Public Health Commons^™

The Association Between Post-Stroke Delirium And Mortality Among Stroke Patients In Long-Term Facilities, Nuo Xu

All ETDs from UAB

Delirium is a common neurobehavioral complication following a stroke. Patients who have post-stroke delirium (PSD) are more likely to have severe prognoses, such as physical function decline, high mortality and an increased need for long-term care. Nursing home residents as one of the fragile and special populations sharing the attributes of old age, and high prevalence of chronic diseases and limited mobility. However, there only a few studies have investigated the association between PSD and mortality among individuals admitted to a long-term care facility. This retrospective cohort study aimed to examine the association between PSD and mortality among the participants …

Applications Of Longitudinal Machine Learning Methods In Multi-Study Alzheimer's Disease Datasets, Charles F. Murchison

All ETDs from UAB

Advances in statistical learning models for prediction have led to broader application across a variety of disciplines, granting generalizations and adaptations that were previ-ously intractable even with advanced computational techniques. Among these is the al-lowance of correlated data with inherent paneled structure such as longitudinal or clus-tered data; adjustments which have already begun to be applied to a variety of supervised and unsupervised machine learning methods which had previously focused on cross-sec-tional data. These modifications have seen rudimentary testing in a number of applied disciplines where correlated data is commonly observed, including medical and clinical research. One field in particular …

Cardiovascular Disease Risk In Head Neck Squamous Cell Carcinoma Patients: Using Electronic Medical Records Data, Amrita Mukherjee

All ETDs from UAB

The objective of my dissertation research was to assess burden of cardiovascular disease (CVD) risk factors in Head Neck Squamous Cell Carcinoma (HNSCC) patients and to determine the association of traditional CVD risk factors and HNSCC-related factors with incident CVD outcomes. For this clinical cohort study, I analyzed electronic medical records (EMR) and tumor registry data on HNSCC patients diagnosed between January 2012 and December 2018 at UAB hospital and O’Neal Comprehensive Cancer Center. First, I assessed prevalence and incidence of traditional CVD risk factors at HNSCC diagnosis (baseline) and at one-year post HNSCC diagnosis, respectively. Then I determined the …

Multidrug-Resistance, Antibiotic-Associated Acute Kidney Injury, And Poor Disease Prognosis In Community-Acquired Bacterial Pneumonia, Adeniyi J. Idigo

All ETDs from UAB

In this dissertation research, I examined the challenges of treating patients with bacterial community-acquired pneumonia (CAP) with the purpose of identifying risk factors linked with multidrug-resistant (MDR) Pseudomonas, treatment toxicity, and poor disease prognosis. I used a retrospective cohort study design to explore a clinical cohort of patients admitted to the University of Alabama at Birmingham hospital network who had bacterial pneumonia diagnosis assessed to be from community transmission between January 2013-December 2019. Electronic medical records were accessed for socio-demographic and clinical information. First, I examined the local prevalence/incidence of Pseudomonas CAP and MDR Pseudomonas CAP, and the relationship between …

Role Of Partnership In Hiv-Related Outcomes In Heterosexual Individuals Newly Diagnosed With Hiv, Maira Sohail

All ETDs from UAB

A supportive intimate partner has shown to be helpful in HIV care of men who have sex with men, and in some African heterosexual couples; however, knowledge on this phenomenon among heterosexual people with HIV (PWH) is limited in the United States context. This project included two quantitative studies and one qualitative study to examine the role of intimate partnership in HIV care among heterosexual, newly diagnosed PWH. Both quantitative studies were conducted among heterosexual, newly diagnosed (2013-2017) individuals at the University of Alabama at Birmingham (UAB) 1917 Clinic. The first study examined the role of partnership (un-partnered, unmarried-partnered, and …

An Investigation Of Strain And Support Needs Of Caregivers Of Older Adults With Delirium And Allied Health Promotion Interventions, Jasmine Vickers

