Public Health Commons^™

“I Had To Go There For My Own Safety” Negotiations Of Access And Autonomy Among Dc Birth Settings, Elizabeth Avery Borgmann

Geography Undergraduate Senior Theses

Childbirth experiences are shaped by spatial context. This study considers the relationships between access to, selection of, and experiences with labor and delivery care among Black birthing people in Washington, DC. Informed by Reproductive Justice and reproductive geographies frameworks, I employ a mixed methods GIS design that integrates mapping of potential spatial access with qualitative analysis of community members’ lived experiences. On the quantitative side, nearest-neighbor and 2-step floating catchment area analyses reveal an east-west gradient of potential spatial access to labor and delivery wards, with low access concentrated in predominantly Black and low-income census tracts of Wards 5, 7, …

Spatial Targeting Of Irrigation Development And Water Resource Management To Mitigate Vector-Borne Disease, April Frake, Brad Peter, Grivin Chipula, Joseph Messina

Geosciences Faculty Publications and Presentations

Scaling irrigated agriculture is a global strategy to mitigate food insecurity concerns. While expanding irrigated agriculture is critical to meeting food production demands, it is important to consider how these land use and land cover changes (LULCC) may alter the water resources of landscapes and impact the spatiotemporal epidemiology of disease. Here, a generalizable method is presented to inform irrigation development decision-making aimed at increasing crop production through irrigation while simultaneously mitigating malaria risk to surrounding communities. Changes to the spatiotemporal patterns of malaria vector (Anopheles gambiae s.s.) suitability, driven by irrigated agricultural expansion, are presented for Malawi's rainy and …

Equity In Access For Veterans In The Va Community Care Program, Baligh R. Yehia, Said A. Ibrahim

Department of Medicine Faculty Papers

No abstract provided.

Pediatric Obesity In The United States: Age–Period–Cohort Analysis, Ashley W. Kranjac, Dinko Kranjac, Roxanne I. Aguilera

Sociology Faculty Articles and Research

The rates of obesity among American children aged 2–5 years has reached a historic high. It is crucial to identify the putative sources of population-level increases in obesity prevalence among preschool-aged children because early childhood is a critical window for obesity prevention and thus reduction of future incidence. We used the National Health and Nutrition Examination Survey data and hierarchical age–period–cohort analysis to examine lifecycle (i.e., age), historical (i.e., period), and generational (i.e., cohort) distribution of age- and sex-specific body mass index z-scores (zBMI) among 2–5-year-olds in the U.S. from 1999 to 2018. Our current findings indicate that period effects, …

Recurrent Upper Gastrointestinal Bleeding Due To Radiation-Induced Hemorrhagic Gastroduodenal Ectasia: A Review Of Current Treatment Options For Radiation-Induced Gastric Injury, Simone Jarrett, Rushi Kaushik Talati, Johann Hasbun, Wenqing Cao, Scott Smukalla

Einstein Health Papers

INTRODUCTION: Acute upper gastrointestinal bleeding is one of the most common medical emergencies that present to the hospital, and delineating the underlying etiology is essential to provide adequate definitive treatment. The purpose of this case report was to review the diagnosis and treatment of a rare complication known as radiation-induced hemorrhagic gastritis (RIHG) that can occur in patients with prior radiation exposure. The motivation for this study arose from the identification of a case within our institution.

CASE PRESENTATION: The study involved a review of the diagnosis and management of a patient who presented with anemia and recurrent episodes of …

Investigating The Association Between Metabolic Syndrome Conditions And Perinatal Mental Illness: A National Administrative Claims Study, Karishma Chhabria, Sudhakar Selvaraj, Jerrie Refuerzo, Chau Truong, Cecilia Ganduglia Cazaban

Faculty, Staff and Student Publications

BACKGROUND: Although the association between mental disorder and metabolic syndrome as a bidirectional relationship has been demonstrated, there is little knowledge of the cumulative and individual effect of these conditions on peripartum mental health. This study aims to investigate the association between metabolic syndrome conditions (MetS-C) and maternal mental illness in the perinatal period, while exploring time to incident mental disorder diagnosis in postpartum women.

