Clinical Epidemiology Commons^™

The Migration Of Carbapenem-Resistant Acinetobacter Baumannii From The Battlefields Of Iraq And Afghanistan To The Healthcare Facilities Of The Veterans Health Administration, Jeffery Rogers

Capstone Experience

Multidrug-resistant organisms (MDRO) pose a great threat to health across the globe. That threat is also felt in the Veterans Health Administration (VHA). Wounded warriors returning home from the battlefields of Iraq and Afghanistan may have brought with them MDROs, such as the bacterium Acinetobacter baumannii, as they have transitioned from military service into the VHA facilities. This study investigates the interconnectedness of military service in the Department of Defense (DoD) and a lifetime of care at VHA through a longitudinal tracking of a linked cohort of combat veterans with battlefield injuries and subsequent MDR infections of A. baumannii. …

Evaluating The Caprini Risk Assessment In An Inpatient Rehabilitation Facility, Alissa Payne, Kelsey Boersma, Sarah Nechuta

Culminating Experience Projects

Deep vein thrombosis (DVT) is an often underdiagnosed disease that can be life threatening for individuals. Currently, the best practice approach to assess the risk of venous thromboembolism (VTE) in patients within a rehabilitation hospital is unknown. We examined how well the Caprini risk assessment (CRA) score predicts VTE events (deep vein thrombosis (DVT), pulmonary embolism (PE)) within an inpatient rehabilitation hospital. Between January 2015 and October 2020, VTE events, the CRA Score, and risk factors were collected from a chart review conducted at Mary Free Bed Rehabilitation Hospital (MFB) among 3,091 patients. Results from the unadjusted logistic regression model …

Treatment Access For Dual Diagnosis Substance Use And Mental Health Disorders, Pedro Banuelos

Electronic Theses, Projects, and Dissertations

In 2018, of 1.3 million Latinx adults in the United States facing concurrent issues with substance use disorders (SUD) and mental health disorders (MHD) 93% remained untreated for either diagnosis. This is concerning since Substance Abuse and Mental Health Services Administration (SAMHSA) data reveals that this population is at greater risk for suicidal thoughts, plans, and attempts. They also face structural barriers such as employment, housing, legal involvement, and insurability that further impede access to treatment.

This study’s purpose was to examine barriers to accessing treatment for Latinx populations confronting co-occurring SUDs and MHDs. This study used a qualitative design …

Prevalence Of Common Disease Conditions In A Large Cohort Of Individuals With Down Syndrome In The United States, Brian Chicoine, Anne Rivelli, Veronica Fitzpatrick, Laura Chicoine, Gengjie Jia, Andrey Rzhetsky

Journal of Patient-Centered Research and Reviews

Purpose: Given the current life expectancy and number of individuals living with Down syndrome (DS), it is important to learn common occurrences of disease conditions across the developmental lifespan. This study analyzed data from a large cohort of individuals with DS in an effort to better understand these disease conditions, inform future screening practices, tailor medical care guidelines, and improve utilization of health care resources.

Methods: This retrospective, descriptive study incorporated up to 28 years of data, compiled from 6078 individuals with DS and 30,326 controls matched on age and sex. Data were abstracted from electronic medical records within a …

The Financing Need For Expanding Paid Maternity Leave To Support Breastfeeding In The Informal Sector In The Philippines, Valerie Gilbert Ulep, Paul Zambrano, Janice Datu-Sanguyo, Mireya Vilar-Compte, Graciela Materuel Belismelis, Rafael Pérez-Escamilla, Grace J. Carrol, Roger Mathisen

Department of Public Health Scholarship and Creative Works

In low- and middle-income countries, almost three-fourths of women in the labour force lack maternity protection. In the Philippines, current laws do not guarantee paid maternity leave to workers in the informal economy. A non-contributory maternity cash transfer to informal sector workers could be used to promote social equity and economic productivity and could provide health benefits by helping mothers meet their breastfeeding goals. The objective of the study is to provide a realistic cost estimate and to assess the financial feasibility of implementing a publicly financed, non-contributory maternity cash transfer programme to the informal sector in the Philippines. Using …

