Epidemiology Commons^™

Impact Of Medicaid Enrollment Timing On Tumor Stage At Diagnosis And Survival In Breast, Colorectal, And Lung Cancer, Gabriel A. Benavidez, Stella Coker Watson Self Ph.D., Ms, Anthony Alberg Ph.D., M.P.H., Janice Probst, Jan Marie Eberth

Faculty Publications

Background: Medicaid-insured patients experience higher rates of late-stage cancer diagnosis and worse survival than non-Medicaid patients. The impact of Medicaid enrollment timing on cancer outcomes is less clear. This study examines the association between Medicaid enrollment and timing with tumor stage and cancer-specific survival for breast, colorectal, and lung cancers. Methods: We analyzed SEER-Medicaid linked data for 276,755 breast, 104,784 colorectal, and 101,058 lung cancer patients < 65 years of age. Patients were categorized as non-Medicaid enrollees, pre-diagnosis enrollees (≥12 months before), or post-diagnosis enrollees (≤12 months after). Multivariable logistic regression estimated odds ratios of late-stage diagnosis, and cause-specific Cox proportional hazards models were used to assess cancer-specific survival, adjusting for demographic and socioeconomic factors. Results: Compared to non-Medicaid enrollees, post-diagnosis enrollees had the highest odds of late-stage diagnosis (breast cancer: OR: 3.41; colorectal cancer: OR: 3.78; lung cancer: OR: 1.87). Pre-diagnosis enrollees also had increased odds, but the …

Rural–Urban Differences In Cognitive Outcomes Among Older Adults: The Roles Of Falls And Depressive Symptoms, Ayse Malatyali, Tom Cidav, Lisa A.K. Wiese, Jian Zou, Monique J. Brown Ph.D., Mph, Junfeng Ma, Breno S. Diniz, Ladda Thiamwong

Faculty Publications

Background: Older adults with Alzheimer’s Disease and Related Dementias (ADRD) experience a higher risk of falls. However, research lacks evidence on the effect of fall exposure on cognitive impairment and dementia. We investigated the association of falls and depressive symptoms with cognitive impairment and dementia in a nationally representative sample. Methods: We analyzed data from 6221 participants (age ≥ 65) in the Health and Retirement Study (HRS) from the 2018–2020 waves, using Multinomial logistic regression models. Measures included the HRS health status questionnaire, HRS cognition scale, and the Center for Epidemiological Studies Depression scale. Results: Prevalence of fall exposure across …

Rural–Urban Differences In Cognitive Outcomes Among Older Adults: The Roles Of Falls And Depressive Symptoms, Ayse Malatyali, Tom Cidav, Lisa A.K. Wiese, Jian Zou, Monique J. Brown Ph.D., Mph, Junfeng Ma, Breno S. Diniz, Ladda Thiamwong

Faculty Publications

Background: Older adults with Alzheimer’s Disease and Related Dementias (ADRD) experience a higher risk of falls. However, research lacks evidence on the effect of fall exposure on cognitive impairment and dementia. We investigated the association of falls and depressive symptoms with cognitive impairment and dementia in a nationally representative sample. Methods: We analyzed data from 6221 participants (age ≥ 65) in the Health and Retirement Study (HRS) from the 2018–2020 waves, using Multinomial logistic regression models. Measures included the HRS health status questionnaire, HRS cognition scale, and the Center for Epidemiological Studies Depression scale. Results: Prevalence of fall exposure across …

Muscular Fitness Levels Of U.S. Children And Adolescents, Daniel J. Mcdonough, Yong Gao, Lynda B. Ransdell, Haichun Sun

International Journal of Physical Activity and Health

Purpose: To describe muscular fitness (MF) levels and percentile benchmarks among U.S. children and adolescents aged 6–15 years old across sociodemographic, physiological, and behavioral subgroups. Methods: Data were from the 2012 NHANES National Youth Fitness Survey (NNYFS). Four strength tests consisting of the plank, knee extension, modified pull-up, and handgrip, were analyzed by age, sex, race/ethnicity, income, BMI category, cardiorespiratory fitness (CRF), and physical activity (PA) among 1,234 participants (51% male) using SAS SURVEY procedures. Results: Mean ± SEM scores were 69.6 ± 1.8 s (plank), 56.6 ± 4.2 lb (left) and 59.2 ± 4.3 lb (right) knee extension, 5.5 …

An Odd Protocol For An Agent-Based Model Of Hepatitis C Virus Transmission In A Homogeneous Syringe-Sharing Network, Seun Ale, Que Thi Nguyet Nguyen Dr., John D. Kelleher Prof., Elizabeth Hunter Dr.

