Significance Statement. Results of previous studies have suggested that marital status is associated with health, and that widowhood increases the risk of mortality. Prior research results also suggest that the context of the predeceased spouse’s death may have a bearing on the subsequent health and mortality risk experienced by the bereaved spouse. However, relatively few studies have examined variability in mortality as a function of historical health-related characteristics of the predeceased spouse. Furthermore, no known published studies to date have combined the use of group-based trajectory modeling to empirically evaluate end-of-life patterns of health change in the predeceased spouse with the survival of the bereaved spouse. The present research seeks to contribute to the body of knowledge by combining these two concepts, in order to explore how the predeceased spouse’s trajectory of morbidity during the last year of their life affects the subsequent survival of the bereaved spouse. It seeks, further, to evaluate the potential confounding or effect modifying roles of gender, age, place of death, use of hospice benefits, and the bereaved spouse’s own baseline comorbidity level, on survival. Gaining a better understanding of the impact of specific factors related to the context of the predeceased spouse’s death on the bereaved spouse’s subsequent survival may help health care providers, social service providers, and family members to identify bereaved elderly who may be at greater risk for adverse health outcomes following widowhood. Understanding which aspects of spousal health are most associated with mortality may also point to new strategies for support-based interventions among bereaved elderly. Definition of Key Terms BIC – Bayesian Information Criterion, a criterion for model selection. CHF – Congestive heart failure. COPD – Chronic obstructive pulmonary disease. CI – confidence interval. CMS – Centers for Medicare and Medicaid Services. Crude mortality rate –the cumulative number of deaths/total person-years of follow-up. Crude mortality risk –the cumulative number of deaths/total persons in the cohort.
Significance Statement. The proposed implementation research will reduce stunting among children under 5 by addressing the underlying causes of stunting in Ethiopia. Current interventions fail to sufficiently address stunting (Xxxxxxx, 2014) and researchers are unanimous in their agreement that there is the need for additional research to better understand associations between recommended strategies and reductions in stunting (Cumming et al., 2019; Xxxxxxxxxx et al., 2015; Xxxxxxx, Xxxxx, & Xxxx, 2019). The proposed study will add to the body of evidence on which factors most affect stunting and influence reduction efforts. Outcomes of this implementation research will be widely disseminated among national and global policy makers as well as Public Health communities of practice.
Significance Statement. Improving CVD interventions at health facilities leads to alleviation of disease burden and improvement in quality of lives among affected people. NCDs, including CVDs, reduce productivity and contribute to poverty, create a significant burden on health systems, and lead to a growing economic burden on national economies (WHO, 2010a). Additionally, CVDs have specific characteristics that further aggravate this burden, including that CVDs are to a large extent incurable and affected people live with their disease for a long period of time. This means that long-term interventions would require large amounts of money to be spent, but prevention of CVDs would actually save governments money in the long term. Against the negative impacts of NCDs, priority has to be given for implementing interventions that have a low cost but high impact and provide a good return on investment. Regarding CVD, it has been estimated that a regimen of aspirin, statin and blood pressure-lowering agents may significantly reduce the risk of death from CVD in people at high cardiovascular risk. Providing such a regimen to those eligible between 40–79 years of age has been estimated to avert about one fifth of cardiovascular deaths in the next 10 years, with 56% of deaths averted in people younger than 70 years. With effective management, the average yearly cost per head of implementing such a regimen has been estimated to range from US$ 0·43 to US$ 0·90 in low-income countries (Xxx et al., 2007).
Significance Statement. This study will contribute to filling significant gaps in the literature concerning the impacts of restrictive practice laws in Georgia and will inform policy decisions regarding making Georgia a full scope practice state for APRNS like Certified Nurse Midwives. The results of this study can be valuable to advocates working to move Georgia from a restrictive practice state to a full scope practice state.
Significance Statement. The global TB incidence and an increasingly mobile world population have a significant and growing impact on U.S. TB control efforts. The percentage of U.S. foreign-born TB cases has been rising for over a decade: in 2009, 13 states reported > 70% of individuals diagnosed with TB were foreign-born.3 While only a portion of the disease burden among foreign-born residents is a result of recently arrived immigrants seeking permanent residence, it is a portion for which a system of TB screening is in place and efforts to improve the quality of those overseas screenings are ongoing. Equally important is the handoff between panel physicians performing the overseas TB screening and the follow-up evaluations performed by U.S. State and local public health. An answer to the question proposed by this study would hopefully provide evidence to support expanding the use, terminating the use, or developing others methods of a referral system for immigrants on arrival who are at risk for TB. Improving the completion rate for U.S. TB evaluations would potentially lead to earlier identification of individuals with TB disease, which would in turn reduce the severity of an individual’s disease, the transmission to others in their family and community, and prevent future cases of TB. Definition of Terms Abbreviations AFB Acid fast bacilli ATS American Thoracic Society CBP Customs and Border Protection, a part of the U.S. Department of Homeland Security CDC Centers for Disease Control and Prevention CXR Chest x-ray DTBE CDC Division of Tuberculosis Elimination DGMQ CDC Division of Global Migration and Quarantine DOS U.S. Department of State DOT Directly Observed Therapy DTW Detroit Metropolitan Airport, Detroit, Michigan EBM Evidence-based medicine EDN Electronic Disease Notification system IGRA Interferon gamma release assay IOM Institute of Medicine LTBI Latent TB Infection NTCA National Tuberculosis Controllers Association (NTCA) TIs Technical Instructions TB Tuberculosis TST Tuberculin skin test WHO World Health Organization
Significance Statement. While the purpose and objective of a public health surveillance system may be clear, challenges to design, implement, operate and evolve technical systems to support the increasing data demands to support surveillance objectives is ever more complex and must keep pace with the speed of technological advances. This project-based thesis presents an innovative technique of technical documentation developed in service of a complex global public health surveillance network that may offer a more comprehensive, versatile, and intelligible illustration technique to capture the flow of surveillance data, potentially disrupting conventional techniques within the industry.
