Community Health and Preventive Medicine Commons^™

“It’S Like 1998 Again”: Why Parents Still Refuse And Delay Vaccines, Jiana L. Ugale, Heather Spielvogle, Christine Spina, Cathryn Perreira, Ben Katz, Barbara Pahud, Phd Amanda F. Dempsey Md, Jeffrey D. Robinson Phd, Kathleen Garrett Ma, Mph Sean T. O’Leary Md, Mph Douglas J. Opel Md

Communication Faculty Publications and Presentations

We conducted a qualitative study from 2018 to 2019 to update the reasons why US parents’ refuse or delay vaccines. Four focus groups and 4 semi-structured interviews involving 33 primary care pediatric providers were conducted in Washington and Colorado. A thematic analysis was conducted to identify themes related to reasons for parental refusal or delay. Five predominant themes were identified: (1) vaccine safety, (2) relative influence of information sources, decision-makers, and timing, (3) low perceived risk of contracting vaccine-preventable disease, (4) lack of trust, and (5) religious objection. Vaccine safety was the theme mentioned most frequently by providers (N = …

A 10-Year Post-Analysis Of The Maya Health Toolkit For Medical Providers, Lorenna Garcia-Bochas

Master of Science in Integrative Biology Theses

Researchers have often overlooked America's Indigenous community when conducting health disparities research. In Central and South America, The World Bank 2015 report identifies 774 indigenous groups living today (Davis-Castro, n.d.). One of the oldest known is the Maya people. The Maya have been through various cultural struggles, from the Spanish conquistadors of the past to current anti-indigenous discrimination, violence, and rhetoric. The historical conflict and prejudice have contributed to why many Maya migrate north to the United States for a better opportunity and a more peaceful life for their families. In doing so, they face many health risks to their …

Disparities In Covid-19 Rates Among Various Demographics And Lack Of Racial Representation In Medical Texts, Diangelo Gonzalez

Celebration of Learning

The 2019 novel coronavirus (COVID-19) outbreak, which originated in Wuhan, China in December of 2019, has impacted nations all over the globe. Given the health disparities which existed within the United States prior to the COVID-19 pandemic, this pandemic continued to pose a significant challenge to the health of the public. The aims of this research study were twofold: (1) to analyze the incidence rates of COVID-19 among different racial and ethnic groups within the United States and (2) to describe the occurrence of diversity within medical texts. Overall, the COVID-19 pandemic exacerbated health disparities within the United States. Understanding …

Environmental Scan Of Primary Care Needs In The Last Decade (2010-2020), Ravninder Bahniwal

Family Medicine Publications

No abstract provided.

Why Should People Use Face Masks In The Time Of Covid? The Jri Position, Jose Bordon, Alex Glynn, Forest W. Arnold

The University of Louisville Journal of Respiratory Infections

No abstract provided.

Mindfulness-Based Cognitive Therapy Staff Training Program To Tackle Postpartum Depression, Helen Xumin Chen

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Women in the process of childbirth go through significant physical and psychological changes. The internal changes along with other external factors can be overwhelming. There is a high rate of new mothers suffering from postpartum depression (PPD) as a result. Problem: High prevalence of PPD is a public health crisis. The condition has a negative impact on the mother-baby unit and the wellbeing of the whole family. Aside from the implications on the health of new mothers and babies, PPD is also costly to the economy. Methods: Mindfulness-Based Cognitive Therapy (MBCT) is a common and effective intervention for …

No Difference In Clinical Outcomes For African American And White Patients Hospitalized With Sars-Cov-2 Pneumonia In Louisville, Kentucky, Julio A. Ramirez, Stephen P. Furmanek, Thomas Chandler, Stephen S. Hanson, Dawn Balcom, Subathra Marimuthu, Sathya Krishnasamy, Jose Bordon, Rodrigo Cavallazzi, Amr Aboelnasr, Mahder A. Tella, William A. Mattingly, Ashley M. Wilde, Daisy Sangroula, Demetra Antimisiaris, Donghoon Chung, Guillermo Cabral, Gabino R Fernandez-Botran, Jiapeng Huang, Martin Gnoni, Ozan Akca, Paul Schulz, Phillip F. Bressoud, Priya Krishnan, Sally Suliman, William P. Mckinney, Bryan Moffett, Leslie A Wolf, Mark Burns, Alex Glynn, Ruth Carrico, Forest W. Arnold

The University of Louisville Journal of Respiratory Infections

Introduction: Current literature indicates that African American individuals are at increased risk of becoming infected with the SARS-CoV-2 virus and suffer higher SARS-CoV-2-related mortality rates. However, there is a lack of consensus as to how the clinical outcomes of African American patients differ from those of other groups. The objective of this study was to define the clinical outcomes of African American and White hospitalized patients with SARS-CoV-2 community-acquired pneumonia (CAP) in Louisville, Kentucky.

