Browsing by Author "Park, Lawrence P"

Background: Understanding the multifactorial causes of anemia on a population level is important for creating effective interventions that mitigate poor health outcomes associated with anemia, particularly in regions where these rates are highly elevated. This study aims to quantify the relative prevalence of iron deficiency anemia, anemia of inflammation, and micronutrient deficiency anemia within 2 – 11 year olds in Madre de Dios (MDD), Peru, where anemia rates are estimated to be between 40 and 50%. It further aims to assess varying risk factors for given etiologies by community type, particularly as many communities in this region experience varied exposure to gold-mining related methylmercury. Methods: Eight communities along the Madre de Dios River, within the Peruvian Amazon, were selected in order to screen 2 – 11 year olds for anemia. Those qualifying as anemic were invited to provide venous blood samples for iron level, inflammation, and nutrition biomarker analyses in order to differentiate between these anemia etiologies. Health history and household characteristics were gathered in survey format, and analyzed in relation to gathered biomarkers. Results: Overall anemia prevalence (18.5%) was significantly decreased from previous studies. 14.9% were iron deficient, 12.8% showed signs of inflammation, and 12.8% were Vitamin B12 deficient. Anemia prevalence varied significantly by sex. Risk factors for anemia did not vary significantly by community type, other than increased annual income in urban and mining communities, and a reduced likelihood for having been born prematurely within mining communities. Conclusions: Peru’s multi-sectoral approach to reducing anemia has shown promising results in MDD. Health determinant variations have proven largely insignificant for anemia outcomes within the screened communities.

Background: Numerous studies have found broad-spectrum antibiotic exposure to be a risk factor for invasive candidiasis, but the risk of candidemia across the spectrum of antibiotic activity and duration of therapy is not well-defined. This retrospective study aims to characterize the hazard for candidemia with respect to depth and breadth of antibiotic exposure among hospitalized adults.

Methods: In this retrospective cohort study of adults admitted to a three-hospital health system from 2016 to 2021, we assessed the impact of duration and spectrum of antibiotic exposure as a risk factor for development of hospital-onset candidemia. Days of antibiotic spectrum coverage for groups of antibiotics were determined using an antimicrobial spectrum index. A proportional hazard regression model was constructed to contextualize the impact of antibiotic exposure among other established risk factors for invasive candidiasis.

Results: Over 1.2 million days of antibiotic therapy were administered across 162,913 hospital admissions, which included 236 episodes of hospital-onset candidemia. Broad-spectrum antibiotic administration was associated with increased hazard for candidemia in univariable analysis only. Among patients who developed candidemia, broader antibiotic exposure was associated with earlier-onset candidemia, and these patients had high rates of comorbidity and severe illness. In multivariable analysis, neutropenia, shock, total parenteral nutrition use, cirrhosis, and acute renal failure, but not broad-spectrum antibiotics, were associated with increased hazard for candidemia.

Conclusions: Numerous prior studies have associated broad-spectrum antibiotic use with risk for invasive candidiasis. In this large cohort of hospitalized adults with high rates of antibiotic exposure, we did not find an association between duration/spectrum of antibiotic exposure and risk for hospital-onset candidemia when controlling for other risk factors. Further study is warranted to assess the impact of dysbiosis on the risk of invasive candidiasis.

Introduction: Chronic diseases have been increasing globally for decades, while the leading chronic diseases worldwide are cancer, cardiovascular disease (CVD), chronic respiratory disease, and diabetes.1 Behavioral risk factors of chronic diseases that can be modified include physical activity, diet, alcohol consumption and tobacco use.3 4 Several guidelines for screening and prevention recommend that family health history (FHH) is collected by primary care providers for disease risk stratification and management.6 7 MeTree, developed in 2014, is a computerized, patient-facing program that collects information about family health history and generates decision support for providers and patients.6 15 There are several potential barriers to implementation of an online FHH software tool including health literacy, computer skills, and behavioral components. This study collects FHH information through MeTree in a rural population in North Carolina through a unique implementation process using research assistants to manually and verbally assist participants. The aims of this study are to characterize the quality of pedigrees collected and to estimate familial disease aggregation among the families of participants.

Methods: This study enrolled 44 participants from an ongoing study conducted by collaborators from Duke University Health System, Duke Clinical Research Institute,

University of North Carolina Pembroke, and Southeastern Regional Medical Center. To collect FHH information, participants constructed family pedigree in MeTree, one family member at a time with the help of one study research assistant. Once participants created a full family pedigree, an individual risk assessment was generated by MeTree.

Results: More than half of the participants were female (n= 30, 68.2%). The ethnic group that composed the largest part of our study population were Lumbee Indians (n=23, 52.3%) followed by White/Caucasians (n=13, 29.5%) and African Americans (n=7, 15.9%). For quality, the average score across all pedigrees was higher than 65% for all seven components of the criteria. The total number of diseases present among all participants and relatives in the study was 930 (Table 3). Cancer was present in 81.8% of pedigrees and made up 12.2% of all reported diseases. Twenty-five percent of all pedigrees had at least one family member that was diagnosed with lung cancer. Diabetes was also frequently reported and was observed in 75% of all pedigrees. Kidney Disease was reported in at least one or more relatives in 52.3% of pedigrees.

