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A Comparison of Classification Trees to Logistic Regression For Exploring CNS and Systemic Biomarker Predictors of Patient Outcome After Traumatic Brain Injury
No full textThere are no approved neuroprotective treatment options for individuals with moderate-to-severe traumatic brain injury (TBI). However, knowledge gaps exist regarding the development and use of early prediction tools that incorporate biomarkers and clinical features reflecting aspects of both central nervous system (CNS) and systemic injury for identifying likely responders to potential neuroprotective treatments. Thus, a secondary analysis was conducted of the ProTECT III multi-center randomized clinical trial utilizing data from N=536 patients who also enrolled in the BioProTECT biosampling protocol. Baseline clinical measures [age, sex, race, Rotterdam CT score, index GCS (iGCS)], assayed systemic injury biomarkers and hormones (serum progesterone, androstenedione, estrone, testosterone, estradiol, and TNFα) and assayed CNS biomarkers (SBDP, S100B, UCHL-1, GFAP) were utilized to predict TBI overall favorable vs. unfavorable outcome using the Glasgow Outcome Scale-Extended (GOS-E) at 6-months and 6-month mortality status. Classification and Regression Tree (CART) models were employed to predict outcome, and findings were compared to logistic regression. Overall, logistic regression outperformed CART modeling; however, both methods identified some consistent baseline predictors. Features common to both GOS-E models included GFAP, age, Rotterdam, iGCS, progesterone, and S100B. Features common to both mortality models included GFAP, age, Rotterdam, and TNFα. The outcomes of this project carry significance for public health as they contribute to an enhanced understanding of biomarkers associated with a patient’s response to TBI and their predictive role in survival and other survivor related outcomes
Improving Access and Patient Satisfaction Within Pediatric Specialty Care Services
No full textPurpose: The purpose of this essay is to establish an understanding of improving access and patient satisfaction in a pediatric hospital, specifically the pediatric specialty care outpatient clinics, by impacting the effectiveness of two projects and an outreach program. The goal of these projects and program is to improve the patient caller experience, build relationships with external family physicians and their associated offices to increase the number of patient referrals to an urban pediatric hospital and its specialty care services, and better satisfy patients with an in-house, free-of-charge medication dispensary cabinet.
Approach: Implementing two individual projects, one relating to access and one relating to patient satisfaction, and revitalizing an outreach program that had been overlooked throughout the peak of the COVID-19 pandemic. I completed research, assisted various stakeholders, and implemented changes that improve several key indicators of access and patient satisfaction.
Results: There has been a decrease in non-scheduling related phone calls for the pediatric specialty care services, improved communication with patients via hospital phone-trees, improved relationships with external family physicians, and patients and physicians now have the option to receive and dispense free-of-charge starter-dose medications and prescriptions.
Conclusion: The two projects and outreach program have all positively impacted the pediatric specialty care clinics in regard to patient satisfaction, experience, and overall access to care
Key Gaps in the Delivery of Comprehensive Clinical Services for Sexually Transmitted Infections (STIs) in Allegheny County
No full textProblem: The CDC reports a steep rise in the number of reportable sexually transmitted infections in the United States over recent years. The ACHD STI/HIV Clinic provides comprehensive STI care, however, considering uninsured and underinsured populations, the health department's clinical services are challenged while providing free or low-cost specialty care. This care deficit impedes sexual and reproductive health adding to the economic burden on the health systems. This matter warrants immediate attention from health authorities, public health specialists, and government bodies.
Methods: 1) Examine County-level operations to identify low-cost specialty care options that allow for clinic enhancement per the CDC best practice standards, especially while providing care for STI complications in the uninsured and underinsured. 2) Review current policies, literature, and reports from public health agencies and relevant articles.
Results: Medicaid, Medicare, and sliding scale are low-cost options currently available for primary care at FQHCs. The Birmingham clinic and McKeesport’s Ninth Street clinic provide specialty care for the uninsured in Allegheny County. The financial assistance programs are offered by AHN and UPMC networks for those with STI complications regardless of HIV status. Other non-profit organizations such as the AHN Center for Inclusion Health and Pittsburgh Area Center for Treatment of HIV provide low-cost specialty care for STI complications in uninsured and underinsured individuals living with HIV, while Planned Parenthood, Allies for Health and Wellbeing, and Central Outreach Wellness Center provide low-cost care for STIs in uninsured regardless of HIV status.
