditional context in Pakistan also plays an influential role in shaping these factors. For a substantial reduction in maternal mortality rates among Pakistani women and girls, a shift within the cultural perception of women's health, specifically regarding ANC, is crucial. To effectively reduce maternal mortality rates in the …

Add-On Soft Electronic Interfaces For Continuous Cuffless Blood Pressure Monitoring, Myeong Namkoong, Balaji Baskar, Lakhvir Singh, Heng Guo, Justin Mcmurray, Kimberly Branan, Md Saifur Rahman, Chin-To Hsiao, Josh Kuriakose, Joanna Hernandez, Arda A Arikan, Luis E Garza-Rivera, Gerard L Coté, Limei Tian

Faculty, Staff and Student Publications

Continuous monitoring of arterial blood pressure is clinically important for the diagnosis and management of cardiovascular diseases. Soft electronic devices with skin-like properties show promise in a wide range of applications, including the human-machine interface, the Internet of things, and health monitoring. Here, we report the use of add-on soft electronic interfaces to address the connection challenges between soft electrodes and rigid data acquisition circuitry for bioimpedance monitoring of cardiac signals, including heart rate and cuffless blood pressure. Nanocomposite films in add-on electrodes provide robust electrical and mechanical contact with the skin and the rigid circuitry. We demonstrate bioimpedance sensors …

Health Risks Of Herbal Medicine In The Us: Recommendations To Improve Awareness And Advance Safety, Darya Sinkevich

Master's Projects and Capstones

Adults in the U.S. use herbal medicine as an alternative and in conjunction with conventional healthcare, in many cases because of cultural and economic considerations. With insufficient governmental regulation of the content of herbal supplements, and limited education of healthcare providers on the potential risks and benefits consumers can experience unexpected and potentially harmful health impacts from using herbal medicine.

The health risks associated with these products include but are not limited to, herbal and prescription drug interactions and heavy metal toxicity. For this project, a scoping literature review was conducted using multiple databases to identify the prevalence, health risk, …

Expanding The Volunteer Role To Include Advance Care Planning Knowledge, Andrea C. Leomo

Master's Projects and Capstones

Problem: Transition patients at the end-of-life are those patients who are not mentally ready or physically eligible for hospice thus not enrolled in a Palliative or Hospice Program. Only one-third of the Transition patient census had completed and filed advance care plans. Healthcare providers are obligated to perform life-saving measures unless documented otherwise. A lack of advance care planning can create complicated scenarios and cause discordant care incidents.

Context: End-of-life care is a delicate subject to navigate conversations with patients. With holistic care being a large component of hospice and palliative care, it is important to have updated and accurate …

Certified Community Behavioral Health (Ccbhc) Outpatient Redesign For Behavioral Health Care, Fatmata Kula Jah

Master's Projects and Capstones

The purpose of this study is to review and utilize components of the Certified Community Behavioral Health Clinic (CCBHC) model to create an outpatient redesign model for behavioral health (without duplicating it). This was accomplished by recommending greater use of, and comprehensive integration of, Peer Support Specialists within the current behavioral health continuum of care by increasing funding for the CCBHC demonstration program through legislative expansion by using Medicaid eligibility. This study also recommends enhanced utilization of technological innovations in order to provide equitable access to populations in rural areas. This will enable CCBHCs to fulfill their mandate of providing …

“Am I Light Enough?”: Mercury Poisoning Due To Skin-Lightening Products, A Policy, And A Culturally Competent Solution, Raven Joyce Redaniel Uayan

Master's Projects and Capstones

Introduction: This paper aims to declare skin-lightening products containing mercury as a public health issue that deserves recognition in health and attention in health policy reforms.

Background and Literature Review: The public health issue analyzed with research and literature review encompasses worldwide mercury poisoning cases, databases of illegal skin-lightening creams, cosmetic safety laws, and policies on online selling platforms. The literature review addresses the existing knowledge regarding mercury in skin-lightening products and identifies the gaps in health policy and awareness surrounding this issue.

Methods: The paper includes many articles analyzing the issue from a global perspective, utilizing …

Improving Minors' Access To Treatment For Opioid Use Disorder: A Policy Analysis, Sara Jane Hamilton

Master's Projects and Capstones

As the opioid epidemic continues to have devastating effects on our communities, medications to treat opioid use disorder (MOUDs) are severely underutilized especially for adolescents. Unlike adults, minors need parental approval before obtaining MOUDs presenting a key barrier to timely treatment. Being able to treat adolescents as soon as they are ready is critically important for people with OUD, and while cost and other barriers have been addressed in the literature, there is a paucity on how parental consent affects the accessibility of treatment. This paper aims to explore a potential policy in California that addresses the lack of access …

Advancing Kidney Health In Hispanic/Latino Communities In The Us: Promotoras, Health Education, And Food Security, Estefania Huerta