Defining Septicemia Incidence And Mortality In South Carolina Through Access To Health Care, Behavioral Health, And Low Socio-Economic Status, Raeann Vossberg

Senior Theses

This study aims to provide an in-depth view of septicemia mortality and incidence in the state of South Carolina through the lenses of socio-economic factors, access to healthcare, and behavioral health factors. This study was conducted using data from the South Carolina Revenue and Fiscal Affairs Office, utilizing their Hospitalization, Inpatient, Emergency Department, and Outpatient data both separately and combined depending on the data point, along with additional data sources for support (see works cited). We hypothesize that the higher rates of septicemia mortality and incidence in the southeastern United States, as well as in South Carolina in particular, could …

Prevalence Of Liver Cirrhosis And Its Association With Obesity Among Hispanics And Mexican Americans: An Evidence Synthesis, Alexa Perlick, Abaigeal Thompson, Colton Wayne, Angel Rendon, Jose Campo Maldonado

MEDI 9331 Scholarly Activities Clinical Years

INTRODUCTION

The obesity epidemic is a growing public health concern. In addition to the already known complications and comorbidities associated with obesity, data suggest that obesity is an independent risk factor for the development of liver disease.^1,2 However, there is a paucity of data regarding the clinical correlation of obesity and cirrhosis in a predominantly Hispanic population of South Texas. The aim of this systematic literature review is to investigate the prevalence of cirrhosis stratified by obesity in Hispanic populations.

MATERIALS AND METHODS

PubMed was used to perform a thorough literature search. The terms liver cirrhosis and obesity were …

Food Insecurity Is Associated With Nonalcoholic Fatty Liver Disease, Cognitive Impairment, And Immune Activation In People Living With Hiv, Javier A. Tamargo

FIU Electronic Theses and Dissertations

Food insecurity (FI) is a socioeconomic condition characterized by inadequate access to enough food and nutrition to sustain health and wellbeing. Food insecurity is a risk factor for chronic and age-related conditions, raising concerns for the aging population of people living with HIV (PLWH), in whom food insecurity is disproportionately prevalent. PLWH are at increased risk of nutrition-related complications and chronic co-morbidities, thus food insecurity may exacerbate adverse health outcomes in this population. This study investigated whether food insecurity was associated with nonalcoholic fatty liver disease (NAFLD), cognitive impairment, and immune activation among socioeconomically disadvantaged adults living with and without …

H1n1 Influenza Virus (Swine Flu): A Comprehensive Insight Into Escalating Catch-22 Scenarios, Muhammad Shahzaib, Ehsan Ul Haq

The University of Louisville Journal of Respiratory Infections

Introduction: Viruses have always been a major cause of various disastrous pandemics in mankind’s history. H1N1 became a threat when its original strain was first discovered back in the swine flu pandemic of 2009. It became highly catastrophic on a large scale because none of the therapeutic interventions and methodologies that were already present at the time were effective against the virus.

Methods: A vast amount of literature and research is available regarding H1N1 influenza from different reputable sources online. The data were gathered with the contrasting and relative situations of 1918 and 2009 pandemics in mind. The overall extracted …

Food Insecurity Measurement And Prevalence Estimates During The Covid-19 Pandemic In A Repeated Cross-Sectional Survey In Mexico, Pablo Gaitán-Rossi, Mireya Vilar-Compte, Graciela Teruel, Rafael Pérez-Escamilla