All ETDs from UAB

Delirium, or the sudden onset of confusion, is common, highly distressing, debilitating, and deadly among hospitalized older adults and is associated with adverse outcomes for their family caregivers. As people are living longer with more complex conditions, more people will face the task of caregiving for older adults with delirium. Family caregivers can make meaningful contributions to delirium care, but high distress, insufficient knowledge, and lack of skills often seen in caregivers can lead to maladaptation and negative health outcomes. A few studies have focused on distress in caregivers from witnessing delirium episodes; however more research is needed to understand …

Likelihood Based Inferential Methods To Analyze Trials Incorporating Patient's Treatment Choice, Rouba A. Chahine

All ETDs from UAB

Randomized clinical trials (RCT) are the gold standards for clinical trials as they reduce bias and minimize variability between different arms of a study. One of the drawbacks of these designs is their lack of flexibility to incorporate patient’s preference, which may reduce recruitment rates and/or reduce patient’s tolerance if they receive a non-preferred treatment. Designs incorporating choice allow a subset of participants to choose a preferred treatment. Some of these designs are Zelen’s (1979), Brewin’s (1989), and Rucker’s (Two-Stage RCT, 1989). Current methods to analyze two-stage RCT are based on an analysis of variance (ANOVA) approach that do not …

Cognitive Progression And Care Patterns In All-Cause Dementia By Prior Cancer Diagnosis, Mackenzie Elisha Fowler

All ETDs from UAB

Cancer and dementia are common aging-related diseases. Cancer and itstreatments are associated with cognitive impairment referred to as cancer-related cognitive impairment (CRCI). Dementias demonstrate similar impairment. Only one study has examined the longitudinal association between cancer and dementia. This dissertation goes beyond limitations of the prior study and has three aims: 1.) to evaluate dementia progression by prior cancer diagnosis, 2.) to evaluate progression of all-cause dementia by cancer treatments, and 3.) to evaluate patterns and predictors of care among dementia patients by cancer history. This study uses EHR data to evaluate cognitive progression by cancer history /cancer treatment characteristics, …

Barriers To Purchasing Narcan® In Georgia: A Survey Of Pharmacy Staff, Thomas E. Griner, Sheryl Strasser, Stacie Kershner, Ashli Owen-Smith, Matthew J. Hayat

Journal of the Georgia Public Health Association

Background: In Georgia, recent measures have expanded public access to naloxone-containing products like Narcan® to combat opioid-related overdose deaths. Although laypersons may legally purchase naloxone products without a prescription for use during opioid-related overdose events, barriers may remain.

Methods: We conducted an anonymous telephone survey to investigate three potential barriers to purchasing naloxone (Narcan®) in Georgia: availability, price, and working knowledge of legal requirements among pharmacy representatives. We surveyed pharmacy representatives in select Georgia counties with high volumes or high rates of poisoning deaths compared with other counties. We also compared responses among chain and non-chain representatives. Descriptive statistics are …

“It Didn’T Matter What The Bill Said...”: Influences On Abortion Policy Legislative Decision-Making In Georgia, Erica Barton, Subasri Narasimhan, Dabney P. Evans

Journal of the Georgia Public Health Association

Background: In March 2019 the Georgia legislature passed HB 481 described as a “heartbeat bill”, prohibiting abortion at around six weeks gestation. Given the prevalence of anti-abortion legislation and the public health implications of abortion restrictions, we sought to understand how Georgia legislators made decisions on this early abortion ban legislation.

Methods: We conducted in-depth interviews with nine legislators from the Georgia House of Representatives who participated in the 2019 legislative session. In-depth interviews were conducted in-person and over the phone. Interview recordings were transcribed verbatim and inductive codes identified. Codes focused primarily on views of: abortion in general; specific …

Parental School Involvement On Physical Activity And Screen Time Among Middle And High School Students, Joseph Greer, Kiran Thapa, Jessica Mcnulty, Janani R. Thapa

Journal of the Georgia Public Health Association

Background: High levels of sedentary activity and low levels of physical activity have led to an increase in childhood obesity. A reduction of sedentary behavior and the promotion of an active lifestyle positively impacts weight status of children. A child may modify their behavior through direct interventions from their parents, such as enforcement of rules or guided activities, or through broad interventions, by expressing their values and modeling behavior. Current research does not establish if broad or specific parental involvement has a greater effect on healthy behavior. Our group sought to support existing evidence that parental involvement directly impacts behavior …

