Public Health Commons^™

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 …

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, …

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 …

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 …

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 …

Seven Attributes Of Risk Assessment, Roger C. Jensen

Safety Health & Industrial Hygiene

Key Takeaways:

- Risk assessment matrixes provide a measurement-like tool for characterizing hazard risk by accounting for severity and likelihood. The best matrix format depends on the needs of the organization.

- The many differences between risk matrixes are due to seven attributes: fundamental elements, orientation, size, axes scales, row and column header terms, risk indicators, and cell colors.

- This article focuses on the two-factor model of risk as a function of severity and likelihood. It was developed with the aim of sharing with the occupational safety community an appreciation for risk assessment matrixes beyond what is typically found …

Not Only How Much But How: The Importance Of Diversifying Funding Streams In A Reimagined Public Health System, J. Mac Mccullough, Umesh Ghimire, Jason M. Orr, Sezan O. Onal, Ashley Edmiston, Krishna Patel, Timothy C. Mccall, Jonathon P. Leider

Public and Population Health Faculty Publications and Presentations

Revenue diversification may be a synergistic strategy for transforming public health, yet few national or trend data are available. This study quantified and identified patterns in revenue diversification in public health before and during the COVID-19 pandemic. We used National Association of County and City Health Officials’ National Profile of Local Health Departments study data for 2013, 2016, 2019, and 2022 to calculate a yearly diversification index for local health departments. Respondents’ revenue portfolios changed fairly little between 2016 and 2022. Compared with less-diversified local health departments, well-diversified departments reported a balanced portfolio with local, state, federal, and clinical sources …

A Retrospective Review: Oxford County Wellness Collaborative's Contributions To Community Health, Emma Schwartz, Rachel M. Gallo Mph

Children, Youth, & Families

Since 2011, Oxford County Wellness Collaborative (OCWC) has been transforming personal, environmental, and economic health by building strong relationships among people and organizations. OCWC contracted with the Data Innovation Project at the Catherine Cutler Institute of Health and Social Policy to synthesize previously collected or reported data and collect primary data to conduct a retrospective evaluation. The evaluation team used this data to convey past successes, better understand the outcomes of the collaborative to date, and provide recommendations for OCWC’s next steps in furthering its impact.

Wastewater Surveillance For Xylazine In Kentucky, Chris Delcher, Dana Quesinberry, Soroosh Torabi, Scott Berry, James W. Keck, Abhya Rani, Bikram Subedi

UK CARES Faculty Publications

Introduction: In the U.S., xylazine, the veterinary non-opioid sedative, has emerged as a major threat to people who use illicitly manufactured fentanyl and other drugs. The aim of this study was to compare wastewater detection of xylazine with other public health and safety surveillance data from 2019 to 2023 in Kentucky.

Methods: Wastewater samples from 5 rest areas, 2 truck weigh stations, and 4 wastewater treat- ment plants were tested for xylazine. Wastewater xylazine positivity rates were compared with xyla- zine-positive submission rates from the National Forensic Laboratory Information System and Kentucky’s fatal overdoses in 6-month periods (Period 1=January−June; Period …

A Mixed-Method Analysis Of The Contribution Of Informal Sport To Public Health In Australia, Ruth Jeanes, Justen O'Connor, Dawn Penney, Ramon Spaaij, Jonathan Magee, Eibhlish O' Hara, Lisa Lymbery

Research outputs 2022 to 2026

Informal sport is a growth area of sport participation but there has been limited examination of how informal and unstructured forms of participation may contribute to health outcomes that are important for public health. This article aims to address the current lack of data examining the health outcomes associated with informal sport participation and consider the potential role of informal sport within efforts to promote healthier communities through sport. The article seeks to broaden understanding of how informal sport participation can contribute to health outcomes, particularly with regard to increasing physical activity and enhancing mental health and social connection. The …

One Health In The Philippines: A Review And Situational Analysis, Lystra Zyrill A. Dayapera, Jenica Clarisse Y. Sy, Sary Valenzuela, Samantha Julia L. Eala, Ciara Maria Ines P. Del Rosario, Karen Nicole C. Buensuceso, Adrian S. Dy, Danielle A. Morales, Anna Giselle Gibson, Geminn Louis C. Apostol

Ateneo School of Medicine and Public Health Publications

The Philippines faces a complex and interconnected web of human, animal, and environmental health issues, including zoonotic and reverse zoonotic diseases, antimicrobial resistance, food insecurity and contamination, and threats from environmental degradation. This paper examines these issues, existing interventions, and their implementation challenges. The overall framework used to analyze the level of operationalization of the One Health approach is the Multi-sectoral One Health Coordination Framework developed by the World Health Organization, Food and Agriculture Organization, and the World Organization for Animal Health. A two-step process was conducted: literature review, followed by consultations with government and non-government stakeholders across national, subnational, …

The Utilisation Of Mushroom Leftovers, Oats, And Lactose-Free Milk Powder For The Development Of Geriatric Formulation, Snigdha Paul, Ravinder Kaushik, Shuchi Upadhyay, Ansab Akhtar, Prince Chawla, Naveen Kumar, Saurabh Sharma, Pooja Rani

School of Medicine Faculty Publications

This study aims to focus on developing a food supplement for the geriatric population using disposal mushrooms, oats, and lactose-free milk powder. Lactose intolerance is most common in older adults, raising the demand for lactose-free foods. One of the major global challenges currently faced by humankind is food waste (FW). Most of the food that is produced for human consumption has not been utilized completely (1/3rd-1/2 unutilized), resulting in agricultural food waste. Mushrooms are highly valuable in terms of their nutritional value and medicinal properties; however, a significant percentage of mushroom leftovers are produced during mushroom production that do not …

Associations Between Disordered Eating Behaviour And Sexual Behaviour Amongst Emerging Adults Attending A Tertiary Education Institution In Coastal Kenya, Stevenson Chea, Adama Kazienga, Eunice Oyugi, Isaac Menza, Carophine Nasambu, Fauz Ibrahim, Osman Abdullahi, Amin Hassan, Amina Abubakar, Kristien Michielsen

Institute for Human Development, East Africa

Background Sexual behavior (SB) is a well-documented pathway to HIV acquisition in emerging adults and remains common amongst African emerging adults. Previous research in high-income countries indicates a correlation between disordered eating behavior (DEB) and engaging in sexual behaviors. We aimed to describe the relationship between DEB and SB amongst emerging adults attending a tertiary educational institution at the Kenyan Coast.

Methods We applied a cross-sectional design nested in a young adults’ cohort study. Eligibility included sexually active emerging adults aged 18–24 years. Three DEBs (emotional, restrained and external eating) were assessed using the Dutch Eating Behavior Questionnaire and analysed …

Two Decades Of Research Capacity Strengthening And Reciprocal Learning On Sexual And Reproductive Health In East Africa – A Point Of (No) Return, Caroline Frisendahl, Emelie Looft-Trägårdh, Amanda Cleeve, Susan Atuhairwe, Elin Larsson, Othman Kakaire, Herbert Kayiga, Annette Aronsson, Anne Kihara, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

As the world is facing challenges such as pandemics, climate change, conflicts, and changing political landscapes, the need to secure access to safe and high-quality abortion care is more urgent than ever. On 27th of June 2023, the Swedish government decided to cut funding resources available for developmental research, which has played a fundamental role in the advancement of sexual and reproductive health and rights (SRHR) globally, including abortion care. Withdrawal of this funding not only threatens the fulfilment of the United Nations sustainable development goals (SDGS) – target 3.7 on ensuring universal access to SRHR and target 5 on …