COMMUNITY-BASED MASTERS PROJECT BOOK of ABSTRACTS CLASS OF 2013
POSTER PRESENTATION & AWARDS RECEPTION JUNE 10, 2013 DREXEL UNIVERSITY, BEHRAKIS HALL
Thank You, Community Preceptors We are grateful to the many community-based partners and preceptors whose consistent guidance and support makes it possible for our students to first enter community health practice.
June 10, 2013 Dear Colleague: The School of Public Health’s founding charge to be the “school without walls” remains the hallmark of our degree programs. Indeed, students at the School of Public Health have always become active practitioners of public health right from the start. Our students today accrue more than 70,000 hours of public health science and community-based practice, helping to address real-world, meaningful concerns at hundreds of community partner sites across the Greater Philadelphia Region, nation and overseas. Students have routinely ranked their Community-Based Masters Project (CBMP) as one of the most meaningful and fulfilling portions of their academic program at the School of Public Health. Further, our data indicates that following the community-based experiences, students are significantly more likely to want to work in community settings. The CBMP integrates the practical skills and culminating experience requirement of full-time MPH students as well as joint degree students. Second year students identify and select a project with a well defined benefit to the public health community setting where they are assigned longitudinally -- working 1 to 1 1/2 days a week throughout the academic year. CBMPs are developed by taking into account the host organization’s public health needs and SPH concentration/departmental specific learning objectives. The projects in this abstract book showcase the depth and breadth of our students’ public health field research. The abstracts shine a spotlight on the meaningful work of our students and community partners. Sincerely,
Marla J. Gold, MD Dean
Advancing Public Health through Science and Practice Our Mission The Drexel University School of Public Health improves the health of communities and populations through innovative education and training programs, cutting-edge research and scholarship, and cooperative partnerships with other civic, business and academic institutions committed to solving our world’s most difficult health challenges.
Our Vision The Drexel University School of Public Health will lead the integration of social justice and human rights in academic public health and be a model for interdisciplinary collaboration and civic engagement.
The nexus of science and practice, of research and real partnerships, defines us.
Contributing to Outreach Methods and Trauma-Informed System Transformation Efforts at the Department of Behavioral Health and Intellectual DisAbility Tolulope Adeleye, MPH, 1 2 Dr. Sandra Bloom , Ava Ashley, JD 1 Drexel University School of Public Health, 2 Department of Behavioral Health and Intellectual DisAbility Background: The nature of healthcare has drastically changed in the recent years. The enactment of the healthcare reform legislation, The Affordable Care Act, as well as a series of national traumatic events have resulted in a shift in the foundation of behavioral health systems in the United States. This shift has been directed toward the use of a public health approach and through trauma-informed service delivery in order to serve the populationâ€™s behavioral health needs. The Department of Behavioral Health and Intellectual Disability has restructured its guidelines to represent a Resilience and Recovery Oriented Treatment model. Although, numerous internal trauma-informed and outreach efforts have taken place, external promotional measures remain inconsistent with long-term goals and are ultimately ineffective. Objective: To analyze and evaluate the current outreach and promotional methods specifically relating to the inclusion of a public health approach and the current trauma-informed behavioral health system transformation efforts at the Department of Behavioral Health and Intellectual Disability. Methods: Reviews of existing outreach tools such as the Trauma Transformation Unit webpage innovative interventions, and social media platforms were conducted. Additionally, interactive and community engagement platforms were also analyzed. Results: The primary themes emerging from the analyses included: substantial internal trauma-informed transformation, however, externally deficient in promotion and system wide uniformity. Specifically, ineffective social media outreach utilization and webpage. Conclusions: In order to achieve the long-term goal of better health outcomes for Philadelphians, future outreach tools must be consistent, frequently used/active, and specific to focus area (i.e. trauma, health reform, intellectual disability, or addiction services). Outreach tools must emphasize the importance of innovation and social media for health promotion and prevention.
Literature review of clinical practices regarding HBV screening prior to chemotherapy for solid tumor cancers to prevent HBV reactivation 1
Kent Akin, MPH , 1 2 Professor Raymond Lum, MPhil, MS , Chari Cohen, MPH, DrPH 1 2 Drexel University School of Public Health, Hepatitis B Foundation Background: In cancer patients with a history of hepatitis B, there exists a risk of hepatitis B reactivation during the course of chemotherapy treatment due to the immune-suppressant nature of chemotherapy. Objective: The objective of this study is to find evidence that would either support or refute pre-chemotherapy screening practices for hepatitis B. Methods: A meta-analysis, literature review-based study in which 165 articles pertaining to hepatitis B reactivation were filtered with selective inclusion criteria to 41 articles. Data regarding common practices, reactivation relative to specific cancers, treatment methods, and outcomes were used to find trends. Results: Several trends can be interpreted from this meta-analysis regarding whether or not screening for hepatitis B prior to chemotherapy leads to an improved prognosis for the patient. Patients who experienced hepatitis B reactivation during or after their chemotherapy involved in studies where prescreening was not performed appeared to have recovered from elevated liver enzymes, which result from the viral flare-up. However, nearly all these cases reviewed under this meta-analysis were case reports with a sample size of only one. Larger studies, where pre-screening was practiced, clearly demonstrated the reduced viral reactivation risks when patients were pre-emptively treated with lamivudine, an antiviral drug. Conclusions: A critical recommendation stemming from this study involves strengthening screening practices prior to solid tumor cancer treatment to minimize the risk of HBV reactivation in cancer patients who had previously been infected with hepatitis B. HBV screening should become a universal prechemotherapy policy, and this screening procedure is considered to be costeffectiveâ€”especially when compared to the alternative of HBV reactivation during chemotherapyâ€”for larger institutions and institutions that serve at-risk populations.
Nurse-to-Nurse Bedside Handoff: An Added Dimension to Improve Care 1
Nita Avary, MPH , 2 Claire Alminde, MSN, RN, CPN 1 Drexel University School of Public Health, 2 St. Christopher’s Hospital for Children Background: Ineffective communication among health care professionals is the leading cause of preventable adverse events in hospitals. Nurse-to-nurse handoff involves the critical exchange of patient information and miscommunication resulting from less than ideal handoffs represents a major risk factor for adverse events to occur. Moving nursing handoff to the bedside from the nursing station, where it normally occurs at St. Christopher’s Hospital for Children, aims to improve nurse-to-nurse communication and to greater involve patients and their families into their plans of care. Objective: First, to demonstrate whether the change to nursing bedside handoff with a standardized approach at St. Christopher’s on the Medical Surgical units has resulted in the following expected outcomes: improved nurse-to-nurse communication, improved patient/parent satisfaction, and reduced errors associated with miscommunication. Second, to use outcomes data to provide recommendations for improvement. Methods: Nurses were interviewed on their satisfaction with various aspects of bedside handoff and patient satisfaction scores and adverse event reports were collected from before (April 2011 to March 2012) and after the change to bedside handoff (April 2012 to March 2013). Quality improvement tools and change management theories were used to guide recommendations. Results: Errors associated with miscommunication were reduced by 17.2%. Overall, patient satisfaction trends either increased or remained stable. Nurses reported better nurse-to-nurse communication and accountability, but reported privacy, interruptions, and parent as well as fellow nurse participation as barriers to compliance. 63% of nurses reported “sometimes” doing handoff at the bedside, followed by 18% reporting “never”. Nurses satisfaction with various aspects of handoff range from 4.38 to 4.79, where 5.0 represents “completely satisfied”. Recommendations for improvement focus on increasing compliance and using better evaluation methods. Conclusions: Nurse-to-nurse bedside handoff improves care and promotes patient safety.
Wills Eye New Hire Experience 1
Vinit R. Awatramani, MPH , 1 2 William J. Hickey, PhD , Cynthia C. Farano and Janice Frayne 1 2 Drexel University School of Public Health, Wills Eye Institute Background: Wills Eye Hospital is a world-renowned ophthalmology surgery center located in Philadelphia, PA. The hospital is altering their current business model with the addition of a 4-bed inpatient unit. This inpatient ward was added for the benefit of providing improved medical treatment for patients with complex eye care needs by maximizing staff and equipment efficiencies. Accreditation agencies require medical facilities that operate as inpatient hospitals to orient their employees in the areas of patient safety, patient privacy rights, cultural and linguistic competencies, bloodborne pathogens, hazardous materials, and emergency preparedness. Aims: This Culminating Community Based Master’s Project (CBMP) was focused on deploying a comprehensive orientation program that not only met accreditation requirements, but also aligned newly hired employees with their new working environment and the organizational culture. Conclusion: Once deployed, the new employee orientation program will ultimately be utilized as an accessible information portal for new and existing employees in order to familiarize themselves with the health system’s policies, procedures, and best practices. It is our objective that the information acquired from this program will not only enhance the quality of care provided by the health system’s employees, but will also facilitate an employee environment that promotes adherence to the health system’s long-term aspirations.
Body Size and Weight Management Among Long-Term Cancer Survivors: Perspectives from clinical care providers 1
Allison M. Baker, MPH , 1,2 2 2 Ann C. Klassen , Katherine C. Smith , Kisha I. Coa 1 Drexel University School of Public Health 2 Johns Hopkins Bloomberg School of Public Health Background: There is a growing population of cancer survivors in the United States. In recent years, there has been increased focus on long-term health and tertiary prevention in this patient group. One element of this is lifestyle modification to support a healthy weight. Because survivorship care is an emerging field, however, little is known about the best ways to support survivors’ weight management. Objectives: To begin to address these gaps, this exploratory study sought to describe how clinical care providers conceptualize and address body size and weight management among cancer survivors. Methods: In-depth, semi-structured interviews were conducted with 33 members of the cancer care team in academic and community settings. Interviews were transcribed and analyzed thematically using qualitative analysis methods. Results: Provider perspectives on body size and weight management differed based on professional roles and the position of patient populations within the survivorship trajectory. Providers conceptualized weight in relation to acute treatment, cancer recurrence, or overall health and comorbidities. These patterns were reflected in their reported framing of weight discussions with survivors, though providers indicated that they counsel patients on weight to varying extents. Providers felt that survivors are especially motivated to lose weight but face many individual-level and capacity-level barriers to doing so. Conclusions: According to clinicians, a complex array of patient- and providerfactors influence cancer survivors’ weight management. This suggests many avenues for future research. Moving forward, there is a need for evidence-based resources to support survivors’ weight management in clinical settings, and various capacity barriers must be addressed. Communication strategies around survivors’ weight should be further explored, such as improving public awareness of connections between overweight and cancer. Acknowledgements: Funded by NCI grant R21 CA152789 “Eating for Life: Dietary Behaviors Among Long Term Cancer Survivors,” to Katherine Smith, PhD (PI), Ann Klassen, PhD, Laura Caulfield, PhD, Kathy Helzlsouer, MD, MHS, Kimberly Peairs, MD, Lillie Shockney, RN, BS, MAS.
Quality Assurance Project to Identify Health Disparities and Barriers in Accessing Quality Health Care 1
Karen Bernabé, MPH , 1 2 Ann Klassen, PhD , Barbara Bungy, MPH, CHES , 2 3 Jill Foster, MD , Tahirah Chichester, BS 1 2 Drexel University School of Public Health; Center for the Urban Child at 3 St. Christopher’s Hospital for Children; Temple University Background: St. Christopher’s Hospital for Children (SCHC) serves a majority of patients living in the North Philadelphia area, a very poor and food insecure region, who face many health disparities and barriers to quality health care. The general pediatric departments are experiencing a high rate of missed appointments and literature shows that the health status of patients is affected when they miss appointments. It remains unclear whether health disparities and barriers are connected with patients missing scheduled appointments. Objectives: In order to improve health care delivery, this quality assurance project identifies internal and external factors that may prevent a patient from attending regularly scheduled medical appointments. These findings will serve as formative research to further inform development for the hospital’s new center of excellence, Center for the Urban Child. Methods: This study takes a mixed methods approach with quantitative data collected from 316 surveys from caregivers of SCHC patients, and qualitative data collected from two key informant interviews. Results: A majority of the participants were young, low-income, single, Hispanic/Latino or African American female caregivers living in the North Philadelphia region. Themes emerging from interviews, field observations, and surveys consist of: difficulty in appointment scheduling, lack of transportation, language barriers, dissatisfaction with long wait times, positive relationships with medical care providers, and a need for more behavioral and mental health services for caregivers. Conclusions: The appointment scheduling and rescheduling process and communication system must be improved. There is a need for more screenings of patients and families for basic needs and work with caregivers and patients to provide resources necessary to attend regularly scheduled appointments. To combat disparities affecting the health of caregivers and patients, a positive deviance approach can also serve to provide services for caregivers from caregivers who experience the same barriers but do keep scheduled appointments.
Does Treatment Type Affect a Breast Cancer Survivor’s Eligibility for Exercise Prescription 1
Greg Bond, MPH , 1 Jana Mossey PhD , 1 Drexel School of Public Health Objectives: It is unknown if breast cancer treatment type of female breast cancer survivors treated in the University of Pennsylvania Hospital System (UPHS) affects eligibility status for a supervised exercise program. To better understand the barriers as to why some breast cancer survivors are not eligible for exercise prescription. Procedures and Methods: The study design was a retrospective medical chart review of 466 female breast cancer patients as noted through ICD-9 codes who were treated by the University of Pennsylvania Hospital System between 1/1/2002 and 12/31/2012. To obtain the data, a request was sent to Penn Data Store asking for 500 randomly selected patient files, which included variables that determined whether the breast cancer survivor would be eligible for bariatric surgery or exercise prescription. Using SPSS to analyze the data, a logistic regression model was used to determine significant associations between treatment type and exercise eligibility, race and exercise eligibility, and age and exercise eligibility. Given the dependent variable is a binary event, a logistic regression was used instead of a linear regression model. Included in the final model were the treatment type as a categorical variable, age as a continuous variable, and race as categorical variable. Treatment types were defines as 1) surgery, 2) surgery & chemotherapy, 3) surgery & radiation, and 4) surgery, chemotherapy, & radiation. The race categorical groups were defined as either non-white or white. Results: The logistic regression model produced results, which showed that treatment type does not affect a subject’s likelihood of being eligible for exercise prescription; p-values were above 0.05 for all respective treatments. Conversely, results proved to be significant for age and race group; p-values of under <0.00 respectively. When age increased one unit, the odds of not being eligible for exercise increased by 0.04. When using non-whites as a reference group, the whites group odds decreased by 0.42 for not being eligible for exercise prescription (the white race group odds ratio demonstrates protection). Conclusion: Treatment type does not appear to be significant in predicting a breast cancer survivor’s eligibility for exercise. However, age and race appear to be significant where older women and non-whites are less likely to be eligible.
Changing Communities: Updating the Social Area Analysis for the City and County of San Francisco 1
Elisabeth Calhoun, MPH , 2 1 Robert Kohn, MPH , Mary Hovinga, PhD, MPH 1 2 Drexel University School of Public Health, San Francisco Department of Public Health Background: In 1984, the Association of Bay Area Governments performed a social-area analysis using 1980 census data, and subsequently divided the city of San Francisco into neighborhoods based on the results. In the 30 years following, the neighborhood boundaries were not updated to reflect the major socio-economic and demographic shifts within the city. This project aims to recreate the analysis and re-define the neighborhoods of San Francisco using meaningful data. Objectives: To perform a statistical analysis of socio-demographic data at the census tract level and adjust the neighborhood boundaries accordingly; to justify the results through modeling of past and present STD incidence rates. Methods: American Community Survey 5-year Estimate data was collected at the census tract level for 65 variables relating to socio-economic status, racial/ethnic background, employment, housing, and families. A Principal Component Analysis was run to consolidate the variables into independent, hypothetical factors. Once neighborhoods were defined, a linear regression analysis was performed, including Akaike and Bayesian Information Criterion statistics. Results: Eight factors emerged and explained 76.7% of the variation in the data set. 13 out of 40 neighborhoods were ultimately altered, bringing the new neighborhood count to 45. Due to census tract redistricting, the old and new models could not be quantitatively compared; however, qualitative information indicates the new neighborhood definitions are a better fit to STD incidence rates. Conclusions: Statistical analysis indicates a major demographic shift in the city over a 30-year period. To keep abreast of future changes and to improve epidemiologic reporting, a similar analysis should be re-run every five to ten years. Provided census tract boundaries remain stable, information criterion statistics can be used to compare old and new models.
Creating an Environment of Care (EOC) Policy and Procedure Manual at Wills Eye Hospital 1
Elizabeth C. Carlitz BS , 1 2 Dr. William Hickey, PhD , Michael Wurster 1 2 Drexel University School of Public Health Wills Eye Hospital Background: Wills Eye Institute is an organization with widespread impact and through the dedication of skilled physicians and staff has shaped the science and medicine of Ophthalmology. Currently, Wills Eye Institute is undergoing an expansion into a Specialty Hospital. With the addition of a 4-bed inpatient hospital unit to its Ambulatory Surgery Center, revisions regarding the EOC will occur. Objectives: The overarching goal of this project was to develop a comprehensive EOC policy and procedure manual for the future Wills Eye Hospital. The aims were to (1) conduct a SWOT analysis of the current state of the policies; (2) research the policies and procedures required to acquire hospital licensure; (3) draft a facility specific, compliant EOC policy and procedure manual, and (4) provide recommendations for the EOC Committee regarding ongoing evaluation of the policies. Methods: Analysis and review of existing State, Federal and professional organization requirements for hospital licensure was completed to inform the content of the policies. A review of available policy materials at Wills Eye and other hospitals informed guidelines and tools for achieving effective procedures. Results: The creation of a comprehensive, readable and accessible EOC policy and procedure manual is a crucial part of maintaining an EOC that promotes patient and staff safety. Additionally, in order to achieve licensure, policies must be compliant with regulatory bodies, including State, Federal and other associations. Thus, a regulatory compliant and facility specific EOC policy and procedure manual was completed to assure the successful licensure and opening of Wills Eye Specialty Hospital. Conclusion: Creating a facility specific and regulatory compliant EOC policy and procedure manual is a crucial step toward successfully obtaining licensure as a Specialty Hospital. With comprehensive and unifying policies, Wills Eye can better enhance patient and staff safety. Additionally, policies must undergo ongoing evaluation by the EOC Committee to stay current with regulations and best practices regarding Hospital safety and security.
Improving Vision Care for Philadelphia's Children Through Better Comprehension and Delivery of Medicaid and CHIP Entitlements 1
Cameron Chase, MPH, MAT , 1 2 Augusta Villanueva, PhD , Colleen McCauley, MPH 1 Drexel University School of Public Health, 2 Public Citizens for Children and Youth Background: Vision screenings are an effective way to identify children who are in need of vision therapy. However, to benefit from vision screening, follow up care must be received. Unfortunately, nearly two thirds of the Philadelphia public school children who fail school vision screenings do not receive needed follow up care even though more than 80% are entitled to public vision benefits through Medicaid and CHIP. The direct consequences for this failure include vision loss, physical discomfort, and poor academic performance for the child. Preliminary research reveals that systematic barriers and low levels of knowledge by Philadelphia parents and eye care providers concerning Pennsylvania's Medicare and CHIP vision care benefits may be preventing children from getting the care to which they are entitled. Objective: This follow-up study characterizes vision providers' knowledge of Medicaid and CHIP benefits and the systematic challenges they face in providing care to Philadelphia's children with public benefits. Methods: Fifty of Philadelphia's 101 Medicaid and CHIP vision providers were surveyed for their knowledge of Medicaid and CHIP vision benefits and their experience serving children with public benefits. Benefit information resources including the Pennsylvania Medicaid Provider Helpline and insurance contractor resources were also surveyed for the accuracy of information offered to providers. Results: Providers are highly misinformed about public vision benefits; less than half correctly answered Medicaid benefit questions and less than a third correctly answered CHIP benefit questions. Public benefit information resources for providers and insurance contractors were also found to communicate benefits differently from what state law dictates. Providers also identified prior authorization and communication wait times with insurance contractors as barriers to service delivery. Conclusions: These concerning results may explain why many Philadelphia children lack access to necessary follow up care for failed vision screenings. Further characterization of these barriers and advocacy for solutions is recommended.
