Public Health Commons^™

Α4 Nicotinic Acetylcholine Receptors In Lipopolysaccharide-Related Lung Inflammation, J. Ritzenthaler, Walter H. Watson, Jesse Roman

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

Sepsis remains an important healthcare challenge. The lungs are often affected in sepsis, resulting in acute lung injury characterized by inflammation. Mechanisms involving lipopolysaccharide (LPS) stimulation of toll-like receptor (TLR) signaling with induction of proinflammatory pathways have been implicated in this process. To date, however, studies targeting these pathways have failed to improve outcomes. We have found that LPS may also promote lung injury through the activation of α4 nicotinic acetylcholine receptors (α4 nAChRs) in immune cells. We observed increased expression of α4 nAChRs in human THP-1 monocytic cells exposed to LPS (100 ng/mL, 24 h). We also observed that …

Micrornas Are Enriched At Covid-19 Genomic Risk Regions, And Their Blood Levels Correlate With The Covid-19 Prognosis Of Cancer Patients Infected By Sars-Cov-2, Simone Anfossi, Faezeh Darbaniyan, Joseph Quinlan, Steliana Calin, Masayoshi Shimizu, Meng Chen, Paola Rausseo, Michael Winters, Elena Bogatenkova, Kim-Anh Do, Ivan Martinez, Ziyi Li, Loredana Antal, Tudor Rares Olariu, Ignacio Wistuba, George A Calin

Faculty, Staff and Student Publications

Background: Cancer patients are more susceptible to an aggressive course of COVID-19. Developing biomarkers identifying cancer patients at high risk of COVID-19-related death could help determine who needs early clinical intervention. The miRNAs hosted in the genomic regions associated with the risk of aggressive COVID-19 could represent potential biomarkers for clinical outcomes.

Patients and methods: Plasma samples were collected at The University of Texas MD Anderson Cancer Center from cancer patients (N = 128) affected by COVID-19. Serum samples were collected from vaccinated healthy individuals (n = 23) at the Municipal Clinical Emergency Teaching Hospital in Timisoara, Romania. An in …

Estrogen Plus Progestin And Colorectal Cancer: Long-Term Findings From The Women's Health Initiative Randomized Clinical Trial, Rowan T Chlebowski, Aaron K Aragaki, Kathy Pan, Juhua Luo, Thomas E Rohan, Karen C Johnson, Jean Wactawski-Wende, Su Yon Jung, Qian Xiao, Sayeh Lavasani, Joann E Manson, Michael S Simon

Faculty, Staff and Student Publications

We report long-term colorectal cancer findings from the Women’s Health Initiative trial where 16,608 postmenopausal women with a uterus were randomized to daily conjugated equine estrogen (CEE) 0.625 mg, plus medroxyprogesterone acetate (MPA) 2.5 mg, or placebo. When intervention ended after 5.6-years, while there were 44% fewer colorectal cancers in the intervention group (43 vs 72, P = 0.003), the cancers more commonly were lymph node positive (59.0% vs 29.4%, P = 0.003). Now after cumulative 24-year follow-up, with 431 breast cancers, CEE plus MPA no longer influenced colorectal cancer incidence (215 [0.15, annualized rate %] vs 216 [0.15], HR …

Apixaban Versus Enoxaparin To Prevent Venous Thromboembolism In Post-Operative Patients With Gynecologic Cancers At An Urban Academic Medical Center, Victoria Diamond, Katherine Gerber, Geno J. Merli, Rebecca J. Mercier, Aaron Shafer, Norman G. Rosenblum

Department of Obstetrics and Gynecology Faculty Papers

OBJECTIVE: A recent clinical trial demonstrated that the use of apixaban was safe and equal to enoxaparin (LMWH) in post-operative gynecologic oncology patients. This study aimed to determine if these findings are applicable in a diverse patient population at a single site urban academic medical center.