METHODS: This observational study identified perinatal women continuously enrolled 1 year prior to and 1 year post-delivery using Optum's de-identified Clinformatics® Data Mart Database (CDM) from 2014 to 2019 with MetS-C i.e. obesity, diabetes, high …

Seroprevalence Of Anti-Sars-Cov-2 Igg Antibodies In Healthcare Personnel In El Salvador Prior To Vaccination Campaigns, José Elías Aguilar Ramírez, Adrianna Maliga, Allison Stewart, Allison Lino, José Eduardo Oliva, Xochitl Sandoval, Emily Zielinski-Gutierrez, Rafael Chacon-Fuentes, Parminder S Suchdev, Susana Zelaya, Mario Sánchez, Delmy Lisseth Recinos, Beatriz López, Ella Hawes, Julie Liu, Shannon E Ronca, Sarah M Gunter, Kristy O Murray, Rhina Domínguez

Faculty, Staff and Students Publications

COVID-19, caused by the SARS-CoV-2 virus, is a highly pathogenic emerging infectious disease. Healthcare personnel (HCP) are presumably at higher risk of acquiring emerging infections because of occupational exposure. The prevalence of COVID-19 in HCP is unknown, particularly in low- to middle-income countries like El Salvador. The goal of this study was to determine the seroprevalence of anti-SARS-CoV-2 antibodies among HCP in El Salvador just prior to vaccine rollout in March 2021. We evaluated 2176 participants from a nationally representative sample of national healthcare institutions. We found 40.4% (n = 880) of the study participants were seropositive for anti-spike …

Assessing The Uptake Of Biosimilar Insulin Glargine Among Physicians For The Treatment Of Diabetes In South Africa, Euganthri Pillay

Walden Dissertations and Doctoral Studies

In South Africa, diabetes is a serious problem where 1 in 9 adults has diabetes, making it the country with the highest diabetes prevalence on the African continent. Even though insulin is an absolute necessity for treating diabetes, it is unaffordable to millions. Biosimilar insulins, however, are innovative medicines that are similar but not exact copies of the originator insulin, making alternative treatment affordable to patients. The problem is that, in South Africa, it is still not known whether patients have access to biosimilar insulin in a country where diabetes is rampant. The diffusion of innovation theory was used to …

Assessing The Uptake Of Biosimilar Insulin Glargine Among Physicians For The Treatment Of Diabetes In South Africa, Euganthri Pillay

Walden Dissertations and Doctoral Studies

In South Africa, diabetes is a serious problem where 1 in 9 adults has diabetes, making it the country with the highest diabetes prevalence on the African continent. Even though insulin is an absolute necessity for treating diabetes, it is unaffordable to millions. Biosimilar insulins, however, are innovative medicines that are similar but not exact copies of the originator insulin, making alternative treatment affordable to patients. The problem is that, in South Africa, it is still not known whether patients have access to biosimilar insulin in a country where diabetes is rampant. The diffusion of innovation theory was used to …

Metabolic Regulator Errγ Governs Gastric Stem Cell Differentiation Into Acid-Secreting Parietal Cells, Mahliyah Adkins-Threats, Sumimasa Arimura, Yang-Zhe Huang, Margarita Divenko, Sarah To, Heather Mao, Yongji Zeng, Jenie Y Hwang, Joseph R Burclaff, Shilpa Jain, Jason C Mills

Faculty, Staff and Students Publications

Parietal cells (PCs) produce gastric acid to kill pathogens and aid digestion. Dysregulated PC census is common in disease, yet how PCs differentiate is unclear. Here, we identify the PC progenitors arising from isthmal stem cells, using mouse models and human gastric cells, and show they preferentially express cell-metabolism regulator and orphan nuclear receptor Estrogen-related receptor gamma (Esrrg, encoding ERRγ). Esrrg expression facilitated the tracking of stepwise molecular, cellular, and ultrastructural stages of PC differentiation. Esrrg^P2ACreERT2 lineage tracing revealed Esrrg expression commits progenitors to differentiate into mature PCs. scRNA-seq indicated the earliest Esrrg+ PC progenitors preferentially …