Reducing Stigma of Behavioral Health Issues Through the Use of Web 2.0 1
Amitoj Chatrath, MPH , Timothy Clement, MPH , 1 1 Joshua McCawley, MPH , and Janee Tyus, MPH 1 Drexel University School of Public Health This project investigated how Web 2.0 technologies and design thinking techniques can be used to build an online platform that will set an example for the effective use of Web 2.0 in behavioral health and in public health practice. The lessons and insights learned from this project can lay the framework for future work in the field on how to effectively use Web 2.0 in a way that can enhance the participation and engagement of stakeholders in meaningful conversations surrounding various behavioral health, public health, and social issues. This project focused on how Web 2.0 and design thinking techniques could be effectively used in working to reduce behavioral health stigma among college students in the United States. These tools were used in the conceptualization and implementation of an online design challenge on a Web 2.0 website that addressed behavioral health stigma and help-seeking behaviors among students on college campuses. In the design challenge, college students were encouraged to engage and participate in a problem solving process, through Web 2.0 websites, in which they would contribute practical solutions for increasing the help-seeking behaviors of college students.
Reducing Stigma of Behavioral Health Issues Through the Use of Web 2.0 Timothy Clement, MPH See Amitoj Chatrath, MPH, for Abstract -Analysis of the Association Between Dietary Quality and Hypertension 1
Xiao Cong, MPH , Amy Auchincloss PhD Drexel University School of Public Health
Background: Dietary quality may reduce hypertension prevalence and risk. Objectives: This cross-sectional study examined the association between dietary quality and hypertension. The potential influence of socioeconomic status (SES) and ethnicity on the aforementioned association was also investigated. Methods: Adults 45-84 years old were recruited from multiple locations in the U.S. in 2001 and information about diet was collected via a food frequency questionnaire, along with hypertension status, demographic information, and other risk factors. This study assessed dietary quality by three approaches: adherence to U.S. dietary guidelines (Alternative Healthy Eating Index-2010 (AHEI-2010) and Dietary Approaches to Stop Hypertension-Sodium (DASHSodium)) and dietary patterns empirically derived from the dataset via principal component analysis. Adjusted odds ratios (ORs) for having hypertension and for uncontrolled hypertension were computed using Poisson regression (appropriate for prevalent outcomes). Interaction terms between dietary scores and SES/ethnicity were used to assess effect modifications. Results: Although most of the confidence intervals of ORs included the null, the direction of the associations between dietary quality and hypertension was as expected. Compared with participants in the best tertiles of AHEI-2010 and DASH-sodium scores, people in the worst tertiles had 3%-5% higher odds of having hypertension. Only 12.2% of participants complied with the DASH-sodium protocol (score â‰Ľ 4.5) and the non-compliance group had 1.05-1.06 times odds of hypertension compared with the compliance group. Empirically derived unhealthy dietary pattern was positively associated with hypertension: compared with best tertile (lower consumption), people in the worst tertile (higher consumption) had 1.09 times odds of hypertension (95% CI: 0.99, 1.21; P=0.07). The healthy dietary pattern was inversely related to uncontrolled hypertension although the association with hypertension as a whole was weaker. Additionally, there was weak/inconsistent evidence of effect modification by SES/ethnicity. Conclusions: Dietary quality was only weakly associated with hypertension prevalence. More research is warranted with other datasets and other dietary assessment methods.
The Importance of Integrating a Nutrition Curriculum into Existing Running Programs for Youth 1
Leslie Conner, MPH Drexel University School of Public Health
Background: Childhood obesity has become a nation wide epidemic among both genders and all racial, ethnic, and socioeconomic groups. Childhood obesity has doubled in children and tripled in adolescents in the past 30 years (Centers for Disease Control). According to the CDC, Approximately 17% (or 12.5 million) of children and adolescents aged 2â€”19 years are obese. Childhood obesity has become an epidemic due to lack of physical activity and nutrition education. According to a study conducted by the American Public Health Association, children are not being offered enough vigorous physical activity through school physical education programs. Running programs for youth have been becoming more prominent over the years to tackle the physical activity aspect, but youth are still lacking nutrition education. Objectives: To design a nutrition curriculum that can be integrated into existing running programs for youth in order to teach children the importance of healthy eating as it pertains to running as well as living an overall healthy lifestyle. Methods: Macro analysis of running programs for youth. To identify the lack of nutrition education in existing running programs for youth. Once the nutrition gap has been identified, multiple versions of a nutrition curriculum will be designed that can be easily integrated and implemented into existing running programs. Not only does healthy nutrition play a critical role in running performance, it plays a crucial role in living a healthy lifestyle. Results: After analyzing existing running programs, only 2 out of 14 programs mentioned that they promote and discuss healthy nutrition habits with their program participants. Because less than 15% of programs analyzed do not implement any kind of nutrition component, children are missing out on a prime opportunity to learn healthy nutrition information. Conclusion: Implementing a nutrition curriculum into existing running programs is ideal and practical. Youth will have the opportunity to learn the importance of physical activity and healthy eating simultaneously.
Individually-based SELF: Protocol Development, Identification of Key Performance Indicators, & Pilot Study of Fidelity 1
Jazzmin Cooper, MPH , 1,2,3 1 Theodore Corbin, MD, MPP , Lisa Ulmer, ScD, MSW 1
Drexel University School of Public Health, Drexel University College of 3 Medicine, Healing Hurt People - DUCOM Department of Emergency Medicine at Hahnemann University Hospital
Background: Young minority males in urban cities and communities are disproportionately involved in interpersonal violence, leading to intentional injuries, homicides, and involvement with the criminal system. Healing Hurt People (HHP) is a community-focused, hospital-based violence intervention program designed to reduce the reoccurrence of injury and retaliation among youth ages 8-30 within Philadelphia. Through the use of trauma-informed care and SELF-groups, which focus on the impacts of life after trauma in the context of Safety, Emotions, Loss/Letting Go, and Future, HHP assists victims of traumatic violence in reducing re-injury, preventing retaliation, and providing support for effective trauma-response management. HHP has made significant impacts in addressing social service needs of its clients. However, no assessment has been made regarding the extent and consistency to which adherence to program policies and procedures occur during case management. Objective: The objectives of this project is to develop a standard protocol for delivering SELF during individual case management, to develop key performance indicators to measure the implementation of SELF during individual case management, and to analyze fidelity to case management protocols. Methods: HHP case management protocols were examined to identify key activities of individual case management and their relation to SELF. Fidelity measures were developed from identified key activities. A retrospective pilot fidelity analysis was conducted using records of clients, 18 years of age and older with active files between September 1, 2012 to February 1, 2013, from the Hahnemann University Hospital site (n= 23). Results: 91% of cases (n=21) examined had a score of 75% for completeness in the screening and intake categories of the fidelity measures. 61% of cases (n=14) examined had a score of 100% for completeness in the case management category. Recommendations on fidelity measures and HHP database were provided based on fidelity analysis results.
Defining the Burden of Burns in the United States Via Database Evaluation, Comparison and Analysis 1
Hannah Crooke, MPH , 1 2 Ed Gracely, PhD , Michael Peck, MD 1 2 Drexel University School of Public Health, American Burn Association Background: American Burn Association estimates that nearly 450,000 people receive medical treatment for burn injuries each year, and nearly 3,400 people die from burn injuries each year in the United States. The ABA needs to gather all available data to decrease the burden of burns across the country. Objectives: The objectives of this research are to define and assess nationwide datasets that contain burn injury information in the United States, and to use a data source to examine associations between socio-economic factors and fire/burn related mortality. Methods: Data source characterization was done by examining ten nationwide data sources on key variables, comparing them on their strengths and weaknesses, and making a recommendation about improving data sources. The case-control study used the National Health Interview Survey linked to the National Death Index for the years 1997 to 2004. Cases were those who died of fire or burn related injury. Controls were chosen from the remaining observations that matched with a NDI file and were older than 18. Initial frequencies and crude odds ratios were calculated, and then stratification was done to look for potential confounders and effect modifiers. After controlling for the necessary variables a final logistic regression model was fit. Results: The results of the data source characterization show a lack of comprehensive data regarding burn injury in the United States. The case-control study suggests a statistically significant association between increased fire or burn related mortality risk and earlier survey year, older age and being non-white as compared to white. Other indicator variables that were not statistically significant in the final model were gender, education level, and marital status. Conclusions: Further studies need to be done that have increased sample size in order to make more concrete conclusions about socioeconomic status and fire or burn related mortality. The currently observed associations, however, can be used to inform which populations the American Burn Association should target with prevention focused interventions. Likewise, the currently observed associations along with the information gathered from the data source comparison can be used to inform the data collection process for the American Burn Associationâ€™s National Burn Repository.
Age-Period-Cohort Effects on Vitamin D Insufficiency in a Nationally Representative Sample of the US Adult Population: NHANES III, NHANES 2001-2006 1
Jess Davies, MPH , 1 Brian K. Lee PhD, MPH 1 Drexel University School of Public Health Background: In the past two decades studies of the U.S. population have shown an upswing in vitamin D insufficiency. Studies based on the National Health Nutritional Examination Survey (NHANES) have shown that population trends do exist (Ginde, Mark, Camargo, 2009). However, to date there has been no attention devoted to the analyzing the period and cohort-related mechanisms in vitamin D trends. Additionally it is important to include age, period, and cohort effects simultaneously in health studies based on data from repeated crosssection surveys to avoid model misspecification and bias interpretations of age and period effects, which previous studies of vitamin D trends have not considered (Yang, & Land, 2006). Methods: Serum 25-hydroxyvitamin D (25[OH]D) levels from The Third National Health and Nutritional Examination Survey (NHANES III), collected from 19881994 and NHANES data collected from 2001-2006 were used to build a hierarchical age-period-cohort (HAPC) model. A specified HAPC cross-classified random effects model (CCREM) was used to estimate the fixed effects for age and random effects of birth cohorts and periods and evaluate the status of vitamin D insufficiency in the U.S. population. Results: Independent of age and birth cohort effects, the predicted probability of vitamin D insufficiency was 63% lower for those in NHANES III. Non-Hispanic blacks were estimated to have the highest predicted probability of vitamin D insufficiency on average in every age, period, and birth cohort. On average mean serum (25[OH]D) levels the mean serum (25[OH]D) levels decreased from 19882006; NHANES III mean serum (25[OH]D) level was 23.57 ng/mL (95% CI, 10.18-38.09) and decreased in NHANES 2000-2006 to 20.10 (95% CI, 10.5930.57). Conclusion: The CCREM model illustrated population trends in race/ethnicity groups persisted across age, period, and cohort effects and insufficiency is increasing over time. Our investigated illustrated the need to account for age, period, and cohort effects in assessing the trends of vitamin D and provides an unbiased estimate of vitamin D insufficiency in the U.S. adult population.
Eliciting Health and Safety Hazard Scenarios and Assessing Dermal Exposure Risk To Workers During Marcellus Shale Hydraulic Fracturing Activity 1
Bevin Durant, MPH , 1 2 Curtis E. Cummings, MD, MPH ; Patrick Gurian, PhD 1 Drexel University School of Public Health, 2 Drexel University College of Engineering Background: Hydraulic fracturing is a well stimulation technique used in the production of natural gas. While hydraulic fracturing has been in use since the mid-nineteenth century as a method for oil and gas recovery, recent advances in horizontal drilling techniques and fracking fluid production have made previously unattainable natural gas reservoirs accessible and economically recoverable. The health and safety risks associated with these processes are underinvestigated. Objective: To elicit the possible health and safety hazard scenarios at drilling sites that lead to dermal exposure to fracking fluid and flowback water among workers and to develop a survey to further evaluate those scenarios. An additional objective of this study is to assess cancer risk following dermal exposure to flowback water among workers at hydraulic fracturing sites. Methods: Preliminary expert interviews were conducted to elicit possible health and safety hazard scenarios at various stages of shale gas development. A survey was created and made available for experts to complete online to rank the health and safety hazard scenarios on various attributes. A cancer risk estimate for dermal exposure to carcinogenic agents in water â€“ namely, benzene â€“ was calculated. An original data set of Marcellus Shale flowback water parameters was compiled, which can be used to inform future risk assessments. Results: Health and safety hazard scenarios were identified through the preliminary interview. The online ranking survey revealed that certain scenarios do put workers at risk for dermal exposure to hydraulic fracturing fluid and/or flowback water. A cancer risk estimate for dermal exposure to carcinogenic agents in water shows an increased risk for developing cancer following exposure to flowback water. Conclusion: Dermal exposure to flowback water increases cancer risk. Regulations to prevent worker exposure to hydraulic fracturing fluid and flowback water should be strictly enforced.
Medical-Legal Partnerships: Improving Health Outcomes for Vulnerable Populations by Addressing Unmet Legal Needs 1,2
Rehma Ehsan, MPH, BA , 2,3 1 Maggie Eisen, MSS, MLSP , Robert Field, PhD, MPH, JD 1 Drexel University School of Public Health , The Health Federation of 2 3 Philadelphia , and The Stoneleigh Foundation Background: There is currently a large body of evidence that suggests patients at community health centers lack access to legal assistance necessary for their health and well-being. In some cases people cannot afford or access healthcare and in other cases, peopleâ€™s legal needs make the healthcare they receive less effective. A medical-legal partnership is a health care delivery model that focuses on improving the health and well being of underserved and vulnerable populations. Legal staff becomes part of a healthcare team, which includes doctors, nurses, social workers, and other staff. Health Center #3 understands this relationship between legal needs and health; and is in the process of planning a Medical-Legal Partnership. Objective: To determine the most prominent unmet legal needs in the community that Health Center # 3 serves by conducting a needs assessment and set up a pilot based on the responses. Methods: An exploratory study was conducted on Health Center #3 patients (n= 710) in order to determine unmet legal needs. A multi-faceted approach was taken in order to see whether the population that Health Center #3 serves has possible unmet legal needs. Students from local law schools and public health programs were trained to approach patients in the waiting room and administer the survey verbally. Surveys, focus groups, and key informant interviews with members of the staff in order to assess their patientsâ€™ legal need were also conducted. Results: The needs assessment showed that there are unmet legal needs in the community. Participants in focus groups, provider surveys, and key-informant interviews showed overall enthusiasm for the medical-legal partnership. 343 respondents claimed not to have any legal needs but when directed questions were asked about socio-legal needs the median was 4, which was the same as the total population. Conclusions: A medical-legal partnership would be helpful in improving the overall health of the population Health Center #3 serves.
Under the Safety Net: Food Sensitivities and Food Assistance Programs 1
Liora Engel-Smith, MPH , 1 1 Amanda Breen, PhD , Mariana Chilton, PhD, MPH 1 Drexel School of Public Health Background: The potential link between food insecurity and food sensitivities (e.g., food allergies, celiac disease, and lactose intolerance) in SNAP (Supplemental Nutrition Assistance Program) and WIC (The Special Supplemental Program for Women, Infants, and Children) participants is unknown. Objective: To investigate the food access challenges for food-sensitive WIC and SNAP recipients. Methods: We interviewed twenty-two experts (dietitians, physicians, government officials, and community educators) on their perceptions of food sensitivities among SNAP and WIC recipients. We also compared the price and availability of specialty and conventional foods in four low-income neighborhoods using a subsection of the Thrifty Food Plan (TFP) shopping list (the basis for SNAP allotment calculations). Results: Per experts interviews, prevalence of food-sensitivities among SNAP recipients is unknown. Prevalence of food sensitivities among PA WIC Infants, children, and women is 1.5%, 6.5%, and 7.5% respectively. In addition, stakeholders identified several food access and nutrition education gaps among these populations. Finally, specialty foods are less available and more expensive then conventional foods. Conclusions: Low-income, food sensitive individuals are vulnerable to poor food access because of their sensitivities and the nutrition assistance programs could do more to accommodate for their needs.
Assessment of Health Related Quality of Life in Overweight and Obese Children Compared to Children with Inflammatory Bowel Disease 1
Amy Faus, MPH , 2 1 Karen Leibowitz, MD , Renee Turchi, MD, MPH 1 Drexel University School of Public Health, 2 Child Health Institute of New Jersey Background: As the United States faces an epidemic of childhood obesity, the importance of understanding the holistic effects of this condition on a child’s life has become an essential focus of research. Health-related quality of life (HRQOL) is a measure of physical, psychological, and social health that can facilitate this understanding. Comparative HRQOL studies examining other serious chronic conditions allow for the contextualization of the significance of obesity’s impact on the measure. Objectives: To compare the effects of two conditions, obesity and inflammatory bowel disease (IBD) on measures of HRQOL. Methods: In this cross-sectional study, 93 patients, ages 5-19, and their parents, completed a generic HRQOL survey, the PedsQL 4.0, during a scheduled appointment at the Child Health Institute of New Jersey. Mean subscale and total HRQOL scores of both patient and parent-proxy surveys for each condition were compared via initial t-tests. Results were adjusted through analysis of variance to control for socio-demographic variables that were identified as potential confounders. Results: After adjusting for potential confounders, analyses revealed no significant difference between groups based on patient reports. Parent-proxy surveys reported significantly lower social functioning scores for obese patients compared to IBD patients (p≤0.05). There was a greater difference between patient-reported and parent-proxy reported scores in the overweight/obese group than the IBD group for physical and social functioning and physical summary scores. Conclusions: Being overweight or obese has a significant negative impact on patients’ HRQOL. This impact is comparable to that of pediatric patients suffering from IBD. Additionally, there is a greater disparity between patient and parent perceptions of HRQOL in the overweight/obese population than in the IBD population. Parents of overweight/obese patients perceive that their child’s social functioning is significantly depressed compared to parents of IBD patients. In light of these findings, health practitioners should recognize the significant impact of obesity on all areas of a child’s and their family’s lives and should seek to provide care that appropriately treats the child and family as a whole.
Neighborhood Safety, Housing Quality and Healthy Food Access: The Impact on Home- and Community-Based Service Use of Older Adults 1,2
Rosie E. Ferris, MPH , 2 1 Allen Glicksman, PhD , Robert I. Field, PhD, MPH, JD 1 2 Drexel School of Public Health, Philadelphia Corporation for Aging Background: Home and Community-Based Services (HCBS) for many older adults are an essential component for maintaining health, independence and the capacity to age-in-place. HCBS have also been found to result in significant healthcare cost savings by reducing unnecessary hospitalization and institutionalization. Therefore, it is essential to understand what factors determine their use. In the 1970â€™s, Andersen and Newman developed the contemporary model used to predict health and social service use, need and knowledge. Studies that attempt to predict need have explained only 10-15% of the variance. Objective: To determine whether the Andersen and Newman model could be strengthened and its explanatory power increased by incorporating potential predictors related to characteristics of the urban environment. Methods: A study was conducted utilizing a sample of older adults (60+) (n=1,343) from Public Health Management Corporation (PHMC) 2008 Household Health Survey cross-sectional data. Structural Equation Modeling (SEM) was employed to analyze potential predictors of unmet HCBS needs. Results: Findings revealed that three variables; lack of access to healthy foods, poor housing quality and feeling unsafe in ones neighborhood were most strongly correlated with unmet HCBS need. This model predicted 49% of the variance. Conclusions: Characteristics of the urban environment, namely access to healthy foods, housing quality and neighborhood safety, may be used to geographically identify older adults in the community who have unmet HCBS needs. Philadelphia Corporation for Aging (PCA) and other Area Agencies on Aging (AAAâ€™s) may increase identification of those in need based on these characteristics and conduct outreach accordingly to achieve their mission of maintaining the health and independence of older adults. Such a strategy will simultaneously help to contain the rapidly increasing health care costs associated with caring for the aging population in the United States.