Conclusions: Using a patient-facing online Health Information Technology tool such as MeTree could potentially lead to better health outcomes due to risk assessment and individually-targeted prevention strategies. MeTree may be an important tool to use to address the large burden of chronic diseases in this region.

Introduction: Global pandemics are major contributors to human morbidity and mortality, economic downturn, and lost productivity. In extraordinary circumstances like the COVID-19 pandemic, we see a showcase of these staggering costs. It has been proposed that surveillance for zoonotic infectious diseases will be integral for limiting the next pandemic. In this pilot project, we employ a group of molecular assays to study bioaerosol samples for evidence of viruses that might pose a zoonotic threat.

Methods: Bioaerosol samples and swine farm characteristics were collected from eight farms in Northern Vietnam during the years of 2019 to 2021. We evaluated 256 specimens using conventional PCR/RT-PCR pan-species coronaviridae and paramyxoviridae molecular assays for evidence of viral presence. Amplicons that appeared to represent a targeted virus family were subsequently sent for sequencing and characterized.

Results: The farms surveyed had an average temperature of 26.3oC and relative humidity of 65.0%. Among the 256 bioaerosol samples studied, 2 showed molecular evidence for paramyxoviruses (0.78%) and none were positive for coronaviruses. Sequencing attempts of the positive samples confirmed evidence of paramyxovirus presence.

Conclusions: Compared to previous publications of viral presence on swine farms, the rates in our study were slightly lower than expected. This might suggest that the swine farms surveyed in this experiment had fewer circulating viruses than typically seen. Despite this, our work suggests that molecular studies of bioaerosol samples can be used to non-invasively screen for novel zoonotic pathogens within swine farm facilities.

Introduction: Police brutality is a form of violence that negatively impacts health globally. Illegal drug use increases the likelihood that substance users will meet police globally. Methamphetamine use trends in South Africa have been increasing since the early 2000s. In this paper, secondary data analysis was done to examine predictors of methamphetamine users experiencing police brutality. Methods: Respondent driven sampling was used to recruit a sample of 360 active methamphetamine users in Delft, Cape Town, South Africa. Clinical interviews and computerized interviews were used to capture historical information about demographics, drug use, experiences of police violence, attitudes towards police, gang involvement, and arrest records. Logistic regression models were used to determine predictors of experiences of police brutality by sex. Results: The sample had a total of 202 males and 160 females, experiences of police violence were 53% and 14%, respectively by sex. 94% of participants reported prior arrests. Of those arrests, 48% and 39% were gang and drug related, respectively. Both male and female participants were more likely to experience police violence when reported weapon-related (OR 2.988, 95% CI=1.543-5.787) and drug-related (OR 1.796; 95% CI=1.140-2.829). Discussion: The analysis presented here adds to the current data about predictors of experiencing police violence. Further research should be conducted to determine if these results are generalizable to populations of substance users outside of the Delft township. The creation of policing policies based on research driven interventions need to be drafted and implemented to decrease the negative effects that abuses of police power have on public health.

Abstract

Background: While highly preventable cervical cancer remains a leading cause of

cancer in women globally. Sub-Saharan Africa is disproportionately affected, and in

Kenya specifically, over 4,800 new cervical cancer cases are diagnosed and over 2,000

deaths occur each year. While screening for human papillomavirus (HPV) is a more

cost-effective screening strategy with the potential to increase screening uptake, there is

substantial lost to follow-up (LTFU) for treatment following a positive HPV screen. This

study aimed to identify the predictors of successful treatment acquisition and explore

the barriers and facilitators to seeking treatment among HPV positive women.

Methods: This mixed-methods study was integrated into an ongoing clusterrandomized

trial of implementation strategies in rural western Kenya. This study

randomly selected 100 HPV positive women from the original study database and

conducted a treatment acquisition behavior survey. The study sought a 50/50 ratio of

women who were treated and LTFU, but obtained data from 61 treated women and 39

LTFU women. A subset of 10 women in each group were then selected for in-depth

interviews. Analysis included descriptive statistics to compare treated and LTFU

women’s responses to the survey questionnaire. Interview transcripts were coded and

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analyzed through code-by-code comparisons of women who were treated and women

who were LTFU.

Results: Cost of transportation and distance to the health facility were the most

common challenges in seeking treatment among both treated and LTFU women. Among

women who sought treatment, 67% (n=41) reported that their peers knew their HPV test

result, whereas among LTFU women only 38% (n=15) reported that their peers knew

their HPV test result (p=0.007). There was a significant difference in knowing their peers’

HPV result between treated and LTFU women (p=0.03). Partner support was described

by treated and LTFU women similarly, in that most women reported that they relied on

their partners for transportation money, and that men not understanding the disease

may prevent them from supporting their wives in seeking treatment. Additional barriers

included fear of the treatment process, stigma within their community, logistical

barriers, and lack of information on the disease and treatment. Facilitators to treatment

seeking included peer encouragement, support and encouragement of their children,

involving men in educational sessions, bringing facilities closer and providing

transportation to the health facility.

Conclusions: Cost of transportation, distance to the treatment facility, support of

partners and children, feelings of fear and stress, stigma within the community and

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logistical barriers were reported similarly across treated and LTFU groups. The greatest

disparity between the two groups was a lack of social support among LTFU women.

Given the potential impact of involving men and women in the community in

educational sessions, and promoting treatment seeking in groups, interventions that use

these treatment facilitators are needed.

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