Client Perspectives On The Development Of A Rapid Prep Initiative At A Sexual Health Center In New Orleans, Louisiana, Aish Lovett, Rose Luder, Rebecca Lillis, Isolde Butler, Julia Siren, Samuel Gomez, Kevin Kamis, Oluyomi Obafemi, Sarah E. Rowan, Stefan Baral, Meredith E. Clement

School of Medicine Faculty Publications

Uptake of PrEP remains suboptimal, especially in the Southern United States. Same-day or “Rapid PrEP Initiatives” (RPIs) in sexual health centers (SHCs) could facilitate access and overcome barriers to PrEP. We studied the adaptation of an RPI from Denver, Colorado to an SHC in New Orleans, Louisiana. Through focus group discussions (FGDs) with local SHC staff and PrEP providers, we developed a preliminary RPI model. In 5 FGDs with SHC clients referred for or taking PrEP, we gathered adaptation recommendations and feedback on model acceptability, feasibility, and utility. Providers and clients voiced unanimous support for the RPI. Clients favored the …

Shea Position Statement On Pandemic Preparedness For Policymakers: Building A Strong And Resilient Healthcare Workforce, Robin L.P. Jump

Faculty Scholarship

Throughout the COVID-19 pandemic, many areas in the United States experienced healthcare personnel (HCP) shortages tied to a variety of factors. Infection prevention programs, in particular, faced increasing workload demands with little opportunity to delegate tasks to others without specific infectious diseases or infection control expertise. Shortages of clinicians providing inpatient care to critically ill patients during the early phase of the pandemic were multifactorial, largely attributed to increasing demands on hospitals to provide care to patients hospitalized with COVID-19 and furloughs.¹ HCP shortages and challenges during later surges, including the Omicron variant-associated surges, were largely attributed to HCP …

Shea Position Statement On Pandemic Preparedness For Policymakers: Introduction And Overview, Robin L.P. Jump

Faculty Scholarship

Throughout history, pandemics and their aftereffects have spurred society to make substantial improvements in healthcare. After the Black Death in 14th century Europe, changes were made to elevate standards of care and nutrition that resulted in improved life expectancy.1 The 1918 influenza pandemic spurred a movement that emphasized public health surveillance and detection of future outbreaks and eventually led to the creation of the World Health Organization Global Influenza Surveillance Network.2 In the present, the COVID-19 pandemic exposed many of the pre-existing problems within the US healthcare system, which included (1) a lack of capacity to manage a large influx …

A Multilevel Intervention To Promote Hpv Vaccination Among Young Adults In Texas: Protocol For A Randomized Controlled Trial, Qian Lu, Lenna Dawkins-Moultin, Dalnim Cho, Naomi Q P Tan, Suellen Hopfer, Yisheng Li, Lois Ramondetta, Yusi Xu, Di Lun, Minxing Chen

Faculty, Staff and Student Publications

BACKGROUND: Human papillomavirus (HPV) infections can cause cancers of the cervix, vagina, vulva, penis, anus, and oropharynx. The most recently approved HPV vaccine, Gardasil-9, protects against HPV infection and can prevent HPV-associated invasive cancers. However, Gardasil-9 is one of the most underused vaccines in the US today. Young adults are at risk for HPV infection, but many are not vaccinated. This study uses a randomized controlled trial (RCT) to test an innovative multilevel intervention to increase HPV vaccination rates among young adults. In this paper, we describe the research protocol.

METHODS: The study uses a two by three factorial design. …

A Multilevel Intervention To Promote Hpv Vaccination Among Young Adults In Texas: Protocol For A Randomized Controlled Trial, Qian Lu, Lenna Dawkins-Moultin, Dalnim Cho, Naomi Q P Tan, Suellen Hopfer, Yisheng Li, Lois Ramondetta, Yusi Xu, Di Lun, Minxing Chen

Faculty, Staff and Student Publications

Background: Human papillomavirus (HPV) infections can cause cancers of the cervix, vagina, vulva, penis, anus, and oropharynx. The most recently approved HPV vaccine, Gardasil-9, protects against HPV infection and can prevent HPV-associated invasive cancers. However, Gardasil-9 is one of the most underused vaccines in the US today. Young adults are at risk for HPV infection, but many are not vaccinated. This study uses a randomized controlled trial (RCT) to test an innovative multilevel intervention to increase HPV vaccination rates among young adults. In this paper, we describe the research protocol.