Utilization of Hospital Billing Data to Analyze Trends of Human Immunodeficiency Virus, Hepatitis C, and Hepatitis B Infection in Southeastern Pennsylvania 1
Lauren E. Finn, MPH , 2 2 Seth Sheffler-Collins, MPH , Marcelo Fernandez-Vi単a, MPH , 2 1 Claire Newbern, PhD , Dr. Alison Evans, ScD 1 Drexel University School of Public Health 2 Division of Disease Control, Philadelphia Department of Public Health Background: The healthcare burden of the intersecting epidemics of human immunodeficiency virus (HIV), hepatitis C (HCV), and hepatitis B (HBV) has not been extensively studied. Most studies have focused on viral co-infection in clinical settings, leading to gaps in knowledge on the impact of co-infection at a population level. Objectives: The purpose of this study was to examine the health care burdens associated with HIV, HCV, and HBV mono-infections and HIV/HCV, HBV/HCV, and HBV/HIV co-infections in southeastern Pennsylvania, and to determined trends in hospitalization among infected individuals, as well as risk factors associated with hospitalization. Methods: Hospitalization data for residents of southeastern Pennsylvania were extracted from Pennsylvania Health Care Cost Containment Council (PHC4) hospital billing database for 1996-2010. Infection status was determined by ICD9 codes indicative of infection or co-infection. The rates of hospitalization for patients with co-infection were compared to those with mono-infection. Results: 13175 persons infected with HCV were identified, with a mean of 1.34 hospitalizations per patient per year. 1055 HBV cases and 4927 HIV cases were also found, with means of 1.59 and 0.98 visits per patient per year, respectively. 1005 cases of HIV/HCV, 869 cases of HBV/HCV, and 295 cases of HIV/HBV were identified, with means of 1.73, 1.99, and 1.79 visits per patient per year, respectively. After controlling for potential confounders, multivariate analysis demonstrated 18.35% and 41.07% decreases in visit rate associated with HCV and HIV mono-infections, respectively, relative to HIV/HCV co-infection (p<0.0001). As compared to HBV/HCV co-infection, HBV mono-infection resulted in an 18.74% decrease in visit rate, and HCV mono-infection similarly decreased visit rates by 32.02% (p<0.0001). Compared to HBV/HIV co-infection, HIV mono-infection resulted in a 41.26% reduction in visit rate (p<0.0001). However, a non-significant (p = 0.3479) 4.18% reduction in visit rate was seen among HBV mono-infected patients relative to HBV/HIV co-infected cases. Conclusions: The observed increases in the rates of hospitalization for virally co-infected persons relative to mono-infected persons indicates a critical need for early identification and treatment of co-infected persons, as well as services integration at both the screening and treatment levels.
Improving the Cultural Competency of a Community-Based CenteringPregnancyÂŽ Program in Northwest Philadelphia 1
Lauren Forbes MPH , 1 2, 3 Suruchi Sood, PhD , Judith Faust, MBA, BSN 1 2 Drexel University School of Public Health, Albert Einstein Medical Center, 3 Enon Tabernacle Baptist Church Background: Poor birth outcomes in the United States disproportionately affect African-American women at double the average rate, and this disparity gap is growing. While reasons for this are not well understood, research suggests that the primary causes are rooted in unique sociocultural and environmental factors that create differential stress burdens for African-American women. The preponderance of stress impacts African-American womenâ€™s physical and mental health across the lifespan and may create differential pregnancy experiences and outcomes. Objective: The objective of this study was to identify the influence of sociocultural stressors and buffers on the pregnancy experiences of African-American women and to use this information to enhance a community-based Centering PregnancyÂŽ prenatal care program that seeks to improve birth outcomes in northwest Philadelphia. The Office of Minority Health has identified cultural competence as an integral factor in eliminating the birth outcomes disparity and other health inequities. Thus this study also sought to generate recommendations for enhancing the cultural competency of the Centering program within the African-American community and improving the partnership between Albert Einstein Medical Center (AEMC) and Enon Tabernacle Baptist Church, the implementing and hosting organizations, respectively. Methods: A qualitative study was conducted using key informant interviews with the Centering co-facilitator (1), experienced African-American mothers over the age of 50 (3), observational assessments of Centering sessions (4), and a literature review. Results: Findings point indicate a need for Centering prenatal care to address the complex sociocultural factors influencing stress levels and the perinatal experience of motherhood for African-American women. A critical need for enhancing the partnership between AEMC and Enon was also identified and determined essential for program efficacy and sustainability. Recommendations were generated for improving the quality of the partnership and enhancing the overall cultural competency of the Centering Program. Conclusions: African-American women are exposed to numerous sociocultural and environmental factors, some of which are protective, but many of which are adverse, creating differential stress burdens that can compromise birth outcomes. The Centering Pregnancy program at Enon has potential to be effective at eliminating the birth outcomes disparity through enhanced cultural competency and an improved community-partnership between the collaborating organizations.
Parent and Caregiver Involvement: Mediators of Change in School-Based Obesity Interventions 1
Maribel Frias, MPH , 1 2 Augusta Villanueva, PhD , Shana Cornfield 1 2 Drexel University School of Public Health, The Food Trust Background: In the United States 31.7% children (2-19 years) are obese or overweight. Overweight children with a parent who is overweight or obese, have a higher risk of becoming overweight or obese adults. School-based obesity interventions with parent involvement have been identified to have the capacity to end adult obesity. Objective: To engage in an in-depth exploration of factors that affect parentsâ€™ effectiveness in school-based obesity interventions and translate findings into future recommendations. Methods: A sample of 34 existing studies was selected to examine the extent of parent involvement. Studies included in this review had to include at least one identifiable type of parent intervention and be a multifaceted school-based intervention. Selected a case study - The Food Trustâ€™s Comprehensive Nutrition Education Program â€“ to assess parent intervention process evaluation component. Results: Available data on parent involvement in school-based obesity interventions is not comprehensive enough. The effectiveness (outcomes) of was mixed; it is difficult to compare across studies because the intensity, duration, frequency, and content of parent interventions differed from study to study or were not detailed enough. Conclusions: Closer monitoring of parental interventions could assist in understanding the effectiveness of parental involvement and explain outcomes. However, even when process evaluations are available, lack of community awareness can prove to be ineffective in involving parents in interventions. Needs of a community must therefore be addressed through the inclusion of culturally competent materials in order to begin to dismantle obesity within schools.
Evaluation of Physical Fitness Component of Nutrition Links Program Implemented at SEPTA Worksite Among Bus Drivers 1
Bianca Marie Garramone, MPH , 1 Rabbi Nancy Epstein, MPH, MAHL 1 Drexel University School of Public Health A pilot program that included Nutrition Links and additional physical activity content was delivered to urban bus drivers at a Southeastern Pennsylvania Transit Authority (SEPTA) bus depot. Nutrition Links, a United States Department of Agriculture-funded program, was delivered by Penn State Extension. A Public Health Masterâ€™s candidate specifically created the physical activity portion of this program for the pilot. This program addressed the growing obesity problem in the United States within a high-risk sedentary population. The program consisted of four 1-hour sessions. Nutrition education was included in all four sessions and the physical activity content was included in three of the sessions. The goal of this program was to educate bus drivers on topics related to nutrition and physical activity in an effort to increase frequency of physical activity and stretching and to promote healthful eating habits. Participants were recruited by flyers hung in the bus depot and talking with bus drivers to determine their interest in a nutrition and physical activity program. A pre- and post-survey that included the International Physical Activity Questionnaire (IPAQ) was administered as part of the outcome evaluation. One-on-one semi-structured follow-up interviews were conducted as part of a process evaluation. At the conclusion of the program, all participants reported engaging in stretching three or more times per week. All participants also reported learning from the nutrition and physical activity content of the program and had implemented lifestyle changes to reflect this learning. In conclusion, the program was successful in educating bus drivers on the basics of physical activity and increasing the frequency of stretching.
A Data Based Analytical Comparison of Nitrous Oxide Levels in Dental Operating Rooms 1
Ryan Graham, MPH , Hernando Perez PhD, MPH 1 Drexel University School of Public Health
Background: While the dental field is considered to have a relatively low hazard risk, dentist report more health problems than any other medical field. On top of encountering infectious, psychological, and physical hazards, dentists are also exposed to waste anesthetic gases. Exposure to waste anesthetic gas is a common occurrence in the dental field; however there are few studies that document these exposures. Objective: To determine common leak sources and the major contributors of nitrous oxide exposure in a dental operating room. Methods: A historic analysis of a data set provided by the University of Pennsylvania’s Environmental Health and Radiation Safety Office, which includes real time point source exposure measurements. Data was compared to the National Institute for Occupational Safety and Health’s (NIOSH) Recommended Exposure Level (REL) of 25 parts per million (ppm) and the American Conference of Governmental Industrial Hygienist’s (ACGIH) Threshold Limit Value (TLV) of 50 ppm for nitrous oxide exposure. Real time point sources were analyzed to identify exposure trends and peaks and to identify if the ACGIH excursion limit of 250 ppm was exceeded. Results: The results showed compliance with the ACGIH TLV when averaged out over an 8-hour time weighted average. However, over short periods of time levels of nitrous oxide in these clinics had peak concentrations between 313 ppm and 637 ppm. Insufficient vacuuming for the waste anesthetic gas scavenging unit, ill-fitting face masks, and system leaks were identified as sources of waste gas exposure. Conclusions: The results highlighted the need for improved workplace practices, administrative and engineering controls, along with new policy recommendations to reduce nitrous oxide exposure and ensure that dentists and their staff have a safe working environment.
Trauma Informed Care Implementation at a Domestic Violence Agency 1
Laura Hunter, MPH , 1 2 Eda Kauffman, MSW , Sandra Bloom, MD 1 2 Drexel University School of Public Health , Women Against Abuse Trauma is pervasive in society and the repercussions for unresolved and untreated trauma leads to physical and mental health problems. Domestic violence is a specific and widespread type of trauma that exists in the U.S. and affects millions of women every year. Women Against Abuse is a leading domestic violence agency in the greater Philadelphia region and serves the community by providing comprehensive services to meet the needs and treat victims of intimate partner violence. Due to the traumatization of clients at the agency, Women Against Abuse has introduced a trauma-informed care model, the Sanctuary Model, that is intended to create a safer organizational culture for both staff and clients. The Sanctuary Model is an innovative and increasingly popular model used for social service agencies to help heal clients who have been through extensive trauma. In order to assess the impact of Sanctuary Model implementation, a qualitative interview was conducted among staff members at the domestic violence agency. Twelve staff interviews were conducted and they included representatives from all departments of the agency. The interviews were transcribed and coded using the grounded theory method. Results indicate that staff members feel that the agency overall is healthier and safer with better communication and relationship building within the agency due to the Sanctuary Model. They did however, express concern that it does not permeate through all departments. Staff members felt the model was a good fit for a domestic violence agency, but the curriculum and material needed to be tailored to meet the agencyâ€™s specific needs better. In addition, staff members expressed the need for more Sanctuary focused trainings for staff so that the whole organization was cohesive in implementation and all staff members had a better understanding of what Sanctuary entailed. Additional research is needed on how to assess Sanctuary success in a domestic violence agency and determine the appropriate tools for evaluation.
Analysis of Clinical Communications about Patients in the Care Coordination Process 1
Elissa Iverson, MPH, RN , Chioma Onyekwelu, MPH, MBBS , 1 1 Zach Risler, MD, MPH , Lauren Zenel, MPH , 2 2.3 Wayne Zachary, PhD , Russell Maulitz, MD, PhD , 1 Theodore Corbin, MD, MPP 1 2 Drexel School of Public Health, Starship Health Technologies, LLC, 3 Drexel University College of Medicine Background: Patient care coordination involves series of verbal and written communications between medical professionals. Effective medical communication can reduce medical errors, improve patient safety, and improve care delivery. This research was undertaken to directly address the need for a firmer focus on clinical care coordination. Aim: To collect data on physicians’ communications, examine the data to understand how care coordination unfolds at the patients’ level and to recommend solutions that would increase coordinated care. Method: Data was collected by direct observation of the modalities and intentions of communication of the Drexel Medicine primary care providers (PCPs) over five months. UCINET, a social network analysis software and STATA were used for data analysis. Results: The study showed that the Electronic Health Record (51%) was the most often used modality of communication by the PCPs followed by face to face communication (20%), telephone (18%), text messaging (3%), and email (2%). Also, situational convergence accounted for 26% of the communication intentions, followed by drill down elicitation (25%), state change alert (11%), cross elicitation (10%), handoff (9%), cross coverage (7%) and report back (3%).Number of observations for each PCP was the main predictor of the number of communications about patients generated by each PCP (coefficient = 4.36, p- value = 0.0001). Conclusion: This research will be used to make recommendations on how communication can be used to improve the quality and effectiveness of patients’ care.
Analysis of Nondiscrimination Policies and Structural Barriers related to Current Interpreters Services and its Effectiveness in Clinical Settings 1
Michelle Jeu, MPH , 1 2 Professor Raymond Lum, MPhil, MS , Mr. Albert P. Black, Jr., FACHE 1 Drexel University School of Public Health, 2 Hospital of the University of Pennsylvania Background: Miscommunication between patients and providers is too common in a health setting nationwide (Chen, 2007). Ineffective communication between patient and provider can have a negative impact on health outcomes. The absence of best practice tools and programs to enhance communication between patient and provider often creates disparities in health service access and delivery in diverse patient populations. Approach: This project evaluates the effectiveness of current hospital policies implemented regarding access to services by limited English proficient (LEP) and hearing impaired populations at the Hospital of the University of Pennsylvania (HUP). The purpose of the project is to examine site specific policy language in a large academic teaching hospital in Philadelphia, Pennsylvania and compare it to best practices policies and programs in place at similar institutions in the U.S. The goal is to identify best practices in providing interpreter services to diverse populations and to implement a policy and process improvement intervention that will reduce deficiencies in current practice through policy initiatives. Estimates of the number of people who visit HUP indicate that approximately 1/7 or nearly 14% of people who visit the hospital require some form of language assistance. Deliverables: In reviewing the literature, a five category assessment of important traits for interpreter services based on a review of best practices was created based on (1) structure, (2) community needs assessment of the population being served, (3) resources and efficiency of delivery, (4) protocols and training of staff interpreters and competency, and (5) a system of monitoring and evaluation of interpreter services (Torres, 2004). A comparison of HUP traits identified areas of focus using information gathered from meetings, internal baseline data, and information provided by HUPâ€™s interpreter service contract company, Quantum, Inc. from September 2012 to March 2013. Implications: The assessment revealed a need for targeted approaches to improve community needs assessment of the population and monitoring and evaluating the quality of the services provided. This project applies literature review, assessment, quality improvement and management models to identify ways to improve the quality of interpreter services.
Process Evaluation: The Child Protection Program & Providers 1
Carmen Johnson, MPH , 2 1 Maria McColgan, MD , Nicole Vaughn, PhD , 1 Drexel University School of Public Health, 2 St. Christopher’s Hospital for Children, Background: Multidisciplinary clinical child protection programs present an opportunity to assess, treat, and intervene in cases of child maltreatment. The Child Protection Program (CPP) at St. Christopher’s Hospital for Children (SCHC), is performing a process evaluation to build capacity as well as improve health outcomes for patients served by the program. Objective: Qualitative semi-structured interviews were conducted to evaluate the effectiveness of the Child Protection Program on increasing the knowledge and skills amongst SCHC around Child Maltreatment. Method: Five providers from five clinical departments at SCHC were asked about the beliefs about, knowledge of, and practice around child maltreatment. In addition, we evaluated providers overall satisfaction with the Child Protection Program. We analyzed the data using grounded theory. Results: All participants indicated that they felt a moral and professional obligation as mandated reporters and providers to assess and treat patients of child abuse and neglect. Participants reported a favorable impression of the Child Protection Program and its services. Yet, inconsistencies were discovered around provider trainings and noon-time conferences on abuse and neglect. Overall participants were highly satisfied with the Child Protection Program’s standard of services, yet found staffing and resources inadequate. Participants also noted inconsistencies for referral of child maltreatment patients. Conclusion: The Child Protection Program at St. Christopher’s Hospital for Children is a vital addition to the continuum of care at the hospital. It has been a great resource of education and is a strong advocate for patients of abuse and neglect. While satisfaction is high for the program, capacity for the program must be built to address the growing needs of the population as well as the cadre of providers that utilize the program’s services.
When Doctors Fail: A Mixed-Methods Study of Non-Doctor Diagnosis of Fibrodysplasia Ossificans Progressiva 1
Amelia Kermis, MPH , 2 3 Frederick Kaplan MD , Michael Yudell PhD, MPH 1 2 Drexel University School of Public Health, Center for Research in FOP & Related Disorders, Perlman School of Medicine, the University of 3 Pennsylvania, Program for the Study of Public Health Ethics and History, Drexel University School of Public Health Background: Fibrodysplasia Ossificans Progressiva (FOP) is an extremely rare, commonly misdiagnosed (90% of the time), debilitating, genetic disorder that turns muscles, tendons, and other connective tissue into bone, rendering movement impossible. Diagnostic biopsies, intramuscular immunizations, minor trauma, or muscle fatigue can initiate transformation of soft tissue into bone, leaving misdiagnosed individuals vulnerable to iatrogenic harm and lifelong disability. Most doctors fail to properly diagnose FOP because of its rarity. Parents who are familiar with the childrenâ€™s symptoms and have access to accurate diagnostic information may insure that the proper diagnosis is made, thus lessening the risk of iatrogenic harm. The most comprehensive resource for accurate diagnostic information is the International FOP Association (IFOPA) website. Making the IFOPA website readily searchable by parents of undiagnosed children is a necessity. Objective: The study was designed to investigate: a) the methods that the general adult public would use to search for health information on the Internet and b) the terms used to search for the clinical symptoms of undiagnosed FOP. A survey was developed to collect data for the study. Methods: A survey was developed and disseminated via email to Drexel Faculty and Staff. The survey was then evaluated using Base SAS and Atlas.ti. In addition, an interview with parents of FOP patients was conducted to understand how they sought for health information when they were trying to find their childâ€™s diagnosis. The results of these interviews were interpreted using Atlas.ti. Results: While the majority of respondents would talk to the doctor first, if the doctor does not know they turned to the Internet. Terms most commonly used to search for toes were infant feet, abnormal foot, toe overlap, big toe deformity, and abnormal toes. Terms most commonly to search for soft tissue swelling in the back were child back lump, child mass back, child back bulge, back lump respiratory illness child, back bump respiratory illness child, child tumor on back, and spine deformity. Implications: Given the results, the Internet is a viable method to disseminate information about FOP.
Creating a Framework for Regional Report Card on Cancer Care Services in Greater Philadelphia 1
Sara Khan, MPH , 2 1 Neil I. Goldfarb, PhD , Raymond Lum, MPhil, MS 1 Drexel University School of Public Health, 2 Greater Philadelphia Business Coalition on Health Background: The Greater Philadelphia Business Coalition on Health (GPBCH) aims to achieve transparency in healthcare. Given that cancer is the second leading cause of death in the US, and Pennsylvania has the fifth highest expected cancer numbers in the country, currently, there are no public reports on quality and performance of services pertaining to cancer care in the Greater Philadelphia region. The quality measures that some oncologists may follow are not publicly reported. This project was designed to create a framework on creating a report card that would highlight the quality of cancer care services provided in the Greater Philadelphia region. Objectives: To create a framework for a report card that would list cancer specialists and make transparent the quality of cancer care services they provide. To drive consumer behavior by helping them make better decisions through this. To improve physician performance by publicly reporting the quality of their services. To give policymakers tools to assess and gauge performances of cancer specialists. Methods: An extensive literature review was conducted on public reporting, the available information on cancer, and public reporting on cancer. Articles were selected on the basis of relevance to public reporting or models of cancer care services, since publishing already meant they were being publicly reported. In addition, a meeting of key stakeholders in quality of cancer care services established the need for a report card, as well as the important aspects that should be included while structuring the report card. Results: Despite the high incidence and mortality rate associated with cancer, little heed is paid to the quality of services provided or the quality and amount of information available on providers and services. Hence there is a desperate need for the availability of publicly reported information on this. Public reports, through multiple means of dissemination have shown success in driving consumer behavior and improving performance of providers. Models can be used from other quality public reports, such as Leapfrogâ€™s Hospital Safety Score. The project is feasible, but there are many challenges that will be faced. Existing standards on quality of care need to be identified and compiled. Data can be taken from online databases, as well as requested from providers. Support needs to come from all stakeholders, while one takes the lead in creating the reportcard. Conclusion: The report card is a way to not only identify and compile a consolidated list of cancer specialists in Philadelphia but also to report the types of service they provide, and the quality of those services. It is therefore recommended that the report card not only be pursued, but also made a priority for transparency. All stakeholders must collaborate to achieve the goal, and structures need to be created so that the report card is replicable, scalable, unbiased and updated frequently. Support from national healthcare quality organizations, such as AHRQ and NCQA should be sought.
