Epidemiology Commons^™

Implementing A Sustainable Antimicrobial Resistance Surveillance Across Riverside County, Felipe Aperador

Electronic Theses, Projects, and Dissertations

This project focuses on improving health surveillance in remote communities, addressing antimicrobial resistance (AMR) enhancing connectivity and data collection. Geographic barriers, high shipping costs, and logistical challenges have historically hindered healthcare delivery in underserved areas. By integrating healthcare facilities into a cohesive surveillance systems, would improve specimen collection and data analysis. A systematic review of literature identified key strategies, including governmental support, strengthening laboratory capacity, addressing logistical barriers, and enhancing connectivity. Notable results include insights to integrate new facilities when creating a surveillance network, supported by training and state-funded resources. Actionable steps, such as implementing National Action Plans, establishing National …

Interventions To Improve Timely Cancer Diagnosis: An Integrative Review, Mark L Graber, Bradford D Winters, Roni Matin, Rosann T Cholankeril, Daniel R Murphy, Hardeep Singh, Andrea Bradford

Faculty, Staff and Students Publications

Cancer will affect more than one in three U.S. residents in their lifetime, and although the diagnosis will be made efficiently in most of these cases, roughly one in five patients will experience a delayed or missed diagnosis. In this integrative review, we focus on missed opportunities in the diagnosis of breast, lung, and colorectal cancer in the ambulatory care environment. From a review of 493 publications, we summarize the current evidence regarding the contributing factors to missed or delayed cancer diagnosis in ambulatory care, as well as evidence to support possible strategies for intervention. Cancer diagnoses are made after …

Cdc’S Core Elements To Promote Diagnostic Excellence, Daniel J Morgan, Hardeep Singh, Arjun Srinivasan, Andrea Bradford, L Clifford Mcdonald, Preeta K Kutty

Faculty, Staff and Students Publications

Nearly a decade after the National Academy of Medicine released the "Improving Diagnosis in Health Care" report, diagnostic errors remain common, often leading to physical, psychological, emotional, and financial harm. Despite a robust body of research on potential solutions and next steps, the translation of these efforts to patient care has been limited. Improvement initiatives are still narrowly focused on selective themes such as diagnostic stewardship, preventing overdiagnosis, and enhancing clinical reasoning without comprehensively addressing vulnerable systems and processes surrounding diagnosis. To close this implementation gap, the US Centers for Disease Control and Prevention (CDC) released the Core Elements of …

Reducing Extreme Heat Impacts On Health In Pregnant Women And Infants: A Community Based Intervention In Kilifi, Kenya, Adelaide Lusambili, Fiona Scorgie, Martha Oguna, Matthew Chersich, Stanley Luchters, Giorgia Gon, Veronique Filippi, Sari Kovats, Kevin Mccawley, Jeremy Hess

Institute for Human Development, East Africa

High ambient temperatures affect maternal and newborn health outcomes and wellbeing. The Climate Heat and Maternal and Neonatal Health in Africa (CHAMNHA) consortium conducted formative qualitative research in rural Kilifi, Kenya, to examine perceptions of heat risks among women, household members and community stakeholders. An intervention was co-designed together with community members. This paper presents the development, implementation, and evaluation of a behavior-change intervention aimed at reducing the burden of heat on maternal and newborn health. The intervention used Digital Audio-Visual (DAV) storytelling (encompassing short videos and a set of photographs) and facilitated group discussions. Intervention groups included pregnant and …

Racial Disparity And Environmental Influences On Perinatal Health In Jefferson County, Kentucky., Felicia A Pugh

Electronic Theses and Dissertations

Background: Severe maternal morbidity (SMM) risk has tripled over the past 30 years. Adverse infant birth outcomes in the U.S. have also increased with substantial Black-White disparities. Objectives: This work compares the frequency of adverse maternal and infant birth outcomes by maternal race (Black vs White) and examines associations between maternal ambient heavy metal exposures and birth outcomes in Jefferson County, Kentucky, 2017-2022. Methods: Jefferson County inpatient hospital delivery and birth certificate records of self-identified Black or White birthing parents were used. Incidence of SMM, stillbirth, preterm birth (PTB), and small for gestational age (SGA) with 95% confidence intervals (CI) …

