Public Health Commons^™

Public And Community Perceptions Of Safe Injection Sites, Bahram Pashaee, Mph, Gary Kaplan, Mslis, Amy Leader, Drph, Mph

Health Equity and Quality Improvement (HEQI) Summit

Background

• The opioid epidemic began in 1999 and the number of deaths from overdoses has since quadrupled by 2019
• 50,000 deaths in the US in 2019 from opioid overdoses and the numbers increase each year
• Research Question: What are the public’s and communities' perceptions of safe injection sites?

Identifying Phytoremediation Performing Plant Species That Can Be Utilized In The Improvement Of Heavy Metal Contaminated Soils, Ashley Clark*, Samuel Mutiti

Graduate Research Showcase

Heavy metal pollution is a problem associated with industrialization and development. Two major metals that are commonly mined and can enter the environment, which can jeopardize communities’ health, are copper (Cu) and lead (Pb). There are different options for reducing heavy metal pollution in the environment via remediation efforts, including physical, chemical, and biological methods. However, physical and chemical remediation can be costly and labor-intensive, making them unsuitable for regions that do not have the funds to utilize these practices. Biological remediation is a more cost-conservative practice that has been shown in many studies to be effective in the gradual …

The Tensegrity Curriculum: A Comprehensive Curricular Structure Supporting Cultural Humility In Undergraduate Medical Education., Anne C Jones, Kristin N Bertsch, Deborah Williams, Millicent King Channell

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Due to growing health disparities in underserved communities, a comprehensive approach is needed to train physicians to work effectively with patients who have cultures and belief systems different from their own. To address these complex healthcare inequities, Rowan-Virtua SOM implemented a new curriculum, The Tensegrity Curriculum, designed to expand beyond just teaching skills of cultural competence to include trainees' exploration of cultural humility. The hypothesis is that this component of the curriculum will mitigate health inequity by training physicians to recognize and interrupt the bias within themselves and within systems. Early outcomes of this curricular renewal process reveal increased student …

Los Intérpretes Médicos Son Un Derecho, No Un Privilegio, Morgan Uesseler

World Languages and Cultures Senior Capstones

This essay explores medical interpretation as a right, not a privilege. It argues that medical interpretation is a vital service that should be required in all healthcare settings, not just in those that are funded by the government. Themes addressed include the difference between interpretation and translation, face-to-face interpretation versus telecommunication, liabilities and risks associated with untrained and uncertified medical interpreters, and the federal law Title VI of the Civil Rights Act of 1964. Challenges experienced during any medical session are underscored, while giving special focus to limited English proficient Hispanic patients whose healthcare literacy is in Spanish, not English.

Toxicological Impacts Of River Chemical Spills In Affected West Virginia Counties, Janice Lorraine Taylor Peters

Walden Dissertations and Doctoral Studies

Factors such as geographical location/proximity and exposure to external environmental events, as well as poor regulatory processes, are known to increase the risk for cancers among affected populations. There is still a gap in the literature related to the incidence of cancers in specific regions with heavy industrialization and environmental health hazards. In West Virginia, chemical contamination events have occurred in or near water systems. The goal of this quantitative, retrospective study was to discover whether there were any differences in the incidence of disease or adverse health effects and cancers due to chemical contamination in four counties (Kanawha, Mingo, …

Pricks And Pills, Anna A. Charles

Theses and Dissertations

"Pricks and Pills" is a collection of audio pieces designed for an online platform where individuals with diabetes can listen to and find emotional support from others who share their experiences. This audio project provides an intimate look into the lives of people navigating the challenges of diabetes. Through heartfelt interviews with individuals and their families, the podcast highlights their journeys, showcasing both their struggles and triumphs.

