Research Day took place on Thursday, April 19 as a celebration of research, innovation, scholarship, creativity and the incredible breadth of research being conducted across the University. Presenters submitted abstracts by March 22. They presented their research and abstract using professional posters. Awards and cash prizes were presented for each category. The results will be posted to the Research Day website in the near future. The following Drexel School of Public Health students and faculty presented at Research Day:
Cardiovascular Disease and Associated Risk Factors in Sub-Saharan Africa
Catherine Ntabadde
Co-Author: Longjian Liu
Advisor: Longjian Liu
The prevalence of cardiovascular disease (CVD) in sub-Saharan Africa has become a major public health concern due the epidemiologic transitions of diseases. Communicable disease such as malaria, HIV/AIDS and TB, remain the predominant health problems in sub-Saharan Africa. However, non-communicable diseases such as cardiovascular diseases and the associated risk factors have been neglected and this has resulted into an increasing burden. CVD is the new epidemic in Sub-Saharan Africa. Because of this serious public health problem, we conducted an in-depth qualitative and quantitative review to provide up-to-date epidemiological information by compiling data that measure the extent of the chronic disease epidemic, focusing on CVD prevalence and mortality, and its associated risk factors. We then discuss the implications of CVD in reshaping the health care delivery systems. The results of our in-depth literature review indicate that (1) CVD is the second leading cause of death after infectious diseases. It accounts for 9.2% of total deaths in most sub-Saharan countries. (2) The prevalence of hypertension (SBP/DBP: ≥140 / 90 mmHg) varies between 15% and 55%. (3) The prevalence rate of diabetes mellitus is around 3%. (4) Prevalence of Hyperlipidemia ranges between 23% (Nigeria) and 67% (black Kenyans). We are conducting further analysis by using data from the WHO-World Health Survey. Our final findings will be presented and discussed in our poster.
Assessing cultural competence of providers within a network of HIV/AIDS care providers
Adedipupo King
Advisors: Nathalie Bartle, EdD, Rashidah Abdul-Khabeer, RN, MHS
It is crucial for healthcare organizations to be aware of the cultural diversity within its clientele and institute suitable procedures to ensure culturally competent services are provided. Cultural competence in service delivery is vital to whether or not clients access care and adhere to their treatment regimen. Such outcomes are particularly desirable for management of HIV-infected individuals. The cultural competence of providers within a network of HIV/AIDS healthcare service providers in Philadelphia was assessed.
Some aims of this project included: 1) Determine key elements of a culturally competent service delivery system; 2) Identify standards used in various healthcare organizations particularly among STD/HIV care providers; 3) Identify major constraints of providers to providing culturally appropriate services; 4) Determine major population groups that make up the clientele of the Circle of Care and to identify their major concerns and needs to receiving culturally appropriate services; and 5) Determine key steps to enhance delivery of culturally appropriate services. Qualitative methods including key informant interviews with care providers and focus group sessions of clients were conducted to address these aims. Culturally and Linguistically Appropriate Standards (CLAS) published by the Office of Minority Health was used to develop the interview guides.
Data collection and analysis are on-going and will be completed by June, 2012. Preliminary results from key informant interviews suggest that organizations may be providing culturally-competent services although in some cases, they have no detailed procedural desc-riptions. Preliminary data from clients imply that experiences of some clients may differ from what organizations believe. For example, some clients believe the information collected by organizations during their first meeting is collected as mere formality because such information is not acknowledged in their subsequent encounters with staff
Alcohol consumption, depression and other chronic disease in low- and middle-income countries: a global health challenge
Siu Yue Ng
Co-Authors: Carol F. Lippa, MD, Longjian Liu, MD, PhD, MSc, FAHA
Advisors: Carol F. Lippa, MD, Longjian Liu, MD, PhD, MSc, FAHA
Alcohol consumption is the third largest risk factor for disease and disability worldwide, and depression is expected to become the world’s second leading cause of disease burden by 2020. Lower economic development and socioeconomic status are generally associated with greater alcohol-related health problems, and countries with less primary care available are expected to suffer more from the burden of mental illness. This research project aims to investigate the association between depression and alcohol consumption, as well as other risk factors, in low-and middle-income countries. We used data from the WHO - World Health Survey (2002-2003), in which fifty countries were classified as low-income or middle-income using the World Bank definition. The results indicate that low-income countries had lower alcohol consumption rate (22.6% vs. 45.5%, p<0.001) and higher depression rate (6.3% vs.5.8%, p<0.001) when compared with middle-income countries. Although the depression rate was higher, treatment rate in low-income countries for depression was 1.5% compared with 5.6% in middle-income countries. Those diagnosed with depression had significantly higher alcohol consumption rate than those who had no clinically diagnosed depression (40.6% vs. 36.2%, p<0.001). This project can help to better understand the patterns of alcohol consumption and depression, and suggest potential public health focus in the low- and middle-income countries.