Reports

The model described in this ODD is an agent-based model of hepatitis C virus (HCV) transmission among people who inject drugs (PWID). The model assumes homogeneous mixing among syringe-sharing agents, without any form of heterogeneity in the agents interactions or syringe-sharing attitude. All syringe-sharing PWID are treated as identical in terms of their interaction frequency and syringe-sharing probability. Interactions are generated dynamically using proximity-based sampling at each timestep (one day), allowing agents to form syringe-sharing interactions based on spatial closeness. The number of daily interaction events is fixed at the population level, and each syringe-sharing agent has the same probability …

An Odd Protocol For An Agent-Based Model Of Hepatitis C Virus Transmission With Inter- And Intra-Group Structural And Behavioural Heterogeneous Syringe-Sharing Networks (5), Seun Ale, Que Nguyen Dr., John D. Kelleher Prof., Elizabeth Hunter Dr.

Reports

The model described in this ODD is an agent-based model of hepatitis C virus (HCV) transmission among people who inject drugs (PWID). The model incorporates structural heterogeneity through a three-group interaction framework and behavioural heterogeneity through group-specific syringe-sharing rates with additional intra-group variability. The syringe-sharing population in the model is divided into core, inner, and outer circle groups representing individuals with high, moderate, and low levels of syringe-sharing interaction intensity, respectively. In addition to differences in the number of daily interaction opportunities across groups, agents in each group are assigned syringe-sharing probabilities that vary at the individual level around their …

An Odd Protocol For An Agent-Based Model Of Hepatitis C Virus Transmission In A Two-Group Structural Heterogeneous Syringe-Sharing Network (M2), Seun Ale, Que Nguyen Dr., John D. Kelleher Prof., Elizabeth Hunter Dr.

Reports

The model described in this ODD is an agent-based model of hepatitis C virus (HCV) transmission among people who inject drugs (PWID). The model extended a baseline homogeneous model by incorporating structural heterogeneity via a two-group interaction framework. The syringe-sharing population in the model is divided into inner and outer circle groups representing individuals with differing levels of syringe-sharing interaction intensity. While all agents share the same syringe-sharing probability and epidemiological processes remain identical across agents, the number of daily interaction opportunities differs between the two groups. Interactions in the model are generated dynamically using proximity-based sampling at each timestep …

An Odd Protocol For An Agent-Based Model Of Hepatitis C Virus Transmission In A Three-Group Structural Heterogeneous Syringe-Sharing Network (M3), Seun Ale, Que Nguyen Dr., John D. Kelleher Prof., Elizabeth Hunter Dr.

Reports

The model described in this ODD is an agent-based model of hepatitis C virus (HCV) transmission among people who inject drugs (PWID). The model incorporates structural heterogeneity through a three-group interaction framework. The syringe-sharing population in the model is divided into core, inner, and outer circle groups representing individuals with high, moderate, and low levels of syringe-sharing interaction intensity, respectively. While the syringe-sharing rate and all epidemiological processes remain identical across agents, the number of daily interaction opportunities differs by agent grouping, capturing variation in structural position within the syringe-sharing network. Interactions are generated dynamically using proximity-based sampling at each …

An Odd Protocol For An Agent-Based Model Of Hepatitis C Virus Transmission With Inter-Group Structural And Behavioural Heterogeneous Syringe-Sharing Networks (M4), Seun Ale, Que Nguyen Dr., John D. Kelleher Prof., Elizabeth Hunter Dr.