Department of Public Health Scholarship and Creative Works

Objective: To validate the telephone modality of the Latin American and Caribbean Food Security Scale (ELCSA) included in three waves of a phone survey to estimate the monthly household food insecurity prevalence during the COVID-19 pandemic in Mexico. Design: We examined the reliability and internal validity of the ELCSA scale in three repeated waves of cross-sectional surveys with Rasch models. We estimated the monthly prevalence of food insecurity in the general population and in households with and without children and compared them with a national 2018 survey. We tested concurrent validity by testing associations of food insecurity with socio-economic status …

Comprehensive Echocardiographic Findings In Critically Ill Covid-19 Patients With Or Without Prior Cardiac Disease, Renuka Jain, Pedro D. Salinas, Stacie Kroboth, Abigail Kaminski, Sarah Roemer, Ana Cristina Perez Moreno, Bijoy K Khandheria

Journal of Patient-Centered Research and Reviews

Purpose: Coronavirus disease 2019 (COVID-19) presents with a spectrum of disease severity, the most serious cases requiring intensive care. Echocardiography is a front-line tool in evaluating cardiovascular complications of COVID-19 in the intensive care unit (ICU); we analyzed transthoracic echocardiograms obtained from this patient population with state-of-the-art ultrasound technology.

Methods: All patients with COVID-19 requiring ICU admission on whom a transthoracic echocardiogram was obtained were included in the study. Focused transthoracic protocols were performed by experienced sonographers. Echocardiographic variables, including speckle-tracking echocardiography, were collected and analyzed. Clinical information was obtained from the electronic medical record. Patients were followed until discharge. …

Interrupted Time Series Analysis To Evaluate The Performance Of Drug Overdose Morbidity Indicators Shows Discontinuities Across The Icd-9-Cm To Icd-10-Cm Transition, Hannah Yang, Emilia Pasalic, Peter Rock, James W. Davis, Sarah Nechuta, Ying Zhang

Peer Reviewed Articles

Introduction: On 1 October 2015, the USA transitioned from the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) to the International Classification of Diseases, 10th Revision (ICD-10-CM). Considering the major changes to drug overdose coding, we examined how using different approaches to define all-drug overdose and opioid overdose morbidity indicators in ICD-9-CM impacts longitudinal analyses that span the transition, using emergency department (ED) and hospitalisation data from six states’ hospital discharge data systems.

Methods: We calculated monthly all-drug and opioid overdose ED visit rates and hospitalisation rates (per 100 000 population) by state, starting in January 2010. We applied …

Corruption: An Impediment To Delivering Pathology And Laboratory Services In Resource-Limited Settings, Emily H. Glynn Md, Timothy Amukele, Taryn Vian

Nursing and Health Professions Faculty Research and Publications

OBJECTIVES

Corruption is a widely acknowledged problem in the health sector of low- and middle-income countries (LMICs). Yet, little is known about the types of corruption that affect the delivery of pathology and laboratory medicine (PALM) services. This review is a first step at examine PALM corruption risks.

METHODS

We performed a critical review of medical literature focused on health sector corruption in LMICs. To provide context, we categorized cases of lab-related fraud and abuse in the U.S.

RESULTS

Forms of corruption in LMICs that may impact the provision of PALM services include informal payments, absenteeism, theft and diversion, kickbacks, …

Implementación De Políticas De Prevención Y Control De La Obesidad Infantil En Estados Unidos Y Latinoamérica: Lecciones Para La Investigación Y La Práctica Transfronterizas, Mireya Vilar-Compte, Rafael Perez-Escamilla, Elizabeth Rhodes, Olga L. Sarmiento, Camila Corvalan, Rachel Sturke, Susan Vorkoper

Department of Public Health Scholarship and Creative Works

Aunque se han hecho avances en el desarrollo y aplicación a gran escala de inter-venciones eficaces contra la obesidad infantil, los retos siguen siendo importantes. Nuestro objetivo era comprender las causas del éxito de Estados Unidos y los países latinoamericanos en la implementación de políticas y programas (PYP) contra la obe-sidad e identificar oportunidades de mejora aplicando los principios de la ciencia de la implementación. Seleccionamos tres estudios de comparación de casos: (1) el etique-tado frontal en los envases de alimentos (México y Chile), (2) los programas de calles abiertas y calles para el juego (Colombia y Estados Unidos) y …