Examining The Relationship Between Patient Engagement With Digital Inhaler Technology And Asthma Control, Tanisha D. Hill

Walden Dissertations and Doctoral Studies

Asthma is a chronic lung disease that has significant public health and economic impact. Nonadherence to asthma medications can lead to poor treatment response and poor asthma outcomes. Digital health technologies have been shown to improve asthma medication adherence as well as asthma outcomes. The purpose of this quantitative research study was to examine the relationship between patient characteristics and mobile app engagement and the relationship between patient engagement with a digital inhaler app and asthma control in adult patients with uncontrolled asthma who were assigned to use a digitally enabled asthma medication and accompanying app for asthma therapy. Several …

Potential Adverse Cardiovascular Side Effects Following Mrna Covid-19 Vaccination, Abigayle Strohmeier

Senior Honors Theses

The COVID-19 vaccine, regarded as a triumph by some and a danger by others, has been studied due to the presence of adverse cardiovascular side effects experienced by some individuals following vaccination. Incidence and prevalence rates of these effects are examined by various demographic factors, primarily age and sex. The most prevalent adverse cardiovascular effects noted are myocarditis, pericarditis, cardiovascular disease, tachycardia, hypertension, palpitation, and acute myocardial infarction. Due to the novelty of the mRNA COVID-19 vaccine, many health studies have focused their data analysis on age or sex characteristics, however many excellent opportunities for future research are necessary to …

Genetic Variants For Head Size Share Genes And Pathways With Cancer, Maria J Knol, Raymond A Poot, Tavia E Evans, Claudia L Satizabal, Aniket Mishra, Muralidharan Sargurupremraj, Sandra Van Der Auwera, Marie-Gabrielle Duperron, Xueqiu Jian, Isabel C Hostettler, Dianne H K Van Dam-Nolen, Sander Lamballais, Mikolaj A Pawlak, Cora E Lewis, Amaia Carrion-Castillo, Theo G M Van Erp, Céline S Reinbold, Jean Shin, Markus Scholz, Asta K Håberg, Anders Kämpe, Gloria H Y Li, Reut Avinun, Joshua R Atkins, Fang-Chi Hsu, Alyssa R Amod, Max Lam, Ami Tsuchida, Mariël W A Teunissen, Nil Aygün, Yash Patel, Dan Liang, Alexa S Beiser, Frauke Beyer, Joshua C Bis, Daniel Bos, R Nick Bryan, Robin Bülow, Svenja Caspers, Gwenaëlle Catheline, Charlotte A M Cecil, Shareefa Dalvie, Jean-François Dartigues, Charles Decarli, Maria Enlund-Cerullo, Judith M Ford, Barbara Franke, Barry I Freedman, Nele Friedrich, Melissa J Green, Simon Haworth, Catherine Helmer, Per Hoffmann, Georg Homuth, M Kamran Ikram, Clifford R Jack, Neda Jahanshad, Christiane Jockwitz, Yoichiro Kamatani, Annchen R Knodt, Shuo Li, Keane Lim, W T Longstreth, Fabio Macciardi, Outi Mäkitie, Bernard Mazoyer, Sarah E Medland, Susumu Miyamoto, Susanne Moebus, Thomas H Mosley, Ryan Muetzel, Thomas W Mühleisen, Manabu Nagata, Soichiro Nakahara, Nicholette D Palmer, Zdenka Pausova, Adrian Preda, Yann Quidé, William R Reay, Gennady V Roshchupkin, Reinhold Schmidt, Pamela J Schreiner, Kazuya Setoh, Chin Yang Shapland, Stephen Sidney, Beate St Pourcain, Jason L Stein, Yasuharu Tabara, Alexander Teumer, Anne Uhlmann, Aad Van Der Lugt, Meike W Vernooij, David J Werring, B Gwen Windham, A Veronica Witte, Katharina Wittfeld, Qiong Yang, Kazumichi Yoshida, Han G Brunner, Quentin Le Grand, Kang Sim, Dan J Stein, Donald W Bowden, Murray J Cairns, Ahmad R Hariri, Ching-Lung Cheung, Sture Andersson, Arno Villringer, Tomas Paus, Sven Cichon, Vince D Calhoun, Fabrice Crivello, Lenore J Launer, Tonya White, Peter J Koudstaal, Henry Houlden, Myriam Fornage, Fumihiko Matsuda, Hans J Grabe, M Arfan Ikram, Stéphanie Debette, Paul M Thompson, Sudha Seshadri, Hieab H H Adams