METHODS: This was a retrospective cohort study of patients who underwent an exploratory laparotomy for confirmed or presumed gynecologic cancer from the years 2017-2023 at a single-site urban academic medical center. Venous thromboembolism (VTE) prophylaxis with LMWH was standard practice at our institution up until January 2021 after which apixaban became standard for post-operative …

Analisis Aktivitas Fisik Pekerja Mal Pelayanan Publik Kota Cilegon, Muhammad Syifa Abdy Mulya, Indri Hapsari Hapsari Susilowati

National Journal of Occupational Health and Safety

Physical activity is important because it has so many benefits. Even so, there are still many workers who are exposed to the risk of lack of physical activity. For this reason, it is necessary to know what affects the implementation of physical activity in workers. Quantitative design was used with a cross sectional study on 58 Cilegon Public Service Mall workers who met the criteria. As a result, 65.5% of workers are classified as active, 34.5% of workers are inactive and 12% of workers do not carry out any physical activity at all. Level of education (p value = 0.005), …

Reviewer Acknowledgements, Randy Wykoff, Emily Wilson

Journal of Appalachian Health

We at the Journal of Appalachian Health would like to thank the multitude of reviewers who have volunteered their time, talents, and attention to the journal. Reviewers help us consider the rigor and quality of the submissions we receive, and their willingness to read material ahead of publication ensures we can bring timely research to our readers in Appalachia and further afield.

Impacts Of The Covid-19 Pandemic On Intimate Partner Violence And Child Maltreatment Services In Rural Northwest North Carolina, Elisabeth G. Galphin, Adam Hege, Amy Dellinger Page

Journal of Appalachian Health

The current study examined the impact of the COVID-19 pandemic on IPV and child maltreatment services in rural northwestern North Carolina. Qualitative interviews were conducted with eight professionals representing six service organizations across four counties. The findings highlighted challenges these agencies faced throughout the pandemic, new risks for the clients served, and positive outcomes. In addition, it has been a useful learning experience as public health and social service agencies learn to serve their communities more effectively moving forward. This is especially relevant for rural communities, as it has put public health preparedness at the forefront.

The Impact Of Primary Care Physician Capacity On Preventable Hospitalizations: Identifying Bright Spots In The Appalachian & Mississippi Delta Regions, Michael Topmiller, Peter J. Mallow, Hoon Byun, Mark Carrozza, Yalda Jabbarpour

Journal of Appalachian Health

Introduction: Several studies have documented that higher rates of primary care physicians are associated with lower rates of preventable hospitalizations. Counties with higher rates of preventable hospitalizations are found in the Appalachian and Mississippi (MS) Delta Regions.

Purpose: (1) To determine if the association of primary care capacity with preventable hospitalizations is different in the Appalachian and MS Delta regions compared to the rest of the U.S., and (2) to explore primary care capacity in counties with lower-than-expected preventable hospitalization rates.

Methods: This study modeled preventable hospitalizations with primary care physicians (PCP) per 100,000 (PCP capacity) while controlling for several …

Psychosocial Factors, Stress And Sleep Among Rural Appalachian Kentucky Residents With Type 2 Diabetes Mellitus, Blake Dipaola, Zoe Taylor, Eric Hennemann, Brittany L. Smalls, Philip M. Westgate, Nancy Schoenberg

Journal of Appalachian Health

Introduction: Rural Appalachian residents experience higher rates of most chronic diseases, including type 2 diabetes mellitus (T2DM). Stress and sleep deficiency also are common in the region.

Purpose: To better understand these associated health burdens, the relationship among these conditions and psychosocial factors—such as depressive symptoms, distress, empowerment, and social support—was examined among Appalachian residents with T2DM.

Methods: Using data collected from a community-based sample of Appalachian adults with T2DM, the study examined whether psychosocial factors were associated with perceived stress (Cohen Perceived Stress Scale) and self-reported sleep deficiency (Epworth Sleepiness Scale). Multilevel linear mixed effects regression modeling was used …

Nutrition Education Needs And Barriers Of Uninsured Clients Who Utilize Free Clinics In Western North Carolina, Manan Roy, Alisha Farris, Erin Loy, Lauren Sastre, Danielle L. Nunnery

Journal of Appalachian Health

Introduction: Many uninsured adults rely on free health clinics for prevention and treatment of chronic disease. Little is known about the nutrition education needs of adults served by free health clinics, especially those living in counties within the Western North Carolina Appalachian Mountain Region.