Methods: This was a retrospective cohort study of hospitalized patients with SARS-CoV-2 CAP at eight hospitals in Louisville, Kentucky. Severity of CAP at time of hospitalization …

Factors Associated With Voluntary Refusal Of Emergency Medical System Transport For Emergency Care In Detroit During The Early Phase Of The Covid-19 Pandemic, Nicholas E. Harrison, Robert R. Ehrman, Andrea Curtin, Damon Gorelick, Alex B. Hill, Erin Brennan, Robert Dunne

Urban Studies and Planning Faculty Research Publications

Importance
Emergency department (ED) and emergency medical services (EMS) volumes decreased during the COVID-19 pandemic, but the amount attributable to voluntary refusal vs effects of the pandemic and public health restrictions is unknown.

Objective
To examine the factors associated with EMS refusal in relation to COVID-19 cases, public health interventions, EMS responses, and prehospital deaths.

Design, Setting, and Participants
A retrospective cohort study was conducted in Detroit, Michigan, from March 1 to June 30, 2020. Emergency medical services responses geocoded to Census tracts were analyzed by individuals’ age, sex, date, and community resilience using the Centers for Disease Control and …

The Double Burden Of Malnutrition And Associated Factors Among South Asian Adolescents: Findings From The Global School-Based Student Health Survey, Sara Estecha Querol, Romaina Iqbal, Laura Kudrna, Lena Al-Khudairy, Paramijit Gill

Community Health Sciences

The health and nutrition of the global adolescent population have been under-researched, in spite of its significant size (1.2 billion). This study investigates the prevalence and associated factors of malnutrition (stunting, thinness and overweight) among adolescents living in South Asia. The sample analysed was 24,053 South Asian schooled adolescents aged 12-15 years that participated in the cross-sectional Global School-Based Student Health Survey (GSHS) between 2009 and 2016. The prevalence of stunting, thinness and overweight was calculated using the World Health Organization (WHO) Child Growth Reference 2007. Associations between the three forms of malnutrition and their possible associated factors were assessed …

Strongyloides Stercoralis Hyperinfection And Disseminated Tuberculosis, Hernan Terroba, Alejandra González, Diana Vera Gonzalez, Roxana Mariela Godoy, Analia Santos, Marisol Arrojo

The University of Louisville Journal of Respiratory Infections

No abstract provided.

Focused Ethnography: Storytelling For Hispanics With Low Health Literacy And Diabetes, Virginia H. Cadenhead

Nursing Theses and Dissertations

Background: Storytelling is an intervention for health communication that has many forms, addresses varied health issues, and is suitable for low health-literate populations. Storytelling can impact knowledge, behaviors, attitudes, and health outcomes. Population Focus: Fictional storytelling has not been researched as an educational adaption in diabetes self-management for Hispanics with low health literacy. Forty-one percent of Hispanics in the United States have low health literacy, a contributing factor to poor health outcomes in chronic disease management. The Hispanic population has disproportional rates of diabetes complications. Research Question: How can short, fictional, orally presented stories be developed as culturally-adapted educational tools …

Does Supportive Supervision Intervention Improve Community Health Worker Knowledge And Practices For Community Management Of Childhood Diarrhea And Pneumonia? Lessons For Scale-Up From Nigraan And Nigraan Plus Trials In Pakistan, Wafa Aftab, Suneel Piryani, Fauziah Rabbani

Community Health Sciences

Background: Lack of programmatic support and supervision is one of the underlying reasons of the poor performance of Pakistan's Lady Health Worker Program (LHWP). This study describes the findings and potential for scale-up of a supportive supervision intervention in two districts of Pakistan for improving LHWs skills for integrated community case management (iCCM) of childhood diarrhea and pneumonia.
Methods: The intervention comprised an enhanced supervision training to lady health supervisors (LHSs) and written feedback to LHWs by LHSs, implemented in Districts Badin and Mirpur Khas (MPK). Clinical skills of LHWs and LHSs and supervision skills of LHSs were assessed before, …

