Public Health Commons^™

Analysis Of Barriers To The Successful Prevention And Management Of Pediatric Obesity And Their Relationship To Care At Community Health Centers, Rebecca Beesley, Nicole Craker

Master of Public Health Program Student Publications

Despite international attention, pediatric obesity continues to burden healthcare. Much research has been done to identify barriers to the successful reduction of childhood overweight and obesity, however, a more condensed and accessible compilation of these barriers was lacking. A literature review was done to identify the barriers healthcare providers perceive to the prevention and management of pediatric obesity. It was performed in Fall of 2013 from the following databases: PubMed, PsycINFO, CINAHL, ERIC, and SocIndex. Two independent reviewers selected relevant articles, developed a coding template, and extracted themes. Barriers to the prevention and management of pediatric obesity fell into three …

The Importance Of The Young Invincibles To The Success Of The Affordable Care, Ethel K. Ishimwe

Master of Public Health Program Student Publications

Health care reform in the United States, as codified in the Affordable Care Act (ACA), includes an individual mandate to insure that all citizens are participants in public or privately funded health insurance programs. Universal participation insures that the national risk pool of insured persons will include the broadest spectrum of patient utilizers from the very healthy, who are low utilizers, to the very sick who are high utilizers of health care services. It is only through this high level of participation that the increased services and cost savings of health care reform can be realized. Key to this comprehensive …

Using A Theory Of Change Approach To Analyze Global Health Diplomacy Practice In Myanmar, Sangeeta Mookherji, Holly Greb, Rebecca Katz

Global Health Faculty Publications

The current picture of global health diplomacy (GHD) is one of increasing complexity, with multiple actors striving for multiple objectives, using a multitude of strategies and activities. Analysis and documentation of GHD practice is urgently needed to help identify the opportunities GHD provides for jointly improving global health and international relations, as well as possible unintended consequences. Systematic analysis of GHD practice is challenging without a conceptual framework. We identified a Theory of Change approach as one way to conceptualize GHD practice and potential impacts that could also depict its complexity and identify relationships and pathways for measuring success. We …

Treatment Of Neurodegenerative Ataxias With Intravenous Immune Globulin, Theresa A. Zesiewicz, Seok Hun Kim, Kelly L. Sullivan, Jeannie Stephenson, Israt Jahan, Susan L. Perlman, Jessica D. Shaw, Tuan Vu, Clifton L. Gooch

Kelly L. Sullivan

Background: Neurodegenerative ataxias, including spinocerebellar ataxias (SCAs), are progressive diseases without effective treatment. There is preclinical evidence that inflammation may contribute to neuronal injury in several neurodegenerative ataxias. Intravenous immune globulin (IVIG) is a therapeutic modality that is used as treatment of several autoimmune and inflammatory disorders.
Methods: The primary objective of this open-label pilot study was to assess the effect of IVIG on neurodegenerative ataxias as measured by total scale for the assessment and rating of ataxia (SARA) score. Three patients received IVIG (2 g/kg of body weight, divided over 5 days) once monthly for 3 months, and were …

Premorbid Personality And The Risk Of Parkinson's Disease, Kelly L. Sullivan, James A. Mortimer, Wei Wang, Theresa A. Zesiewicz, James H. Brownlee Jr., Amy R. Borenstein

Kelly L. Sullivan

Background: Previous studies support the hypothesis that premorbid personality characteristics may be associated with the risk of Parkinson’s disease (PD). However, most of these relied upon subjective reports of premorbid personality earlier in life, which may be subject to recall bias. The objective of the current study was to evaluate the association of PD with risk-taking, routinization, smoking and alcohol consumption in early-adult life as indicators of premorbid personality.
Methods: In-person interviews were conducted with 89 PD patients and 99 controls from a university-based medical center. Associations between indicators of early-adult personality and risk of PD were examined using logistic …

Lung Flute Improves Symptoms And Health Status In Copd With Chronic Bronchitis: A 26 Week Randomized Controlled Trial, Sanjay Sethi, Jingjing Yin, Pamela K. Anderson

Jingjing Yin

Background: Chronic obstructive pulmonary disease (COPD) is characterized by mucus hypersecretion that contributes to disease related morbidity and is associated with increased mortality. The Lung Flute® is a new respiratory device that produces a low frequency acoustic wave with moderately vigorous exhalation to increase mucus clearance. We hypothesized that the Lung Flute, used on a twice daily basis will provide clinical benefit to patients with COPD with chronic bronchitis.

Methods: We performed a 26 week randomized, non-intervention controlled, single center, open label trial in 69 patients with COPD and Chronic Bronchitis. The primary endpoint was change in respiratory …

Birth Control: To What Extent Do Women Report Being Informed And Involved In Decisions About Pregnancy And Birth Procedures?, Rachel Thompson, Yvette D. Miller

Dartmouth Scholarship

Background: Health policy, guidelines, and standards advocate giving patients comprehensive information and facilitating their involvement in health-related decision-making. Routine assessment of patient reports of these processes is needed. Our objective was to examine decision-making processes, specifically information provision and consumer involvement in decision-making, for nine pregnancy, labour, and birth procedures, as reported by maternity care consumers in Queensland, Australia.