Reports

The model described in this ODD is an agent-based model of hepatitis C virus (HCV) transmission among people who inject drugs (PWID). The model incorporates structural heterogeneity through a three-group interaction framework and behavioural heterogeneity through group-specific syringe-sharing rates. The syringe-sharing population in the model is divided into core, inner, and outer circle groups representing individuals with high, moderate, and low levels of syringe-sharing interaction intensity, respectively. In addition to differences in the number of daily interaction opportunities across groups, agents in each group are assigned distinct syringe-sharing probabilities, reflecting variation in risk-taking behaviour across structural groups within the syringe-sharing …

Acute Schistosomiasis In A Traveler Returning From St. Croix, United States Virgin Islands: A Case Report., John Weis, Mackenzie Caruthers, Megan Buller

Ambulatory and Primary Care Articles

In this case report, we describe a patient who presented to their primary care provider with abdominal pain after returning from travel to the Caribbean island of St. Croix. The patient reported two weeks of epigastric abdominal pain, dyspepsia, nausea, and night sweats. Following an initial evaluation that revealed eosinophilia with unclear etiology, they were referred to an infectious disease clinic. Through a targeted infectious evaluation and workup, the patient was diagnosed with acute schistosomiasis syndrome and was treated with praziquantel. Treatment resulted in the complete resolution of her symptoms, and follow-up laboratory evaluation showed complete resolution of her eosinophilia. …

Does Genetic Testing Influence Outcomes: Early Experience In Melanoma Case Series, Ryan Reyes, George Skenteris, Stella Coker Watson Self Ph.D., Ms, Christine Marie-Gilligan Schammel, Steven D. Trocha

Faculty Publications

Background:

The treatment and prognosis of melanoma have historically been based on histologic stage and Breslow depth; however, due to the increase in surveillance, melanomas are being identified at an earlier stage and lower Breslow depth. Advances in genetic testing, such as Decision Dx®, mean that melanoma diagnostic decisions and prognosis can now be directed by genetics. The purpose of this project was to assess the influence of a Decision Dx® high-grade (Class 2A/B) classification on the treatment of melanoma patients at a regional medical center, particularly those not deemed high risk by conventional classification methods, including Breslow depth and …

Early Insights From A Multi-Centre National Stroke Surveillance Initiative In Tanzania, Sarah Shali Matuja, Azan Nyundo, Emmanuel Assey, Joel Bwelemo, Marieke Dekker, Sarah Urasa, Emanuel Makarius, Peter Kishimbo, Philip Adebayo, Paschal Ruggajo

Internal Medicine, East Africa

Background: Stroke is a leading cause of death and disability globally, with sub-Saharan Africa, bearing the greatest burden. Tanzania has only one active stroke registry, limiting evidence-based care and policy development. We aimed to expand the registry into a multi-centre study across eight major tertiary hospitals to generate baseline data for a national stroke registry.

Methods: From January to August 2024, we analysed de-identified data from adults (≥18 years) admitted with a World Health Organisation defined stroke. Data collected included demographics, risk factors, imaging, and in-hospital mortality. Logistic regression identified predictors of mortality.

Results: A total of 1000 patients were …

Achieving And Sustaining Treatment Targets In Rheumatoid Arthritis: A Retrospective Cohort Analysis In Indonesia, Fara Fauzia, Rudy Hidayat, Suryo Anggoro Kusumo Wibowo, Sumariyono Sumariyono, Faisal Parlindungan, Anna Ariane, Johanda Damanik, Abirianty Priandani Araminta, Suci Damaratri

Kesmas

Achieving and sustaining low disease activity (LDA) and remission in rheumatoid arthritis (RA) remains challenging. This study examined the rates and predictors of LDA/remission and sustained LDA/remission in an Indonesian RA cohort. A retrospective study of newly diagnosed adult patients attending a rheumatology clinic in 2020-2021 was conducted. Patients were followed for 12 months to evaluate achievement of LDA/remission, defined as DAS28-ESR ≤3.2, and those meeting the target were observed for an additional 12 months to evaluate sustained LDA/remission. Cox regression was used to identify predictors of time to LDA/remission and loss of LDA/remission. Of 166 participants, 91 (54.8%) achieved …