Concentrations Of Lead, Mercury, Arsenic, Cadmium, Manganese, And Aluminum In The Blood Of Pakistani Children With And Without Autism Spectrum Disorder And Their Associated Factors, Mohammad H. Rahbar, Shahnaz H. Ibrahim, Syed Iqbal Azam, Manouchehr Hessabi, Fatima Karim, Sori Kim, Jing Zhang, Nasreen Gulzar Ali, Katherine A. Loveland

Department of Paediatrics and Child Health

Background: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder with early onset in utero or childhood. Environmental exposure to six metals (Pb, Hg, As, Cd, Mn, Al) is believed to be associated with ASD directly or interactively with genes. Objective: To assess the association of ASD among Pakistani children with the six metals and genotype frequencies of three GST genes (GSTP1, GSTM1, GSTT1).
Methods: We enrolled 30 ASD cases, age 2-12 years old, and 30 age- and sex-matched typically developing (TD) controls in Karachi, Pakistan. We assessed associations of ASD status with various factors using …

Guiding Change: A Multidisciplinary Framework For Interventions Addressing Systemic Racism In Healthcare, Lavette D. King

Master's Projects and Capstones

The relationship between systemic and institutional racism in the U.S., and health outcomes in people of the African Diaspora have been well documented (Bailey et al., 2017). Distrust in the healthcare system is the result of generational trauma compounded by an ongoing issue that has yet to be fully addressed (Scharff et al., 2015). For decades people of African descent have expressed concern about negative experiences with the U.S. healthcare system. Often the encounters leave them feeling, mistreated, unheard and or criminalized. These feelings result in trepidation over using the healthcare system which often further compounds health issues (Washington, 2008). …

Protective Factors That Foster Resilience To Hiv/Aids: Insights And Lived Experiences Of Older Gay, Bisexual, And Other Men Who Have Sex With Men, Renato M. Liboro, Tammy C. Yates, Sherry Bell, Brandon Ranuschio, George Da Silva, Charles Fehr, Francisco Ibañez-Carrasco, Paul A. Shuper

Psychology Faculty Research

Since the beginning of the HIV/AIDS epidemic, gay, bisexual, and other men who have sex with men (gbMSM) have been disproportionately impacted by HIV/AIDS health disparities. Research showed that resilience to HIV/AIDS is associated with increased use of relevant health services, lower sexual health risks, and improved mental health outcomes among racially and ethnically diverse gbMSM. As the subpopulation that has historically been impacted by HIV/AIDS the longest, older gbMSM living with HIV/AIDS have inarguably exhibited resilience to HIV/AIDS the most. The qualitative study described in this paper sought to identify and examine protective factors that fostered resilience to HIV/AIDS …

Use Of Telehealth In Home-Based End-Of-Life Care For Children In Rural Regions, Meaghann S. Weaver

Theses & Dissertations

A national shortage in pediatric-trained providers results in certain geographies, primarily rural, where children with special needs are not able to access home-based care at their end-of-life. Advances in technology have made the use of telemedicine a potential modality for palliative care subspecialty clinicians to provide clinical care and support for adult-trained hospice teams. This dissertation utilizes four approaches to consider telehealth as an unexplored opportunity in care delivery: (1) a systematic review of telehealth measures and instruments to select the Technology Acceptance Model as a validated metric of telehealth acceptance uniquely now applied to pediatric care; (b) a pilot …

Strategies For Addressing Vaccination Disparities And Rates In The U.S Among Racial/Ethnic Minority Adults, Harpreet Kaur

Master's Projects and Capstones

As new and emerging infectious diseases surface, public health officials are working harder to close the immunization gap. Every year, thousands of adults in the U.S suffer adverse health outcomes and die from vaccine-preventable diseases. The COVID-19 pandemic has reminded us of the power of vaccines as they have been able to eradicate diseases, save lives, and create healthier communities. A literature review was conducted to identify the gaps in research as it relates to vaccine disparities among racial/ethnic adult populations.

The literature indicates that ethnic/racial minorities are at disproportionate risk for vaccine-preventable diseases and data has shown increasingly high …

Community-Dwelling Older Adult Fall Prevention Improvement Project, Evan Edminster Bsn, Rn, Cfrn, Tcrn, Cen, Nhdp-Bc

Master's Projects and Capstones

Abstract

Problem: Ground-level falls among community-dwelling adults 60 years and older are significant and contribute to adverse health outcomes such as fractures, functional decline, disability, and death. Additionally, falls among community-dwelling older adults are the number one mechanism of injury seen at a Northern California Level II trauma center. Falls often lead to post-fall fear, activity restriction, and physical deconditioning, further compounding fall risk.