Improving Quality of Discharge Communication between Hospitalists and Primary Care Providers
Tess Woehrlen
Advisors: David Cooperberg, MD, Mary Duden, MBA
Effective communication by hospitalists to primary care providers (PCPs) following hospital discharge may improve patient safety and satisfaction. St. Christopher’s Hospital for Children is part of the Pediatric Hospital Value in Inpatient Pediatrics Transitions of Care Collaborative is working to define and standardize the essential content of discharge communication.
A survey of physician preferences regarding discharge communication from pediatric hospital medicine services was distributed by e-mail to a total of 320 PCPs, twenty PCPs who refer to each of the participating sixteen sites. A parallel survey was distributed to 147 pediatric hospitalist program directors (PDs). Locally, surveys were distributed to twenty randomly selected PCPs who referred patients to St. Christopher’s in May 2011. In addition, the PD filled out a parallel survey. A chi-square analysis was done to test for statistical significance.
A total of 200 PCP responses and 71 PD responses were received, representing response rates of 62.5% and 48% respectively. The results of the survey showed significant differences between PCPs and Program Directors (PDs) regarding which discharge elements were essential. However, seven elements were reported as essential by >75% of PCPs and PDs. These include: (i) dates of admission and discharge, (ii) discharge diagnoses, (iii) discharge medications, (iv) brief hospital course, (v) immunizations given, (vi) pending test results, and (vii) follow-up appointments.
The results of this multi-site study suggest that, even though there are significant differences between PCPs and PDs regarding discharge communication priorities, several elements are perceived as essential by both physician groups. These results will be used to create the essential content bundle to measure the quality of timely communication between hospitalists and PCPs. Annual post-intervention surveys will be used measure the impact of the content bundle on PCP satisfaction.
The Effect of the Broad Autism Phenotype on Physical Activity and Weight Gain in Pregnancy
Jessica Bauer
Advisor: Craig Newschaffer, PhD
Autism is a neurodevelopmental disorder that is characterized by language delays and difficulties with social and emotional functioning. Currently 1 in 110 children in the United States have an autism spectrum disorder and little is known about the cause. The Early Autism Risk Longitudinal Investigation (EARLI) is a prospective study examining genetic susceptibility and environmental risk factors for autism. The study follows pregnant women who have a child diagnosed with autism spectrum disorder throughout their pregnancy and the new babies up to age three through the collection of biological samples and surveys regarding diet, health behaviors, medical history, and various environmental exposures. Several EARLI instruments, including the Social Responsiveness Scale (SRS), health behaviors preconception, health behaviors pregnancy, maternal interview and maternal interview update were used to determine if there was an association between the maternal broad autism phenotype and lifestyle-related variables during pregnancy. This provides insight on the potential role ASD-related genetic liability might have in confounding associations between prenatal maternal lifestyle variables and autism risk in subsequent EARLI study analyses. ASD genetic liability is difficult to measure and epidemiologic studies of autism risk factors have used measures such as parental history of psychiatric disorders as a broad proxy for genetic predisposition to autism. This study aims to determine whether direct, quantitative measurement of broad autism phenotype through tools like the SRS may provide a better approach for controlling for genetic liability. In addition to examining parental broad autism phenotype as a confounder of risk factor associations, the questions of whether and how the broad autism phenotype influences behaviors related to healthy lifestyle is of interest and has been underexplored in the literature.
Misperceptions Regarding Hepatitis B Vaccination Status Among High-Risk Asian and Pacific Islander Immigrants in Philadelphia
John Kim, MPH(c), CPH
Co-Author(s): Kuan-Lung Daniel Chen, MPH, CPH, Karen Ariola, MPH, Chari Cohen, MPH, DrPH(c), Yvonne Michael, ScD, SM, Alison Evans, ScD
Advisor: Alison Evans, ScD
Background: Chronic hepatitis B virus is a leading cause of primary liver cancer and cirrhosis, especially in Asian and Pacific Islander immigrants. Vaccination of high-risk groups is critical for controlling HBV.