Methods: An in-person survey was distributed to 202 clients of two free health clinics in western North Carolina. Descriptive analyses were conducted to determine frequency distributions for food and physical activity practices, acceptable topics and strategies for nutrition education, and the acceptance and barriers for various modalities.

Results: Depending on the clinic, 49-58% of participants were …

Using Public Funeral And Obituary Listings To Identify Spikes In Excess Mortality In One Appalachian County, Allen Archer, Melissa White, Megan Quinn, Randy Wykoff

Journal of Appalachian Health

Introduction: Delays (10-22 months) in availability of official state and county-level mortality data could have significant public health consequences. The COVID-19 pandemic illuminated the need for health officials to access timely death data to identify unexpected increases in mortality in their communities.

Purpose: The purpose of this study is to determine if funeral home listings and/or newspaper obituaries could help identify excess mortality on the local level, prior to the availability of official death records.

Methods: To calculate excess mortality, four years (2017–2020) of data were collected from three sources: the state health department, online funeral home listings, and newspaper …

Aftermath: A Word To Appalachia Following Hurricane Helene, Emily Wilson

Journal of Appalachian Health

On September 27, 2024, Hurricane Helene caused massive and catastrophic flash flooding in the lower Appalachian Region, leveling towns and forever altering much of the landscape. This is an open letter to the people of Appalachia who were affected by the disaster that blindsided our region.

Enhancing Digital Health Equity: A Personalized Approach For Spanish-Speaking Patients, Marissa Witmer, Julianna Lenoir, Mph, Angela Gerolamo, Phd, Crnp, Pmhnp, Akshay Krishnan, David Rigas, Kristin L. Rising, Md, Mshp

Jefferson Center for Connected Care Posters

Background

Limited English Proficiency (LEP) is a barrier among Hispanic communities in accessing digital health tools including patient portals.¹

Patient portals provide patients with access to their electronic medical records. With portals, patients can schedule visits, message providers, check test results, and order medication refills, among other tasks.

Portal use has been shown to help patients better manage chronic diseases, enhance doctor-patient relationships, improve patient understanding and awareness of health status, and increase adherence to therapy.²

Despite interest in using patient portals, Spanish-speaking patients often struggle to use them due to low digital literacy.³

Provision of personalized …

Excess Potassium Promotes Autophagy To Maintain The Immunosuppressive Capacity Of Myeloid-Derived Suppressor Cells Independent Of Arginase 1, Ramesh Thylur Puttalingaiah, Matthew J. Dean, Liqin Zheng, Phaethon Philbrook, Dorota Wyczechowska, Timothy Kayes, Luis Del Valle, Denise Danos, Maria Dulfary Sanchez-Pino

School of Medicine Faculty Publications

Potassium ions (K+) are critical electrolytes that regulate multiple functions in immune cells. Recent studies have shown that the elevated concentration of extracellular potassium in the tumor interstitial fluid limits T cell effector function and suppresses the anti-tumor capacity of tumor-associated macrophages (TAMs). The effect of excess potassium on the biology of myeloid-derived suppressor cells (MDSCs), another important immune cell component of the tumor microenvironment (TME), is unknown. Here, we present data showing that increased concentrations of potassium chloride (KCl), as the source of K+ ions, facilitate autophagy by increasing the expression of the autophagosome marker LC3β. Simultaneously, excess potassium …

Norovirus Acute Gastroenteritis Amongst Us And European Travellers To Areas Of Moderate To High Risk Of Travellers’ Diarrhoea: A Prospective Cohort Study, Martin Alberer, Christine L Moe, Christoph Hatz, Kerstin Kling, Amy E Kirby, Lisa Lindsay, Hans D Nothdurft, Margarita Riera-Montes, Robert Steffen, Thomas Verstraeten, Henry M Wu, Herbert L Dupont

Faculty, Staff and Student Publications

BACKGROUND: Acute gastroenteritis (AGE) is a major medical condition for travellers worldwide, particularly travellers to low- and middle-income countries. Norovirus (NoV) is the most common cause of viral AGE in older children and adults, but data on prevalence and impact amongst travellers is limited.