Methods: Participants were women who had a live birth in Queensland in a specified time period and were not found to have had a baby that died since birth, who completed the extended Having a Baby in Queensland Survey, 2010 about …

An Analysis Of Abnormal Electrocardiograms In First And Second Year Medical School Students, Molly Anne Kalish

PCOM Biomedical Studies Student Scholarship

The high stress level placed upon medical school students, particularly during their first and second didactic years, may have a negative effect on their health. Although surveys and subjective questionnaires have been used to evaluate the effects medical school has upon a student’s cardiovascular health, there has been little clinical data obtained to confirm this notion. The aim of this longitudinal study was to demonstrate whether any abnormal cardiovascular parameters, specifically QTc wave interval, cardiac axis vector and blood pressure abnormalities, could be documented to occur in two different classes of medical students during their first two years. Such information …

Hiv Testing Implementation In Two Urban Cities: Practice, Policy, And Perceived Barriers., Camden J Hallmark, Jennifer Skillicorn, Thomas P Giordano, Jessica A Davila, Marlene Mcneese, Nestor Rocha, Avemaria Smith, Stacey Cooper, Amanda D. Castel

Epidemiology Faculty Publications

BACKGROUND: Although funding has supported the scale up of routine, opt-out HIV testing in the US, variance in implementation mechanisms and barriers in high-burden jurisdictions remains unknown.

METHODS: We conducted a survey of health care organizations in Washington, DC and Houston/Harris County to determine number of HIV tests completed in 2011, policy and practices associated with HIV testing, funding mechanisms, and reported barriers to testing in each jurisdiction and to compare results between jurisdictions.

RESULTS: In 2012, 43 Houston and 35 DC HIV-testing organizations participated in the survey. Participants represented 85% of Department of Health-supported testers in DC and 90% …

Smokefree Moms: A Qualitative Study For The Development Of A Text-Based Intervention For Smoking Cessation In Pregnant Women, Monika Lin, Lorien C. Abroms

GW Research Days 2014

No abstract provided.

A Pilot Academic-Community Partnership To Advance The D.C. Healthy Schools Act, Nisha Narayanan, Jonathan Tatum, Margarita Ramos, Jessica Kim, Nisha Punatar, Michele L. Mietus-Snyder

GW Research Days 2014

No abstract provided.

Wonder Drugs To Hot New Diets: Knowledge Is Power! Adult Health Literacy, Adnan Ahmeduddin, Mary Grace Bowring, Kelly Davis, Indra Gomez, Sarah Halle, Courtney Middlebrook, Molly Sadowsky, Lauren Shauger, Lauren Violette

ISCOPES Posters and Presentations

No abstract provided.

Short And Long-Term Lifestyle Coaching Approaches Used To Address Diverse Participant Barriers To Weight Loss And Physical Activity Adherence, Elizabeth M. Venditti, Judith Wylie-Rosett, Linda M. Delahanty, Lisa L. Mele, Mary A. Hoskin, Sharon Edelstein

GW Biostatistics Center

Background

Individual barriers to weight loss and physical activity goals in the Diabetes Prevention Program, a randomized trial with 3.2 years average treatment duration, have not been previously reported. Evaluating barriers and the lifestyle coaching approaches used to improve adherence in a large, diverse participant cohort can inform dissemination efforts.

Methods

Lifestyle coaches documented barriers and approaches after each session (mean session attendance = 50.3 +/- 21.8). Subjects were 1076 intensive lifestyle participants (mean age = 50.6 years; mean BMI = 33.9 kg/m2; 68% female, 48% non-Caucasian). Barriers and approaches used to improve adherence were ranked by the percentage of …

Engagement With Care, Substance Use, And Adherence To Therapy In Hiv/Aids, Patrice K. Nicholas, Suzanne Willard, Clinton J. Thompson, Carol Dawson-Rose, Inge B. Corless, +20 Additional Authors

GW Biostatistics Center

Engagement with care for those living with HIV is aimed at establishing a strong relationship between patients and their health care provider and is often associated with greater adherence to therapy and treatment (Flickinger, Saha, Moore, and Beach, 2013). Substance use behaviors are linked with lower rates of engagement with care and medication adherence (Horvath, Carrico, Simoni, Boyer, Amico, and Petroli, 2013). This study is a secondary data analysis using a cross-sectional design from a larger randomized controlled trial (n = 775) that investigated the efficacy of a self-care symptom management manual for participants living with HIV. Participants were …

Cardiometabolic Risk Assessments By Body Mass Index Z-Score Or Waist-To-Height Ratio In A Multiethnic Sample Of Sixth-Graders, Henry S. Kahn, Laure El Ghormli, Russell Jago, Gary D. Foster, Robert G. Mcmurray, John B. Buse, Diane D. Stadler, Roberto P. Trevino, Tom Baranowski, Healthy Study Group