Trends of HIV/AIDS Heterosexual Transmission in Pennsylvania From 1985-2011 1
Courtney Kirkland, MPH , 1 2 2 Yvonne Michael, ScD, SM , Michael Allen, MPH , Godwin Obiri, DrPH, MS 1 Drexel University School of Public Health, 2 Pennsylvania Department of Health Background: From 1999 to 2009, heterosexual contact was the largest category of HIV transmission in Pennsylvania. This pattern of transmission differs from the general trend in the United States, in which the MSM transmission category was the most common mode of HIV transmission. Objective: This project aims to identify subgroups in Pennsylvania with high proportions of heterosexual HIV transmission during this time period and evaluate the PA HIV/AIDS surveillance reporting procedures that report transmission risks for the cases. Methods: Several analyses were conducted on HIV/AIDS adult cases from 1985-2011 (n=52,730) utilizing eHARS dataset to evaluate trends of heterosexual transmission in Pennsylvania. The validity of the data set was examined using the kappa statistics and using frequency tables to identify investigators with high proportions of reported heterosexual transmission. Using national trends, the prevalence of HIV in Pennsylvania was compared in regards of mode of transmission and race/ethnicity. From the descriptive analyses of Pennsylvania data, characteristics associated with a greater proportion of HIV heterosexual transmission were included in a multivariate logistic regression. Results: The prevalence of men who acquired HIV/AIDS through heterosexual transmission were higher in Pennsylvania than in the United States. Using only HIV positive men in Pennsylvania from 1999-2009, the predictors associated with greater odds of transmission via heterosexual contact in the surveillance system were being African American (OR: 1.997, 95% CI: 1.840 – 2.167), being reported by a certain investigators (OR: 2.344, 95% CI: 2.054 – 2.675), being over 50 years old (OR: 1.677, 95% CI: 1.517 – 1.854), being diagnosed between 19992009 (OR: 1.045, 95% CI: 1.032 – 1.059), and being diagnosed in urban cities (OR: 1.864, 95% CI: 1.701 – 2.043). Conclusion: There are many factors that contribute to the increase of the heterosexual contact transmission category in Pennsylvania between 1999-2009. Although this project did provide insight into the some of the contributing factors such as African American men, change in surveillance systems by CDC, and being reported by certain investigators, intensive research is needed to confidently associate any factor with the anomaly in trends. In the future, there should be more education and training for surveillance staff and health care providers regarding HIV risk ascertainment and the public health implications from this project should be used as the basis in future research.
Policy Recommendations from the Caregivers of Witnesses to Hunger in Camden, NJ 1
Molly Knowles, MPH 2 2 Jenny Rabinowich, MPH, Mariana Chilton, PhD, MPH 1 2 Drexel University School of Public Health, Center for Hunger-Free Communities, Drexel University School of Public Health Background: In 2011, 14.9% of US households were food insecure, meaning that they did not have enough food for an active, healthy life. In households with children less than 6 years old, the rate of food insecurity climbs to 21.9%. Food insecurity is associated with many adverse health effects, particularly for children in the first three years of life. Despite the impact of food insecurity on young children, the perspective of their caregivers is often neglected in discussions of policy solutions to food insecurity and poverty. Objective: To engage low-income parents and caregivers of young children in recording and sharing their experiences of hunger and poverty and making public policy recommendations on poverty, health, and well-being in their communities. Design/Methods: A mixed-method participatory action research study utilizing the Photovoice technique partnered with 10 mothers and grandmothers of children 0-6 years old who are participating in public assistance programs. A questionnaire addressed food security status, public assistance participation, and maternal and child health indicators. Participants took a total of 774 photographs and participated in semi-structured individual interviews and focus groups. Grounded theory analysis of qualitative interview and photograph themes was performed to identify participantsâ€™ descriptions of policy-related obstacles and participant recommendations for policy change. Results: Participants reported food quality, hunger, housing, homelessness, education, employment, physical environment, and safety as main concerns with roots in policy-related obstacles. Participants also described food assistance programs, community resources, and collective action as community strengths that could be supported through policy action. Participants identified policy recommendations along three major themes, including 1) restructuring the welfare system program requirements and methods by which benefits are awarded, 2) reforming housing policy, and 3) increasing public and community investment in Camdenâ€™s built environment and public resources. Conclusion: Participantsâ€™ policy recommendations encompass multiple levels, including changes to federal, state, and local policies. Public health research and public policy efforts to combat food insecurity should actively solicit input from participants in public assistance programs.
Autism in the Context of a Public Health Organization 1
Kaitlin H. Koffer, MPH, BA , 1 2 Jennifer Kolker MPH , Lindsay Lawer MS 1 2 Drexel University School of Public Health, A.J. Drexel Autism Institute Background: Autism is a neurodevelopmental disability that has become a pressing issue both nationally and internationally over the past two decades. Autism and the related disorders on the Autism Spectrum have a profound effect not only on the individuals who are diagnosed but also on their families, government agencies, the educational system, the healthcare system, and beyond. Given these population level effects, it is important to explore the many aspects of autism that can have an impact on the public health. Autism in the Context of a Public Health Organization explores the following topics areas: the cost of autism, the outcomes of adolescents and adults with autism, and early intervention and detection. Objective: Autism in the Context of a Public Health Organization was two-fold in focus and execution. The first focus was to gain experience and greater understanding the leadership and management of a non-profit, public health organization with a focus in autism through immersion in program development and operations. The second focus was to research autism as a public health issue and then explore what gaps exist in the available literature and what implications there are for future research. Methods: Relevant research related autism and the selected areas that affect public health were identified through a search of databases. The desired samples were from longitudinal studies, large sample sized cross-sectional studies, large cohort studies, census data or other national survey statistics. Public health core competencies were used as markers of success for the goal of leadership in an public health organization. Results: The cost of autism, the outcomes of adolescents and adults, and early intervention and detection are very important areas of autism research in the context and framework of public health. However, the amount of research articles about these subject areas that met the selection criteria was very low. Conclusions: While there were research articles found that examined each of these areas of research, more research should be done on the public health implications of autism and the operations and leadership of the A.J. Drexel Autism Institute provide the necessary infrastructural support to conduct such research.
Addressing Mold Exposures in Indoor Environments: Developing a Public Health Program for Philadelphia 1
Karen Lazars, MPH , 1,2 2 2 Esther Chernak, MD, MPH , Catherine Klinger, MPH , Ray Delaney, MBA 1 Drexel University School of Public Health, 2 Philadelphia Department of Public Health Background: The lack of residential mold regulation in Philadelphia leaves citizens vulnerable to exposure, and potentially to adverse health effects. The Philadelphia Department of Public Health (PDPH) wanted to establish the framework for a public health program that would prevent exposure to mold in residential settings. Objective: The goal of this project was to develop the components of a public health program for PDPHâ€™s Division of Environmental Health Services. The aims were to: (1) develop a surveillance tool; (2) draft regulation to create moldprotective property codes; (3) create educational tools for the general public; and (4) create mold remediation guidelines for landlords, building managers, and contractors. Methods: A literature review of the health effects of mold exposure was conducted to inform deliverables. Analysis of existing mold regulations and educational materials informed policy, educational tools, and remediation guidelines. Results: Deliverables are based on CBMP objectives. A Microsoft Access-based data collection tool was created for surveillance purposes and may identify seasonal or geographic trends in mold growth. Analysis showed that mold regulations in the U.S. are limited to real estate transactions, education, task forces, and licensure for remediation. It was determined that Philadelphia would be best served by amendments to new property codes that discourage moisture intrusion. Educational materials created include: A Guide to Mold Free Living for residents and Philadelphia Mold Remediation Guidelines for landlords, building managers, and contractors. Conclusion: PDPHâ€™s mold program will benefit from surveillance, policy, and educational resources. These measures will contribute to ensuring safe and healthy living conditions free from mold in Philadelphia.
Evaluation and Improvement Initiative Proposal for an Asthma Home Remediation Program 1
Adam Lefky MPH , 1 2 Igor Burstyn PhD , Bruce Bernstein PhD 1 Drexel University School of Public Health, 2 St. Christopherâ€™s Hospital for Children Background: Asthma is a serious health concern facing children, especially in Philadelphia. According to the Philadelphia department of Public Health, there are 12.9 asthma hospitalizations in children age 0-14 per 100,000, while national values are 2.7 hospitalizations per 100,000. Asthma attacks often occur as a result of environmental triggers such as mold, dust, and tobacco smoke, and often these triggers can be eliminated from the home, but the families lack resources to do so. The Healthy Homes Healthy Kids program was created to provide home remediation for families of asthmatic patients at St. Christopherâ€™s Hospital for Children to ideally reduce the severity of asthma in these children. Objective: To create a proposal for future works that can be used as a quality improvement initiative and evaluation for the Healthy Homes Healthy Kids asthma home intervention program. Methods: A proposal for future works was drafted that would work towards assessing the effectiveness of the HHHK program. Many issues were taken into account, such as how to best control for the experiment, how best to measure asthma severity, and how to define the quality of the program. In addition, literature on current asthma home interventions was reviewed and made available to the program for use in future changes and confirmation of current practices. Results: The final work proposed a future project that would act as quality improvement for the HHHK program in three ways. First, it would determine if those enrolled in the program actually saw a decrease in asthma severity. Next, it would compare with a control group to ensure any decrease was due to the program and not other factors. And finally, a cost benefit analysis would be done to determine the most effective use of money in reducing the burden of childhood asthma. Conclusion: Future and past works should greatly assist the HHHK program in providing better service to families of asthmatic children, ideally reducing the impact of asthma in the future.
Social Support: A predictor of Anxiety and Depression During Gestation amongst HIV + and HIV – Pregnant Women 1
Jimeka Leonard, MPH , 1 2 Marcia Polanski, ScD, MS, MSW Erika Aaron RN 1 2 Drexel University School of Public Health, The Woman’s Care Center at Drexel University College of Medicine Objective: The purpose of this study is to determine if social support is a predictor of anxiety and depression during gestation for hiv + and hiv – pregnant women. Background: Depression and anxiety are both known to have adverse neonatal outcomes. Females who are HIV + and have expressed depressive symptoms they are less likely to follow the rigorous medical adherence and suffer from lower quality of life. Social support has been shown to have effects on depression. Social support has also been shown to improve apger scores as well as neonatal outcomes of the mother. Being able to identify anxiety and depression early on during pregnancy via social support will help decrease adverse neonatal outcomes associated with each. Methods: Participants were recruited from the Woman’s care center at Drexel University College of Medicine Obstetrics and Gynocology. Woman had to be at least 24 weeks pregnant, speak English, give birth to an infant, and attend two pre-natal care visits. Participants participated in an in person interview. To assess for depression the CES-D was used. To assess for anxiety the STAI – Y forms were used. Results: 258 Participants were recruited. 64 were HIV + and 194 were HIV -. The average age of the population was 25 (SD 5.34). The population reflected the sites surrounding community with over 70% being African American. It was determined that there were significant differences between the HIV+ and HIVgroups in regards to depression scores and stai scores (p < .05). Social support from relationship and family was significant in association to anxiety scores for females who were HIV - during gestation. This was not the same for those who were HIV +. However for certain anxiety factors the type of social support was significant for those who were HIV +. Conclusions: These results demonstrate that social support does have impact on depression and anxiety amongst HIV + and HIV – pregnant women. Varying anxiety factors are more effected by social support for those who are HIV +. Gaining a better understanding of anxiety factors that affect those who are HIV + and HIV – during pregnancy is important in eliminating adverse neonatal outcomes.
Determining the Effects of Youth Homelessness on HIV Transmission Risk Behaviors Using YRBS Data 1
Cristina Resczenski Lerner, MPH , 1 2 Mary Hovinga, PhD , Alison Lin, MPH 1 Drexel University School of Public Health, 2 Childrenâ€™s Hospital of Philadelphia Objective: This project analyzes Philadelphia Youth Risk Behavior Survey (YRBS) data to identify significant associations between youth homelessness and behaviors that increase the risk of HIV transmission and infection. By quantifying the behaviors and demonstrating the strength of associations, the results can inform decision making regarding HIV prevention strategies in youth. Methods: The three YRBS questions regarding housing insecurity were combined to create the exposure variable and each of the HIV risk behaviors was made into a binary outcome. Odds ratios were then calculated for each of the possible HIV risk behaviors and their significance was measured using a chisquare statistic and appropriate alpha. Logistic regression was then performed in order to control for demographic variables. Results: A number of variables were found to be significantly linked with housing insecurity, spanning across a wide range of behaviors. Youth who had ever had insecure housing were more than four times as likely to be threatened at school and four times as likely to be injured in a fight. They were more than three times as likely to be forced to have sex and more than twice as likely to have had sex before the age of 14. Youth with insecure housing were also almost five times as likely to use illicit drugs, including intravenous drugs. Perhaps not unsurprisingly, they were also twice as likely to hurt themselves on purpose and more than twice as likely to attempt suicide. Conclusions: The results show that youth with insecure housing are forced into a number of behaviors that put them at increased risk of HIV contraction and transmission. Although the connections to sexual and drug behaviors may seem obvious, the mental health and physical safety questions point to a broader impact of housing insecurity that affects the youth as a whole, making them incapable at times of keeping themselves safe and making their health a priority. Risk behaviors, like the ones shown to be significant, not only increase the likelihood of HIV exposure, they also disempower youth to make positive, healthy decisions for themselves.
Micro Health Insurance in the Developing World Assessment of a Program at El Salvador 1
Ana M. Lopez, MPH , 1 2 Mary Duden , Meredith G. Mick 1 Drexel University School of Public Health, 2 Foundation for International Medical Relief of Children Background: Social protection in health is a major concern in most of the developing world. These countries lack of efficient public and private health insurance sectors. Usually the programs available are not accessible for the large proportion of the population that works in the informal economy. Lowincome households bared high out-of-pocket payments at point of service and if free or low-rate public services are available to them, often they are of low quality. Micro health insurance (MHI) schemes have been implemented to cover to a certain extent the costs of certain illness-related losses of rural, low income and underserved households in the developing world. Objective: Conduct a literature review on MHI programs in the developing world to gain knowledge on these schemes. From the information acquired provide feedback to further the effectiveness of the MHI program at El Salvador. Methods: Search for articles about MHI programs in academic databases. Describe the organizational models implemented, and the effect of cost sharing and provider payment methods on these programs. Use this information to assess the MHIP that FIMRC runs at El Salvador. Results: A total of 39 articles in scholarly journals were analyzed, five of them were review-articles. Studies report five organizational models for MHI schemes: mutual model, benevolent insurer, provider model, partner â€“ agent model and commercial insurer. Different levels of cost sharing bring different degree of changes in health services utilization, and control of moral hazard within MHI clients. Provider payment methods influence both provider and patient behavior in MHI schemes. Conclusions: MHI serves as a mechanism to provide healthcare with quality to the underserved in the developing world. Nevertheless its success and sustainability depends on variables such as the type of organizational model, degree of cost sharing and provider payment methods implemented. The nature of the risks that it covers and the sociopolitical environment of its targeted population should also be considered.
Zoonotic Diseases in Immunocompromised Patients: A Comparison of Knowledge base and Communication among Veterinarians and Oncologists 1
Katherine Lothstein, MPH , 1 1 Mary Hovinga, PhD, MPH , Renee Turchi, MD, MPH 1 Drexel University School of Public Health Objectives: Increasing human/animal interactions has raised the risk of zoonotic disease transmissions between species. Immunocompromised patients undergoing prolonged chemotherapy are at a higher risk of infection. The One Health Concept promotes increased awareness of zoonotic diseases in the veterinary and medical field as well as improved communication and collaboration. This study evaluated the effectiveness of the One Health Concept implementation by evaluating the relationship between these two health fields and their awareness of zoonotic diseases in immunocompromised patients. Methods: Parallel surveys, created for veterinarians and oncologists, were distributed through an online survey site accessed through professional organizations or direct contact. Comparative statistical analysis between the two fields was performed using SAS version 9.2. Results: Results, obtained from 75 veterinarians and 43 oncologists throughout Pennsylvania and Tennessee, indicated that veterinarians discussed zoonotic disease risk with owners and suspected zoonotic cases in patients more frequently than oncologists. There were significant differences of opinion concerning the role of each profession in the education and prevention of zoonotic diseases in patients and petâ€™s owners. There was also limited communication between the two fields. Overall, approximately half of the veterinarians had knowledge of One Health compared to none of the oncologists. Conclusion: The One Health Concept remains a relatively new idea in the medical and veterinary fields. While the concept may be expanding into the veterinary educational system, it has yet to become part of medical education. Zoonotic diseases impact the health of both humans and animals, therefore it is imperative that we increase awareness of One Health and encourage veterinarians and oncologists to communicate and collaborate to improve both prevention and treatment of zoonotic diseases.
Geographic and Disparity in Influenza Vaccination and Flu Control in Patients with Cardio-vascular Disease in the United States: Trends over the Last Decade using BRFSS 2001, 2006 and 2011 1
Zeeshan Mansuri, MD , 1 Longjian Liu, MD, PhD, MSc, FAHA 1 Drexel University School of Public Health Background: Cardio-Vascular Disease (CVD) is a persistent public health challenge and is the leading cause of death in United States. Existing literature suggest an association between influenza vaccination and prevention of CVD. Evidence from individual studies has been consistent. Objectives: The purpose of the study to examine the geography and disparity in terms of influenza vaccination between Pennsylvania and United States over 2000-2010 and to further explore difference in effect across age groups, racial/ethnic groups and insurance status to provide evidence to guide service and policy development. Methods: Using the Behavioral Risk Factor Surveillance System (BRFSS) data from 2001, 2006 and 2010, we compared Pennsylvania and United States in terms of vaccination by age groups, sex, and insurance status and also compared Pennsylvania to the top 5 and the bottom 5 states in terms of overall weighted vaccination rates. We were interested in the trends over time and the possible causes for the same. Results: Influenza vaccination was higher in the >=65 age group compared to the 50 to 64 age group. However, among people having CVD, the rate of vaccination had increased from 2001 to 2006 and then subsequently decreased from 2006 to 2011. Whites had the highest rates of vaccination and Hispanics had a significantly low level of vaccination. Conclusions: There is a significant geographic and age related disparity between Pennsylvania and United States. The causes of decreased vaccination in the people with CVD must be looked into. The rates of overall vaccination has decreased in the people with CVD in the age group >=65. Efforts must be made to increase the awareness of the general population regarding the protective effects of the flu shot from CVD, especially in the 50-64 age group. Also, the cost of the vaccination should be reduced to make it more affordable to the general population.