METHODS: Prospective, multi-site, observational cohort study conducted 2015-2017, amongst adult international travellers from the US and Europe to areas of moderate to high risk of travel-acquired AGE. Participants provided self-collected pre-travel stool samples and self-reported AGE symptoms whilst travelling. Post-travel stool samples were requested from symptomatic subjects and a sample of asymptomatic travellers within 14 days …

The Lived Experiences Of Work Related Violence Against Public Health Professionals During Covid-19 Pandemic, Cynthia Howell

Walden Dissertations and Doctoral Studies

Work-related violence (WRV) against public health professionals is increasingly prevalent worldwide but received much greater attention during the COVID-19 pandemic. This qualitative study addressed a gap in the literature by exploring public health professionals' experiences with WRV threats, what factors contributed to their vulnerability, and the severity of these threats during the COVID-19 pandemic from 2020 to 2023. Rogers' (1975) Protection Motivation Theory was the conceptual framework for phenomenological study. Twelve public health professionals, both male and female, including epidemiologists, nurses, physicians, researchers/scientists, and community health workers, who actively worked during the COVID-19 pandemic and were residents of New York …

Marijuana Legalization And Opioid Use Disorder In Ontario, Canada, From 2015 To 2021, Luke Ome Agada

Walden Dissertations and Doctoral Studies

This study examined the trends in opioid-related hospitalizations and deaths in Ontario, Canada, from 2015, to 2021, with a particular focus on the periods before and after cannabis legalization. The social problem addressed was the ongoing opioid crisis, exacerbated by rising opioid-related health issues. Grounded in the harm reduction theory, this research explored whether cannabis legalization could serve as a substitute to mitigate opioid use disorder. Data were extracted from the Discharge Database, Emergency Department Database, National Ambulatory Care Reporting System, and Hospital Morbidity Database. Analysis using the generalized estimation equation (GEE) method revealed a significant increase in opioid-related hospitalizations, …

Access To Waitlisting And Posttransplant Outcomes In Patients With Failed Kidney Allografts Secondary To Recurrent Glomerulonephritis, Ryan Gately, Germaine Wong, Armando Teixeira-Pinto, Helen Pilmore, Carmel Hawley, Scott Campbell, William Mulley, Wai H. Lim

Research outputs 2022 to 2026

Background. Recurrent glomerulonephritis (GN) is an important cause of allograft loss after transplantation when GN is the primary cause of kidney failure. Retransplantation after allograft loss from recurrent disease requires careful consideration. We aimed to determine the probability of relisting and the risk of allograft loss after retransplantation in recipients with prior allograft loss from recurrent GN. Methods. Using data from the Australia and New Zealand Dialysis and Transplant Registry and multivariable Cox modeling, we compared the probability of waitlisting and allograft loss after second transplantation between those with and without prior allograft loss from recurrent disease. Results. Of 3276 …

Black Women’S Perceptions Of Perinatal Healthcare In New York City Community Health Centers, Asiyah Franklin

Walden Dissertations and Doctoral Studies

The purpose of this qualitative study was to explore the experiences of Black women who have received perinatal care in New York City (NYC) community health centers and the perceived impact on their maternal health behaviors and outcomes. Although maternal health care delivery and outcomes among Black women have been explored in research, socially and economically disenfranchised Black women in NYC who rely on community health centers for perinatal care have not been included in this research. This study involved addressing the lack of knowledge of Black women’s experiences with perinatal care in NYC’s community health system and consisted of …

Examining The Relationship Between Employment And Health Status Among Adults With Autism Spectrum Disorder (Asd) In The United States, Winifred Beckles

Walden Dissertations and Doctoral Studies

Autism spectrum disorder (ASD), characterized by challenges in social communication and repetitive behaviors, is a developmental disability that impacts over five million adults in the United States. Despite the significant amount of research literature on the association between health and employment in the general population, there remains a gap in research on the relationship between health and employment in adults with autism. Utilizing the Social Ecological Model (SEM) framework, this study examined whether there is a relationship between employment, current living status, non-paid activities, United States Census regions, type of health insurance, and health status when controlling for age, race, …