Conclusion: Structural bias, racism and stigma inherently co-exist within the health systems. Allocating more public health funds can allow for enhanced quality of STI clinical care services including specialty care, developing health programs with a focus on harm reduction, and above all, destigmatizing STIs is essential for improving sexual and reproductive health outcomes. Point-of-care testing, linkage to care, along with financial and social support are promising. As a local government agency, ACHD advocates for public health initiatives driven to overcome health inequities and provides free STI care in Allegheny County
Investigating Miscarriage Risk Factors: A Cross-Cluster Analysis in Thatta District, Sindh, Pakistan: findings from Global Networks’ Maternal and Newborn Health Registry
No full textMiscarriage, a global public health issue, has unique implications in low-resource settings in areas such as Thatta, Pakistan. This prospective interventional cohort study aims to assess the rate of miscarriage and the factors that contribute to it in the female reproductive age range of 18-45 years old residing in Thatta. This article used data from the Global Network's maternal and neonatal health registry, which spanned the period of July 2022 to December 2022. A total of 526 women were interviewed, 292 women in the high miscarriage group (miscarriage rate >100 / 1000), and 234 women in the low miscarriage group (miscarriage rate <100 / 1000), revealing specific demographic characteristics related to differences in miscarriage rates; maternal age and education emerge as significant factors. Miscarriage rates were greater among older women, particularly those above 35 years of age (p = 0.001), and those with lower levels of education (p < 0.001). Furthermore, home births were associated with higher rates of miscarriage (p = 0.01) than hospital or clinic deliveries, indicating the need for competent attendants and improved access to medical services. A focused intervention was implemented encompassing a PowerPoint presentation - including the causes, symptoms, treatment, and prevention of miscarriages – along with the average score achieved by participants before the intervention (pre-tests), and after (post-tests). A significant increase between the pre-test and post-test values of 17 lady health workers (p = 0.009), highlights the efficacy of the targeted intervention in enhancing healthcare delivery
Contact Tracing and Partner Notification Services for STI Prevention in the Digital Era: A Literature Review
No full textBackground: Sexually transmitted infections (STIs) pose a significant public health concern. Easily communicable and associated with decades of stigma, STIs require robust and interdisciplinary approaches for their management and reduction. Over the last decade, STI rates have risen drastically, indicating a clear need for adaptions to public health responses. Contact tracing and partner notification services are used to aid in the prevention of STI’s by identifying a person who has potentially been exposed to coordinate testing and care. This literature review examines studies done over the last 15 years that specifically discuss how the use of technology can be a strong tool in STI contact tracing, partner notification services, and coordinating testing. This essay aims to explore ways that technology has aided in the advancement of epidemiological prevention of STI’s, unpack the limitations that exist in practice, and make recommendations for future directions.
Methods: Literature was collected through the online database Ovid Medline using keywords “contact tracing,” “partner notification” and “partner notification services,” “digital contact tracing,” “epidemiology,” and “sexually transmitted diseases” to narrow the search. Literature was then put through a screening process and assessed for eligibility against a set of inclusion and exclusion criteria. A total of 23 (n=23) articles were included in this literature review.
Results: The literature demonstrates that new forms of technology, including instant messaging and social apps, have the capacity to aid clinicians and public health practitioners in more efficient contact tracing services while being a method of communication that is supported by communities included in studies. Modern technology as a tool for contact tracing is convenient for the client and eases provider burden in conducting contact tracing and sharing results. Limits and gaps in practice remain, namely concerns over privacy and data protection and staff reassignment and funding issues.
Keywords: contact tracing, sexually transmitted diseases and infections, epidemiology, technology, partner notification services
Recommendations on public health strategies for sexually transmitted infections in China
No full textSexually Transmitted Infections (STIs) are a major public health challenge globally, affecting the health, well-being and quality of life of millions of people. Despite efforts to contain these infections through education, preventive measures, and treatment, the prevalence is still high. Although China has actively responded to the global health sector strategy on HIV, viral hepatitis and sexually transmitted Infections 2022-2030 proposed by the World Health Organization, STIs in China are still a public health issue that needs attention due to the combined impact of rapid economic development, rich ethnic diversity, vast geographical range, and institutional changes. This paper highlights the importance of a comprehensive strategy that includes sex education, provision of safety tools, vaccination, and improved testing and surveillance to address the epidemic of STIs in China. According to the current situation STIs, including HIV/AIDS, in China, the differences in prevalence by gender, age and region were analyzed. From a public health perspective, this paper will propose improvements that can be made in the control of STIs in China
Supportive state labor context and improved mental health among adults in the United States: Attenuated benefits for Latina/o/x populations
No full textObjectives. To examine associations between state labor policies and mental health in the United States (U.S.) population and determine whether such policies benefit Latina/o/x populations specifically.
Methods. Data were derived from the Household Pulse Survey, a national, population-based survey. This study used an index for state labor context that considered three policy domains at the state level (wages, worker protections, and rights to organize). Associations between state labor context and mental health outcomes – validated measures of depression and anxiety - were examined in the overall population and among Latina/o/x adults specifically.
Results. In the overall U.S. sample, participants in states with more a favorable state labor context had lower odds of both depression and anxiety than those living in states with the least favorable index scores. However, the protective effects of state labor context on mental health outcomes were non-significant when restricted to Latina/o/x participants.