Zika Virus Concern And Preventative Behaviors During Pregnancy: Analysis Of 2017 Georgia Pregnancy Risk Assessment Monitoring System Data, Priya R. Nair, Christine E. Stauber

Journal of the Georgia Public Health Association

Background: Zika virus infection can cause severe health complications in pregnant women such as microcephaly and other congenital anomalies in the developing fetus but it can be prevented. It is imperative to develop an understanding of concern about Zika virus among pregnant women as this can influence their Zika virus preventative behaviors.

The purpose of this study was to gain an understanding of Zika virus concern among women in Georgia with live births in 2017 and to examine the frequency of condom use among those who were sexually active during their most recent pregnancy.

Methods: This cross- sectional study used …

Tobacco Reborn: The Rise Of E-Cigarettes And Regulatory Approaches, Daniel G. Aaron

Lewis & Clark Law Review

This Article examines e-cigarettes, FDA-regulated products which heat nicotine-containing fluid into an aerosol to be breathed into the lungs. Recent data show that e-cigarettes are used by about one-fifth of U.S. high school students. Given that we have, in the Surgeon General’s words, reached an epidemic of youth e-cigarette use, it is worth asking how a product within FDA jurisdiction became a serious threat to 3.6 million youth.

This Article reviews the law surrounding e-cigarettes and the history of FDA’s attempts to regulate them. Administrative law doctrines instruct us that increased presidential control will rein in misbehaving agencies by allowing …

How Inflammation, High-Density Lipoproteins, And Genes Affect The Relationship Between Apol1 And Kidney Outcomes, Ninad S. Chaudhary

All ETDs from UAB

Over the past decade, the discovery of novel genetic loci on chromosome 22q, apolipoprotein-L1 (APOL1), has given insights into the racial differences in kidney outcomes at the population level. APOL1 risk alleles are unique to African ancestry and confer increased susceptibility to end-stage kidney disease (ESKD) especially among individuals without diabetes. However, the diseases do not occur in all who inherit these alleles. Current efforts are driven towards identifying the factors that can interact with APOL1 in the development of kidney diseases. This dissertation investigated whether the association between APOL1 and kidney outcomes is affected by inflammatory markers (AIM1), high-density …

Grappling With Covid-19 By Imposing And Lifting Nonpharmaceutical Interventions In Sri Lanka: A Modeling Perspective, Mahesh Jayaweera, Chamath Dannongoda, Dilum Dilshan, Janith Dissanayake, Hasini Perera, Jagath Manatunge, Buddhika Gunawardana

Physics & Astronomy Faculty Publications

The imposition and lifting of non-pharmaceutical interventions (NPIs) to avert the COVID19 pandemic have gained popularity worldwide and will continue to be enforced until herd immunity is achieved. We developed a linear regression model to ascertain the nexus between the time-varying reproduction number averaged over a time window of six days (Rts) and seven NPIs: contact tracing, quarantine efforts, social distancing and health checks, hand hygiene, wearing of facemasks, lockdown and isolation, and health-related supports. Our analysis suggests that the second wave that emerged in Sri Lanka in early October 2020 continued despite numerous NPIs. The model indicates that the …

Epigenetic Mechanisms Underlying Hiv-Infection Induced Susceptibility Of Cd4+ T Cells To Enhanced Activation-Induced Fasl Expression And Cell Death., Smita Ghare, Paula M. Chilton, Aakarsha V. Rao, Swati Joshi-Barve, Paula Peyrani, Andrea Reyes-Vega, Craig J. Mcclain, Kendall Bryant, Robert L. Cook, Mathew Freiberg, Shirish Barve

Faculty and Staff Scholarship

Background:

Chronic immune activation and CD4⁺ T cell depletion are significant pathogenic features of HIV infection. Expression of Fas ligand (FasL), a key mediator of activation-induced cell death in T cells, is elevated in people living with HIV-1 infection (PLWH). However, the epigenetic mechanisms underlying the enhanced induction of FasL expression in CD4⁺ T lymphocytes in PLWH are not completely elucidated. Hence, the current work examined the effect of HIV infection on FasL promoter-associated histone modifications and transcriptional regulation in CD4⁺ T lymphocytes in PLWH.