Faculty, Staff and Student Publications

The size of the human head is highly heritable, but genetic drivers of its variation within the general population remain unmapped. We perform a genome-wide association study on head size (N = 80,890) and identify 67 genetic loci, of which 50 are novel. Neuroimaging studies show that 17 variants affect specific brain areas, but most have widespread effects. Gene set enrichment is observed for various cancers and the p53, Wnt, and ErbB signaling pathways. Genes harboring lead variants are enriched for macrocephaly syndrome genes (37-fold) and high-fidelity cancer genes (9-fold), which is not seen for human height variants. Head size …

Risk Factors For Hepatitis A Hospitalizations And Mortality In Kentucky's 2018 Hepatitis A Outbreak, Tanya Campbell

Walden Dissertations and Doctoral Studies

In 2018, the state of Kentucky faced an outbreak of Hepatitis A virus (HAV), which led to a significant increase in HAV cases, hospitalizations, and fatalities. The social-ecological model (SEM) was used in a cross-sectional design to identify the factors associated with this outbreak. This approach employed secondary data extracted from the National Notifiable Disease Surveillance System (NNDSS). Logistic regression was used to test hypotheses determining homelessness, drug use, and HAV vaccine status were related to HAV hospitalizations. There was a statistically significant association between the covariate age and HAV hospitalization (p = 0.004), and between homelessness and hospitalization (p < .001); however, associations between drug use and HAV vaccine status were not statistically. Intervention programs should target homeless populations; such targeting can lead to a reduction in HAV infections and HAV outbreaks. Implications for positive social change include motivation for policymakers and public health officials to assist in curtailing hospitalization and mortality rates caused by HAV in high-risk groups. Targeted prevention and intervention measures can mitigate the incidence of HAV in high-risk populations and enhance their health prospects.

Implementation Of A Doula-Supported Postpartum Wellness Toolkit In A Black Community-Based Maternal Wellness Program, Janice Luethje, Leslie Torres

Doctor of Nursing Practice Projects: College of Nursing

Objective: The objective of this project was to expand the areas of focus within a maternal wellness program at a Black community center and to evaluate the satisfaction levels of the doulas who utilized the material during postpartum home visits. The toolkit covers a range of postpartum topics in the areas of nutrition, exercise, sexual health, mindfulness, and social support as well as a postpartum mental health screening tool.

Design: This quality improvement project included three distinct phases: The pre-implementation phase, the implementation phase, and the post-implementation phase.

Setting: The project location was a Black community center in Lincoln, Nebraska. …

Unplanned Pregnancy As An Independent Risk Factor For Antepartum Si In A Post Roe Vs. Wade World, Rianna Mcnamee

Rowan-Virtua Research Day

Abstract: The objective of this literature review is to determine whether unplanned pregnancy is an independent risk factor for developing antepartum SI. Background: The Supreme Court of the United States of America recently ruled that the constitution of the United States does not confer a right to abortion to its citizens. As of October 2023, twenty-one states had developed full or partial bans on abortion, resulting in millions of Americans residing in areas where terminating unplanned pregnancy is not a viable option. There is evidence that indicates antepartum suicidal ideation (SI) is higher than that of the general population, however …

An Unexpected Finding During A Breast Excisional Biopsy: A Case Report, Emily Forester, Anjeanette Brown

Rowan-Virtua Research Day

Background: Pacemaker leads within the breast are rare. Although it is infrequent, there are some reports of implanted cardiac devices or wires migrating into breast tissue or through the chest wall. To the best of our knowledge, there are no current reports of pacemaker leads within the breast tissue of a patient with concurrent breast cancer. This case aims to detail the surgical management of this rare phenomenon.

Case Presentation: A pacemaker-dependent, female patient presented to the operating room for a left breast excisional biopsy. Intraoperatively, two epicardial leads were unexpectedly found within the center of the patient’s breast tissue. …

Clinical Outcomes For Va-Ecmo Patients Associated With Hyperlipidemia: An Analysis Of The National Inpatient Sample, Dakota B. Pastore, Tony Elias, Rafail Beshai, Kyrillos Girgis, Maziyar Daneshvar, Keith Anacker

Rowan-Virtua Research Day

Introduction: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is considered the most advanced temporary life support which provides complete hemodynamic support in addition to gas exchange. There is limited data available on the impact of hyperlipidemia (HLD) on VA-ECMO patients. We sought to examine the national inpatient sample (NIS) database to describe in-hospital outcomes among these patients.