Short-Term Survival And Prognostic Factors In Cervical Cancer Patients Requiring Hemodialysis: A Retrospective Cohort Study, Muhammad Trihatmowijoyo Bundjali, Maruhum Bonar Hasiholan Marbun, Wulyo Rajabto, Ikhwan Rinaldi, Hamzah Shatri, Dwi Lestari Partiningrum, Dadang Makmun, Pringgodigdo Nugroho, Sukamto Koesnoe, Pradana Soewondo

Kesmas

Cervical cancer is a common gynecological malignancy, particularly in developing countries, where it coexists with renal impairment in over one-third of patients. This disease typically presents acutely and progresses rapidly. Consequently, kidney replacement therapy, including hemodialysis (HD), is commonly required. To assess survival rates and associated factors, this retrospective cohort study analyzed the medical records of 252 cervical cancer patients who began HD across a three-month follow-up period. Kaplan–Meier analysis indicated a median short-term survival duration of 71.5 days (range: 7–90), with 1-, 2-, and 3-month survival rates of 56%, 51%, and 49%, respectively. Multivariate Cox regression identified post-HD systolic …

Factors Associated With Antiretroviral Therapy Adherence In Patients With Hiv At A Public Hospital In Central Jakarta, Indonesia, Kareena Sari Fatimah, Laily Hanifah, Chandrayani Simanjorang, Nayla Kamilia Fithri

Kesmas

Patients with human immunodeficiency virus (HIV) are required to take antiretroviral therapy (ART) to suppress the virus. However, suboptimal adherence remains a critical barrier that can lead to treatment failure and persistent transmission risks. This study aimed to identify factors associated with ART adherence in patients with HIV. This quantitative study with a cross-sectional design consisted of patients with HIV aged >18 years who received care at the voluntary counseling and testing clinic of a public hospital in Jakarta, Indonesia. Purposive sampling was used. This study used HIV care and ART overview forms as instruments. Data were analyzed using multiple …

The Role Of Gynecologic Oncologists In Improving Survival Outcomes Of Epithelial Ovarian Cancer: A Retrospective Cohort Study, Widyorini Lh Hanafy, Bambang Dwipoyono, Asri C. Adisasmita, Yosephine E. Regina, Airine S. Lians, Oktaviani P. Rahayu, Jane G. Auwelia

Kesmas

Epithelial ovarian cancer (EOC) is a leading cause of gynecological cancer mortality and is often diagnosed at an advanced stage, resulting in poor survival outcomes. Access to specialized gynecological oncology services has been associated with improved prognosis; however, data on its impact in Indonesia remain limited. This study aimed to evaluate the association between gynecologic oncologist (GO) services and disease-free survival (DFS) in patients with EOC. This retrospective cohort study included 76 patients with EOC who were treated at a national cancer hospital in Jakarta between 2015 and 2018. Patient data were obtained from medical records and followed for three …

Urban–Rural Disparities In Metabolic Risk Factors For Hypertension Among The Elderly In Indonesia, Susiana Nugraha, Puri Wulandari

Kesmas

Hypertension remains a major public health challenge among the elderly in low- and middle-income countries. This cross-sectional study examined demographic and metabolic factors associated with hypertension among the elderly living in urban and rural areas of West and Central Java Provinces, Indonesia. This study included 1,920 adults aged ≥60 years who had resided in the study areas for at least six months, were able to communicate effectively, and provided informed consent. Data were collected between March and August 2023 using stratified multistage random sampling, structured questionnaires, and biochemical measurements. Multivariable logistic regression revealed distinct patterns of association across settings. In …

Association Between Dietary Folate And Prostate Cancer Aggressiveness Among African Americans And European Americans, Lihchyun Joseph Su, Sarah O'Connor, Daniela Ramirez Aguilar, Minjae Lee, Harrison Wong, Hui-Yi Lin, Jeannette T. Bensen, James L. Mohler, Lenore Arab, Longgang Zhao, Ebonee N. Butler, Laura Farnan, Susan E. Steck Phd, Mph, Rd