Reducing Stroke Disparities Among the Urban Hispanic Population 1
Phillip Ramon Martinez, MPH , 1 2 Jennifer Breaux, DrPH, MPH, CHES , Toby Mazer, MPH , 2 Dr. Mary Bouchaud, PhD, MSN, CNS, RN, CRRN 1 2 Drexel University School of Public Health, Delaware Valley Stroke Council Objectives: The goal of this project is to raise awareness of stroke among the Hispanic community through education on the signs and symptoms of stroke as well as their individualized risk factors. Methods: A focus group comprised of two Hispanic females between the ages of 20 and 30 and two Hispanic males between the ages of 40 and 50 and a comprehensive literature review were used to assess the knowledge of the community about stroke and stroke prevention in North Philadelphia, Pennsylvania. The focus group lasted one hour and was comprised of 7 questions related to stroke. The qualitative analysis of the focus group used theme analysis and coding by three individuals. Results: Eight major themes emerged from the focus group: knowledge surrounding the signs and symptoms of stroke; preventative medical care and knowledge about how often to see a doctor; the demographic most at risk for a stroke; communication barriers and issues with healthcare professionals; money to pay for medical care; barriers to receiving medical care; use of herbs and plants for treatment; and cultural competency of healthcare professionals. Conclusion: Major themes: health literacy, barriers to healthcare, and traditional medicine. Limitations: demographic of participants, location of focus group, and number of times focus group was held. Recommendations: increase health literacy in the community and education healthcare professionals on traditional medicine practices.
Development and Concept-testing of an Evidence-based Arthritis Education and Management Program 1
Ashley McCants, MPH , 1 2 Lisa Ulmer, ScD, MSW , Miriam Burnett, MD, MDiv, MPH 1 2 Drexel University School of Public Health, African Methodist Episcopal Church Connectional Health Commission Background: The African Methodist Episcopal Church (AMEC) Connectional Health Commission has a mission of providing continuous health-related service, integrated with the Christian faith, through churches to the congregants and their respective communities. One way the Commission does this is through the provision of health education, which is done through a variety of methods (e.g. programs and online sources). The Commission has extensively addressed many health topics including asthma, diabetes, and cardiovascular disease, but arthritis has only been minimally addressed. Objectives: To develop a culturally-tailored, evidence-based Arthritis Education and Management Program. To develop its accompanying materials, specifically a training manual, a toolkit, and a partnership and tips list. To concept-test the program and materials to revise them. Methods: A literature review was conducted to identify evidence-based information regarding program development, and to determine content inclusion. Web sources were also reviewed for potential utilization in the program. Concept-testing was conducted through a focus group of AMEC congregants in a suburb of Philadelphia to provide feedback for the program and its materials. Results: A program based on the Social Cognitive Theory, whose goals include: to increase knowledge of arthritis, to increase knowledge of available resources about arthritis, and to increase self-efficacy in managing or preventing arthritis. The program discusses Arthritis with particular focus on its four most prevalent types: Osteoarthritis, Fibromyalgia, Gout, and Rheumatoid Arthritis. The specific topics covered in the program include myths, overviews of the conditions, prevention and management strategies, emotions, nutrition, and communicating with health professionals. A manual that outlines the entire program. A toolkit that includes PowerPoint slides, videos, handouts, problem-solving scenarios, and a list of tangible tools to aid in discussion. Finally, a partnership and tips list that includes tips on how to establish partnerships with other churches in the community, recreational centers, hospitals, senior centers, and the nearest active Arthritis Foundation Chapter. Conclusion: The program and materials developed through this project will aid the Commission in further addressing the topic of Arthritis. It is also recommended that the program and materials continue to be concept-tested in other communities to develop a standard program for eventual implementation.
Reducing Stigma of Behavioral Health Issues Through the Use of Web 2.0 Joshua McCawley, MPH See Amitoj Chatrath, MPH, for Abstract -Creating a Public Health Advisor Position in the Region III Office of the Department of Health and Human Services Focused on Tobacco Control and Cardiovascular Disease 1
Jeffrey McCortney, MPH , 1 2 2 Dennis Gallagher MA, MPA , Dalton Paxman, PhD , Mahak Nayyar, MPA 1 Drexel University School of Public Health, 2 U.S. Department of Health and Human Services Background: Among the goals of the Community-Based Masterâ€™s Project are enhancing knowledge in core public health skills, developing public health practice skills, fostering civic responsibility and other values of citizenship, advancing personal and professional development, and enhancing capacity skills of community partners. As an intern with the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Health, Office of the Regional Health Administrator, Region III, I had the finest possible opportunity to accomplish all of these goals. Working directly with the Regional Health Administrator and other office staff, I contributed directly to the advancement and implementation of health policy for the Mid-Atlantic region. Objectives: To be immersed in the culture of the public sector, to be exposed to and gain an understanding of the workings of government, and contribute to the implementation of public health policy. Approach: My work included performing literature reviews on the best practices of integrating clinical medicine and public health, creating issue briefs on local tobacco control and cessation laws, and giving presentations on Medicare preventive service utilization. I was included in the daily operations of the office, and thanks to the collaborative spirit of the RHA staff, I experienced what life is like as a staff member of the federal government. Conclusion: An internship is the most immersive CBMP opportunity and best prepares students for life as a public health professional.
Socioeconomic Disparities in Burn-Injured Adults and Children: Analysis, Cost Burden, and Prevention Policy Development 1
Jessica McCreary, MPH , 1 2 Darryl Brown PhD , Michael Peck MD, ScD 1 2 Drexel University School of Public Health American Burn Association Background: There are approximately 40,000 hospitalizations relating to burn injury every year. Children and adults of low socioeconomic status experience burn injuries at an increased rate compared with those not of low socioeconomic status (SES). Racial disparities in burn injury rates also exist, however research has identified that racial disparities are likely a reflection of SES. This disparate rate of burn injuries among these children and adults has resulted in an economic burden for families. Objective: To characterize the socioeconomic disparity in the experience of burn hospitalizations among children and adults. Additional objectives are to develop and cost burden for families using an out-of-pocket cost to family income ratio and to develop policy recommendations to impact prevention corresponding to identified socioeconomic predictors. Methods: A retrospective study was conducted on children and adults using the 2010 National Inpatient Sample (NIS) from the Healthcare Cost and Utilization Project (HCUP) to assess specific International Classification of Disease (ICD-9) codes of first (n= 889), second (n= 19,961), third (n= 12,688) and deep third (n= 1,429) degree burns. Insurance status was used as a proxy for socioeconomic status. Mean length of stay (LOS) and mean costs were compared for different insurance coverage groups that included Medicaid, private insurance, uninsured, other and missing. Seniors were excluded from this study and no Medicare data was used. The out-of-pocket cost to family-income ratio was determined using the National Health Interview Survey (NHIS) linked to the Medical Expenditure Panel Survey (MEPS) for the year 2010. Results: For first, second, third and deep third degree burns, patients with Medicaid had a mean length of stay (9.1 days) and mean cost ($22,025) that was significantly higher than those with private insurance (7.4 days and $19,392) or those that were uninsured (7.4 days and $18,614) (p<0.0001). A similar trend was seen when burns were grouped into their first, second, third and deep third degree burn categories. Conclusions: Adults and children with Medicaid experienced burn injuries at a higher rate than those with other types of coverage. This disparate burn experience yields costs that are a burden to society and families. Prevention policies geared toward low SES families are needed to reduce this disparity.
Predicting Risk of Mortality from Cardiovascular Disease Using Artificial Neural Networks 1
Kathan Mehta, MPH, MBBS , 1 Longjian Liu, MD, PhD, MSc 1 Drexel University School of Public Health Background: Cardiovascular Diseases (CVD) are the most common cause of death in United State. In 2011, 725,270 people died because of CVD in the United States. While there are several scoring systems like Framingham Risk Score (FRS), based on Cox proportional hazard regression method to predict risk of the development of CVD, none of them predicts risk of death from CVD. Objective: To develop a novel model to predict CVD mortality using artificial neural networks (ANNs), and to compare the results with that predicted by using Cox proportional hazard regression models. Methods: We used NHANES III data (1988-1994) linked with its Mortality File. CVD related mortality was identified by using ICD10 codes as per American Heart Association (AHA) guidelines. We developed models to predict CVD related mortality based on Cox-proportional hazard method. We assessed ability of ANNs in predicting the CVD related mortality. In addition to the application of the variables used in FRS model (age, gender, total cholesterol, HDL cholesterol, presence of diabetes, smoking status, systolic blood pressure and use of medication for high blood pressure), we included serum C-reactive protein level, serum creatinine, Red blood cell Distribution Width (RDW), and EKG characteristics (QRS duration in lead II) in the ANNs model. Results: The model based on FRS variable was useful in predicting CVD related mortality (c-Stat: 0.8). While adding C-reactive protein level, serum creatinine, and RDW in the FRS model did not significantly improve prediction. However, once adding EKG characteristics these models on the basis of Cox hazard regression have been improved significantly (c- Statistics: 0.84, p<0.05). Using the same variables, the ANN models further improved the prediction of CVD mortality (c- Statistics: 0.88, p<0.05). Conclusions: EKG characteristics can help to identify the patients at high risk of death from CVD. Artificial Neural Networks can improve the prediction as compared to traditional methods.
Statistical Analysis of National Inpatient Sample for Morbidity Related to Occupational and Environmental Health 1
Tapan Mehta, MPH, MBBS , 1 Arthur L. Frank, MD, PhD 1 Drexel University School of Public Health Objective: The project explored the National Inpatient Sample hospitalization dataset from the year 1998 to 2010 for environment and occupation related hazards, and provide a platform for further exploration of the dataset to understand the trends of various environmental and occupational exposure related hospitalization in the United States. Methods: We queried The National Inpatient Sample Hospitalization Data for various exposures using International Classification of Diseases 9th revision (ICD - 9 CM). The hospitalizations due to work place injuries were separated and compared with the general population trends. Results: Based on all the classified chemical, metal, gas, and other environmental exposure like heat and cold in the ICD 9 coding system, we targeted to separate the data for a total 50 different exposures. Out of which, we were able to separate data for 43 exposures. The frequencies for general population hospitalizations and work place injury related hospitalizations in all 43 exposures were analyzed for demographic trends using variables yearly time trend, sex, age, duration of hospitalization, and cost of hospitalization. Conclusion: The National Inpatient Sample Hospitalization Data is significantly underutilized to understand the trends related to occupational and environmental exposures. The exposures are underreported and there is a need for improving the quality of documentation for ICD codes. The exposure specific nationally available statistics are also not representative. More accurate methods are required for documentation of environmental and occupational exposures for a better understanding of the magnitude of the problem.
The Evaluation of Parenting Stress and Satisfaction among Parents and Caregivers of NICU Graduates Enrolled in the Next Steps Program at St. Christopher’s Hospital 1
Meriam Mikre MPH , 2 1,2 Bruce Bernstein DrPH , Renee Turchi MD, MPH 1 Drexel University School of Public Health, 2 St. Christopher’s Hospital for Children Background: For preterm infants leaving the neonatal intensive care unit (NICU) the transition creates an opportunity for uncoordinated care resulting in the increased emotional stress of the family. The Next Steps Program (NSP) at St. Christopher’s Hospital was created to serve as a bridge for infants and their parents leaving the NICU. The program provides a continuum of care that features services of neonatologists, pulmonologists, and general pediatricians all located at a single site. The NSP is based on the assumption that through the coordinated and ongoing care from the already familiar NICU and specialty staff, the transition from the NICU to a primary care setting will lessen the emotional burden on the parents and caregivers. Objective: To evaluate the current state of parents and caregivers enrolled in the Next Steps Program by measuring the levels of perceived stress as well as the overall satisfaction with the clinic. Methods: The Parenting Stress Index- Short Form (PSI-SF) was used to measure parent and caregiver stress while the Patient Satisfaction Survey was conducted to assess levels of satisfaction. Additional data was compiled from extraction of data from medical records and interview questions regarding demographics. A REDCap database was used to store survey results while SPSS and Microsoft Excel were used for data analysis. Results: A total of 81 participants were surveyed for this analysis, 8 participants had missing data for one question in which the mean score was used as a substitute. The PSI-SF results show that a majority of the participants fit within the normal range of Total Stress levels. Further evaluation showed that stress levels decreased as age of the participant increased (r= -.193). Results also showed increased Total Stress levels among women and ethnic minorities. Lastly, an inverse relationship was observed between Total Stress levels and Total Satisfaction with the clinic, showing that participants who were more satisfied with the services had lower PSI-SF scores. Conclusions: Participants currently enrolled in the NSP fall within the normal range of stress levels. Additionally, variances exist when participants are categorized by age, sex and ethnicity.
Curriculum Infusion Within Drexel University Undergraduate Courses 1
Katherine Minese, MPH , 2 1 John Watson, MS, NC, LPC, Dr. Stephen Lankenau 1 Drexel University, School of Public Health 2 Drexel University, C.H.O.I.C.E.S. Center Objectives: Establish a functional alcohol and drug task force to specifically address alcohol and other drug (AOD) issues from a systems wide approach, which includes multiple stakeholders. One specific targeted stakeholder was the faculty at Drexel University in order to employ a relatively new strategy to address AOD abuse: curriculum infusion. Curriculum infusion is the process of integrating information about AOD abuse prevention into the curriculum of regularly offered courses. Methods: The project established a pilot interview program to better understand professorsâ€™ attitudes related to curriculum infusion. Individual semi-structured interviews were conducted with 4 Drexel University professors in a 25-minute time slot. The interview guide focused on themes revolving around the health belief model: perceived barriers, perceived benefits, perceived susceptibility, perceived severity. The data was coded to enable themes to evolve, using the grounded theory approach. The data was then grouped around The Health Belief Model, allowing for greater understanding of the perceived benefits, perceived susceptibility, and self-efficacy of teachers. Results: Participant interviewees identified barriers in creating an infused curriculum, however, they felt that the benefits of using an infused curriculum outweighed barriers. The interviews revealed various themes, such as the caliber of Drexel University students, issues of substance abuse portrayed positively within the media, and how there is a need for such programs for all college students. There was also discussion about whether such a program would be considered advocacy, which may not be as well received by students. Conclusions: Since some professors expressed a willingness to implement curriculum infusion into their current curriculum, more research regarding specific messages and implementation strategies is needed. Results show state that curriculum infusion practice could become a viable prevention message throughout Drexel University. Some of the strategies include: emphasizing real world experiences in the classroom, offering subtle messages of prevention and exploring all the options a student can turn to for substance abuse help.
Results of a Community Needs Assessment to Reduce Sexual Health Disparities in North Philadelphia Meaghan Mingo, MPH¹, 2 Randall Sell, ScD¹, Kenneth Cruz, MHS 1 2 Drexel University School of Public Health YOACAP Background: Philadelphia is facing significant racial and ethnic health disparities, particularly in HIV and STIs. While numerous studies have documented these disparities nationwide, six census tracts in Philadelphia (in North Philadelphia and Nicetown) were selected for this project due to their high prevalence of HIV, chlamydia, gonorrhea, and syphilis. These communities have particularly high rates of these STI’s among young people 15-34. The CDC awarded YOACAP, a local nonprofit, funding to launch a planning and intervention project to reduce STD disparities, promote sexual health, and advance community wellness using community engagement methods. Methods: Residents of the six census tracts of interest were surveyed concerning the social determinants of health, HIV/STIs, and community problems and preferred solutions for reducing STIs. This needs assessment utilized the RARE methodology, and a field research team comprised of trained local community members conducted street intercept interviews. Results were analyzed using SPSS to determine frequencies of key measures and crosstabulations with age, gender, and incarceration history. Chi-square and Fisher’s Exact tests were used to test for significance. Results: STI’s were not identified in the top five community problems by participants, instead, issues such as violence, drugs, dirty streets, and job opportunities were identified. Community members identified free condoms, drug and alcohol treatment, free testing and counseling, face to face counseling, and job readiness and leads as the best solutions to reduce STIs in the community. A third of participants reported having had an STI in their lifetime (34%), and 53.2% reported having some type of unprotected sex within the past 6 months. Conclusion: STI’s and associated sexual risk behaviors remain an issue for these communities, however, respondents identified preferred solutions to addressing these disparities within their community. The broader social determinants of health appear to be of more pressing concern to participants, who have competing economic and environmental concerns. Sexual health disparities interventions should incorporate this reality into planning and programming for interventions, and ensure that they include both free resources (such as condoms and testing), as well as components such as job training and drug and alcohol counseling.
The Effects of Mental Diseases and Childhood Experiences on Obese: Data Taken from the National Epidemiologic Survey on Alcohol and Related Conditions 1
Sathya Narayan, MPH , 1 Jana Mossey, PHD, MPH, MSN 1 Drexel University School of Public Health Background: Obesity is a growing, costly and serious epidemic in the United States. In the United States, about 34% of adults are obese, out of which are composed of 41% of African Americans and 31% of Hispanics. There are several factors that contribute to BMI, including age, gender, genetic factors and psychological issues. Many studies have tried to find associations between the first few exposures and obesity however psychological issues relating to obesity are hardly studied. Objectives: My objective is to test my two hypotheses: whether there is a positive relationship between childhood experiences (childhood abuse and/or childhood neglect) and obesity and whether there is a positive relationship between mental diseases (major depressive disorder or bipolar disorder) and obesity. Methods: Data to analyze the relationship to obesity was taken from NESARC, National Epidemiologic Survey on Alcohol and Related Conditions. This survey was sponsored by NIAAA, National Institute on Alcohol Abuse and Alcoholism. Everyone was nationally representative of the US non-institutional population of 18 years and older with oversampling of African Americans, Hispanics and ages 18 – 24. The survey itself took place from 2001 – 2002 for wave one and from 2004 – 2005 for wave two. Informed and consenting participants were interviewed in their home using a CAPI method, which is a Computer Assisted Personal Interviewing system. The main objective of NESARC was to determine the impact of alcohol use and abuse in order to eliminate health disparities and estimate trends. Results: There were about even distribution of participants (~30% each) amongst the three BMI categories (normal weight, overweight and obese), with more participants in the overweight (~36%) and obese (~34%) categories. The prevalence of obese participants is highest in both of the mental disorders, bipolar disorder (~38%) and major depressive disorder (~32%). The prevalence of overweight participants is highest in both of the childhood experiences, childhood abuse (~35%) and childhood neglect (~36%). The odds of being obese are slightly higher than being overweight in childhood abuse (OR 1.285 CI 1.106 – 1.494), bipolar disorder (OR 1.216 CI 1.003 – 1.474) and major depressive disorder (OR 1.151 CI 1.1046 – 1.266) but not in childhood neglect (OR 0.852 CI 0.793 – 0.915). Those who have no education has more than a two-folds likelihood (OR 2.148 CI 1.318 – 3.503) of being overweight and more than threefolds likelihood (OR 3.194 CI 1.907 – 5.350) of being obese, compared to those
who have a college or higher degree. Exercising nearly never slightly increases the chances of being overweight (OR 1.287 CI 1.157 â€“ 1.433) and obese (OR 1.407 CI 1.240 â€“ 1.597), compared to exercising almost always. Lastly, those who rated their health as good or poor had a two-folds likelihood (OR 2.435 CI 1.988 â€“ 2.983) of being obese, compared to those who rated their health as excellent. Conclusion: In terms of childhood experiences, there was a positive correlation between those who experienced childhood abuse and being overweight and obese, compared to those who did not experience childhood abuse. However, there was a negative correlation between those who experienced childhood neglect and being overweight and obese, compared to those who did not experience childhood neglect. In terms of mental disorders, there was a positive correlation between those who had bipolar disorder and being obese, but not being overweight, compared to those who did not have bipolar disorder. Lastly, there was a positive correlation between those who had major depressive disorder and being obese, but not overweight, compared to those who did not have major depressive disorder.
An Assessment of Outcomes in HIV Positive Pregnant Women with Mental Illness: A Retrospective Cohort Using the Medical Records from an HIV Clinic in Philadelphia 1
Chukwuma Nwachukwu, MPH , 2 2 Ed Gracely PhD , Gregg Alleyne MD 1 Drexel University School of Public Health, 2 Drexel University College of Medicine Background: HIV and AIDS has rapidly progressed into a global pandemic since the first clinical diagnosis was made in 1981. Mental illness is also the leading cause of disability in the developed world according to CDC statistics. There are studies that show a higher prevalence of mental illness in individuals diagnosed with HIV. Though there have been major strides made in diagnoses and treatment of these conditions, there is still a lot that that is unknown about the interactions between them especially with a concomitant pregnancy. Objective: To assess pregnancy and neonatal outcomes in HIV positive pregnant women with mental illness and compare these with controls who do not have mental illness. Methods: A retrospective chart review of medical records from an inner city HIV clinic (2009 to 2012) was undertaken. The sample was selected from pregnant women who had clinically diagnosed mental illness and compared with controls who had no mental illness on two outcomes; with analysis of risks using odd ratios. Results: 97 women in our sample had a current mental illness while 159 women did not (n= 256). About 65% of the cases were between the age of 25 and 35 years, 80% were African Americans, and about 65% also had incomplete high school or no education at all. 55% admitted to current cigarette use, 11% to alcohol use, and 31% to illicit drug use (crack, marijuana, heroin or unspecified other). Of the sample, 16% had pre-term delivery compared to 17% of controls while 18% had low-birth weight compared to 17% of controls. There did not seem to be any statistically significant difference between our cases and controls. Conclusion: There is need for further study in this area as our small sample size may have prevented us from observing a clear association.
