Class of 2017 Abstract / Objectives: A chart will be used to assess the need for the asthma education program. The chart review aims to: analyze the refill history of asthma medications along with verifying adherence via electronic health record and assess if patients are getting appropriate asthma therapy per 2007 NHLBI asthma guidelines. Methods: The patient’s MHC Healthcare electronic record profile and pharmacy refill record will be accessed. The information that will be obtained from the electronic health record will be: ethnicity, age, sex, allergic rhinitis diagnosis, flu vaccine status, pneumonia vaccine status, GERD diagnosis, spirometry measure if available, use of prednisone for exacerbation, prescribed asthma therapy, and provider’s (MD, NP, PA, etc)’s notes that might indicate nonadherence. The information that will be obtained from the pharmacy record are controller and rescue medication refill history. The information will be recorded in paper data collection forms and electronic versions will be saved to the secure college of pharmacy workgroup. The raw physical information described above will be stored in a locked cabinet at MHC healthcare pharmacy inside the pharmacy director’s office and the de-identified information will be stored in the secure workgroup. Results: Conclusions:

No description available.

A breach of the skin barrier, due to a burn wound, facilitates colonization by various microorganisms. Burn wounds can become colonized from the patients’ own skin flora, respiratory tract, or with exogenous bacteria from the environment. Strategies to treat burn wound infections are multipronged: removal of the infected necrotic tissue, wound dressing to protect the damaged area, and treatment with specific antimicrobials to prevent reinfection. The development of chronic infections, which could potentially lead to sepsis, depends largely on how well the microorganisms form biofilms within the wound. There are numerous antimicrobial gels and antibiotics that help prevent a burn wound from becoming infected, as well as, eliminate an already infected burn wound. However, global antibiotic resistance by microorganisms to these treatments has greatly increased, and it is imperative that new antimicrobial agents be formulated before infections become untreatable. Staphylococcus, Pseudomonas, Acinetobacter, Escherichia, Candida, Citrobacter, and Klebsiella are common causative agents of burn wound infections and are becoming increasingly resistant to antimicrobial medications. A newly synthesized antimicrobial gel compound (AGC) has shown promise in preventing growth of various bacteria and fungi commonly associated with burn wound infections. This study evaluated the activity of the AGC on a panel of Gram-positive and Gram- negative bacteria, and the fungi, Candida albicans, which represent the top ten causative infectious agents of burn wounds. The AGC reduced, to varying degrees, the microorganism’s growth, cell viability, and cellular metabolism. This novel antimicrobial compound shows promising potential as an effective option for prevention and treatment of infections in burn wound victims to avoid sepsis.

The Surgeon Generals Conference on Childrens Mental Health held in 2000 brought attention to the fact that children and adolescents with mental health and substance abuse problems are an underserved population. Rates of psychiatric disorders are high among this population, yet very few adolescents who need help actually receive it. A comprehensive literature review was undertaken to examine various aspects of adolescent health, including rates of mental health and substance abuse as well as treatment and mental health service utilization among this population. Barriers to care are discussed, with emphasis on gender, ethnicity, psychiatric diagnosis, treatment setting, and parental influences. In the past, the specialty mental health care sector has been relied on to provide treatment for adolescents. This thesis examines school-based mental health services, and Student Assistance Programs in particular, as alternatives to treatment for the adolescent population. School-based clinics have the potential to reduce some barriers to care, hence increasing rates of care for adolescents with mental health and substance abuse problems. Other recommendations to reduce barriers to care and increase rates of treatment are presented. Mental health and substance abuse have a significant impact on the health of the nation. These disorders cause or exacerbate numerous health problems, including cancer and heart disease. In 1996, mental health problems cost the United States $150 billion in direct and indirect costs (USDHHS, 2000). The relevance of public health in this thesis is exemplified by the potential of public health to decrease the health consequences associated with these disorders by working to increase rates of treatment.