Faculty Publications

Background: Despite the confirmed beneficial effects on preventing neural tube defects, concerns about high intakes of synthetic folate, or folic acid, in promoting cancer progression have been raised. This study evaluated the association between folate intake and prostate cancer (PCa) aggressiveness among African-American (AA) and European-American (EA) males. Methods: This study included 722 AA and 775 EA men with prostate cancer. Folate intake (dietary folate equivalent (DFE), synthetic folate, natural folate) was estimated using the National Cancer Institute Dietary History Questionnaire and detailed dietary supplement use questionnaire. Analyses included univariable comparisons of demographic and clinical characteristics of the two racial …

Trends In Self-Reported Responses To Nutrition Facts Labels Before And After Nutrition Labeling Policy Implementation: A Comparison Of Adults In The United States And Mexico, Jim Thrasher Ph.D., Ma, Ms, Victor Vilalobos, Dai Fang, Alejandra Jáuregui, Alejandra Contreras-Manzano, Rachel Davis Ph.D., Lana Vanderlee, Christine M. White, Rachel B. Acton, James W. Hardin, Edward A. Frongillo Jr. Ph.D., Simón Barquera, David Hammond

Faculty Publications

Background

Objectives

Methods

A Transcriptional Program Associated With Neurotransmission In The Living Human Brain, Alexander W. Charney, Lora E. Liharska, Eric Vornholt, Alissa Valentine, Anina Lund, Alice Hashemi, Ryan C. Thompson, Terry Lohrenz, Jessica S. Johnson, Nicole Bussola, Esther Cheng, You Jeong Park, Salman Qasim, Alisha Aristel, Lillian Wilkins, Kimia Ziafat, Hannah Silk, Lisa M. Linares, Brendan Sullivan, Claudia Feng, Beniamino Hadj-Amar Ph.D.

Faculty Publications

At the foundation of neurotransmission, and by extension at the foundation of brain function, are coordinated programs of gene expression involving many thousands of genes. These programs are poorly defined in humans because most modern studies that characterize human brain gene expression use tissue obtained in the postmortem state when neurotransmission and brain function have ceased. Here, to advance knowledge of the gene expression programs at the foundation of neurotransmission in the human brain, gene expression was characterized in 130 prefrontal cortex (PFC) samples obtained from participants of the Living Brain Project (LBP) during neurosurgical procedures in conjunction with intracranial …

Survival On Image Regression With Application To Partially Functional Distributional Representation Of Physical Activity, Rahul Ghosal, Sunwoo Emma Cho, Marcos Matabuena

Faculty Publications

Technological advancements in wearable devices and medical imaging often lead to high-dimensional physiological signals in the form of images or surfaces. To address these data structures, we develop a novel survival on image regression model with a specific focus on partially functional distributional representation of wearable data. The existing approaches for functional data and survival outcomes have been primarily developed for uni-dimensional functional predictors. Drawing on recent developments in distributional data analysis, we model temporally varying distributional patterns of physical activity (PA) as a partially functional distributional predictor within a semiparametric Cox model framework. We use tensor product splines to …

Environmental Chemicals And Maternal Depression During And After Pregnancy: A Scoping Review, Pengfei Guo, Yunyue Shi, Cindy Nguyen, Haoran Zhuo, Tormod Rogne, Zeyan Liew

Faculty Publications

Purpose of Review

There is increasing evidence that several environmental exposures may pose a risk for depression, including maternal depression. We conducted a scoping review of epidemiological evidence regarding maternal exposure to environmental chemicals and perinatal depression.

Recent Findings

We searched PubMed, Embase, Web of Science, Dimensions, and Scopus, and summarized the findings from 27 articles that examined environmental chemical exposures and maternal depression. Studies of ambient air pollutants (N = 11) showed exposure to NO₂ and PM10 to be most consistently associated with antenatal or postnatal depression. Studies of endocrine-disrupting chemicals, including phthalates (n = 6), …

Social, Political, And Economic Determinants For Hiv Prep Care Delivery Innovations, Joanne Senoga Brown

Walden Dissertations and Doctoral Studies

Pre-exposure prophylactic care delivery innovations (PCDI) are critical to the Ending the HIV Epidemic (EHE) initiative. While individual studies have examined isolated factors such as patient awareness, provider willingness to prescribe, and cost-effectiveness, few have synthesized these findings into a unified framework explaining how structural social, political, and economic determinants jointly influence PCDI. Prior literature remains fragmented, emphasizing behavioral or programmatic variables rather than systemic structures. This meta-analysis was done to examine how structural determinants independently and collectively influence PCDI across the 47 U.S. EHE jurisdictions. Guided by the consolidated framework for implementation research and Rogers’s diffusion of innovations theory, …