Pre-Covid-19 Social Determinants Of Health Among Mexican Migrants In Los Angeles And New York City And Their Increased Vulnerability To Unfavorable Health Outcomes During The Covid-19 Pandemic, Mireya Vilar-Compte, Pablo Gaitán‐Rossi, Lucía Félix‐Beltrán, Arturo V. Bustamante

Department of Public Health Scholarship and Creative Works

COVID-19 has disproportionally affected underrepresented minorities (URM) and low-income immigrants in the United States. The aim of the study is to examine the underlying vulnerabilities of Mexican immigrants in New York City (NYC) and Los Angeles (LA), its correspondence with area-level COVID-19 morbidity and mortality, and to document the role of trusted and culturally sensitive services offered during the pandemic through the Ventanillas de Salud (i.e. VDS, Health Windows) program. The study uses a mixed-methods approach including a cross-sectional survey of Mexican immigrants in LA and NYC collected in the Mexican Consulates at the onset of the pandemic, complemented with …

From The Legal Literature: Covid And The Criminal Law, Francesca Laguardia

Department of Justice Studies Faculty Scholarship and Creative Works

No abstract provided.

The Intellectual Property Of Covid-19, Ana Santos Rutschman

All Faculty Scholarship

The response to COVID-19 is indissolubly tied to intellectual property. In an increasingly globalized world in which infectious disease pathogens travel faster and wider than before, the development of vaccines, treatments and other forms of medical technology has become an integral part of public health preparedness and response frameworks. The development of these technologies, and to a certain extent the allocation and distribution of resulting outputs, is informed by intellectual property regimes. These regimes influence the commitment of R&D resources, shape scientific collaborations and, in some cases, may condition the widespread availability of emerging technologies. As seen throughout this chapter, …

Covid-19 Employee Health Checks, Remote Work, And Disability Law, Elizabeth Pendo

All Faculty Scholarship

The Americans with Disabilities Act (ADA) prohibits discrimination against people with disabilities, about 61 million individuals in the U.S. The law’s protections in the workplace are especially important during COVID-19, which has worsened pre-existing disparities experienced by people with disabilities. The ADA also applies to new strategies to reduce the risk of COVID-19 infection in the workplace. This Chapter will focus on two strategies that impact individuals with and without disabilities – employee health screening, testing and vaccination policies, and new or expanded remote work programs.

Another Step In Diagnostics Consultation Model© Actualization: Examining The Impact Of Consultation Workflow Processes On Providers' Clinical Decision Making, Elizabeth K. Leibach

Theses and Dissertations

Background
Communication errors in health services delivery significantly compromise quality in clinical decision making (CDM). Diagnostic information generated by clinical laboratories (CL) accounts for as much as 93% of objective data in the clinical record and therefore is foundational in CDM. This work describes the Diagnostics Consultation Model© (DCM©), a CL communications portal, which supports CDM within interprofessional teams, providers, and institutions. Specific aims were to develop and validate a workflow prediction index (the complexity index, CI) to assign resolution of consultation requests based on an algorithm comprised of characteristics available at the point of consultation initiation. The CI functions …

Prevalence And Correlates Of Secondary Syringe Exchange (Sse) Among People Who Inject Drugs (Pwid) In Rural Kentucky, Jordan R. Wilson

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Aim: To describe the prevalence of secondary syringe exchange (SSE) in a sample of syringe service program (SSP) clients in rural Appalachian Kentucky and to identify the correlates of SSE.

Methods: Participants (n=338) completed interviewer-administered questionnaires. Only those who reported having ever exchanged syringes at a SSP (n=140) were included in analysis. SSE was measured through self-report of obtaining syringes for someone else at a SSP in the past 6 months. Prevalence and correlates of SSE were examined using bivariate analysis and multiple logistic regression.