Method:

Flow cytometric analysis was performed to examine the Fas-FasL expression on …

An Assessment Of Contamination Fingerprinting Techniques For Determining The Impact Of Domestic Wastewater Treatment Systems On Private Well Supplies, Chris Fennell, Bruce Misstear, David O'Connell, Donata Dubber, Patrice Behan, Martin Danaher, Mary Moloney, Laurence Gill

Articles

Private wells in Ireland and elsewhere have been shown to be prone to microbial contamination with the main suspected sources being practices associated with agriculture and domestic wastewater treatment systems (DWWTS). While the microbial quality of private well water is commonly assessed using faecal indicator bacteria, such as Escherichia coli, such organisms are not usually source-specific, and hence cannot definitively conclude the exact origin of the contamination. This research assessed a range of different chemical contamination fingerprinting techniques (ionic ratios, artificial sweeteners, caffeine, fluorescent whitening compounds, faecal sterol profiles and pharmaceuticals) as to their use to apportion contamination of private …

Seaweeds Polysaccharides In Active Food Packaging: A Review Of Recent Progress, Carina Dietz, Shubham Sharma, Amit Jaiswal, Swarna Jaiswal

Articles

Background

Due to its short lifetime, food packaging leads to a rapid accumulation of plastic in our surroundings and thereby also has a huge impact on environmental pollution. To reduce these effects and create a more sustainable approach towards food packaging, biodegradable and biobased polymers have been developed and are emerging on the market.

Scope and approach

This review provides the current state of research regarding active packaging and the incorporation of seaweed into food packaging. Further, it summarises the resulting consequences of the seaweed incorporation on mechanical, physical, thermal, antioxidant, antimicrobial, and chemical properties, as well as the release …

Mortality Risk Attributable To Wildfire-Related Pm2·5 Pollution: A Global Time Series Study In 749 Locations, Gongbo Chen, Yuming Guo, Xu Yue, Shilu Tong, Antonio Gasparrini Antonio Gasparrini, Michelle L. Bell, Joel Schwartz, Jouni J K Jaakkola, Antonella Zanobetti, Eric Lavigne, Paulo Hilario Nascimento Saldiva, Haidong Kan, Dominic Royé, Ai Milojevic, Ala Overcenco, Aleš Urban, Alexandra Schneider, Alireza Entezari, Ana Maria Vicedo-Cabrera, Ariana Zeka, Aurelio Tobias, Baltazar Nunes, Barrak Alahmad, Bertil Forsberg, Shih-Chun Pan, Carmen Íñiguez, Caroline Ameling, César De La Cruz Valencia, Christofer Åström, Danny Houthuijs, Do Van Dung, Evangelia Samoli, Fatemeh Mayvaneh, Francesco Sera, Gabriel Carrasco-Escobar, Yadong Lei, Hans Orru, Ho Kim, Iulian-Horia Holobaca, Jan Kyselý, João Paulo Teixeira, Joana Madureira, Klea Katsouyanni, Magali Hurtado-Díaz, Marek Maasikmets, Martina S Ragettli, Masahiro Hashizume, Massimo Stafoggia, Mathilde Pascal, Matteo Scortichini, Micheline De Sousa Zanotti Stagliorio Coêlho, Nicolás Valdés Ortega, Niilo R I Ryti, Noah Scovronick, Patricia Matus, Patrick J. Goodman, Rebecca M Garland, Rosana Abrutzky, Samuel Osorio Garcia, Shilpa Rao, Simona Fratianni, Tran Ngoc Dang, Valentina Colistro, Veronika Huber, Whanhee Lee, Xerxes Seposo, Yasushi Honda, Yue Leon Guo, Tingting Ye, Wenhua Yu, Michael J. Abramson, Jonathan M. Samet, Shanshan Li

Articles

Many regions of the world are now facing more frequent and unprecedentedly large wildfires. However, the association between wildfire-related PM2·5 and mortality has not been well characterised. We aimed to comprehensively assess the association between short-term exposure to wildfire-related PM2·5 and mortality across various regions of the world.