Objective: This study assessed the vaccination status and vaccine perceptions of high-risk APIs in Philadelphia.
Methods: 935 participants were screened at 17 locations throughout Philadelphia. Participants completed a questionnaire regarding their country of birth, ethnicity, education level, and perception of vaccine status. Participants were screened for infection and protection status. Infected individuals were referred to appropriate health care; vulnerable individuals were referred for vaccination. Fisher’s exact test was performed to assess the difference between APIs and non-APIs with respect to their vaccine perception.
Results: Overall, 6.4% (n = 60) were infected with HBV and 52.1% (n = 487) had protective antibodies. 6.5% (n = 56) of participants believed they were vaccinated, but had no protective antibodies. 87.5% (n = 49) of participants with misperceptions of their antibody status were immigrants from high-risk countries; 67.9% (n = 38) were female; 39.3% (n = 22) had less than a college degree. There was no statistically significant difference between APIs and non-APIs with respect to perception of their vaccine status (p > 0.05).
Conclusions: It is critical that those at highest risk for HBV infection be protected via vaccination. This study indicates that some individuals have misconceptions regarding their vaccination status, and suggests that self-report of HBV vaccine may be unreliable. These data suggest the need for HBV education and screening, particularly among the immigrant population.
Gender Differences in Serum Biomarkers and Systolic Function among African Americans with Heart Failure
Feng Feng Liu
Co-Authors: Raghunandan Dudda Subramanya, MD, Brian Hall, JD, Shelley Hankins, MD, Min Li
Advisors: Howard J Eisen, MD, and Longjian Liu, MD, PhD, MSc, FAHA
Background: African Americans (AAs) suffer from high burdens of heart failure. However, evidence on how heart failure disproportionately affects AAs is not clear.
Objectives: Evaluate the biomarkers’ differences in African American. Explore the risk factors to the decreased Left Ventricular Eject Fraction (LVEF) and the end-stage heart failure.
Methods: This study examined a random sample of 150 patients aged 26 to 90 years older (M=67, F=83) African American with heart failure from the Cardiology Division of Hahnemann Hospital. The differences of biomarkers (serum lipids, glucose, creatinine, hemoglobin, white blood cell), and systolic function (LVEF) were measured between male and female. Logistic regression model was used to explore the relationship between biomarkers and LVEF. The association between biomarkers and heart failure stages in AAs was also explored in this study.
Results: There are no significance relationship between biomarkers and LVEF. But, significant differences in serum total cholesterol (167.58vs. 189.97, p<0.01), low-density lipoprotein cholesterol (88.17 vs. 107.13, p<0.01), creatinine (2.21mg/L vs. 1.54 mg/L, p<0.01), and LVEF (33.38% vs. 49.54%, p<0.01) between male and females patients with heart failure are existed. After adjusting high-density lipoprotein, low-density lipoprotein, total cholesterol, triglyceride, WBC, blood pressure, age, and BMI, male have a high risk to have end-stage heart failure (OR: 3.21, 95% CI: 1.129, 8.863). In the combined data analysis, adjustment for low-density lipoprotein, total cholesterol, triglyceride, White Blood Cell (WBC), and albumin and hemoglobin, high glucose level is associated with end-stage heart failure (OR: 5.176, 95% CI: 1.179, 22.732). Body Mass Index (BMI) had no significant association with decreased LVEF (OR: 0.971, 95% CI: 0.932, 1.013). Comparing to patient with normal BMI, patient with BMI greater than 25 kg/m2 appeared having lower risk of decreased LVEF (<50%) (OR: 0.36, 95% CI: 0.012, 1.078). Patients with BMI great than 30 kg/m2 also appeared having lower risk of decreased LEVF (OR: 0.87, 95% CI 0.36, 2.1). The similar results were obtained between BMI and heart failure stages (OR: 0.84, 95% CI 0.28-1.8).
Conclusions: Significant differences in lipids and systolic function may exist between male and female patients with heart failure among Africa Americans. Compared to female, male are the high-risk group to have end-stage heart failure. BMI may be inversely associated with decreased systolic function and having end-stage of heart failure among Africa Americans.