Context: When trauma centers provide targeted outreach and screening for unmanaged health risks such as falls, they reduce unnecessary disability and premature death in the local population. Reducing total fall victim numbers and fall recidivism also …

Exploring Community Perceptions, Attitudes And Practices Regarding The Covid-19 Pandemic In Karachi, Pakistan, Anam Shahil Feroz, Naureen Akber Ali, Ridah Feroz, Noshaba Akber, Salima Nazim Meghani

Community Health Sciences

Background: The Government of Pakistan is facing difficulty to contain the surge of COVID-19 due to the country's social, political, economical and cultural context. Experiences from the previous epidemic suggest that community perceptions, social norms and cultural practices can impede COVID-19 containment. To understand social responses towards COVID-19, the study aims to explore the understanding of COVID-19 and the acceptance of control measures among community members.
Methods: We conducted an exploratory qualitative study using a purposive sampling approach, at two communities of Karachi, Pakistan. In-depth interviews were conducted with community members including, young, middle-aged and older adults of both genders. …

Apple Cider Vinegar Weight Loss Drinks: Portrayal On Pinterest, Sydney Chamberlain, Jana Mitchell, Davis Major, Lena Elemam, Cassandra Cleland

PANDION: The Osprey Journal of Research and Ideas

Apple cider vinegar has shown great promise for weight loss in controlled lab settings, yet these claims are widely shared on social media and may not yield the same benefits. This study used directed content analysis to examine how apple cider vinegar weight loss drinks were portrayed on Pinterest, a social media website utilized to bookmark online content. Using the search terms “apple cider vinegar weight loss drinks,” researchers sampled every fifth pin to collect 200 relevant pins. A codebook was developed, pilot tested and used to code pins. Of the 200 pins, the majority of pins (66%) positively portrayed …

The Increasing Role Of Pragmatic Clinical Trials And Real-World Data In Healthcare Research, Julio A. Ramirez, Ruth Carrico

The University of Louisville Journal of Respiratory Infections

No abstract provided.

Proper Medication Adherence Is A Challenge For Older Snap Participants With Chronic Health Conditions, Colleen Heflin, Chinedum O. Ojinnaka, Irma Arteaga, Lauryn Quick

Population Health Research Brief Series

Diabetes and hypertension are among the leading causes of poor health and mortality in the United States. Properly taking prescribed medications to manage these conditions is critical for maintaining health and preventing complications. This is especially true for older adults, who are more likely to live with these chronic conditions. This brief summarizes findings from a study of an older adults in Missouri who participated in the Supplemental Nutrition Assistance Program (SNAP) between 2006 and 2014. On average, 1 in 4 individuals with hypertension and 1 in 3 with diabetes did not properly take prescribed medications to manage their health …

Improvement Cycles In Medical Education: From Quality Improvement To Patient Care And Clinical Research, Julio A. Ramirez

The University of Louisville Journal of Respiratory Infections

No abstract provided.

Perceptions And Experiences Of Healthcare Providers During Covid-19 Pandemic In Karachi, Pakistan: An Exploratory Qualitative Study, Anam Shahil Feroz, Nousheen Pradhan, Zarak Hussain Ahmed, Mashal Murad Shah, Nargis Asad, Sarah Saleem, Sameen Siddiqi

Community Health Sciences

Objective: To explore healthcare provider's perspectives and experiences of the barriers and facilitators to treat and manage COVID-19 cases.
Design and setting: We conducted an exploratory qualitative study using a purposive sampling approach, at a private tertiary care teaching hospital in Karachi, Pakistan. Study data were analysed manually using the conventional content analysis technique.
Participants: Key-informant interviews (KIIs) were conducted with senior management and hospital leadership and in-depth interviews (IDIs) were conducted with front-line healthcare providers.
Results: A total of 31 interviews (KIIs=19; IDIs=12) were conducted, between April and May 2020. Three overarching themes emerged. The first was 'challenges faced …

Examining Correlates Of Feeding Practices Among Parents Of Preschoolers, Deepa Srivastava, Lucy R. Zheng, Dipti Dev

Department of Child, Youth, and Family Studies: Faculty Publications

Background: Parent feeding practices play a critical role in children’s eating behaviors. Limited research has explored child-level correlates of parent feeding practices.

Aim: To identify correlates of feeding practices (responsive and controlling) among parents of preschoolers in the United States.

Methods: Participants included parents (n = 273) of preschoolers (3–5 years), recruited from early care and education settings (n = 24) located in a metropolitan city in the US. Analysis included descriptives, correlations, and multiple regression.