Results: Overall, 30% of participants reported SSE. Participants in the second [aOR= 3.83; 95% CI: …

Maintaining Population Health In Low‐ And Middle‐Income Countries During The Covid‐19 Pandemic: Why We Should Be Investing In Community Health Workers, Benjamin Palafox, Alicia Renedo, Gideon Lasco, Lia M. Palileo-Villanueva, Dina Balabanova, Martin Mckee

Development Studies Faculty Publications

Community health workers in low- and middle-income country primary health care systems are well suited to perform essential functions on the frontlines of Covid-19 pandemic responses. However, clear and coordinated guidance, updated infection control training, and reliable access to personal protective equipment must be ensured in order to deploy them safely and effectively. With these additional responsibilities, community health workers must also be supported to ensure that hard-fought gains in population health, including progress on non-communicable diseases, are sustained throughout the pandemic.

The Occupational Depression Inventory—A Solution For Estimating The Prevalence Of Job-Related Distress, Renzo Bianchi, Irvin Sam Schonfeld

Publications and Research

We are concerned about researchers’ reliance on the burnout construct and the MBI-GS to estimate the prevalence of job-related distress. In this paper, we first describe some of the problems plaguing the burnout construct and its measures. Then, we present the Occupational Depression Inventory, a new instrument designed to help occupational health specialists get a clearer view of the mental health status of the workforce (Bianchi and Schonfeld, 2020).

Incidence Of Neonatal Abstinence Syndrome Epidemic And Associated Predictors In Nevada: A Statewide Audit, 2016–2018, Kavita Batra, Patricia Cruz, Chad L. Cross, Neeraj Bhandari, Farooq Abdulla, Jennifer R. Pharr, Mark P. Buttner

Environmental & Occupational Health Faculty Publications

Neonatal abstinence syndrome (NAS) is a postnatal withdrawal syndrome among neonates born to mothers with drug dependence disorders. NAS poses a significant public health challenge nationally, with a six-fold increase in incidence (1.2 to 6.7 per 1000 hospital births/year) from 2000–2016. Besides national data, it is critical to quantify NAS at the state-level to identify target areas for prevention. The objectives of this study were to ascertain statewide burden, including county and regional distribution of NAS in Nevada during 2016–2018, and to investigate potential factors associated with NAS. This study utilized hospital administrative data, and a total of 100,845 inpatient …

Epidemiology Of Non-Alcoholic Fatty Liver Disease And Risk Of Hepatocellular Carcinoma Progression, Krishna Chaitanya Thandra, Adam Barsouk, Kalyan Saginala, John Sukumar Aluru, Prashanth Rawla, Alexander Barsouk

Kimmel Cancer Center Faculty Papers

Non-alcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease worldwide. Its incidence has grown alongside the increasing global prevalence of type 2 diabetes, obesity, and metabolic syndrome. The risk of progression to hepatocellular carcinoma for nonalcoholic steatohepatitis patients over 5 years is 8%, and despite targeted and immunotherapy treatment advances, HCC maintains a bleak 5-year survival of 19%. NAFLD’s primary risk factors are components of metabolic syndrome as well as possible sleep disturbances. NAFLD is most common among men 50-60 years of age, though incidence in women catches up after menopause. In the US, Hispanics are …

Inaction On Lead Despite The Relevant Knowledge: Predictors, Covariates, And Outreach Implications, Alessandra Rossi, Bernabas Wolde, Pankaj Lal, Melissa Harclerode

Department of Biology Faculty Scholarship and Creative Works

Testing residential soil and paint for lead provides actionable information. By showing where and how much lead exists on the residence, it allows one to quantify risk and determine the best ways to reduce exposure along with the corresponding health and financial costs. For these reasons, several federal and state programs offer outreach to audiences on the benefits of testing residential soil and paint for lead. Not all individuals who know about lead’s adverse health effects, however, test their residence for lead, potentially limiting the actionable information that could have helped to reduce their exposure. Such individuals represent a challenge …