Investigating Mental Health Outcomes Of National Collegiate Athletic Association (Ncaa) Division I Student-Athletes At The University Of Louisville, 2019-2023., Paul Harvey

Electronic Theses and Dissertations

Mental health outcomes among collegiate student-athletes, has become a broader concern in the 21^st century. This study examines prevalence and incidence of anxiety and depression amongst student-athletes at the University of Louisville from 2019-2023 across different Sports Groups. The prevalence of anxiety was found to be 20.22% and risk of anxiety was 15.65%. The prevalence of depression was found to be 13.11% and risk of depression was 18.75%. Logistic regression was used to estimate the association between sports groups and anxiety/depression. There was a borderline association between sports groups and prevalence of anxiety after confounder adjustment (OR=1.86, 95% CI: …

Differences In Prostate Cancer (Pca) Stage At Primary Diagnosis And Pca-Specific Mortality Among Rural Versus Urban Populations In Kentucky., Chase Herrmann

Electronic Theses and Dissertations

Kentucky Cancer Registry (KCR) prostate cancer (PCa) cases between the years of 1994 and 2021 were analyzed to examine differences between rural and urban populations’ primary stage at diagnosis and PCa-specific mortality. After adjusting for covariates, rural populations did not experience significantly higher odds of stage 3 diagnosis when compared to urban populations (OR = 1.02, 95% CI = 0.95 – 1.06). Rural populations had 16% increased odds of stage 4 diagnosis when compared to urban populations (OR = 1.16, 95% CI = 1.10 – 1.23). Rural populations had a 17% increased rate of PCa-specific death when compared to urban …

The Perception Of Waiting Times On Patient Satisfaction And Patient Care: A Cross-Sectional Study At A Tertiary Health Care Institution In Kenya, Soud Seif, Jasmit Shah, Ali Chandani, Sayed Karar

Internal Medicine, East Africa

Introduction: Patients often spend significant time waiting for care, which influences patient satisfaction, perceived quality, access to care, and utilization of various health care services. Waiting time and resulting implications remain understudied in low- and middle-income countries like Kenya. This study aimed to describe the impact on the perception of waiting times on patient satisfaction and care at a tertiary healthcare institution in Kenya.

Method: We conducted a prospective cross-sectional study between the first of April 2023 and the thirty-first of August 2023 at the Emergency Room (ER) at Aga Khan University Hospital, Nairobi. Data was collected through a structured …

Ocular Surface Squamous Neoplasia (Ossn) Risk Factors In Lusaka, Zambia: The Role Of Hiv And Socioeconomic Status, Stepfanie N. Siyumbwa, Peter Julius, Tabitha Nkhata, Obvious N. Chilyabanyama, Abraham Mengist, Gleb Haynatzki, Charles Wood

Capstone Experience: Master of Public Health

Objective

To identify and evaluate potential risk factors for OSSN at the University Teaching Hospital (UTH) in Lusaka, Zambia.

Methods

Data from 475 patients were analyzed retrospectively, and it included 390 with OSSN and 85 with benign biopsies. Variables with significance values

Results

Several key predictors of OSSN were identified after controlling for confounders in the household cooks sub-population, these were, a lower household income (adjusted odds ratio [aOR] = 0.64, 95% CI: 0.46–0.90, p = .009), a Lab confirmed HIV-positive status (aOR = 3.56, 95% CI: 1.72–7.21, p = .001) and exposure to biomass smoke (aOR = 2.47, 95% …

A Comprehensive Literature Review Of Barriers To Hormone Therapy Utilization: Strategies For Improving Menopause Management In Women Aged 40-60, Suhan Lee

Capstone Experience: Master of Public Health

Menopause is a natural transition marked by the cessation of ovarian activity, often accompanied by vasomotor symptoms (VMS), genitourinary syndrome of menopause (GSM), and psychological changes that significantly impact women’s quality of life. Hormone therapy (HT) has been the primary treatment for managing menopausal symptoms, particularly VMS, providing substantial relief when initiated within 10 years of menopause. Despite its effectiveness, HT usage has declined dramatically over the past two decades primarily due to barriers such as stigma, safety, misinformation, provider hesitancy, financial barriers, and cultural beliefs. This comprehensive literature review explores key factors influencing HT decision-making, including the media’s role …

Changes In The Contributions Of Risk Factors To Under-Five Mortality In Low- And Lower-Middle-Income Countries (1997-2022): An Analysis Of Demographic And Health Survey Data, Bereket Kefale, Jonine Jancey, Amanuel T. Gebremedhin, Gavin Pereira, Gizachew A. Tessema

Research outputs 2022 to 2026

Background: Under-five mortality (U5M) is a critical public health challenge in low- and lower-middle-income countries (LLMICs), where over 90% of global deaths occur. Despite progress, the changing contributions of risk factors to U5M in LLMICs remain unexplored.