Methods: The NIS was searched for hospitalizations of adult VA-ECMO patients with and without a concomitant diagnosis of HLD for the years 2019 and 2020. The primary outcome was inpatient mortality.

Results:This study included 3,885 VA-ECMO patients, of which 1,082 (27.8%) patients had HLD. …

Outcomes Of Thoracic Endovascular Aortic Repair (Tevar) Procedure In Octogenarians, Nonagenarians And Centenarians: A Population-Based Study, Dakota B. Pastore, Tony Elias, Rafail Beshai, Kyrillos Girgis, Maziyar Daneshvar, Keith Anacker

Rowan-Virtua Research Day

Introduction: Limited data exists for patients undergoing a thoracic endovascular aortic repair (TEVAR) procedure who are older than or equal to 80 years old (YO). This study sought to examine the national inpatient sample (NIS) database to describe in-hospital outcomes among these older patients.

Methods: The NIS was searched for hospitalizations of adults who underwent a TEVAR procedure in 2019 and 2020. The study compared those aged 80 YO and over to those younger than 80 YO. The primary outcome was inpatient mortality. Secondary outcomes included hospital length of stay (LOS), and total hospital charges (TOTHCG).

Results: This study included …

Sex Differences In Outcomes Among Patients Undergoing Thoracic Endovascular Aortic Repair (Tevar) Procedure: A Retrospective Cohort Study, Dakota B. Pastore, Tony Elias, Rafail Beshai, Kyrillos Girgis, Maziyar Daneshvar, Keith Anacker

Rowan-Virtua Research Day

Introduction: There is limited data about sex differences in patients undergoing a thoracic endovascular aortic repair (TEVAR) procedure. This study sought to examine the national inpatient sample (NIS) database to describe in-hospital outcomes by gender.

Methods: The NIS was searched for hospitalizations of adult patients who underwent TEVAR in 2019 and 2020. For this cohort, female patients were identified, and pregnant patients were excluded. The primary outcome was inpatient mortality. Secondary outcomes included hospital length of stay (LOS), and total hospital charges (TOTHCG).

Results: This study included 696 patients who underwent TEVAR. 255 (36.6%) females were identified, of which, 7 …

Evaluating The Effectiveness Of A School-Based Cognitive Behavioral Youth Depression Prevention Program In Improving Life Satisfaction, Roshani Patel, Steven M. Brunwasser, Alissa Hochman

Rowan-Virtua Research Day

Depression is the leading cause of disability worldwide, known as the global burden of disease. Incident cases from 1990 to 2017 have increased by 49.86%. Additionally, rates have been seen to dramatically rise in adolescents aged 18-25 (17%) compared to rates in individuals aged 10-14 (1.1%). This makes it beneficial to have prevention programs for middle school aged children. The Penn Resiliency Program (PRP) is a youth depression prevention program focused on cultivating healthy thinking styles and behavioral coping skills. In our study, we used archival data from a randomized control trial of PRP to evaluate whether the program led …

Accessibility To Gender Affirming Treatments For Transgender Patients In New Jersey, Tara Young, Tara Pellegrino

Rowan-Virtua Research Day

Background: The literature clearly indicates that gender affirming treatments, such as gender reassignment surgery, counseling, exogenous hormones, and feminization/masculinization surgery, are highly effective and beneficial for transgender patients.

Purpose: The purpose of this review was to assess the barriers to accessing gender affirming treatments in New Jersey.

Methods: This review utilized the PubMed database and Google searches to gather information. The search terms included LGBTQ healthcare, LGBTQ Medicaid, transgender treatment, transgender healthcare, top surgery New Jersey, New Jersey Medicare and Medicaid, and transgender Health Insurance in New Jersey.