Analysis of Clinical Communications about Patients in the Care Coordination Process Chioma Onyekwelu, MPH, MBBS See Elissa Iverson, MPH, RN for Abstract -Evaluating Perspectives on Sexuality Instruction During Medical Residency and Physician Comfort in Discussing Sexuality with Patients 1
Ikenna Opurum, MPH , 2 2 Mary Duden, MBA , Shannon.M. Criniti, MPH , Sandra Urdaneta Hartmann , 2 2 Owen Montgomery , Mark Woodland 1 Drexel University School of Public Health, 2 Drexel University College of Medicine 1
Background: Patients expect healthcare providers to be knowledgeable and approachable regarding sexual health issues. Despite this expectation, there is evidence to suggest physicians often feel unprepared to adequately discuss patient sexual health. Objective: To assess perceptions regarding the quantity and effectiveness of sexuality instruction received during medical residency. Methods: A cross-sectional survey was constructed to evaluate medical residents in the various clinical residency programs of Drexel University College of Medicine. Residents were asked about knowledge, comfort, communication skills, and perceived barriers to discussing patient sexual health issues. Descriptive analysis was performed. Results: Of 396 eligible residents, 130 residents in 12 programs participated (32.8% response rate). The majority of residents (68%) had so far received no lectures or courses specific to sexual health during their residency program, and 60.9% reported 0 hours of sexuality instruction. Only 20% felt they would be prepared to address patientsâ€™ sexual health after completion of their program. While 51% of residents felt they had knowledge to address their patientâ€™s sexual health, only 11% often discussed sexual health issues with patients. More than 70% responded that education on the following topics would be clinically useful: abortion, anatomy/physiology, child sexual abuse, HIV, sexual assault/trauma, sexual history taking, sexual side-effects of medications, and STIs. Lack of time (64.2%) was the top perceived barrier to discussing sexual health issues with patients, though one-third (33.3%) cited their own lack of knowledge. Conclusion: There is need for planning and integration of sexual health education into the curricula of medical residency programs for the potential benefit of both physicians and patients.
Assessing the Efficacy of Training Medical Providers to Perform Oral Health Services 1
Lauren Orsini, MPH , 1 2 Nancy Epstein, MPH, MAHL , Bonnie Magliochetti, RN, RDH 1 Drexel University School of Public Health, 2 Pennsylvania Chapter of the American Academy of Pediatrics Background: Early Childhood Caries (ECC) is the most common chronic disease in children. In 2007, only 4% of children under the age of 3 with Medicaid in Pennsylvania had a dental visit. HTHC is a program within the PA AAP that aims to improve the oral health disparities in Pennsylvania. Included in HTHC’s program are the goals of improving oral health literacy for families, promoting medical/dental collaboration, and improving the dental care delivery system. This study aims to evaluate the effectiveness of HTHC’s trainings, including the Medical Home Conference trainings and EPIC (Educating Practices/Physicians in their Communities) trainings, both which train pediatricians to include oral health in their offices. Objectives: To evaluate the effectiveness of HTHC’s trainings to pediatric practices and to develop a more comprehensive understanding of the best practices of integrating dental health into residency programs and into medical homes. Methods: This study included phone-interviews with 30 pediatric practices that were trained to to perform an oral health screening, make an ECC risk assessment, apply fluoride varnish, and make a dental referral, at the Medical Home Conference trainings and EPIC trainings. To complement these interviews, the study also included the analysis of data on pediatricians that are submitting claims for D1206 from DPW. Best practices reports were also developed to identify successful models of medical/dental collaboration to inform HTHC’s approach to medical/dental collaboration. Results: Of the contacted Medical Home Conference trained pediatricians, 50% reported that they were implementing the dental services and of the contacted EPIC trained pediatricians, 33% reported that they were implementing the dental services. DPW data revealed that 15 of the 24 Medical Home Conference trained providers were documented as eligible for billing for D1206 and other requested data was not available. In the best practices reports, the “spiral curriculum” was identified as a successful model of interdisciplinary training and the concept of health home was identified as an effective method to integrate dental services into a medical home. Conclusions: HTHC’s trainings are effective and are an important factor to improve access to dental care for low socioeconomic status children in the state of Pennsylvania.
Development and Review of a Training Program for Public Health Professionals Who Respond to Suspicious, Unknown, Potentially Hazardous Substances 1
Demetrios M. Papazaharias, MPH , 2,3 1 Patrick L. Gurian , Esther D. Chernak 1 2 Drexel University School of Public Health, Drexel University College of 3 Engineering, The Center for Advancing Microbial Risk Assessment Background: Previous research has shown that significant gaps exist in first respondersâ€™ knowledge of response to potential biological threats. The same gaps appear with public health professionals, especially with those who may be called upon to assist in potential emergencies, who do not have the same background as emergency preparedness professionals. As a result, Congress passed the Pandemic and All-Hazards Preparedness Act in 2006, which called for â€œa competency-based training program to train public health practitioners.â€? The purpose of this research is to develop a training that will meet one component of this need for public health professionals, the response to suspicious or hazardous substances that may constitute a threat to human health. Objectives: To clarify the role of the public health professional in situations involving potentially hazardous substances, to identify specific knowledge and training needs, to address them via the development of a training module, and to obtain subject matter expert review of the content of the training material. Methods & Results: The project consisted of a literature review of current guidance and training materials developed for professionals who are responsible for field responses to suspicious substances. This review also incorporated previous research completed by the Center for Advancing Microbial Risk Assessment (CAMRA) and other agencies regarding current knowledge and education and training needs. A training was developed using these background sources of information as well as data from modeling studies performed by CAMRA that project health risk from exposure, emphasizing agent dispersal properties and the health risk from low-dose exposures. The training focused on how public health agencies and professionals can inform the types of decisions made in such events by risk assessment and communicating health impacts. Challenges that were faced included making response recommendations in areas that had little guidance as well as reconciling differences in perspectives between first response and public health. Future Research: A referral sample of subject matter experts in both public health and risk assessment will be asked to review and evaluate the training for scientific accuracy as well as relevance. Once this is completed, the training will be piloted for public health agency staff in the Philadelphia metropolitan area, and evaluated via standard evaluation tools.
Drought impacts and policy implications: a white paper for greater national leadership in drought management 1
Gus Porter, MPH , 1 Dennis Gallagher 1 Drexel University School of Public Health Severe and extended drought in the United States and its interconnected consequences poses a significant risk to the health, well-being and security of the nation. The current method of addressing drought is not sufficient. The federal government must play a greater role in coordinating drought mitigation, response and recovery. Despite recent extensive drought in the United States, no comprehensive and coordinated drought policy exists at the national level. Instead, a patchwork of federal programs exists with no central coordination or communication which advances an inefficient response. Federal programs place too great an emphasis on droughtâ€™s agricultural impacts and respond with insurance and bail-out packages, but need to shift to a more proactive mitigation-based approach coordinated among the numerous agencies involved in drought management. There must be a policy-shift at the federal level in recognition of droughtâ€™s impacts on various industries and the current national drought policy void. Drought is more than an agricultural concern and new policies must be implemented recognizing droughtâ€™s many threats, including public health. A coordinated national drought policy will improve efficiency of program delivery and improve interagency communication and cooperation. Congressional action is needed to establish a standing drought task force that will strengthen drought preparedness and response programs as well as recognize drought as a significant hazard worthy of further action.
Internship at the Department of Health and Human Services: Development of Region III Prevention Collaborative Priorities based on Vaccine, Heart Health and Utilization Factors 1
Joshua Prasad MPH , 1 2 Dennis Gallagher, MA, MPA , Dalton Paxman PhD 1 2 Drexel University School of Public Health, US Department of Health and Human Services Background: The Internship based Community Based Master’s Experience allows for students to become immersed in the overall culture of the public health workforce. During this internship, several major projects were completed for work in the Office of the Assistant Secretary of Health. One such project was done in conjunction with the United States Department of Health and Human Services Region III Prevention Collaborative to determine what the Collaborative primary focuses should be in 2013. Objective: Perform research and inform staff for the implementation of government policy. The priorities from 2012 – Vaccine Coverage, Heart Health, and Service Utilization were used as the basis for data collection and analysis to determine if these should remain a focus of the Regional Prevention Collaborative (RPC). Methods: A “Regional Profile” was developed by collecting and analyzing data from various open sources, such as the Behavioral Risk Factor Surveillance System, to statistically and visually summarize the selected health factors of the region. Data cleaning was performed in SAS and Microsoft Excel, maps were generated using ArcGIS and a final pamphlet was created using Microsoft Publisher. Results: The Regional Profile was presented at the March RPC meeting, which was accompanied by oral recommendations. The example used for vaccine health showed that Influenza and Pneumococcal Vaccine Coverage in seniors, which was considered to be a priority group, showed a well-covered baseline population across the Region. Similar recommendations were made for the other selected factors. The ability to research and create outputs that are presented to senior staff that is used directly to inform is a valuable internship experience. Conclusion: The Regional Prevention Collaborative has several factors to consider in the upcoming year that would help focus its priorities and help affect its targeted populations. This project is representative of the comprehensive work and many projects that the internship provides for students. Working through the rigors of a regular office schedule allows students to experience the multifaceted and immersive nature of public health service.
Emergency Department Reliance and Overuse among Medicaid Patients 1
Roshni Punjabi, MPH, BA , 1 Darryl Brown, PhD 1 Drexel University School of Public Health Background: One of the major healthcare concerns today is regarding healthcare expenditure being used and rather overused by the expenses of the Emergency Room. According to studies, 67 million out of the 120 million annual ER visits are potentially avoidable, which is more than half. Of all the healthcare spending, around 38 billion dollars are being wasted in unnecessary Emergency Room usage annually in the United States. A relationship has been established in prior studies between emergency room usage, abuse, and other such scenarios with race, socioeconomic status, education, and of course insurance. Emergency Department Reliance is the measure used to relate a patientâ€™s primary care usage in relation to their overall emergency department usage. Objective: This study will be used to identify characteristics of a patient who may be eligible for random survey, whose demographics may indicate he or she may be overusing the emergency room and may be reliant on the emergency room as their primary source of health care. Method: A quantitative analysis was conducted by use of MEPS, a nationally representative survey, and by processing the database via SAS 9.0 and creating correlations between demographics and certain survey responses and high Emergency Department Reliance; a profile of patients can be created to target to assess barriers to primary care. Results: A lot less Medicaid patients showed Emergency Department Reliance than expected, however the demographics of patients was still those with income less than $41,475, so those who are eligible for Medicaid and perhaps are uninsured or underinsured. Conclusion: Low socioeconomic status and those eligible for Medicaid in addition to those that do not have access to a primary care provider prefer using the ER as their source of primary care.
Increasing Teen Referrals to Healthcare Services: Developing a Guideline for Healthcare Providers Partnering with Youth-Serving Agencies 1
Shikha Rai, MPH , 1 2 Randall L. Sell, ScD , Rebecca Merkh, MA 1 2 Drexel University School of Public Health, Family Planning Council The teen birth rate of Philadelphia was 63 births per 1,000 women between the ages of 15 to 19 in the year 2011, which was higher than the national average of 31.3 births per 1,000 women in the same age group. The 2011 Youth Risk Behavior Survey data indicated that 61 percent of the high school students in the City of Philadelphia were sexually active in comparison to 47.4 percent of teens nationwide. Moreover, the percentage of sexually active high school teens, who did not use a condom during their last intercourse, increased from 37 percent in the year 2009 to 40.0 percent in the year 2011. Significant disparities and huge social and economic costs are attached with teen pregnancy and childbearing. Therefore, in order to address the widespread problem of teen pregnancy and consequences related to it, the Centers for Disease Control and Prevention has partnered with the Office of the Assistant Secretary for Health to reduce teenage pregnancy and address disparities in teen pregnancy and birth rates as a part of the President's Teen Pregnancy Prevention Initiative (TPPI). The program is focused on increasing youth access to community based clinical services and providing evidence-based and evidence-informed pregnancy risk reduction programs to youth. The teens participating in these programs are provided with information; however, there are still barriers that prevent them from seeking reproductive and sexual health services from health centers within their community. The main aim of Community Based Masters Project is to develop a guideline that will act as a tool kit for the health care providers of the TPPI while working with youth serving organizations to enhance the capacity of these organizations to refer teens to reproductive and sexual health services by identifying the barriers of accessing to these services.
Analysis of Clinical Communications about Patients in the Care Coordination Process Zach Risler, MD, MPH See Elissa Iverson, MPH, RN, for Abstract -Advancing mHealth in Rural Gambia: The Improvement of Dental Health Practices Using FrontlineSMS and the Enhancement of Vaccine Inventory Control at Trekking Sites Idris T. Robinson, MPH, BS See Opetomi O. Seriki, MPH, BS for Abstract -Investigating the Inclusion of LGBT Health-Focused Curriculum Content to Enhance the Knowledge and Attitudes of First-Year Medical Students Toward LBGT Population Health 1
Monica Rocha, MPH, BS , 1 2 Augusta Villanueva, PhD , Dana Farabaugh, MD 1 Drexel University School of Public Health, 2 Drexel University College of Medicine Lesbian, gay, bisexual, and transgender (LGBT) populations face unique health issues that are compounded by a lack of physician training in culturallycompetent best practices in LGBT health. Backed by the Theory of Planned Behavior, this project aimed to examine the effects of the introduction of LGBT health-focused course material on the knowledge regarding and attitudes toward LGBT health of first-year medical school students. First-year medical school students at the Drexel University College of Medicine (DUCOM) were surveyed using a validated survey tool developed by Kelley et al. (2008) regarding knowledge, attitudes, and critical experiences regarding LGBT health and populations. The results of the preliminary survey were used to develop an optional, 2-hour seminar for first-year DUCOM students that focused on Student participants will be surveyed using the same validated survey tool pre- and post-survey participation, and the results of which will be used to develop recommendations for the first-year medical school curriculum at DUCOM. A representative sample of students (n=64, 24.5%) from the first-year DUCOM class completed the baseline survey.
The results of the baseline survey indicated generally positive attitudes of respondents toward LGBT health and caring for LGBT patients. However, some knowledge deficits indicated the potential for competency development. The twohour seminar that was developed based on these findings focused on knowledge enhancement and practical skill-building through the use of case studies. Low student attendance at the developed seminar necessitated the development of strategies for improving participation at the seminar that will be implemented in the Fall of 2013. The results of this project indicate that LGBT health should be included as part of the required course material for DUCOM, content should be consistent throughout the curriculum and focus on inclusion of core competencies and skillbuilding, and material should be included iteratively throughout undergraduate medical education and residency.
Development of a Harm Reduction Curriculum for Health Care Providers Working with Injection Drug Users: A Mixed-Methods Approach 1
Jennifer L. Rosenberg, MPH , 1 2 Stephen E. Lankenau, PhD , Silvana Mazzella, BSW 1 2 Drexel University School of Public Health, Prevention Point Philadelphia Background: Harm reduction is a public health approach that accepts drug use as a part of society and attempts to reduce the negative consequences associated with drug use. The problem addressed in this study is the lack of harm reduction focused health care taking place in Philadelphia for injection drug users (IDUs). Objectives: The primary objective of this study is to determine the current and desired state of harm reduction focused health care for IDUs in Philadelphia. An additional objective is to develop a harm reduction curriculum for health care providers. Methods: A convenience sample of 116 clients from Prevention Point Philadelphia (PPP) completed a survey about their most recent experience with a health care provider. Three client focus groups also took place, which discussed experiences with primary care providers, emergency room physicians, and negative interactions with doctors. Additionally, 14 semi-structured interviews were conducted with PPP staff members (n=3) and harm reductionist health care providers (n=11). Quantitative data from the client survey was summarized using descriptive statistics. Qualitative data was analyzed thematically using grounded theory technique. Results: Quantitative results describe the current state of harm reduction. Demographic features (gender, race, age, drug use, living situation) of the client sample were similar to the overall client population of PPP. Primary care doctors were least likely to know about their patientsâ€™ drug use (30%). The emergency room ranked last for quality ratings of overall doctor experience, overall office experience, staff attitudes and paperwork. Five qualitative themes were identified that describe the desired state of harm reduction and recommendations for the curriculum: 1) interpersonal and relationship skills of the health care provider, 2) health care provider harm reduction knowledge, 3) concerns about pain and withdrawal, 4) patient responsibility and empowerment, and 5) infrastructure and logistics of the health care system. Based upon these results, a curriculum module focusing on pain and withdrawal was developed. Conclusions: Further development of the harm reduction curriculum should incorporate the five themes identified in this study as well as direct input from clients. The curriculum should be used to first educate emergency room doctors and primary care providers.
Using Research as a Tool for Advocacy in Demonstrating the Importance for Complete Nutrition in Chronically Ill Individuals 1
Joan Schmeling, MPH, BS , 2 2 Cynthia Dinger, RD, LDN , Kelly Rand, MA 1 2 Drexel University School of Public Health, Metropolitan Area Neighborhood Nutrition Alliance Background: Individuals who suffer from chronic illnesses, often coupled with acute nutritional risks have higher health care costs when not enrolled in programs to provide complete nutritional care, including home delivered meals than individuals who are. Increasing their overall health from a nutritional standpoint allows them to better tolerate treatments and thus lowering their overall health care costs. Objective: Use evidence-based research conducted by the Metropolitan Area Neighborhood Nutrition Alliance (MANNA) as an advocacy tool highlighting the importance of complete nutrition coupled with meal-delivery services in lowering overall health care costs for chronically ill individuals. Advocating will be directed towards making potential policy changes regarding how medical food programs receive funding and reimbursement. Methods: Using data and results from MANNAâ€™s pilot study, research manuscripts were composed and published to increase the exposure of the organization and its significance. This information also helps the advocacy team frame and establish its short and long term advocacy goals, developed through the strategic advocacy plan. Identification of key stakeholders develops who will be targeted with our advocacy plan. Results: Pilot study results have been actively disseminated and accepted for publication and conference presentations. Formation of a political map is in the works, which will clearly depict whom the advocacy work will be targeted at. Finally, the MANNA advocacy team has been established and will be working with an advocacy consultant to establish goals and objectives. Conclusion: There is an ever-growing concern about health care costs for individuals in our country, especially as the population ages. By raising awareness of the importance of complete nutrition and meal service programs like MANNA and its cost saving benefits, advocacy can occur, thus working towards the ultimate goal of policy changes regarding funding and reimbursement of these programs.