Health Risks Associated With Adopting New-Generation Disposable Products Among Young Adults Who Use E-Cigarettes, Shuyao Ran, James J Yang, Megan E Piper, Hsien-Chang Lin, Anne Buu

Faculty, Staff and Student Publications

New-generation disposable e-cigarettes have become increasingly popular among young adults in the USA since the FDA's partial flavor ban. This study aims to examine longitudinal changes in health risks among young adults who adopted these novel products, as well as the health effects of device types beyond the effects of other important e-cigarette characteristics. This study recruited e-cigarette users via voluntary response sampling from three college campuses in the USA to respond to four-wave online surveys conducted in four consecutive semesters. Among the participants who adopted disposables during the study, their health risks (dependence symptoms, respiratory symptoms, combustible tobacco use) …

Racial Bias In The Treatment Decision Of Breast Cancer In African American And Caucasian Women, Hayaat Mariette Amara

Walden Dissertations and Doctoral Studies

Breast cancer stands as a formidable health challenge in the United States, ranking as the most prevalent and deadly diagnosed cancer and the second leading cause of cancer-related death among women. Of particular concern is the disproportionate impact on African American women, who experience elevated mortality rates compared to other demographic groups. This quantitative study, grounded in critical race theory, investigated whether there is an association between race as well as comorbidity score and first-course treatment plans for breast cancer among women in the State of Georgia, United States, adjusting for the stage of breast cancer, age, and household income. …

Exploring The Association Between Parenting Stress And A Child’S Exposure To Positive Childhood Experiences (Pces), Elizabeth Crouch Ph.D., Elizabeth Radcliff, Monique J. Brown Ph.D., Mph, Peiyin Hung Ph.D

Faculty Publications

High levels of parenting stress, defined as a caregiver or parent feeling stress or aggravation from parenting, has been previously shown to be associated with an increased likelihood of neglect, child maltreatment, and household dysfunction: adverse childhood experiences (ACEs). Despite the potential mitigation of positive childhood experiences (PCEs) on ACEs, prior studies on the increased likelihood of a child experiencing ACEs due to parenting stress have left a critical question unanswered: whether high parenting stress may decrease a child’s likelihood of experiencing PCEs. We analyzed the 2019–2020 National Survey of Children’s Health to examine whether higher levels of parenting stress …

Progress In Physical Activity Research, Policy, And Surveillance In Canada: The Global Observatory For Physical Activity – Gopa!, Ashley Cathro, John C Spence, Christine Cameron, Andrea Ramirez Varela, Diana Morales, Eduardo Ribes Kohn, Michael Pratt, Pedro C Hallal

Faculty, Staff and Student Publications

BACKGROUND: The purpose of this paper is to examine the evolution of physical activity research and the comprehensiveness of national physical activity policies and surveillance systems in Canada.

METHODS: A systematic review was conducted by the Global Observatory for Physical Activity (GoPA! ) on physical activity and health publications between 1950 and 2019. Findings from Canada were extracted and included in the present analysis. The number of articles published, female researcher involvement in authorship, author institution affiliations, and publication themes were examined. Policies were evaluated by determining if there was a standalone physical activity plan and if national guidelines existed. …

55-Word Stories: Insight Into Healthcare, Nancy E. Krusen

Translational Science in Occupation

Narrative medicine and health humanities focus on arts, ethics, and clinical practice. Many health education programs incorporate creative activities to facilitate learner self-awareness and insight. We include them to address programmatic themes of professional growth and translational science.

Trends In Gaps Of Care For Patients With Congenital Heart Disease: Implications For Social Determinants Of Health And Child Opportunity Index, Abbas H. Zaidi, Adam Alberts, Devyani Chowdhury, Claude Beaty, Benjamin Brewer, Ming Hui Chen, Sarah D. De Ferranti

Department of Surgery Faculty Papers

BACKGROUND: Lifelong continuity of care is essential for patients with congenital heart disease (CHD) to maximize health outcomes; unfortunately, gaps in care (GIC) are common. Trends in GIC and of social determinants of health factors contributing to GIC are poorly understood.