Master's Projects and Capstones

Chronic Kidney Disease (CKD) is not only a public health concern that affects the health of people living in the United States, but also a global health concern affecting millions worldwide. Diabetes is the leading cause of CKD and when CKD is not managed, it can turn into a life-threatening condition known as End-Stage Renal Disease (ESRD) where life is not sustainable without dialysis or a kidney transplant. Although CKD is prevalent among all populations in the United States, the Hispanic/Latino population suffers the most complications (Desai et al., 2019). In 1973, Congress extended Medicare services to people with ESRD …

Understanding Healthcare Worker Experiences And Personal Protective Equipment (Ppe)-Related Skin Reactions/Injuries During The Covid-19 Pandemic: A Mixed Methods Approach, Susan Solmos

Theses & Dissertations

Personal protective equipment (PPE)-related facial skin reactions/injuries occurred in 75.13% of healthcare workers during the COVID-19 pandemic. Critical appraisal of cross-sectional studies identified methodological gaps as the majority of survey questions were not content-validated and those that were lacked descriptions of methods and psychometrics for the survey questions/tool. The aims of this dissertation study were to describe the nature, severity, and distribution of selfie captured PPE-related facial injuries using a validated tool (quantitative) and describe the contextual factors associated with PPE-related facial injuries and what factors influence nurses and Health Care Workers (HCWs) to share their experiences (qualitative). The setting …

Understanding The Compositional And Contextual Factors Influencing Maternal Health Experiences And Outcomes, Tambudzai P. Ndashe

Theses & Dissertations

Despite being preventable, adverse maternal health outcomes continue to be a problem in the United States, which fares worse at preventing these issues than other industrialized nations. Although our understanding of the factors that play a role in the etiology of adverse maternal health outcomes has improved over time, there is still a lot left to understand regarding the role of contextual factors, the upward trajectory of outcomes such as severe maternal morbidity (SMM), and the disproportionate impact of adverse maternal health outcomes on non-Hispanic Black women. This thesis attempted to evaluate the factors that influence procedure-related severe maternal morbidity …

Reducing Oral Health Disparities: Effectiveness Of Preventive Dental Care On Treatment Use, Expenditures And Determinants Of Service Utilization, Rashmi Lamsal

Theses & Dissertations

Given the importance of oral health in maintaining the general health and well-being of an individual, this dissertation includes three independent studies examining dental care utilization and expenditures among adults in the U.S. The first study examines the effectiveness of preventive dental visits on treatment utilization and expenditures among adults aged 18 and above. The second study focuses on the impact of paid sick leave on different types of dental services utilization among working adults aged 18-64. Finally, the last paper compares the differences in dental care utilization and related expenditure between foreign-born and US-born adults with diabetes. The paper …

An Exploration Of Policies, Equity, And Emerging Threats To The Traffic Safety Environment In The U.S., Sachi Verma

Theses & Dissertations

Road traffic crashes are among one of the leading causes of death around the globe. Additionally, it also causes long-term physical disabilities, mental trauma, and financial pressure. By implementing road safety guidelines such as speed limits, drug and alcohol checkpoints, restraints, and penalties, motor vehicle crashes can be reduced. Road traffic crash survival primarily depends on emergency medical service's timely triaging. Rapid triaging and reduced response times can help road traffic crash morbidities and mortalities. However, several factors can be responsible for EMS delays in responding to a fatal crash. This dissertation aims to observe multiple factors related to EMS …

A Multicenter, Controlled Human Infection Study Of Influenza A(H1n1)Pdm09 In Healthy Adults, Justin R Ortiz, David I Bernstein, Daniel F Hoft, Christopher W Woods, Micah T Mcclain, Sharon E Frey, Rebecca C Brady, Christopher Bryant, Ashley Wegel, Robert W Frenck, Emmanuel B Walter, Getahun Abate, Sarah R Williams, Robert L Atmar, Wendy A Keitel, Nadine Rouphael, Mathew J Memoli, Mamodikoe K Makhene, Paul C Roberts, Kathleen M Neuzil

Faculty, Staff and Students Publications

BACKGROUND: We evaluated the associations between baseline influenza virus-specific hemagglutination inhibition (HAI) and microneutralization (MN) titers and subsequent symptomatic influenza virus infection in a controlled human infection study.

METHODS: We inoculated unvaccinated healthy adults aged 18-49 years with an influenza A/California/04/2009/H1N1pdm-like virus (NCT04044352). We collected serial safety labs, serum for HAI and MN, and nasopharyngeal swabs for reverse-transcription polymerase chain reaction (RT-PCR) testing. Analyses used the putative seroprotective titer of ≥40 for HAI and MN. The primary clinical outcome was mild-to-moderate influenza disease (MMID), defined as ≥1 postchallenge positive qualitative RT-PCR test with a qualifying symptom/clinical finding.

RESULTS: Of 76 …