Creation Of A Covid-19 Community Testing Team For Home Health And Hospice, Lilah Raja

Master's Projects and Capstones

The novel SARS-CoV-2 strain (COVID-19) was identified in Wuhan, China in December 2019 (Eddy et. al, 2020). The resulting US outbreak has affected the Kaiser Permanente (KP) Oakland health care system. With the threat of COVID-19 highest among immunosuppressed and elderly clients, KP Oakland home health and hospice (HH/HO) department is rapidly mobilizing to provide community and in-home testing for eligible clients. A project was created to build a COVID-19 testing team workflow to provide diagnostic and preventative testing. This project focuses on team-based interventions that will change the pre-existing practice of requiring HH/HO clients to travel to remote testing …

Covid-19 Viral Testing Disparities In Los Angeles City, Laura Cyphers

Student Scholar Symposium Abstracts and Posters

Hispanic and Black communities have been disproportionately impacted by COVID-19-related morbidity and mortality (California Department of Public Health, 2020). Inequitable access to viral testing resources may have exacerbated these COVID-19-related racial and ethnic health disparities. For example, reports from the Los Angeles Department of Public Health revealed glaring viral testing disparities in April 2020 (early pandemic), with predominantly White communities in Los Angeles County receiving 65% more tests than Hispanic and Black communities. In response, California statewide testing was expanded for communities of color (Vann et al., 2020). To investigate access to viral testing in Los Angeles City, the current …

Acute Ischemic Stroke As The Presenting Feature Of Covid-19 In The Young And Pregnant, Nermila A. Ballmick, Jiri F. Kubac, Hossein Akhondi

HCA Healthcare Journal of Medicine

Introduction: Coronavirus disease (COVID-19) is an emerging and rapidly evolving public health issue that has become globally widespread and an overwhelming pandemic. Clinical manifestations of the disease include asymptomatic carrier states, acute respiratory distress syndrome, and even multiorgan dysfunction. Here, we present a unique and rare case of an acute ischemic stroke (AIS) in an asymptomatic pregnant woman with no predisposing medical illnesses.

Discussion: An 18-year-old G2P1 African American woman at 7 weeks gestational age with no significant medical or family history presenting to the Emergency Department during the initial phases of the pandemic with complaints of new onset left …

Epidemiology And Pathophysiology Of Common Skin Diseases In West Africa: An Immunodermatological Framework, Osazomon Imarenezor

All HCAS Student Capstones, Theses, and Dissertations

This capstone reviews the common skin diseases on a global scale. With these dermatoses being further funneled into Africa and then magnified into common West African dermatoses, the meta-analyses of literature available paints a clear picture of the epidemiological & pathological factors and their contribution to the skin disease. Each article analysed in this analysis was taken from a 20-year span of January 2000 to December 2019. The selection of articles was fine-tuned by identifying the distribution of skin disease, revealing the populations affected (age, gender, ethnicity, etc), the main causes, country of origin, the prognosis of disease, and the …

Laboratory And Epidemiological Characteristics Of Zika Virus Infections In Florida, Stephen L. White

FIU Electronic Theses and Dissertations

Until recently, Zika virus (ZIKV) was an obscure virus that rarely caused infections and was unknown to most. In 2015 and 2016, ZIKV came into the public spotlight as Brazil and other countries began to report large increases in infections with ZIKV and reported potential complications with developing fetuses and neurologic manifestations. In 2016, the state of Florida identified and responded to an outbreak of locally acquired ZIKV infections in Miami-Dade County. This dramatic increase in infections demonstrated both its importance as an emerging infectious disease and the paucity of knowledge surrounding ZIKV. This study seeks to utilize the data …