Results: For responsive feeding practices, positive associations included child’s weight with unintentional modeling (β = .17, 95% CI [0.12, 0.53]), child vegetable …

People With Disabilities Still At Risk In Congregate Care Settings, University Of Montana Rural Institute

Health and Wellness

This report provides an analysis of data to better understand where cases and deaths are rising in nursing homes as of August 8 2021. We hope this analysis can help support local community planning and networking among rural partners to improve outcomes.

• COVID-19 cases among residents and staff are on the rise in nursing homes with the steepest increases in urban areas and in the South and Midwest.
• Disabled people are disproportionately overrepresented in the resident populations of unsafe congregate settings, such as nursing homes.
• Vaccination rates across both residents and staff in nursing homes have stagnated.
• Policy priorities should …

Opening Pandora’S Box From Readmissions To Transitional Care Patient-Centered Outcome Measures, Mathew J. Reeves, Michele C. Fritz, Ifeyinwa Osunkwo, Corita R. Grudzen, Lewis L. Hsu, Jing Li, Raymona H. Lawrence, Janet Prvu Bettger

Health Policy & Community Health: Faculty Publications

Background:

Measuring the effectiveness of transitional care interventions has historically relied on health care utilization as the primary outcome. Although the Care Transitions Measure was the first outcome measure specifically developed for transitional care, its applicability beyond the hospital-to-home transition is limited. There is a need for patient-centered outcome measures (PCOMs) to be developed for transitional care settings (ie, TC-PCOMs) to ensure that outcomes are both meaningful to patients and relevant to the particular care transition. The overall objective of this paper is to describe the opportunities and challenges of integrating TC-PCOMs into research and practice.

Methods and Results:

This …

Implementation Of Complex Interventions Lessons Learned From The Patient-Centered Outcomes Research Institute Transitional Care Portfolio, Sabina B. Gesell, Janet Prvu Bettger, Raymona H. Lawrence, Jing Li, Jeanne Hoffman, Barbara J. Lutz, Corita R. Grudzen, Anna M. Johnson, Jerry A. Krishnan, Lewis Hsu, Dorien Zwart, Mark V. Williams, Jeffrey L. Schnipper

Health Policy & Community Health: Faculty Publications

Background:

Despite the well-documented risks to patient safety associated with transitions from one care setting to another, health care organizations struggle to identify which interventions to implement. Multiple strategies are often needed, and studying the effectiveness of these complex interventions is challenging.

Objective:

The objective of this study was to present lessons learned in implementing and evaluating complex transitional care interventions in routine clinical care.

Research Design:

Nine transitional care study teams share important common lessons in designing complex interventions with stakeholder engagement, implementation, and evaluation under pragmatic conditions (ie, using only existing resources), and disseminating findings in outlets that …

Evaluating A Community-Based Breastfeeding Support Organization In Nebraska, Katelyn Elaine Goodroe

Capstone Experience: Master of Public Health

Specific Aims: The aims of this evaluation plan are to investigate the role of the Nebraska nonprofit organization, MilkWorks, in promoting breastfeeding and family support programming and to identify future internal and external growth opportunities through an assessment of the organizational practices using stakeholder perspectives and marketing structure to better promote infant and parental health.

Significance: As a best practice, evaluation of MilkWorks is critical to providing proper services for promoting infant development and parental health in urban and rural Nebraska communities.

Background: MilkWorks was founded in Lincoln, Nebraska, by mothers with the intention of promoting breastfeeding by offering support …

Application Of The Ultra-Poverty Graduation Model In Understanding Community Health Volunteers’ Preferences For Socio-Economic Empowerment Strategies To Enhance Retention: A Qualitative Study In Kilifi, Kenya, Njeri Nyanja, Nelson Nyamu, Lucy Nyaga, Sophie Chabeda, Adelaide Lusambili, Marleen Temmerman, Michaela Mantel, Anthony Ngugi

Family Medicine, East Africa

Background: A significant shortage of healthcare workforce exists globally. To achieve Universal Healthcare cover- age, governments need to enhance their community-based health programmes. Community health volunteers (CHVs) are essential personnel in achieving this objective. However, their ability to earn a livelihood is compromised by the voluntary nature of their work; hence, the high attrition rates from community-based health programmes. There is an urgent need to support CHVs become economically self-reliant. We report here on the application of the Ultra-Poverty Graduation (UPG) Model to map CHVs’ preferences for socio-economic empowerment strategies that could enhance their retention in a rural area …