Timely use of emergency contraception after all contraceptive failures could prevent up to 50% of all unintended pregnancies. In 2002, 85% of adolescents pregnancies were unintended, resulting in almost 500,000 births and 235,000 abortions. Emergency contraceptive services may be especially useful to adolescents because of their erratic patterns of sexual behavior and contraceptive use. Providing these services during emergency department hospital visits is vitally important in helping adolescents to prevent unwanted pregnancies. This IRB-approved study aimed to expand upon current data in the literature by assessing the type and amount of emergency contraceptive services provided to adolescents in these hospital settings nationwide. Research included in this thesis represents a pilot study of thirty-two physicians who work in twenty-one childrens hospital emergency departments across the United States. Telephone surveys were conducted with these physicians to assess the types of EC services available in their emergency departments and their attitudes regarding these services. Recommendations for undertaking a full-scale study of this same target population include improving response rates by modifying the survey administration protocol and increasing the number of contacts made with each physician. Results indicate that childrens hospital emergency department physicians are not meeting the current standard of care for emergency contraceptive counseling and prescribing practices with adolescents. These results support the need for increased education and awareness for emergency department physicians in childrens hospitals regarding emergency contraception and strategies to optimally communicate this information to their adolescent patients. The relevance of public health in this thesis is exemplified by the potential of the research to inform both the public health and medical communities about how emergency contraception is provided to female adolescents in children's hospital emergency departments. Comparison of results from both this pilot study and the full-scale study that will be based on this pilot study may lead to legislative and hospital policy change to improve the availability of emergency contraceptive services to adolescents, and hence to a reduction in the unintended pregnancy rate among adolescents.

Many older adults perceive spirituality as an important resource in their lives and spiritual practices as crucial to their health and well-being. Unfortunately, there is limited knowledge of how spirituality is defined by African American and Caucasian American men and women aged 65 years and older. In addition, less understanding on the role spirituality played in the self-management of chronic illness among this population. The purpose of this qualitative study was to define, explore, and describe spirituality in the life of chronically ill elders and to examine its relationship to self-management of chronic illness in terms of gender and race. The grounded theory approach guided the study design and analysis. This study used both comparative method and thematic content analysis in a sample of eighty-eight older adults in the �Self-Care Study,� a NIA-funded study on the process of self-care among older adults. The analytic technique of comparative method defined spirituality while thematic content analysis identified patterns of spirituality and self-management. Each in-depth interview was audiotaped and transcribed verbatim. Results identified three types of spirituality: transpersonal transcendence, interpersonal transcendence, and intrapersonal transcendence. In describing the spiritual/self-management connection nine themes emerged: 1) God: the healer, 2) God: the enabler through doctors, 3) faith in God, 4) prayer as a mediator, 5) spirituality as a coping mechanism, 6) combining traditional medicine and spiritual practices, 7) selected spiritual practices of self-care, 8) empowering respondents to practice health-promoting activities, and 9) personal responsibilities in the self-management of illness. These findings suggest a new direction for public health practice, education, and research. Spirituality is a pervasive factor in this population and may help to ensure positive health-promoting behaviors. The public health significance of this study is great because it is important for public health educators to understand the role spirituality plays in the self-management of chronic illness among the elderly. The implications for public health educators and researchers are the possible collaboration with faith-based institutions to assess, plan, develop, and evaluate interventions within the context of older adults.

In the United States between 1991 and 2001, there was an increase of over 848% in new AIDS cases in African American women fifty and older. This increase is due in part to changes in reporting. Because of the startling statistics and scarcity of studies in this population, this study examines the HIV prevention needs of two groups of African American women over fifty, injection drug users and non injection drug users. Focus groups were used to collect data on general HIV knowledge, experience with HIV prevention, psychosocial factors, drug involvement, and risks and barriers to HIV infection and prevention. Data was also collected through a survey that gathered information on demographics, sources of HIV information, HIV testing and risks including knowledge of risk, belief of risk and risk behaviors. This study found that lack of education and misconceptions regarding disease transmission act as a barrier for prevention efforts; a need for inclusive HIV prevention efforts such as multi-generational in-home programs, multi-family programs and the incorporation of prevention messages with existing health services; a need for skills building, condom negotiation skills and self-empowerment. Effective methods suggested were techniques that align with African American culture and heritage such as storytelling, inclusion of family and community. In order to generalize findings from this study, future research must include a representative sample of African American women 50 years and older such as churchgoers, sorority women, health conscious women, ex offenders, past injection drug users, infected or affected women and newly single women. The findings of this study are significant to public health research because they add to a growing body of knowledge regarding the HIV prevention needs of this group, can be used to design prevention messages for the population from which they were gathered, and most importantly provide insight to what a subpopulation of this group views as effective prevention methods. Recommendations for future research are also provided for federal government agencies, state public health agencies, community organizations, the family structure, HIV service groups, physicians, universities and researchers.