Results: New Jersey State Medicaid covers both gender affirming surgery and …

Investigating Patient Barriers In Receiving Mammography Screenings Following The Covid-19 Pandemic, Nicole Clarke, Tara Pellegrino

Rowan-Virtua Research Day

Current literature shows reduced breast cancer mortality is associated with compliance of mammographic screenings (Duffy, 2020), specifically increasing the survival rate an estimated 1-2% every year for the past thirty years (Giordano, 2004). However, during the Covid-19 pandemic, rates of basic cancer screenings, including breast cancer, all declined (Chen, 2021). Unfortunately, even in a “post-pandemic” world, years after the height of the pandemic, the Rowan-Virtua School of Osteopathic Medicine Family Medicine Office has noticed many female patients still have not kept up with their routine basic healthcare screenings. While there are many barriers in access to healthcare, this survey-based study …

Impact Of Diabetic Education On Reducing Hospital Readmission Rates: A Literature Review Of Adults With Diabetes, Frank Camarda

Rowan-Virtua Research Day

According to 2018 data from the Diabetes Institute Foundation, adults in the U.S. diagnosed with diabetes accounted for 17 million emergency department visits. The readmission rate for patients with diabetes far exceeds the general readmission rates for hospitalized patients. While there is recognition of the need for diabetic education to reduce hospital readmissions, optimizing long-term self-management of diabetics remains a focus of ongoing research.

Investigating The Factors That Lead To Sports Related Injuries In Children, Kinjal Shah, Shawna Rotoli

Rowan-Virtua Research Day

This project’s focus is to investigate if playing contact versus non-contact sports at a young age leads to more sports related injuries and to identify which factors correlate with increased injury rate in order to develop the most effective prevention and treatment methods. Data was collected through a survey including questions that delve deeper to quantify the amount of strain being put on the youth athlete’s body such as hours played a week, level of competitiveness, weeks played in a year, contact versus non-contact sport, and number of sports played. The following set of questions then addressed the actual injury …

Addressing Gaps In Care Through A Medical Student-Led Cancer Screening Project, Matthew Green, Hannah Ngo, Dakota B. Pastore, Jenna Zappetti, Olivia Siciliano, Meghan Mcquade, John Sauer, Anne Jones

Rowan-Virtua Research Day

Background: Colorectal cancer (CRC), breast cancer (BrCa), and cervical cancer are three of the most preventable cancers. Despite the known significance for early detection and treatment, barriers to screening remain. We developed a medical student-led project to improve adherence to national cancer screening guidelines in patients across Rowan-Virtua Family Medicine (FM) practices. This study assesses the initiative’s efficacy in improving adherence to CRC, BrCa, and cervical cancer screenings.

Methods: Rowan-Virtua FM patients between the ages of 21-75 (n=735) were identified as due or up-to-date on cancer screenings based on chart review. Student volunteers were trained to contact patients to discuss …

A Rare Intervention: Perimortem Hysterotomy In An Obstetric Emergency In A 32-Year-Old Female, Alec Mirchandani

Rowan-Virtua Research Day

In the realm of obstetric emergencies, perimortem hysterotomy stands as a rare but crucial intervention, employed in dire circumstances to salvage both maternal and fetal lives. This procedure, involving the surgical delivery of a fetus from a mother in cardiac arrest, presents a unique set of challenges and ethical considerations for healthcare providers. This case report delves into the intricate details surrounding a perimortem hysterotomy performed under emergent conditions, exploring the clinical decision-making process, procedural intricacies, and outcomes. Through this narrative, we aim to shed light on the complexities of managing obstetric emergencies, emphasizing the critical role of timely intervention …

What Is The Impact Of Marijuana Usage On Sexual Dysfunction Among Individual And How Do Factors Such As Frequency Of Use, Dosage, And Duration Of Marijuana Consumption Influence Sexual Function, Zachary A. Harris, Russell Levi, Saad Ahmed

Rowan-Virtua Research Day

Sexual health is an integral piece of human vitality, encompassing a multitude of psychological & physiological factors. There has been an unprecedented amount of interest surrounding cannabis and its impact on sexual function in the past decade. The interplay between the acceptance of cannabis and its widespread use presents the need for research into the correlation between cannabis and sexual health outcomes. The primary components of cannabis, cannabidiol (CBD) and tetrahydrocannabinol (THC) have attracted scrutiny for their potential effects on sexual function. Anecdotal accounts suggest heightened sexual desire and pleasure, however there are conflicting reports raising concerns regarding performance issues …

Standardization Of Discharge Instructions For Mild Traumatic Brain Injury/Concussion In Children Presenting To Ed: A Qi Project, Niralee K. Rana, Nicole Gerber, Michael Alfonzo, Snezana Osorio, Deborah Levine

Rowan-Virtua Research Day

Background: Mild traumatic brain injuries (mTBI) or concussions account for high rates of emergency department (ED) visits. Concussion diagnoses are used less often in young children leading to a variability in parental education and discharge instructions. Lack of discharge guidance may increase parental anxiety, impact recovery, and increase ED visits.