Methods: The study uses a two by three factorial design. …

The Cost Of Long-Term Care In The Mountain West, 2023, Madison Dwyer, Freddy Nie, Annie Vong, Caitlin J. Saladino, William E. Brown Jr.

Health

This fact sheet examines data on the cost of long-term care for the Mountain West states of Arizona, Colorado, Nevada, New Mexico, and Utah from the Genworth “Cost of Care Survey.” Data on long-term care includes home health care, adult day health care facilities, licensed assisted living facilities, and certified and licensed nursing homes.

Restoring, Protecting, And Expanding Abortion Access In The United States: Seeking Consensus Through The Delphi Method, Sarah Pickering

Dissertations and Theses

Background: The Dobbs v. Jackson Women’s Health Organization Supreme Court decision exacerbated inequitable access to abortion in the US. Agreement is needed on which strategies should be prioritized to restore, protect, and expand abortion access.

Methods: We convened a multidisciplinary, geographically diverse Delphi panel of clinical, research, policy, legal, and advocacy experts to reach consensus (i.e., agreement >67%) on recommended actions. Using feedback from three rounds of surveys, and input from a select expert advisory group (N=10), we iteratively refined the statements and recommendations.

Results: The panel (N=85) developed 25 consensus statements and 32 recommendations for action by advocates, funders, …

A One Health Approach To Enhancing Sars-Cov-2 Surveillance, Lauren C. Cybulska

Dissertations and Theses

Background

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the virus that causes coronavirus disease-2019 (COVID-19) in humans, can also infect domestic dogs (Canis lupus familiaris) and cats (Felis catus). Susceptibility and viral transmissibility in these species are concerns for public health due to the spillover risk to humans or other animals. This dissertation uses a One Health framework to explore key issues on this topic. We aim to identify gaps in understanding of SARS-CoV-2 in companion animals and investigate novel surveillance methods through human, animal, and environmental health perspectives.

Methods

Paper 1 provides an in-depth exploration of …

Perception Of Pre-Existing Dm2 Management Among Pregnant Asian Indian Immigrants During Covid-19, Sanya Bedi Grewal

Walden Dissertations and Doctoral Studies

Type 2 diabetes is a chronic disease that exerts a significant burden among communities by increasing healthcare costs, reducing productivity, higher rates for premature mortality, and tangible socioeconomic burden, which overall reduces the quality of life. The purpose of the study was to explore the perception of pregnant Asian Indian immigrants regarding diabetes self-management strategies during the COVID-19 pandemic. Five women were recruited via purposive sampling from Facebook groups. Data were collected via individual interviews using Facebook groups. The health belief model was used to help understand and interpret the findings. Clarke and Braun’s thematic analysis method was used to …

Exploring Associations Between Poverty, Race/Ethnicity, Gender, And Childhood Obesity In Cherokee County, South Carolina, Lillie Mae Hall

Walden Dissertations and Doctoral Studies

Childhood obesity (CHO) rates have increased significantly worldwide over the last decade. The magnitude of CHO extends beyond physical health to include economic stability, social connections, and access to daily living resources. CHO is complex and requires a multifaceted approach that may differ from traditional prevention approaches and treatment. Over the years, interventions have focused on maintaining a balance of healthy eating and active living to reduce weight and promote lifelong behavior change. Body mass index (BMI) surveillance studies have been conducted in Cherokee County, South Carolina since 2012 to assess and inform CHO interventions. However, the data have not …

Access To Prostate-Specific Antigen Testing And Mortality Among Men With Prostate Cancer, Hari S. Iyer, Benjamin V. Stone, Charlotte Roscoe, Mei Chin Hsieh, Antoinette M. Stroup, Charles L. Wiggins, Fredrick R. Schumacher, Scarlett L. Gomez, Timothy R. Rebbeck, Quoc Dien Trinh