Mrthods: We analysed Demographic and Health Survey (DHS) data from 24 LLMICs across two periods: 1997-2005 and 2016-2022. We included 139,890 live births in 1997-2005 and 319,034 in 2016-2022. A mixed-effects robust Poisson regression model with a log link function was employed to identify risk factors of U5M in each period. Population-attributable fractions (PAFs) were calculated and compared to investigate changes in the …

Improving Nutrition Outcomes Through Enhanced Allocative Efficiency Of Investments In 24 High Risk Counties In Kenya: An Optima Nutrition Modelling Study, Morris Ogero, Nick Scott, Veronica Kirogo, Anthony Ngugi

Population Health, East Africa

Introduction ;Undernutrition remains a significant global challenge, severely impacting children’s development and growth. To address this, the Sustainable Development Goals target a substantial reduction in stunting and wasting by 2025. Achieving these goals requires scaling up evidence-based nutritional interventions; however, limited budgets pose challenges in funding all necessary programs. To assist policymakers in making informed decisions, the World Bank developed the Optima Nutrition Modelling tool, which optimizes the allocation of nutrition investments. Kenya, with its high prevalence of stunting, was the focus of this study. Using the Optima Nutrition model, we aimed to (1) assess the impact of scaling up …

Insights Into Cancer Awareness And Health Practices In Rural Kenya: A Cross-Sectional Study Of Esophageal, Breast, Prostate, Cervical, And Colorectal Cancers, Rosebella Iseme-Ondiek, Joseph Abuodha, Anthony Ngugi, Mansoor Saleh, Innocent Abayo

Population Health, East Africa

PURPOSE; In sub-Saharan Africa (SSA), there has been an epidemiologic transition from infectious diseases to noncommunicable diseases, including a projected doubling in incidence of cancer. Understanding the underlying factors driving this surge is crucial for designing effective strategies to mitigate the cancer burden. This study focuses on assessing knowledge, attitudes, screening practices, and health behaviors related to five most prevalent cancers in SSA: prostate, breast, cervical, esophageal, and colorectal—among a predominantly rural coastal population in Kenya.

MATERIALS AND METHODS ;We used a cross-sectional study design targeting 1,500 adult respondents randomly selected from an existing community health and demographic surveillance system. …

Pregnancy Care Integrating Translational Science, Everywhere (Precise): A Prospective Cohort Study Of African Pregnant And Non-Pregnant Women To Investigate Placental Disorders – Cohort Profile, Rachel Craik, Joseph Akuze, Marie-Laure Volvert, Hannah Blencowe, Moses Mukhanya, Angela Koech, Grace Mwashigadi, Marleen Temmerman, Marvin Ochieng, Emily Mwadime

Centre of Excellence in Women and Child Health

Purpose: The Pregnancies' Care Integrating translational Science, Everywhere Network was established to investigate specific placental disorders (pregnancy hypertension, preterm birth, fetal growth restriction and stillbirth) in sub-Saharan Africa. We created a repository of clinical and social data with associated biological samples from pregnant and non-pregnant women. Alongside this, local infrastructure and expertise in the field of maternal and child health research were enhanced.

Participants: Pregnant women were recruited in participating health facilities in The Gambia, Kenya and Mozambique at their first antenatal visit or at the time a placental disorder was diagnosed (Kenya and The Gambia only). Follow-up study …

Factors Related To The Incidence Of Hypertension Among People Above 18 Years At The Cibatu Public Health Center, Bekasi Regency, Verizka Azra, Yustiyani Yustiyani, Minsarnawati Minsarnawati, Catur Rosidati

Indonesian Journal of Public Health Nutrition (IJPHN)