Advancing mHealth in Rural Gambia: The Improvement of Dental Health Practices Using FrontlineSMS and the Enhancement of Vaccine Inventory Control at Trekking Sites Olutosin O. Seriki, MPH, BA See Opetomi O. Seriki, MPH, BS for Abstract -Advancing mHealth in Rural Gambia: The Improvement of Dental Health Practices Using FrontlineSMS and the Enhancement of Vaccine Inventory Control at Trekking Sites 1
Opetomi O. Seriki, MPH, BS , Olutosin O. Seriki, MPH, BA , 1 Idris T. Robinson, MPH, BS , 1 1 John A. Rich, MD, MPH , Shannon P. Marquez, MEng, PhD , 2 Kebba S. Badgie, CEO 1 Drexel University School of Public Health, 2 Sulayman Junkung General Hospital (SJGH) Background: Millions of people in The Gambia are currently facing a series of life threatening health issues due to a lack of infrastructure, which hinders access to health information and prevents adequate treatment of diseases. Unfortunately, unlike many developed countries, many developing countries do not have the resources or a reliable health care system to combat these issues. Objectives: In developing countries, basic documentation methods are used to track vaccine inventory control. Though this manual system is not as organized and sophisticated as those in developed countries, it has worked for a number of years. The current methods are outdated and advances in this area could improve health outcomes. Dental health is another major health concern in The Gambia. There is a need to help dental clinicians increase patient compliance to improve patient dental health outcomes. Methods: Students traveled to The Gambia for 6 weeks and observed common hospital practices throughout the country, while participating in a number of public health projects. Upon returning to the United States, the students applied concepts from the Human Centered Design Toolkit to analyze their experience. Literature reviews, qualitative data analysis, and interviews were also conducted to determine the best way to address some of these problems. Results: FrontlineSMS text messaging software system was introduced to the SJGH dental clinic as a tool that can be integrated with current trekking practices. In addition, 4 options were presented as alternative ways improve vaccine inventory management while trekking at local villages.
Conclusions: SJGH will be presented with a plan detailing feasible options to improve the efficiency of the SJGH trekking system and improve patient health outcomes. Overall, these results of this project will help guide the advancement of mHealth at SJGH. -Associations of Periodontal Disease with Insulin Resistance and Type II Diabetes, Results from NHANES 2009-2010 1
Sonali Shambhu, MPH , 1 Brian Lee, PhD 1 Drexel University School of Public Health Background: Almost 50% of U.S adult population has some kind periodontal disease and the same time diagnosed and undiagnosed diabetes accounts for 8.3% of the total U.S population. The bidirectional relationship has been known for years. People with diabetes have higher risk of developing periodontitis and oral infections in response worsen the glycemic control among individuals. Objective: To determine if periodontal disease was associated with insulin resistance, a precursor for type II diabetes, and type II diabetes among U.S. adults above 30 years. In addition we also wanted to determine if a single localized periodontal focus of infection was associated with insulin resistance and type II diabetes in a nationally representative sample. Methods: National Health and Nutrition Examination Survey Participants aged 30 years and above (n= 1451 adults for insulin resistance and n= 3057 for type II diabetes) with a mean age of 44.5 years (57% male), were evaluated to test the cross-sectional association of periodontal disease and type II diabetes. Insulin resistance values (HOMA- IR >75 the percentile) were modeled against continuous as well as quartiles of mean clinical attachment loss (mCAL) and peak clinical attachment loss (pCAL) in multiple logistic regressions. Results: Type II diabetes was found to be associated with, continuous mCAL, quartiles of mCAL, continuous pCAL and quartiles of pCAL. We found that rd insulin resistance was associated only with the 3 quartiles of pCAL values. Conclusions: Periodontal disease is associated with insulin resistance and type II diabetes among the U.S adult population aged 30 years and above. The association was found to be similar with localized & generalized form of periodontitis suggesting that local foci of infection was equally important to generalized periodontal infection.
Exposure Assessment of Methyl Mercury in Pregnant Women & Neonates Due to Fish Consumption- a public health concern. 1
Raghav Sharma MPH , 1 Arthur Frank MD, PhD 1 Drexel University School of Public Health Background: Mercury is a naturally occurring element present in air, water and soil with numerous hazardous health effects known to humans. This element is predominantly found in three forms 1) Elemental mercury 2) Inorganic mercury and 3) Organic mercury, also called Methyl mercury. Out of the three known natural forms, methyl mercury is one of the most important forms due to its potential toxic effects and easy bio magnification in living organisms. Methyl mercury is a pollutant which magnifies itself in the food chain and reaches human population mainly through their diet, which involves fish (both sea fish and fresh water). Thus it poses a serious health risk to fish eating populations and developing nervous system is the most susceptible target of all the organs. Methyl mercury conjugates with a protein named cysteine and this MeHg-Cysteine conjugate can easily cross placental and blood brain barriers and thus predisposing the developing fetus to a high neurodevelopmental risk. These concerns warrant an exposure assessment of methyl -mercury in pregnant women who have fish consumption and their neonates. Objectives: Primary objective of this research is to provide a rationale to conduct an exposure assessment of blood methyl mercury level in pregnant women who have dietary fish intake and their newborns. Secondly this research aims at developing a survey questionnaire to assess the dietary intake of fish and confounders such as residential area, dental fillings and occupational exposures. Finally, to serve as a guide in future to provide dietary instructions to pregnant women about their fish consumption. Methods: A comprehensive review of multiple databases was performed using the keywords methyl mercury, fish, blood, cord blood, pregnant women, newborns, infants and neonates. Reference Manager 12 software was used to search for published literature using the above search parameters and to manage different databases. Additional references were hand searched and included in the literature review. A survey questionnaire was developed using United Nations Environment Program guidelines to assess mercury exposure in relation to fish consumption while adjusting for potential confounders. Results: Methyl mercury exposure is found to be associated with number of health effects such as neurodevelopmental deficits in children ranging from delayed onset of walking to reduced neurologic test scores. Other health effects include reproductive toxicity, renal toxicity and immunosuppressive effects. Limited research has been done to correlate maternal and cord blood methyl mercury level ratio in relation to fish consumption. A dietary questionnaire to correlate methyl mercury exposure in pregnant women to their fish consumption was developed.
Conclusion: Methyl mercury is a known neurotoxic substance present in fish. Pregnant women and their neonates are at increased risk of adverse health effects and this warrants an exposure assessment of blood mercury levels. Also there is limited research to establish maternal blood-fetal blood mercury level ratio in relation to fish consumption which is critical in risk assessment process. -Eastern Tower Community Center: Intergenerational Health Services for Philadelphia Chinatown Community Members 1
Jennie Shaw, MPH , 1 2 Raymond Lum, MPhil, MS , Andrew Toy 1 Drexel University School of Public Health, 2 Philadelphia Chinatown Development Corporation Background: Founded in 1969, The Philadelphia Chinatown Development Corporation (PCDC) supports the residents and businesses of the Philadelphia Chinatown community and works to provide meaningful services to its community members. With the development of a new community center, Eastern Tower Community Center (ETCC), PCDC will look to expand health services to those residing in and around Chinatown. Objectives: Identify the health concerns of varying age groups within the Chinatown population and built a coalition of health professionals at Drexel University who will provide health services to the community. Methods: Best practices in health services were gathered via site visits, literature review, informational interviews and stakeholder meetings. Web searches were also utilized to identify like programs throughout the country and investigate health and intergenerational elements within similar community centers. Results: Programming trends at like-centers exhibited the importance of senior health and wellness education, group exercise, academic partnership and cancer and/or chronic disease screening. Through stakeholder meetings, connections were made with various health professions departments at Drexel University who are able to carry out health services at ETCC, focused in prevention, clinical and mental health. Conclusions: The provision of health services at Eastern Tower Community Center is feasible and an important element in serving the Chinatown community. Meetings with departmental leaders at Drexel University exhibited the willingness and ability of health professions faculty and students to partner with PCDC and have a presence at ETCC. With the assistance of academic and community partners, PCDC/ETCC should implement initial health programming aimed toward prevention and health behavior education for individuals of all ages in Chinatown, followed by clinical and mental health services.
Childhood neglect as a risk factor for Metabolic Syndrome 1
Benak Shivalingappa, MPH , 1 Dr Jana Mossey, PhD 1 Drexel University School of Public Health Background: The International Diabetes Federation, American Heart Association, National Institutes of Heart, Lung and Blood, World Heart Federation, International Atherosclerosis Society and International, Association for the Study of Obesity published a joint statement in 2009 which defined metabolic syndrome as a syndrome which comprises of ANY 3 of the 5 conditions - Abdominal Obesity, hypertriglyceridemia (>150), low HDL(<40 for men and <50 women), High blood pressure (>138/80) and fasting blood sugar of >100 with obesity being more (Leroith, 2012). Metabolic syndrome is a risk factor for many morbid conditions like Type 2 diabetes, stroke, and myocardial ischemia (Tenenbaum, Motro, Schwammenthala, Fismana, 2004). Many attempts have been made to study the risk factors for metabolic syndrome. Many of them have also been successful in exploring many risks like diet, exercise, race, gender, income and education (Park, Palaniappan, Heshka, Carnethon & Heymsfield, 2003).. There are studies which show that stress can lead to an alteration in eating behavior which in turn can lead to obesity (Torres & Nowson, 2007). Studies also link psychological stress during childhood and bad childhood experiences to early mortality and obesity. Aim: In this study we explored the possibility of physical neglect during childhood as a risk for metabolic syndrome. We are testing the hypothesis that physical neglect during childhood is associated with the metabolic syndrome during adulthood. Methods: This is a cross-sectional study using the Wave 2 survey results of the NESARC data. Results: Our study did show some positive association between childhood neglect and metabolic syndrome during adulthood (Odds Ratio â€“ 1.26, 99.9 confidence intervals - 1.056 - 1.503). We did control for potential confounders like age, gender, education levels, family income, alcohol abuse, nicotine dependence, DSM IV mood disorders and DSM IV psychotic disorders. Conclusions: There is some positive association between metabolic syndrome and physical neglect during childhood. However, further research is required to find the intermediate biological link between physical neglect and metabolic syndrome.
Health Workers Working Healthy 1
Yu-Chen Tang, MPH , 1 2 Carla Campbell, MD, MS , Ellie Barbarash, MS, CPEA 1 Drexel University School of Public Health, 2 1199C Training & Upgrading Fund Problem: Healthcare workers face a number of serious safety and health hazards. Absence of accessible occupational safety and health training can cause injuries and illnesses and threaten workersâ€™ quality of life. It can also contribute to huge economic costs and negatively impact patient safety in the healthcare settings. Background: 1199C Training & Upgrading Fund is a joint labor and management training initiative offering educational programs for union members throughout Philadelphia and southern New Jersey. Healthcare Workers Working Healthy (HWWH) is an OSHA Susan Harwood grant funded training program that addresses occupational hazards among low literacy and hard-to-reach healthcare workers. Methods: Level 1 Evaluations were conducted after each training session to assess the effectiveness of training. Level 2 Evaluations includes Pre & Posttests were disseminated before and after each training session. Level 3 Evaluations were conducted 3 to 6 months after each training to evaluate if there were behavioral changes that impacted workplace safety in a positive way. Results: 95% of a total of 561 participants responded the training program was effective. For each class, between 45 to 75 participants filled out Pre & Post-test. Overall the trainees showed great improvement in their post-tests. Level 3 Evaluations from a cohort of peer-trainers showed positive behavioral changes at their workplace.
Study of the impact on clinical decision making and evidence-based information utilization by nursing professionals based on experience, education, and exposure to evidence-based information 1
Christina Taylor, MPH , 1 2 David Smith, PhD , Luke Petosa MSc 1 2 Drexel University School of Public Health, ECRI Institute The use of evidence-based information in medicine is an approach developed to help healthcare providers manage the widespread and easily available medical literature. However, most health professionals report they do very little critical appraisal and satisfice by relying on summaries and practice guidelines, often not fully supported by evidence. The literature suggests a dual-process: intuitive, automatic, and requiring of little cognitive energy (System 1) and analytical, deliberate and more effortful (System 2). This study investigated the impact of training and experience on the decision making of nurses to best design communication methods and educational strategies for imparting evidence-based information. It surveyed nursing students and professionals using case-based open-ended qualitative questions. Responses were analyzed based on experience and education levels. A total of 55 responses were included for analysis. The population consisted of 18% pre-licensed nursing students and 82% post-licensure nurses. Pre-licensed nursing students were more likely to consult a peer reviewed journal and their supervisor/nursing instructor whereas post-licensure nurses were more likely to additionally consult own expertise and organizational polices. Pre-licensure nurses followed a pattern of System 2 (analytical) thinking and post-licensure participants followed System 1 (pattern recognition) thinking. The population consisted of 25% early learners (0-1 years), 15% early clinical learners (>1-5 years), and 58% experts (>5 years). Early clinical learners were more likely to consult their own expertise, coworkers, and organizational polices. Experts were most likely to consult their expertise and organizational policies as compared to the other two groups. Early learners followed System 2 (analytical) thinking, early clinical trainers followed a transitional pattern, and experts followed System 1 (pattern recognition) thinking. The study concluded that the differences in use of evidence based information by nurses by education and experience levels should influence the design of communication and educational strategies for imparting evidence based information.
Reducing Stigma of Behavioral Health Issues Through the Use of Web 2.0 1
Janee Tyus, MPH See Amitoj Chatrath, MPH for Abstract -Assessing the Needs of a Community Partner: Qualitative Evaluation and Curriculum Modification 1,2
Laura Urbanski, MPH , 2 2 1 Candace Roberson-James, DrPH , Serita Reels, MPH , Suruchi Sood, PhD 1 Drexel University School of Public Health, 2 Drexel University College of Medicine Background: Health disparities continue to exist in the United States. Training health outreach workers has been one approach addressing these disparities. However, despite the comorbidity of disease these programs often target a single illness. Philadelphia Ujima is an organization which uses the health outreach worker model to decrease the effects of health disparities through health education and training of trainers by partnering with groups across the city. Ujima recently partnered with Congreso de Latinos Unidos, a multi-service organization in North Philadelphia, in an effort to address the disproportionate burden of disease suffered by Latinos in the city. Objectives: This purpose of this project is to address disease comorbidities within the context of limited organizational resources. This study will be used to modify Ujima’s existing health curriculum to enable Congreso to address the overlapping health concerns of the population they serve. Methods: In-depth interviews were conducted with the staff of Congreso’s Family Wellness Department to assess the needs of the population with whom they work. These interviews were qualitatively analyzed using a grounded theory approach. An follow-up survey was distributed to interviewees to determine the accuracy of analysis. Themes identified in this process were used to modify Ujima’s existing curriculum. Results: Themes identified as barriers to health included limited personal resources, language, trauma and unsafe communities, lack of institutional funding, and compartmentalization of health by the majority of social service organizations. The dedication of Congreso’s clients to their families and their receptiveness to help were identified as strengths. Congreso emphasizes a holistic view of health and the staff serve as positive role models for clients. The staff identified a need for a curriculum that addressed the relationship between trauma and nutrition to health in a culturally competent and engaging way. Conclusions: Themes identified from these interviews support the need for an integrated health curriculum to train the staff of Congreso’s Family Wellness Department.
Building Capacity for Autism Services in Eastern Pennsylvania 1
Tawny Vu, MPH , 1 2 Jennifer Kolker, MPH , Lindsay Lawer, MS 1 2 Drexel University School of Public Health, A.J. Drexel Autism Institute Background: Autism Spectrum Disorders (ASDs) are neurological disorders typically identified in the first three years of a childâ€™s life. The rise in occurrence of ASD is alarming; according to the Centers for Disease Control and Prevention, approximately 1 in 88 children in the United States have been diagnosed with an autism spectrum disorder. Further, the Autism Census commissioned by the Bureau of Autism Services, Pennsylvania Department of Public Welfare, reported that in 2005 there were nearly 20,000 Pennsylvanians living with ASD and many studies have demonstrated the difficulties families face while seeking services. Objective: 1. To help families and individuals connect with potential service providers 2. To study the impact of Medicaid and private insurance on autism services. Methods: First, a series of four autism resource fairs was implemented in order to help families and individuals find the services they need. Secondly, the impact of Medicaid and private insurance on services for individuals with ASD will also be examined using Needs Assessment data collected by the Autism Services, Education, Resources, and Training (ASERT) Collaborative as commissioned by the Bureau of Autism Services. Results: The number of lives touched as a result of the planning and implementation of the resource fairs was over 1000 people. Contacts with legislators, families, and service providers in Eastern Pennsylvania were established. For the research paper, it was found that Medicaid was a heavily utilized method of paying for autism services. However, it was also seen that most survey respondents said that they use both Medicaid and private insurance to fund services. Conclusions: Both parts of this project have the shared purpose of building capacity for autism services. As a result of the ASERT Autism Resource Fairs, service organizations have learned from each other in order to better serve individuals with service needs. Further, families now have more information on services and access to the ASERT resource hub for future needs. For the research paper, additional research and analysis is required, but it is clear that Medicaid plays a significant role in autism service payment and that private and public insurance only cover certain services.
A Cross Sectional Analysis of Fast Food Locations, Dietary Quality, and Diabetes 1
Sachin Walawalkar, MPH, BHMS , 1 1 Amy Auchincloss PhD, MPH , Elizabeth Nobis, MPH 1 Drexel University School of Public Health Background: Type 2 diabetes is a highly prevalent expensive chronic disease that increases morbidity and premature mortality. Eating outside of the home (fast food and restaurant food) has been linked to low dietary quality. Little research has been conducted on the association between the locations of fast food outlets and type 2 diabetes. Objectives: A cross-sectional study of the relationship between dietary intake, fast food locations and type 2 diabetes. The hypothesis is that increased fast food exposure is associated with poor diet quality and prevalence of type 2 diabetes and impaired fasting glucose. Methods: Data were obtained from a sample recruited from multiple cities. Dietary quality scores (Mediterranean diet score and Solid Fats and Sugars) were created from a food frequency questionnaire. Cross tabulations evaluated associations between quintiles of the two diet scores and demographic and environmental characteristics. Linear and logistic regression models were used to assess the association between density of fast food outlets in a neighborhood and dietary quality and diabetes and impaired glucose respectively. Results: Inverse expectation, fast food exposure was positively associated with better diet (accordance to Mediterranean diet score) and negatively associated with worse diets (SoFAS diet score). As expected, results suggested that, adjusted for age and sex, density of fast food outlets was positively associated with diabetes, however confidence intervals included the null and after adjustment for other covariates, the association declined. Fast food density was positively associated with impaired fasting glucose. Adjusted for age and sex, relative to the lowest neighborhood density of fast foods, odds ratio (OR) was 1.33 (95% CI: 1.10 â€“ 1.63) and 1.12 (95% CI: 0.91-1.37) for medium and high density fast food outlets, respectively but declined to 1.22 (CI: 0.97-1.54) and 1.06 (CI: 0.80-1.41) for medium and higher densities of fast food respectively after adjustment for additional covariates. Conclusion: Dietary quality may be beneficial in reducing prevalence of type 2 diabetes, but an association could not be established in this sample. Further research is needed.
Understanding African American Supermarket Shopping Habits and Health Outcomes in the Context of a Church Initiative 1
J. K. Wall, MPH, BA , 1 N. A. Vaughn, PhD , 1 Drexel University School of Public Health Purpose: The purpose of this study is to characterize the supermarket shopping habits of African Americans participating in a nutrition- and fitness-focused church initiative. The deliverable of this study is a supermarket shopping habits survey that identifies food-purchasing behaviors. The responses from the survey cultivated discussion on food resource management and affordability of and access to healthy foods among African Americans in an urban environment. Methods: A supermarket shopping habits survey was developed based on current literature on food purchasing behaviors, common grocery store practices like list making, frequency of shopping trips, impact of price on shopping, purchasing of certain items, and use of nutritional information in decision-making. The survey was administered before and after the AmeriHealth Caritas Partnership 40 Day Journey, a six-week program for individuals wishing to adopt a healthier lifestyle, at two church sites in South Philadelphia and West Philadelphia. Pre and post surveys were analyzed using SPSS. Results: Pre-Survey South Philadelphia: (n=50) 61.2% reported that price of grocery items impacted the way they shopped; Post-Survey South Philadelphia: (n=26) 47.6% reported that price impacted the way they shopped; Pre-Survey West Philadelphia: (n=88) 62.1% reported that price impacts the way they shop; Post-Survey West Philadelphia: (n=42) 58.3% reported that price impacted the way they shop. Across the two church sites, an average of 58.8% reported on the pre-survey that they made a grocery list prior to shopping. The post-survey revealed that across the two church sites an average of 63.95% created a grocery list prior to shopping. Across the two church sites an average of 57.45% considered themselves healthy shoppers before the 40-Day Journey compared to an average of 82.8% after the healthy lifestyle program was completed. Conclusion: Price of groceries was a major factor that influenced the shopping habits of study participants which has implications for policy on a national level through The Food, Conservation, and Energy Act as well as a local level through the Philadelphia Food Charter and Food Policy Council. Initiatives to improve affordability of healthy foods are necessary for populations to meet recommended dietary guidelines and reduce onset of diet-related disease.