Conclusion. These results suggest that favorable state labor policies are associated with better mental health, in aggregate. However, the mental health benefit of these policies are attenuated among Latina/o/x populations. Additional policy research and targeted interventions should address the specific labor policy considerations that contribute to mental health in Latina/o/x populations
Age-related Comparison of Protein Composition in Serum and Platelet-Rich Fibrin (PRF)
No full textPeriodontal disease is one of several inflammatory disease that is found with a higher prevalence in the older adult populations. The pro-inflammatory cytokines IL-6 and TNF- are two proteins that are found in higher concentrations in aging populations and may contribute to the pathogenesis of disease and healing alterations. Additionally, with healing alterations in this population we find a decrease in overall angiogenesis and regenerative potential with reduced delivery of growth factors. Without these growth factors present, conversion to healing phases maybe delayed or altered. Autologous blood products such as platelet-rich fibrin (PRF) are one way to improve wound healing and regeneration by delivering increased concentrations of growth factors. For the current study, growth factors VEGF and PDGF and pro-inflammatory cytokines IL-6 and TNF- were chosen to be analyzed as a function of age in PRF and serum preparations. 43 participants (22 younger and 21 older adults) were enrolled in the study and 20mL of blood was collected for protein quantification. No statistically significant difference in the PRF and whole serum preparations of growth factors were noted in the older adult population. However, cytokine concentrations were statistically significantly higher after initial release 2hrs (day 1). Plasminogen was tested to further understand the degradation of fibrin clots and was significantly higher in both PRF and whole serum preparations in the older adult participant group. Further clinical studies evaluating the age-related differences in growth factors, cytokines and plasminogen and their relationship to wound healing outcomes would be of benefit in this field
Prediction of Milk to Plasma ratio of drugs A Pilot Evaluation of using Rapid Equilibrium Dialysis
No full textBreastfeeding is the optimal way to support neonatal immunity and growth. Many women take at least 1 medication during the breastfeeding period. Some medications can cross the epithelial membrane of the mammary gland and get into the milk which may lead to exposure of maternal medications to the infants and could precipitate unwanted effects. Different factors that may affect the transfer of drug from plasma to milk can be classified into physiological properties and physiochemical properties of the drugs etc.
To measure the impact of these factors, different approaches such as clinical studies, animal studies, in vitro studies and computational models have been employed. There are critical limitations associated with each approach. We decided to focus on the in vitro approaches. The use of rapid equilibrium dialysis (RED) technique, which utilizes two chambers separated by a dialysis membrane, (one chamber represents the plasma and the other represents the milk). The purpose of this thesis is to validate an in vitro model that could help in predicting the milk-plasma ratio (M/P) of drugs with different physiochemical properties i.e., lipophilicity and protein binding. Specifically, we evaluated the impact of changes in fat content in the milk and plasma protein binding on partitioning of a moderately lipid soluble drug, ketamine.
This study developed a sensitive and specific way to measure ketamine and its metabolites in plasma and breast milk. The study documented that ketamine is not adsorbed onto the device used for partitioning. It also documented that plasma protein content had minimal impact on the M/P ratio. The fat content of human milk significantly affected the M/P ratio partitioning. The M/P predicted by partitioning method appeared to under predict clinically observed M/P ratio. This observation is likely related to low fat content of the milk samples. Future studies should focus on evaluating human milk with various fat content on the M/P ratio
Early Implant Failure Using Guided vs. Non-Guided surgical protocol: A Review of Electronic Health Records in a School of Dental Medicine
No full textObjectives: The aim of this study was to compare the early failure rates of guided and non-guided implant surgery, as well as implant placement site and implant system used.
Methods: A one-year retrospective evaluation of electronic health records (EHRs) was conducted at the University of Pittsburgh, School of Dental Medicine (SDM). Implants placed from February 28th, 2022 to March 1st, 2023 were recorded. Whether they were guided or unguided, all failure implants within the same time frame were evaluated. The placement site and implant systems used were documented.
Results: 456 implants were placed. Only 20 implants failed, representing a 4.2% failure rate. 220 implants were placed in the mandible. 236 implants were placed in the maxilla. There was no statistically significant difference in the early failure rate between the maxilla and the mandible (p>0.05). In terms of early implant failure, there was no statistical difference between the guided and non-guided surgical protocols (p>0.05). NobelActive (Nobel Biocare) demonstrated a failure rate of 16.42%, which was statistically significant (p<0.05) when compared to other implant systems.
Conclusion: Within the limitations of this study, there was no difference between guided and non-guided surgical protocols in terms of early implant failure. Maxillary or mandibular implant placement had no effect on early implant failure. The implant systems used had statistically significant failure rate differences, but the correlation was unclear. Therefore, future studies should investigate further systemic and local factors that may be associated with early implant failure to provide stronger evidence