Hypertension is a non-communicable disease that still becomes a public health issue. The percentage of hypertension cases at Cibatu Public Health Center increased from 31.7% in 2021 to 37% in 2022. Based on a preliminary study, hypertension was found to be the most common non-communicable disease at Cibatu Public Health Center. This study aimed to identify factors associated with the incidence of hypertension among individuals aged 18 years and older at Cibatu Public Health Center, Bekasi Regency, in 2024.We conducted a cross-sectional study in May involving 121 respondents. This study used standardized questionnaires that had been validated in previous research, …

Health Literacy, Health Perception, And Influencing Factors Among Immigrants, Canan Birimoglu Okuyan, Ebru Deveci, Fatma Karasu

Makara Journal of Health Research

Background: Individuals living in rural areas face several healthcare disadvantages, including limited access to medical facilities and specialists during emergencies. This study examines healthy lifestyle behaviors, health perceptions, and influencing factors among immigrants in a rural region of southern Türkiye.

Methods: This cross-sectional study involved immigrants registered at a family health center. Data were collected using a sociodemographic questionnaire, the Perception of Health Scale, and the Health Literacy Scale.

Results: Statistically significant differences in THLS-32 scores were found based on participants’ occupation, marital status, and education level (p < 0.05). A moderately positive correlation was observed between health literacy and health perception scores (p < 0.05).

Conclusions: Research on the relationship between …

Assessing Healthcare Students’ Self-Efficacy In Disaster Response: A Cross-Sectional Analysis, Aydın Şenol, Abdülkerim Adıyaman, Canan Birimoglu Okuyan

Makara Journal of Health Research

Background: Assessing healthcare students’ self-efficacy in disaster response is crucial for preparing them to effectively manage real-world disaster situations. This study aimed to assess the self-efficacy status of healthcare students in disaster response.

Methods: The data for this cross-sectional analysis were gathered from 498 healthcare students between November 18, 2023, and February 14, 2024, using an individual diagnostic form and the disaster-response self-efficacy (DRSE) scale. This scale is used to assess an individual’s self-efficacy in responding effectively to disasters, including on-site rescue competency, disaster psychological nursing competency, disaster role quality, and adaptation competency.

Results: The mean age …

Inequities In The Rehabilitation Process Of Musculoskeletal Injuries In Maine, Devon A. Grant

Thinking Matters Symposium

Since 2016, Maine’s population has grown as a result of migration and a welcoming of refugees. Changes in state demographics influence the population’s and individuals’ social determinants of health (SDOH) (ie., “where people live, learn, work, and play”) and health literacy (ie., a person’s ability to find, understand, and use information to inform health-related decisions). This project aims to identify the health inequities or disparities throughout Southern Maine in the care of injuries to the lower extremity, such as the knee or ankle, as well as explore factors that influence the healthcare outcomes of athletes in surrounding communities. This study …

Relation Of Persistent Organic Pollutant Exposure With Autism, Gender, Age, And Body Mass Index, Tekle Mitiku

Walden Dissertations and Doctoral Studies

Approximately one third (37%) of children in the United States are impaired with autism spectrum disorder (ASD) resulting in intellectual disability, and about 1 in 6 children in the United States has one or more developmental disabilities. The economic burden of ASD is estimated to be over $40 billion lost per year. The purpose of this study was to determine the relationship of polybrominated diphenyl ether derivatives (PBDEs) with ASD, age, gender, and body mass index (BMI). The conceptual framework of the study was based on the physiologically based pharmacokinetic theory that the body burden of PBDEs’ free radicals may …

Sexually Transmitted Infection (Sti) Incidence And Risk Factors Among People With Hiv (Pwh): Insights From A 13-Year Cohort Study In South Carolina, Salome-Joelle Gass, Shujie Chen, Jiajia Zhang Ph.D., Bankole Olatosi

Faculty Publications

The Ending the HIV Epidemic (EHE) initiative aims to reduce new HIV infections by 90% by 2030 in the United States (US). However, rising sexually transmitted infection (STI) rates exacerbate the bidirectional infection risk between HIV and STIs. Most research on STIs among people with HIV (PWH) has focused on high-risk groups, resulting in limited data on broader populations. This study addresses that gap by examining the incidence and risk factors for gonorrhea, chlamydia, and syphilis in a statewide cohort of PWH in South Carolina. Data from South Carolina’s HIV and STI surveillance systems were linked, and all PWH aged …