With the growing number of older adults and, therefore, the increasing importance of disability as a public health outcome, it is important to better understand the causes and correlates of functional decline and disability in the elderly. Traditionally, most research on disability has focused on individual risk factors. However, a growing body of research is finding evidence of the role of the social and physical environment in health outcomes generally. But to date, limited research has examined the neighborhood environment as a causal factor in disability among older adults. This dissertation examines the influence of the socioeconomic and social characteristics of neighborhoods and municipalities in Allegheny County, Pennsylvania on individual functional status prevalence and change among a sample of adults 65 and older in the County. The research suggests that some effects of neighborhood social environments on functional status may be present, but are weak relative to individual risk factors. Neighborhood effects were not found for disability prevalence in this sample, but were found for change in function over a period of 20 months. The analysis indicates that neighborhoods with higher rates of serious crime are associated with declines in function. Also, neighborhoods with more concentrated social and economic disadvantages as well as those with more concentrated affluence were both associated with some improvement in function. The association of disadvantage with improvement in function requires further clarification. The analysis suggests that more sensitive measures of disability and function may be required to detect neighborhood effects. This type of research is of great public health relevance because it has the potential to suggest and inform a range of new community-based public health interventions to improve the functional health of the elderly.

The use of dietary supplements by individuals with cancer is increasing. Many individuals with the diagnosis of cancer consume these supplements while undergoing treatment for cancer, including those enrolled in clinical trials. Clinical trials may involve the use of drugs or investigative agents, which are being studied to determine their safety and efficacy in the treatment of cancer. The focus of this study was to determine if individuals enrolled in clinical trials for the treatment of cancer use dietary supplements (vitamins, minerals and herbs) and the reasons why they are using them. The study's aims were (1) to document the use of dietary supplements among patients with breast, prostate, and colorectal cancer who are enrolled in a clinical trial, (2) to evaluate the perceptions of oncologists regarding their patients use of dietary supplements, and (3) to evaluate the design of clinical trials to determine the proportion that specifically address the use of dietary supplements. The study employed an exploratory, descriptive design whereby 99 patients with cancer who were enrolled in a clinical trial for the treatment of cancer were interviewed. A total of 53 oncologists were surveyed and the design of 70 multi-institutional breast, prostate and colorectal cancer clinical trials were reviewed. The study findings indicate that patients with breast, prostate and colorectal cancer are consuming dietary supplements while enrolled in clinical treatment trials. In general, the reasons they are using the dietary supplements are to enhance their health and to do something to help themselves. The patients perception is that they communicate this information to their oncologists, however, detailed information about the dietary supplements such as brand, type, dosage and frequency, is not routinely assessed and documented. In general, the design of the clinical trials did not specifically address the use of dietary supplements, and there were often discrepancies between the description in the study body and the accompanying case report forms. The importance of these findings from a public health perspective is that patients are consuming unregulated substances while enrolled in a clinical trial for the treatment of cancer and potentially may be at risk for drug interactions.

Sexually transmitted disease (STD) testing among sexually active young women is essential in preventing and controlling the STD epidemic. STD testing is critical because infections such as Chlamydia trachomatis and Neisseria gonorrhoeae are primarily asymptomatic in women. If women do not routinely test for STDs, this can facilitate the spread of these diseases and lead to serious sequelae. The research presented explores socio-demographic, psychosocial, and health-related factors that may be associated with young womens STD testing behaviors. The Health Belief Model (HBM) provides the theoretical framework for explaining the relationships that exist between background factors, HBM perceptions of STDs and STD testing, and the total number of STD tests completed during the two-year study. The population studied for this research is a sample of 14 29 year old women, approximately 80% of whom are African-American. Univariate regression analysis between background factors and the outcome indicated that age, race, education, having symptoms of an STD at baseline, current antibiotic use, and having condom problems were associated with an increasing number of STD tests completed. A similar analysis between HBM perception variables and the outcome showed that only perceived severity was significant. A multivariate stepwise linear regression model of significant background and perception factors revealed that having symptoms at baseline, current antibiotic use, and having condom problems were significant to an increasing number of total STD tests completed. These findings demonstrate that an assessment of behaviors and current health status of young women can be helpful in understanding utilization of STD services. The results also suggest that the HBM may not be sufficient in characterizing STD testing behaviors, however, improved measures of these constructs can better assess trends in the data. The public health significance of this study is that it provides theoretical and empirical attention to factors associated with STD testing behaviors, an area of research that has received limited consideration.