School of Public Health Faculty Publications

Importance: Prostate-specific antigen (PSA) screening for prostate cancer is controversial but may be associated with benefit for certain high-risk groups. Objectives: To evaluate associations of county-level PSA screening prevalence with prostate cancer outcomes, as well as variation by sociodemographic and clinical factors. Design, Setting, and Participants: This cohort study used data from cancer registries based in 8 US states on Hispanic, non-Hispanic Black, and non-Hispanic White men aged 40 to 99 years who received a diagnosis of prostate cancer between January 1, 2000, and December 31, 2015. Participants were followed up until death or censored after 10 years or December …

Perception Of Pre-Existing Dm2 Management Among Pregnant Asian Indian Immigrants During Covid-19, Sanya Bedi Grewal

Walden Dissertations and Doctoral Studies

Type 2 diabetes is a chronic disease that exerts a significant burden among communities by increasing healthcare costs, reducing productivity, higher rates for premature mortality, and tangible socioeconomic burden, which overall reduces the quality of life. The purpose of the study was to explore the perception of pregnant Asian Indian immigrants regarding diabetes self-management strategies during the COVID-19 pandemic. Five women were recruited via purposive sampling from Facebook groups. Data were collected via individual interviews using Facebook groups. The health belief model was used to help understand and interpret the findings. Clarke and Braun’s thematic analysis method was used to …

Impact Of Telehealth On Type 2 Diabetes Self-Management During The Covid-19 Pandemic, Nancy Olivo Marshall

Walden Dissertations and Doctoral Studies

The incidence of Type 2 diabetes mellitus (T2DM) is on the rise, particularly among adults aged 18 years and older. Glycosylated hemoglobin (HbA1c) levels are commonly used by healthcare professionals to assess glucose variability; fluctuations are associated with an increased risk of adverse effects. The COVID-19 pandemic highlighted the importance of self-directed management of HbA1c levels through telehealth. The purpose of this retrospective quantitative study was to investigate the effectiveness of self-directed management of HbA1c levels using telehealth among T2DM diagnosed adults at a community health service organization in the northeastern U.S. from December 2018 to 2022. Using multivariate regression …

Exploring Associations Between Poverty, Race/Ethnicity, Gender, And Childhood Obesity In Cherokee County, South Carolina, Lillie Mae Hall

Walden Dissertations and Doctoral Studies

Childhood obesity (CHO) rates have increased significantly worldwide over the last decade. The magnitude of CHO extends beyond physical health to include economic stability, social connections, and access to daily living resources. CHO is complex and requires a multifaceted approach that may differ from traditional prevention approaches and treatment. Over the years, interventions have focused on maintaining a balance of healthy eating and active living to reduce weight and promote lifelong behavior change. Body mass index (BMI) surveillance studies have been conducted in Cherokee County, South Carolina since 2012 to assess and inform CHO interventions. However, the data have not …

Well-Child Visits For Early Detection And Management Of Maternal Postpartum Hypertensive Disorders, Farah H Amro, Kim C Smith, Syed S Hashmi, Michelle S Barratt, Rachel Carlson, Kristen Mariah Sankey, Michal Fishel Bartal, Sean C Blackwell, Suneet P Chauhan, Baha M Sibai

Faculty, Staff and Student Publications

IMPORTANCE: Innovative approaches are needed to address the increasing rate of postpartum morbidity and mortality associated with hypertensive disorders.

OBJECTIVE: To determine whether assessing maternal blood pressure (BP) and associated symptoms at time of well-child visits is associated with increased detection of postpartum preeclampsia and need for hospitalization for medical management.