Remnant Cholesterol And Atherosclerotic Cardiovascular Disease Risk In Populations With Different Low-Density Lipoprotein Cholesterol Elevations: A Prospective Cohort Study, Hong Zheng, Guanlin Chen, Zhenyu Huo, Yulong Lan, Yuxian Wang, Peng Fu, Weiqiang Wu, Haixiang Zheng, Kuangyi Wu, Zegui Huang, Dan Wu, Shouling Wu, Youren Chen

Research outputs 2022 to 2026

Background: Low-density lipoprotein cholesterol (LDL-C) and remnant cholesterol (RC) are risk factors for atherosclerotic cardiovascular disease (ASCVD). However, the extent to which differences in RC levels affect ASCVD risk in populations with varying degrees of LDL-C elevation remains unclear. This study aimed to investigate whether RC can provide additional risk stratification value across different sexes, ages, and elevated LDL-C statuses. Methods: This study included 12 743 elevated LDL-C participants (LDL-C ≥3.4 mmol/L) and 50 073 age- and sex-matched non-elevated LDL-C controls from the Kailuan Study. Elevated LDL-C participants were categorized by RC levels into <0.5, 0.5 to <1.0, and ≥1.0 mmol/L subgroups. Kaplan-Meier curves and Cox proportional hazards models were used to assess the relationship between RC levels and ASCVD risk across different sexes, ages, and high LDL-C statuses. Results: During a median follow-up of 12.8 years, 1686 elevated LDL-C participants (13.2%) and 5252 non-elevated LDL-C participants (10.5%) developed ASCVD. In the borderline-high LDL-C group (3.4 ≤ LDL-C < 4.1 mmol/L), those with the lowest RC levels showed no significant risk difference compared with controls (hazard ratio [HR], 1.03 [95% CI, 0.93-1.13]), and this pattern remained consistent across different sexes and ages. In contrast, in the high LDL-C group (LDL-C ≥4.1 mmol/L), even when RC was at the lowest level, ASCVD risk remained significantly higher than that of controls (HR, 1.20 [95% CI, 1.02-1.41]). CONCLUSIONS: In the borderline-high LDL-C population, those with the lowest RC levels showed no significant risk difference compared with controls, and this pattern remained consistent across different sexes and age subgroups. In the high LDL-C population, even when RC was at the lowest level, ASCVD risk remained significantly higher than that of controls.

The Enduring Legacy Of Nuclear Tests: Barriers To Managing Type 2 Diabetes Among Marshallese Pacific Islanders In The United States, Bernard A. Muriithi

Occupational Therapy Faculty Scholarship

Introduction / Rationale: Nuclear tests conducted by the United States caused significant damage to the environment and traditional food sources in the Marshall Islands. The Marshall Islanders began to depend on imported processed food, but the change of diet resulted in significant increases in chronic diseases, in addition to cancers and birth defects associated with nuclear radiation. Since the 1986 Compact of Free Association, over 15,000 Marshallese have relocated to the United States, and the majority live in one U.S. state. This community of Marshallese has the highest prevalence rate for type 2 diabetes in the world.

Objectives: identify the …

A Rare And Challenging Polymicrobial Pleural Infection Involving Cupriavidus Pauculus In A Patient With Rheumatoid Arthritis And Multiple Complications, Moiz Ahmed Khan, Syeda Samiya Kamal, Muhammad Muneeb, Summaya Zafar

The University of Louisville Journal of Respiratory Infections

A 58-year-old female with a 15-year history of rheumatoid arthritis (RA) and a history of treatment consisting of methotrexate, hydroxychloroquine, leflunomide, and chronic prednisolone therapy, presented with fever, productive cough, dyspnea, and left leg cellulitis. She developed septic shock complicated by tension pneumothorax requiring emergency thoracostomy and non-ST-elevation myocardial infarction (NSTEMI). Pleural fluid culture grew Cupriavidus pauculus, a rare environmental gram-negative bacillus, alongside Burkholderia cepacia and Candida parapsilosis, indicating polymicrobial infection which was most likely predisposed by patient's immunosuppressed state from RA and prolonged steroid use. Treatment consisted of trimethoprim/sulfamethoxazole, meropenem, fluconazole, and cardiopulmonary support, and culminated in …