The Impact of Menu Labeling on 'Healthful' Fast Food Options: An Exploratory Case-Control Trend Analysis of Menu Offerings from Fast Food Establishments, 2005-2011
Alexa Namba
Co-Authors: Amy Auchincloss, PhD, MPH, Beth Leonberg, MS, RD, CSP, FADA, LDN, Sachin
Walawalkar
Advisor: Amy Auchincloss, PhD, MPH
In recent years, legislation requiring the posting of nutritional information at chain restaurants has been implemented in municipalities across the country to combat rising obesity rates. While early research into the effect of such labels on consumer decisions has shown mixed results, no quantitative assessment into the restaurant industry’s response to these mandates has been conducted. This project aimed to evaluate the impact of menu-labeling legislation on offerings from fast food restaurants between 2005-2011. Using the nutrition menus from five case (Arby’s, KFC, Long John Silver’s, SONIC, and Wendy’s) and four control restaurants (Bojangles', Culver's, Hardee’s, and Whataburger), this exploratory study compared menu offerings in areas currently under menu labeling mandate and outside of those municipalities. A trend analysis of menu items pre and post-menu labeling legislation quantitatively assessed whether these regulations motivated restaurants to increase their ‘healthful’ menu options or modify the nutritional content of their existing menu items. Over the past 7 years, the average calories for an a la carte entree has remained moderately high (approximately 450 calories, standard deviation of 190), with no clear systematic differences between restaurant chains in case vs. control areas. Additionally, less than 25% of all entrees and sides qualified as ‘healthful’ on a number of nutritional criteria. While the overall prevalence of 'healthful' options remains low for all years and all chains, a noteworthy increase in the prevalence of healthy entrees was seen at case locations relative to controls after menu labeling legislation (from 13% to 20% at the case locations vs. remaining static at 8% at the control locations, p<0.05). These findings suggest that menu labeling has thus far not motivated restaurants to improve their menus overall but it may motivate restaurants to slightly increase healthier options.
The Utilization of a Deprivation Index to Inform Socioeconomic Status
Melissa Miller
Advisor: Yvonne Michael, ScD
Health research has become heavily focused on the effects of Socioeconomic Status (SES) on health. Currently though, there is a deficit in the literature regarding a gold standard for quantifying a complex variable like SES. A study by Messer and colleagues (2006) utilizes neighborhood-level data to create an index, which summarizes many indicators of SES into one quantifiable variable. This project seeks to recreate the Messer et al. index to observe its utility in a study area spanning Pennsylvania, New Jersey, and Delaware. Eight SES indicators were extracted from the 2000 census and used to create the deprivation index. These indicators represented education, income, occupation, employment, and housing. A principal analysis approach was used to reduce these indicators to the first principal component. The resulting first component accounted for only 34.32% of the variability seen across the three sites, whereas the Messer et al. index accounted for 66.9% of the variability across eight sites. Additionally, component loadings were not consistent between study areas (0.01-0.88). The low correlation between these specific census indicators and overall neighborhood deprivation for our study area suggests that this particular index may not be generalizable to all populations. This study does however, provide insight into the possible benefits of establishing policies focused at the neighborhood-level, rather than those focused on the individual.
Investigating Widespread Impact of State Colorectal Cancer Prevention and Control Initiatives on Late Stage Diagnosis Rate and Costs
John Nguyen
Advisor: Craig Newschaffer, PhD
Colorectal cancer morbidity and mortality is a cause for concern nationally. In Pennsylvania, colorectal cancer is the third most commonly diagnosed cancer in men and the second most common in women. The early detection of colorectal cancer drastically improves chances of survival. The relative five year survival rate for early detection where the disease is still localized is 90%. The Pennsylvania Colorectal Cancer Control Program is a major initiative geared towards reducing the burden of illness and death due to colorectal cancer, specifically through increasing education and the availability of screening throughout the state. The goal is to use statewide cancer surveillance data to assess the effectiveness of statewide cancer prevention initiatives on colorectal cancer by analyzing changes in late stage diagnosis rates and to assess the changes in economic burden over time. Data from the Pennsylvania Cancer Registry was used to assess changes in late stage diagnosis through analysis using logistic regression. Additional analyses using group level poisson regression on the same dichotomous outcome and polytomous logistic regression using the standard cancer stage categories were conducted for specificity comparative analysis. Data from the Pennsylvania Health Care Cost Containment Council was used to assess the changes in economic burden using log linear models on inpatient costs and charges. The expected results of the study are a statistically significant decrease in late stage colorectal cancer diagnosis over time and an increase in economic burden of colorectal cancer over time. Reductions in late stage cancer diagnosis can potentially correlate to reduction of mortality from colorectal cancer. Additionally, the methods used in this study can be applied to assess the effectiveness of cancer prevention initiatives using statewide surveillance data in other states.