DESIGN, SETTING, AND PARTICIPANTS: This is a pre-post quality improvement (QI) study. Individuals who attended the well-child visits between preimplementation (December 2017 to December 2018) were compared with individuals who enrolled after the implementation of the QI program (March 2019 to December 2019). Individuals were enrolled at an academic …

Irx4204 Induces Senescence And Cell Death In Her2-Positive Breast Cancer And Synergizes With Anti-Her2 Therapy, Cassandra L Moyer, Amanda Lanier, Jing Qian, Darian Coleman, Jamal Hill, Vidyasagar Vuligonda, Martin E Sanders, Abhijit Mazumdar, Powel H Brown

Faculty, Staff and Student Publications

PURPOSE: Rexinoids, agonists of nuclear retinoid X receptor (RXR), have been used for the treatment of cancers and are well tolerated in both animals and humans. However, the usefulness of rexinoids in treatment of breast cancer remains unknown. This study examines the efficacy of IRX4204, a highly specific rexinoid, in breast cancer cell lines and preclinical models to identify a biomarker for response and potential mechanism of action.

EXPERIMENTAL DESIGN: IRX4204 effects on breast cancer cell growth and viability were determined using cell lines, syngeneic mouse models, and primary patient-derived xenograft (PDX) tumors. In vitro assays of cell cycle, apoptosis, …

An Atlas Characterizing The Shared Genetic Architecture Of Inflammatory Bowel Disease With Clinical And Behavioral Traits, Vikram R Shaw, Jinyoung Byun, Rowland W Pettit, Jason K Hou, Kyle M Walsh, Younghun Han, Christopher I Amos

Faculty, Staff and Students Publications

BACKGROUND: Inflammatory bowel disease (IBD) development is a complex, multifactorial process that involves extrinsic and intrinsic factors such as host genetics, the immune system, the gut microbiome, and environmental risks. To help understand the genetic contribution of clinical, behavioral, psychiatric, and diet-related traits, we aim to provide a deep and comprehensive characterization of the shared genetic architecture between IBD and hundreds of potentially related traits.

METHODS: Utilizing publicly available summary statistics from a previously published IBD genome-wide association study and hundreds of traits from the United Kingdom BioBank (UKBB), we performed linkage disequilibrium score regression (LDSR) analysis to estimate cross-trait …

Strength Of Selection In Lung Tumors Correlates With Clinical Features Better Than Tumor Mutation Burden, Ivan P Gorlov, Olga Y Gorlova, Spyridon Tsavachidis, Christopher I Amos

Faculty, Staff and Students Publications

Single nucleotide substitutions are the most common type of somatic mutations in cancer genome. The goal of this study was to use publicly available somatic mutation data to quantify negative and positive selection in individual lung tumors and test how strength of directional and absolute selection is associated with clinical features. The analysis found a significant variation in strength of selection (both negative and positive) among tumors, with median selection tending to be negative even though tumors with strong positive selection also exist. Strength of selection estimated as the density of missense mutations relative to the density of silent mutations …

Building Trust: The Role Of Place-Based Consciousness In Vaccine Hesitancy, Ramsey W. Ash

Quantitative Social Science Undergraduate Senior Theses

Vaccine hesitancy poses a threat to public health initiatives of the 21st century. Following a stark divide in the rural/urban COVID-19 vaccine uptake and harsh disparities between these areas in COVID-19 moralities and morbidities, further understanding of the drivers of vaccine hesitancy are needed. This study makes use of the framework of place-based consciousness (PBC), pioneered by scholars of rural political science, such as Katherine Cramer, to explore this phenomenon as a mechanism by which to understand vaccine hesitancy. To examine this, an experimental survey was distributed to 300 Americans (150 rural and 150 urban) that inquired about their PBC, …

Development Of An Advanced Step Counting Algorithm With Integrated Activity Detection For Free Living Environments, Paige M. Dolan

Master's Theses

Physical activity plays a crucial role in maintaining overall health and reducing the risk of various chronic diseases. Step counting has emerged as a popular method for assessing physical activity levels, given its simplicity and ease of use. However, accurately measuring step counts in free-living environments presents significant challenges, with most activity trackers exhibiting a percent error above 20%. This study aims to address these challenges by creating a machine learning algorithm that leverages activity labels to improve step count accuracy in real-world conditions. Two approaches to balancing data were used: one employed a simpler oversampling technique, while the other …