Contraceptive Needs Assessment of Female Bhutanese and Iraqi Refugees in Philadelphia 1
Allyson A. Wang, MPH , 2 3 Suruchi Sood, PhD , Gretchen Wendel 1 2 Drexel University School of Public Health, Nationalities Service Center Background: Limited research has been conducted examining female Bhutanese and Iraqi refugees resettling in any host country. There is a great need for more information about this populationâ€™s reproductive health and more specifically, contraceptive needs, in the Philadelphia area. Objectives: To determine what the contraceptive needs are for female Bhutanese and Iraqi refugees in the Philadelphia area. This study examines whether or not differences exist between the accessibility of contraception for female refugees before and after entering the U.S. The barriers and facilitators for female refugees to obtaining contraception before and after arriving to the U.S. are also explored. Methods: A mixed method cross-sectional study examining the contraceptive needs of female refugees involving written surveys and in-person interviews was conducted. Fourteen female refugees were surveyed and three female refugees participated in in-depth interviews. The study period was from April 4, 2013 to May 17, 2013. Results: Quantitative data showed that before arriving to the U.S., 64% of respondents found no problems obtaining contraception. After arriving to the U.S., only 29% of respondents are not interested in obtaining contraception. The one apparent barrier was lack of awareness about where to go for contraception. Qualitative data showed that stronger communication and more knowledge facilitate obtaining contraception. Conclusions: The results do not strongly suggest that contraception is an imperative need of this population. The lack of information on the unmet need for contraception could be due to the small sample size. Additional research and time to conduct this research are necessary to find out more about this populationâ€™s contraceptive needs and design interventions to address these needs.
Assessing Infection Control and Licensing in Tattoo Artists: A Cross-Sectional Study 1
Julia Wells, MPH, BS , 1,2 2,3 Esther Chernak, MD MPH , Ami Patel, PhD , 2 2 Leigh Anne Rainford, MPH , Shadia Bel Hamdounia, BA 1 2 Drexel University School of Public Health, Philadelphia Department of 3 Public Health, Centers for Disease Control and Prevention Background: Over 20% of Americans have at least one tattoo, and rates of tattooing in adolescents and young adults are even higher. Tattooing presents opportunities for disease transmission and infection control (IC). IC requirements for tattooists often vary by location or licensure status. Objective: To elicit information regarding knowledge, attitudes and practices of tattoo artists toward IC and regulation of tattooing operations via an anonymous survey. Methods: Data was collected via a self-administered survey at the Philadelphia Tattoo Arts Convention held February 2013. The survey addressed IC practices, knowledge of unregulated tattooing practices and attitudes towards IC training and licensure. A Likert scale used the responses “Always,” “Most of the time,” “Sometimes,” “Rarely” and “Never” to assess IC practices. Results: Sixty three respondents included 43 (77%) licensed artists, three licensed apprentices, and eight unlicensed artists/apprentices. Median experience length was seven years. Eighty-one percent of respondents had been offered BBP training and 72% felt the industry provides adequate opportunities for education. Twenty-five percent (n = 17) of respondents reported sustaining at least one sharps injury during tattooing irrespective of gender or length of experience. The majority of respondents rarely/never reported use of a sanitizing gel/foam instead of hand washing. More than 90% of respondents reported implementing most IC measures “Always” or “Most of the time,” but use of disposable machine covers (17.5% indicating “Sometimes,” “Rarely” or “Never” ) and replacement of machine rubber bands (35% indicating “Sometimes,” “Rarely” or “Never”) indicate areas for improvement. Nearly a third of respondents had tattooed without a license, and 29% had tattooed in an unlicensed facility, most commonly in their home (14%). Conclusions: The data indicates that there may be resistance to formal avenues of infection control education among some tattoo artists. Gaps were also identified in the recognition of opportunities for equipment cross-contamination. Interventions should emphasize infection control education through both public health authorities and leaders in the tattoo community, as well as promoting consumer patronization of licensed facilities, particularly for adolescent customers.
Strengthening Nutritious Food Access in West Philadelphia: Community Building and the Development of a Community Café Model 1,2
Patrick Wiggins, MPH , 1 2 Nancy E. Epstein, MPH, MAHL , Aishah Miller 1 Drexel University School of Public Health, 2 Center for Hunger-Free Communities Background: Food insecurity is a pressing public health issue throughout the United States because the lack of access to healthy food contributes to a poor diet and the onset of obesity, thus increasing the risk of developing life-threating, chronic diseases including heart disease, cancer, and type 2 diabetes. West th Philadelphia-University City ranks as the 5 poorest zip code in Philadelphia, and th th Lancaster Avenue’s “Buffer Zone” between 38 and 40 and Lancaster Avenue lacks restaurants that sell affordable, nutritious meals. This section of the corridor is the nexus between residents of West Powelton and Mantua, and Drexel University students and staff. Objective: To engage neighborhood residents, community members and organizations to build collaboration; to build a sense of community and rapport among focus group participants for the planning and development of the community café; to develop the café model with neighborhood resident and community member input. Methods: Four focus groups and three key informant interviews were conducted with residents of West Philadelphia-University City from March – April, 2013. Participants of the first two focus groups were invited to continue to subsequent focus groups. Qualitative results for a new community café were obtained and analyzed to develop the community café model. Results: A total of 24 out 40 residents were recruited for the focus groups and key informant interviews. The first two focus groups revealed neighborhood residents’ perspectives that a community café could not only make accessible affordable, locally-sourced nutritious meals, but also could bring about community well-being, economic development, and unity. Results were reported to the community café team, and with community member input in consideration, the name LOVE café was chosen for the café. Additionally, 3826 Lancaster Avenue, Philadelphia, PA 19104 was selected as the café location. Lastly, the second set of focus groups revealed a consensus for 2:00 – 7:00PM hours of operation, small plates for $3, and a “pay what you can” with a suggested price payment option. Conclusions: Community Café development with community member involvement and input throughout the planning process can set the precedent for collaborative, innovative food serving models to strengthen nutritious food access.
Evaluation of Physical Activity Habits in a Population at High Risk for Breast and Ovarian Cancer After Participation in an Exercise Based Intervention Program 2
Marc Witcher, MPH , 1 2 Kathryn Schmitz, PhD, MPH , Seth Welles, PhD, ScD 1 University of Pennsylvania Center for Clinical Epidemiology and 2 Biostatistics, Drexel University School of Public Health Background: Exercise has been linked to improved cancer risk profiles. An intervention utilizing this finding is of special interest in the case of women at high hereditary risk of breast and ovarian cancer due to the severity of preventive measures and their consequences in early adult life. Objectives: The goal of this project was to evaluate the exercise habits of a cohort of women at high risk for cancer from the Women in Steady Exercise Research Sister (WS) longitudinal study, a randomized controlled trial of exercise on putative breast and ovarian cancer risk factors. Methods: A self-report questionnaire was administered via the REDCap electronic survey system to 81 women who completed the study at least 6 months ago from the WS control group (n=20), WS low-dose exercise group (n=20), WS high-dose exercise group (n=21), or a control group of women who were screened but not included in the WISER Sister study (n=20). Results: There was no significant difference in exercise distributions between study groups. Physical activity levels averaged 3.96, 6.16, 5.78, and 5.23 METhours/week for the non-study, control, low dose and high dose groups, respectively; which were lower than American Cancer Society recommended levels (7.5 MET-hours/week). Depression was negatively associated (β = .94) and body-image and the amount of walking done per day were positively associated (β = 1.69 and β = 2.42, respectively) with being more likely to exercise, as shown by logistic regression. Body image score was found to be positively predictive of being in a higher exercise group by ordinal logistic regression (β = 1.74). Conclusions: Social cognitive theory suggests that proficiency at physical activity should tend to increase physical activity, thus no difference in the physical activity distributions of exercise and non-exercise groups is surprising. The two psychometric variables that emerged have been shown in the literature to be associated with physical activity, and further depression scoring has been shown to be associated long term with past physical activity. Physical activity may not have been fully captured in the present study. Future studies of this type would benefit from larger sample sizes and updated survey wording.
Evaluate the Impact of Lifestyle Intervention in the WISEWOMAN Program 1
Lezhou Wu, MPH , 1 1 Lisa Ulmer, ScD , Jamiliyah Gilliam, MS 1 Drexel University School of Public Health Background: The Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) program is a national program that was launched to help low-income, uninsured and under-insured women, ages 40-64, reduce their risk for heart disease, stroke, and other chronic diseases. WISEWOMAN program provides eligible clients with clinical services and lifestyle interventions. Objective: To evaluate the impact of lifestyle interventions by analyzing goals in dietary and physical activity (PA) changes, as well as the corresponding goal attainments. Methods: A content analysis was performed to code chart data and goal attainments were identified by two coders via a consensus study. Goal attainments were firstly rated on a scale of 1 to 5 (higher values mean better attainments). For the purpose of analysis, we further classified goal attainments into two categoriesâ€”expected or better (>=3) and less than expected (<3). The marginal logistic regression model using generalized estimating equation (GEE) approach was conducted to assess the progress of goal attainments during telephone follow-ups. Results: Of 375 clients, only 81 clients completing at least three telephone follow-ups were included in the present analysis. Overall, 346 diet goals and 162 PA goals were developed for these 81 clients. Of 346 diet goals, 189 had clear goal attainments, according to outcomes of content analysis; of 162 PA goals, 114 were able to be evaluated for their attainments. 144 (76.2%) diet goals and 58 (50.9%) PA goals were attained as expected or better. GEE models showed nd that goals of health dietary change were more likely to be attained in the 2 st follow-up, compared with that in the 1 follow-up (adjusted OR: 4.900, 95% CI 2.350-10.217); however, no significant association with dietary goal attainments st rd was found between 1 and 3 follow-up (adjusted OR: 1.237, 95% CI 0.5262.912). PA goal attainments did not vary significantly across follow-ups after nd st rd st adjustment for covariates (2 vs. 1 : OR 0.965, 95%CI 0.441-2.110; 3 vs. 1 : OR 0.481, 95%CI 0.174-1.327). nd
Conclusions: Lifestyle interventions improve health eating significantly till the 2 rd follow-up, but did not continue to the 3 follow-up; PA-aimed interventions did not significantly facilitate health behavior changes during follow-ups.
Post cardiac arrest myocardial dysfunction: Use echocardiography as a detection method and outcomes 1
Yuan Yao, MPH , 1 Longjian Liu, MD, PhD, MSc, FAHA , 2 2 2 Anne Grossestreuer, MS , David Gaieski, MD , Sarah Perman, MD 1 Drexel University School of Public Health, 2 Hospital of University of Pennsylvania Background: Many of patients with out-of-hospital cardiac arrest are able to be initially resuscitated, but only a small proportion of them survive to hospital discharge. A common cause of this high mortality rate is post-cardiac arrest myocardial dysfunction, which is temporal and full recovery can occur after appropriate treatment. Objectives: This study aims to explore the predictors of post-cardiac arrest myocardial dysfunction and evaluate their influence on survival and final neurologic outcome. Methods: A retrospective chart review was performed of 238 out-of-hospital cardiac arrest patients who underwent echocardiography examination after resuscitation at two hospitals: an academic medical center and a tertiary-care community hospital. Abnormal left ventricular ejection fraction (LVEF) was defined as <40%. LVEF was abstracted by 72-hour post-cardiac arrest. Results: 24-hour abnormal LVEF was observed in 91(44.39%) patients. Among patients who had serial echocardiography, 15 (53.57%) patients' LVEF recovered from abnormal to normal by 72-hour, and 5 (17.86%) patients' LVEF remained abnormal by 72-hour. 42 (46.15%) patients with abnormal EF survived to discharge, 33(36.26%) neurologically intact at discharge. Having a witnessed event predicted abnormal LVEF in first 24-hour (OR, 0.34; 95% CI, 0.15-0.79) and final neurologic outcome (OR, 3.11; 95% CI 1.09-8.86). Male gender (OR 3.76 95% CI 1.53-9.24), shockable first documented pulseless rhythm (OR 2.71, 95% CI 1.20-6.15), bystander CPR (OR 3.02, 95% CI 1.35-6.77), doses of epinephrine during resuscitation (OR 0.35, 95% CI 0.18-0.70) and longer duration of resuscitation (OR 0.28, 95% CI 0.12-0.67) were also associated with neurologic outcome. Conclusions: In survivors of out-of-hospital cardiac arrest, some patients with initially abnormal LVEFs recover by 72-hours, suggesting post-cardiac arrest myocardial stunning. Abnormal LVEF after resuscitation is not predictive of outcome. Gender, witnessed event, shockable first documented pulseless rhythm, bystander resuscitation efforts, lower dose of epinephrine during resuscitation, and shorter duration of resuscitation are protective predictors of final neurologic outcomes. Public health efforts to improve survival rates of out-of-hospital cardiac arrest should emphasize modifiable predictors, including increasing rates of bystander CPR and promoting the use of early defibrillation by laymen.
Medicaid Expansion: The Faces of Uninsured Health Center Patients 1
Natalie Yaworsky, MPH , 1 2 Dennis Gallagher, MP, MPA , and Suzanne Cohen 1 Drexel University School of Public Health, 2 The Health Federation of Philadelphia Background: In 2010, Congress passed The Patient Protection and Affordable Care Act, which improved access to Medicaid by standardizing minimum yearly income eligibility levels across all states to 133 percent Federal Poverty Level (FPL). Since states are not required to expand, many states like Pennsylvania have opted out, leaving some 490,000 low-income residents without affordable health insurance coverage. Objectives: Partner with the Health Federation of Philadelphia (HFP) and video interview uninsured health center patients. Examine their financial struggles, health status, and emotional distress levels. Edit videos, which will be used by HFP to advocate for Medicaid expansion in Pennsylvania. Methods: 3 (1 Male, 2 Females) of 16 recruited uninsured health center patients were eligible and available for video interviews. They were between the ages of 18-65, U.S. citizens, had incomes at or below 133 percent FPL, and were patients of Spectrum Health Services, Inc. The interviews were transcribed and assessed for consistent themes. The videos were edited into 14 shorter clips using Apple’s iMovie video editing program. Results: Patients had health insurance in the past, but due to significant financial constraints, they could no longer afford insurance premiums. As a result, they postponed preventive mammography and colorectal screenings, and were not able to address health concerns prevalent in their family health histories. They also faced a great deal of stress and anxiety knowing that without health insurance they could “lose everything” should an emergency health scare arise. Conclusions: The ACA builds on prior health care policies, which uniquely resulted from American circumstances and ideological values. Although the extensive law expands access to over 24 million low-income individuals, it still does not recognize that health insurance is a “right” of all U.S. citizens. In the immediate future, more advocacy and campaigning must be done to convince PA Governor Corbett to expand Medicaid coverage. In the near future, measures must be taken to make health disparities a national priority.
The Patient-Centered Rapid Response Team: A Quality Improvement Pilot Project 2
Samson A. Zarbiv, MD, MPH , 1 1,2 Corinne Klein, MD , Renee Turchi, MD, MPH 1 Drexel University College of Medicine/Hahnemann University Hospital, 2 Drexel University School of Public Health Background: Rapid Response Teams (RRT) are generally considered to be the “best practice” method of achieving patient-safety goals. This complex clinical microsystem can be thought of in a functional manner as a system comprised of ‘four limbs’: (1) early patient identification, (2) response triggering, (3) crisis response, (4) data collection/process improvement. The success of any RRT protocol depends highly on the institution’s cultural barriers and facilitators to quality improvement pilot projects. Objective: To effectively guide the implementation of a novel Rapid Response Team quality improvement project – the Patient-Centered Rapid Response Team (PCRRT) – that aims to improve the quality of care in clinically unstable patients being treated on non-critical care floors of the inpatient hospital setting. Methods: This quasi-experimental study consisted of two phases. First, an inductively-oriented quality improvement “needs assessment” was conducted utilizing qualitative analysis of ten case-studies of actual RRTs that occurred on the designated pilot floors (15 and 20) over a 30 day period. These case-studies informed the development of recommendations that are crucial to implementation of the PCRRT intervention. Secondly, a prospective before-and-after study of the newly implemented PCRRT protocol will assess the efficacy of the intervention itself. Results: Themes elicited from case study analysis that were considered essential to successful implementation of the PCRRT protocol included: (1) transparency and accountability in RRT event measures and documentation; (2) inter-disciplinary training for front-line nurses and physicians on the proper use of a RRT; (3) mandatory post-event feedback/debriefing sessions conducted in a safe and democratic setting for all participants in a RRT; (4) monthly quality assurance reviews of the RRT led by hospital administrators. Conclusions: The introduction of the PCRRT protocol is itself a process in social change that is influenced by a plethora of factors that are not amenable to traditional scientific control mechanisms. These influential factors include leadership, structural environment, prior quality improvement project failures, and a deeply rooted organizational history. As such, it is crucial to understand the organization’s specific needs and cultures to ensure long-term adoption of this patient-safety PCRRT protocol as a necessary “first step” of any RRT improvement intervention.
Analysis of Clinical Communications about Patients in the Care Coordination Process Lauren Zenel, MPH See Elissa Iverson, MPH, RN, for Abstract -Prenatal Maternal Cytokines and 12 Month AOSI Scores 1
Xi Zuo, MPH , 1 2 Craig J. Newschaffer, PhD , Lindsay Lawer, MS 1 2 Drexel University School of Public Health, A.J. Drexel Autism Institute Background: Even with the high autism (ASD) prevalence of 1 in 88 US children, etiologic mechanisms remain largely unknown. There are also no identified biological markers for diagnosis. Abnormal maternal immune activation has been reported to link with ASD under the hypothesized mechanism of cytokines facilitated neuroimmune cross-talk during fetal development. Objective: To examine 1) the distribution of cytokine expression levels over the entire pregnancy among mothers who already have a child with ASD, and 2) estimated the associations with 12- month AOSI score, a summary measurement of ASD-related phenotype, in offspring. Methods: In this multisite prospective cohort study, comprehensive data on 90 mothers was analyzed. 22 cytokines and chemokines were measured throughout three trimesters of pregnancy. Descriptive analysis was used to evaluate the distribution of every cytokine in each trimester. We also constructed separated linear regression models to assess the association between log-transformed cytokine expression levels and AOSI scores. Wilcoxon-Mann-Whitney tests were used to explore associations between unusual trajectory (unusual increase for pro-inflammatory cytokines and decrease for anti-inflammatory cytokines during pregnancy) and AOSI scores. Results: Unadjusted linear regression model primarily suggested significantly negative associations between IL-17 and AOSI score during both 2nd and 3rd rd trimester, while IL-2 and IFN-γ were negatively related in the 3 trimester. The interaction models suggested IL13, IL-1ra, IL1 β, IL2, TNFα, Exotaxin, and MCPnd 1 were negatively correlated with AOSI score in the 2 trimester. It also showed nd gestational age within 2 trimester negatively affected the association. We also found relatively higher MIP-1α or lower IP-10 during mid-pregnancy was significantly more likely to have offspring with higher AOSI scores than mothers without these two cytokine profiles.
Conclusion: No associations that consistently match with expectations, though little is known about expected cytokine trajectories in pregnancy. The findings are limited due to small sample size, and more data need to be accumulated before there is sufficient power. Further research should focus on adjustment or stratification for infection and examining extreme cytokines values. Supplemental support of a community-based autism intervention: It focused on helping a non-profit organizations agency Elwyn better engage the local Chinese immigrant communities. For this component, home-visit, interview, in addition a Chinese version of support material around toilet training young children with ASD, as well as a Chinese language educational video clip were produced. These materials will be used to help decrease service disparities in this largely poor, Philadelphia minority community.