Objectives: To increase the proportion of ED patients discharged with age-appropriate instructions for mTBI by 50% by June 1, 2024, and to determine the impact age-appropriate instructions have on decreasing parental anxiety.

Methods: This observational time series with planned sequential experimentation is in progress at a Pediatric ED affiliated with …

Case Report: A Case Of Ttp In The Ed, Brian F. Lim, Andrew Caravello, James A. Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report a case of a 54-year-old female who presented with mild shortness of breath, lower chest discomfort, fatigue, and weakness ongoing for several days and was diagnosed with thrombotic thrombocytopenic purpura (TTP). TTP is characterized by microangiopathic hemolytic anemia and thrombocytopenia due to either an inherited or immune-mediated reduction in von Willebrand Factor (VWF) cleaving protease ADAMTS13.

Patients presenting with non-specific symptoms is becoming increasingly common and initial bias could be to attribute symptoms to viral syndrome or upper respiratory tract infection. However, the differential for non-specific complaints is extensive and thorough review of labs and re-evaluations of patients …

Clinical Outcomes For Cardiac Ablation In Octogenarians, Nonagenarians, And Centenarians: A Retrospective Cohort Study, Tony Elias, Mena Elmalh, Kyrillos Girgis, Michael Valderrama, Rafail Beshai

Rowan-Virtua Research Day

Background

Cardiac ablation is a therapeutic intervention aimed at correcting abnormal heart rhythms by disrupting electrical pathways in the heart, using techniques such as radiofrequency or cryoablation. Despite its effectiveness, there is a scarcity of data regarding the outcomes of cardiac ablation specifically among elderly patients. Previous studies have highlighted the complexities and challenges associated with managing cardiac arrhythmias in the elderly population, emphasizing the need for further investigation into treatment outcomes in this demographic.1,2 Therefore, this study aimed to investigate in-hospital outcomes among elderly patients who underwent cardiac ablation using data from the National Inpatient Sample (NIS) Database.

Methods …

Case Report: Monkeypox Diagnosed In The Ed, Richard M. Baluyot, Joseph Pagano, James A. Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Rashes are one of the most common chief complaints we see as emergency medicine physicians on a day-to-day basis. Most of them tend to be self-limited and require very little workup and can be discharged home; however, it is our job to try to identify rashes that may require isolation in order to prevent an outbreak in our communities. Here we present a case of one such rash that has gained major media attention as of late, Monkeypox.

The Effect Of Covid-19 Pandemic On Sanitation Practices And Anxiety In The General Population, Leah Cliatt, Joanna Petrides

Rowan-Virtua Research Day

Background: Illness anxiety and fear of contracting coronavirus increased considerably during the COVID-19 pandemic. The media, being in lockdown, and cyberchondria had the largest impact on the population’s anxiety surrounding illness. While this kind of reaction to illness is expected during the pandemic, there is limited data on post-pandemic illness anxiety levels in the general population. Patients’ perception of disease impacts medicine at every level; medical professionals need to understand the concerns and fears of their patients in order to treat the post-pandemic patient. We hypothesized that sanitation practices and anxiety surrounding illness have not returned to baseline pre-COVID-19 …

Use Of Point-Of-Care Ultrasound In The Diagnosis Of Postpartum Cardiomyopathy, Muhammad Noman, Frank A. Wheeler, James A. Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Postpartum cardiomyopathy (PPCM), also known as peripartum cardiomyopathy is a rare form of heart failure (HF) that occurs in the late stages of pregnancy or in the early postpartum period. For it to be classified as PPCM, it must occur in the absence of another identifiable cause for HF and have left ventricular (LV) systolic dysfunction with an LV ejection fraction (LVEF) less than 45%. Here we present the case of a 46-year-old female G3P2 presented 5 days postpartum cesarean section delivery in acute respiratory distress where point of care ultrasound was used for assessment of the lungs to visualize …