Doctors Can’T Be Doctors All Of The Time: A Qualitative Study Of How General Practitioners And Medical Students Negotiate Public-Professional And Private-Personal Realms Using Social Media, Megan Marshall, Vikram Niranjan, Eimear Spain, Joe Macdonagh, Jane O'Doherty, Raymond O'Connor, Andrew O'Regan

Articles

The objective of this study is to explore the experiences and perspectives of general practitioners’ and medical students’ use of, and behaviour on, social media and to understand how they negotiate threats to professional and personal life on social media.

Food Contact Surfaces: Challenges, Legislation And Solutions, Shubham Sharma, Amit Jaiswal, Brendan Duffy, Swarna Jaiswal

Articles

Food contact surfaces (FCSs) include all surfaces that may come in contact with the food during production, processing, and packaging. Food processing industries encounter several challenges due to its microbial interaction with the FCSs, such as cross-contamination of pathogenic microorganisms or allergens in food, formation of biofilm, biodeterioration of food contact surface leads to food with reduced shelf-life and quality. A legal EU framework provides the fundamental postulates for the safety and inertness of all Food Contact Materials (FCMs). Legislations have an important role in providing regulatory guidance on the quality assurance systems and verifying their implementation as a means …

Undergraduate Students’ Perspectives On Mental Health Services, Resources, And Supports During Covid-19: A Qualitative Dissertation, Amy Hutson Chatham

All ETDs from UAB

During the COVID-19 pandemic, increased isolation from supportive relationships, uncertainty about the future, fear of illness, and lack of traditional life-events took a toll on university student mental health. It is important to understand undergraduate students’ mental health needs during the COVID-19 pandemic and their desires for support from their institutions of higher education. Existing studies have documented increased rates of depression, stress, and anxiety among university undergraduates; however, these studies rarely illuminate students’ perspectives on mental health services, resources, and supports that they need during and because of the COVID-19 pandemic. This phenomenological study explored the perspectives of undergraduate …

Viral Load Is Not A Predictor For Hearing Loss In Children With Congenital Cytomegalovirus Infection, Nazia Kabani

All ETDs from UAB

Background: Congenital cytomegalovirus (cCMV) infection is a leading non-genetic cause of sensorineural hearing loss (SNHL) in children. Most infants (~90%) with cCMV have no clinical abnormalities at birth (asymptomatic cCMV), but 10-15% of these children develop SNHL. Due to lack of biomarkers, it is currently not possible to identify asymptomatic infants at-risk for hearing loss.Objective: To determine whether newborn viral load (VL) levels are predictive of hearing loss in children with asymptomatic cCMV. Methods: As part of the NIDCD CHIMES study, newborns at seven U.S. medical centers were screened for CMV by saliva PCR and enrolled in a follow-up study …

Gait Adaptability With Healthy Aging And Parkinson’S Disease, Daniel Kuhman

All ETDs from UAB

Human locomotion often occurs through environments with complex sets of external demands (e.g., obstacles, uneven surfaces, altered terrain, etc.). Fortunately, humans have developed locomotor systems capable of rapidly adapting gait patterns to navigate these environments. Advanced age and neurological disorders such as Parkinson’s disease (PD) are associated with physiological changes that add to the complexity of locomotion – these individuals must not only adapt to changing environmental demands, but also to changes in internal function (e.g., reduced muscle strength, dysfunctional sensorimotor integration). While there is a growing body of literature indicating that healthy older adults maintain adaptability, less is known …

The Role Of Race, Sex, And Place In The Association Of Diabetes And Cardiovascular Disease, Gargya Malla

All ETDs from UAB

Cardiovascular disease risk is higher among adult with diabetes than those without diabetes. This increase in risk may vary by race, sex, and neighborhood characteristics. Recent US data showed a resurgence in stroke and coronary heart disease (CHD) among adults with diabetes, and an increase in heart failure (HF) mortality. Therefore, this dissertation investigated how cardiovascular disease risk may vary by race, sex, and neighborhood characteristics for adults across the glycemic spectrum.Data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, an ongoing prospective cohort of 30,239 Black and White adults age 45 years at baseline (2003-07) …