METHODS AND RESULTS: This retrospective cohort study included patients with CHD, aged 0 to 34 years, who underwent surgery between January 2003 and May 2020, followed up at a pediatric subspeciality hospital. Patients were categorized as having simple, moderate, and complex CHD based on 2018 American Heart Association and American College of Cardiology guidelines. Social determinants of health, such …

Preventing The Next Fall: The Power Of A Simple Checklist In Reducing Patient Falls, Ryan P. Bialaszewski, Michael Sander, Maria Hincapie, Rita Garza, Aurora Cavazos

MEDI 9331 Scholarly Activities Clinical Years

Background:
Preventable medical errors and adverse events in US hospitals are far too common and contribute to an estimated $17 billion annually in healthcare expenditures. Falls comprise the majority of these preventable adverse events and are a significant cause of increased healthcare costs, prolonged hospital stays, and patient morbidity and mortality. The average cost per hospital fall is estimated at $62,521 ($35,365 direct costs). Despite numerous preventative measures, the complexity of managing multiple interventions can lead to inconsistent application. Inspired by the success of surgical "time-out" checklists in operating rooms, we hypothesized that a standardized checklist for fall prevention could …

Assessing The Climate Readiness Of Physician Education Leaders In Graduate Medical Education, Deborah Simpson, Anne Getzin, Aaron A. Levy, Victoria Gillet

Journal of Patient-Centered Research and Reviews

Climate change affects patient health through an array of exposures, including increasing heatwaves, extreme weather events, poor air quality, and expanding vector-borne illnesses. Physicians are at the forefront of addressing the health consequences of these exposures with patients, and environmental sustainability has become a priority for health care organizations. Accordingly, climate change and health is becoming a critical area for graduate medical education (GME). As GME leaders design and drive education in residency and fellowship programs, understanding those leaders’ baseline knowledge on this topic and its alignment with their organizations’ priorities is an essential step in the development of climate …

Sall4 And Gata4 Induce Cardiac Fibroblast Transition Towards A Partially Multipotent State With Cardiogenic Potential, Hong Gao, Saliha Pathan, Beverly R E A Dixon, Aarthi Pugazenthi, Megumi Mathison, Tamer M A Mohamed, Todd K Rosengart, Jianchang Yang

Faculty, Staff and Students Publications

Cardiac cellular fate transition holds remarkable promise for the treatment of ischemic heart disease. We report that overexpressing two transcription factors, Sall4 and Gata4, which play distinct and overlapping roles in both pluripotent stem cell reprogramming and embryonic heart development, induces a fraction of stem-like cells in rodent cardiac fibroblasts that exhibit unlimited ex vivo expandability with clonogenicity. Transcriptomic and phenotypic analyses reveal that around 32 ± 6.4% of the expanding cells express Nkx2.5, while 13 ± 3.6% express Oct4. Activated signaling pathways like PI3K/Akt, Hippo, Wnt, and multiple epigenetic modification enzymes are also detected. Under suitable conditions, these cells …

Social Isolation And Loneliness Prevention Among Rural Older Adults Aging-In-Place: A Needs Assessment, Jodi L. Southerland, Shimin Zheng, Kayla Dodson, Erin Mauck, Juanita-Dawne R. Bacsu, Monique J. Brown Ph.D., Mph, Jeremy Holloway, Steffi M. Kim, Ayse Malatyali, Matthew Lee Smith

Faculty Publications

Introduction: The adverse effects of social isolation and loneliness (SI/L) have been documented among older adults in rural communities and contribute to poor health outcomes, premature disability and mortality, and increased burden on the healthcare system. The identification of factors contributing to SI/L among older adults can build the foundation for rural policymakers and leaders to allocate resources and develop tailored strategies more efficiently. The purpose of this article is to describe findings from a needs assessment designed to understand local factors that contribute to SI/L among rural older adults in a county in Northeast Tennessee. Findings from the needs …