Association Between Environmental Exposures To Perfluoroalkyl And Polyfluoroalkyl Substances And Military Veterans Cancer Determination, Stephen A. Pereira Jr

Walden Dissertations and Doctoral Studies

This study involved evaluating whether cumulative exposure to perfluoroalkyl and polyfluoroalkyl substances (PFAS) was associated with kidney cancer, bladder cancer, and adult leukemia among U.S. veterans. Pooled National Health and Nutrition Examination Survey (NHANES) data from 2005–2015 were analyzed for sample of 2,500 veterans with available serum PFAS measurements and physician-diagnosed cancer histories. This study employed a cross-sectional, correlational design grounded in a post-positivist paradigm. Inclusion required complete data for (a) serum PFAS concentrations, (b) kidney cancer, bladder cancer, and adult leukemia, and (c) covariates age, sex, race/ethnicity, smoking status, and body mass index. Cumulative PFAS was modeled as a …

Experiences Of Care-Seeking Parents With Children With Autism Spectrum Disorder In India, Yash Navnit Patel

Walden Dissertations and Doctoral Studies

Autism spectrum disorder (ASD) affects approximately 18 million individuals in India, yet the factors influencing parental care-seeking behavior were not well understood. Guided by the health belief model, the purpose of this basic qualitative study was to explore how parents’ perceived severity of a child’s symptoms, parental beliefs about the causes of autism, and perceived mental and physical health outcomes of caregiving influence parents’ intention to seek services for children aged 1–10 years diagnosed with ASD in India. Data were collected using semistructured interviews with 10 mothers of autistic children. Data were analyzed using Braun and Clarke’s six-step thematic analysis. …

Ecologic Factors Contributing To West Nile Virus Hyperendemicity In Central South Carolina: An Integrated Vector–Human–Environmental Study, Elba S. Fridriksson, Ahayla Muraleedharan, Kyndall C. Dye-Braumuller, Madeleine M. Meyer, Kia Zellars, Hiuxuan Li, Melissa S. Nolan Ph.D., Mph

Faculty Publications

West Nile virus (WNV) is an endemic arboviral infection in the United States that has undergone phyloge-netic evolution since its introduction 25 years ago. An integrated vector–human–pathogen study was conducted in the summer of 2023 to unearth contemporary Culex quinquefasciatus habitat patterns and human transmission spillover foci in South Carolina, a state with historically little WNV data. A serosurvey revealed WNV seroprevalence 10 times the national average (22% versus 2%, respectively), with unusual epidemiologic risk factors. Female Culex quinquefas-ciatus WNV positivity was low (2.7%), with viral phylogenetics 100% homologous to the WN02 clade. Mosquito vectors clustered in affluent urban neighborhoods …

International Normative Charts For Twin Weight, Length, And Head Circumference At Birth, By Gestational Age And Sex: The Twin Neonatal Cross-Sectional Study Of The Intergrowth-21st Project, Francesca Giuliani, Sonia Deantoni, Enrico Bertino, Yasmin A. Jaffer, Manorama Purwar, Fernando C. Barros, Leila Cheikh Ismail, Wu Qingqing, Ilaria Stura, Maria Carvalho

Obstetrics and Gynaecology, East Africa

Assessing the size of twins at birth using charts developed for singletons may over diagnose small for gestational age in this sub-population. The study aimed to produce international, twin-specific, newborn size normative charts by gestational age and sex. This longitudinal observational study in eight geographically diverse settings prospectively collected data between May 2009 and August 2013 from healthy pregnant women and their newborn twins. The participants were enrolled as part of the INTERGROWTH-21st study, and recruited based on World Health Organization recommendations for evaluation of anthropometric measures. All the women met, in addition to the underlying population characteristics of low …