Risk Of Delirium With Opioid Use Among Older Adults In The Emergency Department, Rachel Michelle Skains

All ETDs from UAB

Objectives: Delirium affects 7-17% of older Emergency Department (ED) patients. Inadequate pain control and opioid pain management have been reported to increase risk for delirium. The aim of this study was to evaluate the association between pain severity, opioid exposure, and delirium among older ED patients.Methods: A single-center retrospective cohort study was conducted in an academic Geriatric ED. Patients aged ≥65 years with an Identification of Seniors at Risk (ISAR) score ≥2 and an Emergency Severity Index (ESI) level 3 were enrolled into the Geriatric ED Pathway. Those who received a delirium screening using the Nursing Delirium Screening Scale (NuDESC) …

Association Of Abdominal Obesity And Risk Of Atrial Fibrillation: Findings From The Reasons For Geographic And Racial Differences In Stroke (Regards) Study, Joonseok Kim

All ETDs from UAB

Background: Our knowledge of the association between abdominal obesity (AO) and the risk of atrial fibrillation (AF) after adjusting for body mass index (BMI) is limited. Methods: We included 11,617 black and white participants (mean age 63.0 + 8.4 years) from the REGARDS (REasons for Geographic and Racial Differences in Stroke) national cohort study who were free of AF at baseline between 2003 and 2007, and completed a follow-up exam between 2013 and 2016 with assessment of AF. A multivariable logistic regression model was used to estimate the odds ratio (OR) with 95% confidence interval of incident AF associated with …

Attitudes, Beliefs, And Perceived Self-Efficacy Pre- And Post- Suicide Prevention Training, Angela Marie Sullivan

All ETDs from UAB

A 2017 World Health Organization (WHO) data brief included suicide in the top 20 causes of death worldwide. The WHO also listed suicide as the second leading cause of death for those aged 15 – 29 worldwide. In the US, suicide is the leading cause of violent death and has been consistently ranked as the 10th leading cause of death among all age groups in the US since 2008. In Alabama, the CDC reports suicide as the 11th leading cause of death in the state and the second leading cause of death for those aged 15 – 34. This study …

The Influence Of Sunlight Exposure And Sun Protecting Behaviours On Allergic Outcomes In Early Childhood, Kristina Rueter, Anderson P. Jones, Aris Siafarikas, Paola Chivers, Susan L. Prescott, Debra J. Palmer

Research outputs 2014 to 2021

The dramatic rise in allergic disease has occurred in tandem with recent environmental changes and increasing indoor lifestyle culture. While multifactorial, one consistent allergy risk factor has been reduced sunlight exposure. However, vitamin D supplementation studies have been disappointing in preventing allergy, raising possible independent effects of ultraviolet (UV) light exposure. The aim of this study was to examine whether UV light exposure influences the development of allergic disease in early childhood. Direct sunlight exposure (290–380 nm) in early infancy was measured via UV dosimeters. Outdoor exposure, sun protective behaviours, and allergy outcomes were assessed over the first 2.5 years …

The Missing Link Between Medical Science Knowledge And Public Awareness: Implications For Tourism And Hospitality Recovery After Covid-19, Jun Wen, Haifeng Hou, Metin Kozak, Fang Meng, Chung-En Yu, Wei Wang

Research outputs 2014 to 2021

Purpose: As the world grapples with the pervasive effects of the coronavirus pandemic, a notable disconnect has emerged in the public's understanding of scientific and medical research. Particularly, the travel industry has become unquestionably vulnerable amid the COVID-19 outbreak; this pandemic has interrupted the industry's operations with devastating economic consequences. This paper aims to highlight the importance of deconstructing barriers between medical science and public awareness related to COVID-19, taking tourism as a case in point. It also discusses the role of interdisciplinary research in facilitating the tourism and hospitality industry's recovery and alleviating tourists' uncertainties in the wake of …