GW Biostatistics Center

Convention defines pediatric adiposity by the body mass index -score (BMIz) referenced to normative growth charts. Waist-to-height ratio (WHtR) does not depend on sex-and-age references. In the HEALTHY Study enrollment sample, we compared BMIz with WHtR for ability to identify adverse cardiometabolic risk. Among 5,482 sixth-grade students from 42 middle schools, we estimated explanatory variations (R²) and standardized beta coefficients of BMIz or WHtR for cardiometabolic risk factors: insulin resistance (HOMA-IR), lipids, blood pressures, and glucose. For each risk outcome variable, we prepared adjusted regression models for four subpopulations stratified by sex and high versus lower fatness. …

Competency-Based Medical Education In Two Sub-Saharan African Medical Schools., Elsie Kiguli-Malwadde, E Oluwabunmi Olapade-Olaopa, Sarah Kiguli, Candice Chen, Nelson K. Sewankambo, Adesola O. Ogunniyi, Solome Mukwaya, Francis Omaswa

Health Services Management and Leadership Faculty Publications

Background

Relatively little has been written on Medical Education in Sub-Saharan Africa, although there are over 170 medical schools in the region. A number of initiatives have been started to support medical education in the region to improve quality and quantity of medical graduates. These initiatives have led to curricular changes in the region, one of which is the introduction of Competency-Based Medical Education (CBME).

Institutional reviews

This paper presents two medical schools, Makerere University College of Health Sciences and College of Medicine, University of Ibadan, which successfully implemented CBME. The processes of curriculum revision are described and common themes …

The Associations Between Homa-Ir And Muscular Strengthening Activity In Euglycemic U.S. Adults, William Robert Boyer Ii

UNF Graduate Theses and Dissertations

Background: Muscular strengthening activity (MSA) has been shown to be inversely associated with insulin resistance (IR). The associations between quartiles of the homeostatic model assessment of insulin resistance (HOMA-IR) and self-reported MSA in a nationally representative sample of euglycemic U.S. adults were examined.

Methods: Sample included adult participants (≥20 years of age [n=2,543]) from the 1999-2004 National Health and Nutrition Examination Survey (NHANES). HOMA-IR was categorized into quartiles based on every 25^th percentile. No MSA was the dependent variable.

Results: Following adjustment for covariates, those with HOMA-IR values in third (p

Conclusions: Having a higher HOMA-IR value is associated …

Estimation And Uncertainty Analysis Of Impacts Of Future Heat Waves On Mortality In The Eastern United States, Jianyong Wu, Ying Zhou, Yang Gao, Joshua S. Fu, Brent A. Johnson, Cheng Huang, Young-Min Kim, Yang Liu

Global Health Faculty Publications

Background: Climate change is anticipated to influence heat-related mortality in the future. However, estimates of excess mortality attributable to future heat waves are subject to large uncertainties and have not been projected under the latest greenhouse gas emission scenarios.

Objectives: We estimated future heat wave mortality in the eastern United States (approximately 1,700 counties) under two Representative Concentration Pathways (RCPs) and investigated sources of uncertainty.

Methods: Using dynamically downscaled hourly temperature projections for 2057–2059, we projected heat wave days that were defined using four heat wave metrics and estimated the excess mortality attributable to them. We apportioned the sources of …

Review Of Hyperuricemia As New Marker For Metabolic Syndrome, Laura Billiet, Sarah Doaty, James D. Katz, Manuel T. Velasquez

Global Health Faculty Publications

Hyperuricemia has long been established as the major etiologic factor in gout. In recent years, a large body of evidence has accumulated that suggests that hyperuricemia may play a role in the development and pathogenesis of a number of metabolic, hemodynamic, and systemic pathologic diseases, including metabolic syndrome, hypertension, stroke, and atherosclerosis. A number of epidemiologic studies have linked hyperuricemia with each of these disorders. In some studies, therapies that lower uric acid may prevent or improve certain components of the metabolic syndrome. There is an association between uric acid and the development of systemic lupus erythematosus; the connection between …

Humidity And Gravimetric Equivalency Adjustments For Nephelometer-Based Particulate Matter Measurements Of Emissions From Solid Biomass Fuel In Cookstoves, Sutyajeet Soneja, Chen Chen, James M. Tielsch, Joanne Katz, Scott L. Zeger, William Checkley, Frank C. Curriero, Patrick L. Breysse

Global Health Faculty Publications

Great uncertainty exists around indoor biomass burning exposure-disease relationships due to lack of detailed exposure data in large health outcome studies. Passive nephelometers can be used to estimate high particulate matter (PM) concentrations during cooking in low resource environments. Since passive nephelometers do not have a collection filter they are not subject to sampler overload. Nephelometric concentration readings can be biased due to particle growth in high humid environments and differences in compositional and size dependent aerosol characteristics. This paper explores relative humidity (RH) and gravimetric equivalency adjustment approaches to be used for the

pDR-1000 used to assess indoor PM …