Significance Statement. I use an innovative qualitative data source, namely fictional narratives, to tap into image- rich social representations of HIV & AIDS. Narratives provide insight into how people make sense of the world, and how they communicate those understandings to others in their cultural community (Xxxxxx, 1990). The analysis is broadly situated within the Theory of Social Representations (Moscovici 1981; Joffe and Bettega 2003) which focuses on the complex symbolic, emotive and social aspects of everyday lay meaning- making. Social representations communicate norms and values in symbolic form. They are often pre-conscious and therefore less subject to informant bias than conscious evaluative judgments like attitudes. Narratives have been identified as a particularly valuable and underused data source for the study of social representations (Laszlo 1997; Xxxxxx 2002). This study is situated within a multi-country research process on young Africans‟ narratives about HIV & AIDS (Winskell and Xxxxx 2009). In their stories, young people draw on their own lived or imagined experience and on other culturally-determined sources of social understanding to create context, meaning and values (Winskell 2011). Thus, the Scenarios from Africa narratives provide unique insights into young people‟s explanatory models about HIV & AIDS, and into their appropriation of dominant cultural norms around gender, sexuality and stigma (Winskell 2011). Definition of Terms
Significance Statement. The results of the thesis will be given to COTN to show how WASH practices and socioeconomic factors in the villages could be risk factors for diarrheal disease in school-aged children. Additionally, the results could guide the development of interventions targeting specific WASH practices that potentially reduce rates of diarrhea. If successful, these interventions could be scaled up to the district level in areas practicing similar WASH habits with high rates of diarrheal disease. Definition of Terms Diarrhea: Diarrhea is defined as the passage of three or more loose or liquid stools per day (WHO, 2017). School-aged children: For the purposes of this thesis, school-aged children include any child less than 18 years of age who attends school. The range for this study was 3-17 years old. Improved water source: WHO defines an improved water source as one that, “by nature of its construction, adequately protects the water from outside contamination, in particular from fecal matter” (JMP, 2012). Examples of improved water sources include piped household water, public standpipe, borehole, protected dug well, protected spring, and rainwater collection (JMP, 2012). Unimproved water source: An unimproved water sources is not protected from outside contamination and is therefore susceptible to fecal matter and other pathogens. Examples of unimproved water sources include unprotected well, unprotected spring, surface water, tanker truck water, and bottled water (JMP, 2012). Improved sanitation: WHO defines improved sanitation as any sanitation facility “that hygienically separates human excreta from human contact” (JMP, 2012). Examples of improved sanitation include sewer connections, septic system connections, pour-flush latrines, ventilated improved pit latrines and pit latrines with a slab or covered pit (JMP, 2012). Unimproved sanitation: Unimproved sanitation is defined as sanitation facilities that lack the ability to hygienically separate human excreta from human contact (JMP, 2012). Examples of unimproved sanitation include pit latrines without slabs or platforms, hanging latrines, bucket latrines, or open defecation in fields or forests (JMP, 2012).
Significance Statement. The significance of this project is in the Sunapsis system’s ability to facilitate the work of the international office at Emory University. This work is critical to allowing international students and scholars to remain in the United States, and to allow Emory as an institution to continue enrolling international students, hosting international scholars, and hiring international employees. Remaining in compliance with immigration regulations is challenging even with a small population; Emory’s international population is significant. Tools provided by the system would assist the international office in automating required reporting and drawing attention to potential problems before the scholar and/or the institution falls out of compliance. What does this mean for the Xxxxxxx School of Public Health? As of the 2012/2013 reporting period, Xxxxxxx employs or hosts 63 international scholars from 25 different countries. They are engaged in teaching, research and service in nearly every department at Xxxxxxx.2 Many more scholars are not hosted by Xxxxxxx but are at Emory making contributions to the field of Public Health through the Task Force for Global Health, the Global Health Institute, The Xxxxxx Center, and other organizations. Xxxxxxx also offers several fellowships that invite international students and scholars. These include the Muskie Graduate Fellowship; the Xxxxxxxx Fellowship; the HIV/AIDS and Tuberculosis (EITRP) training program, funded by the Xxxxxxx Foundation; and the Xxxx Xxxxxxxx Fellowship. Emory continues to exercise commitment to bringing international Public Health scholars to the United States; that commitment requires support from an international office. The successful implementation of an international student and scholar case management 2 Due to privacy considerations, information that may allow an international scholar to be personally identified cannot be provided. system will allow the office of International Student and Scholar Services to continue providing that support at an optimal level. Definition of Terms DHS: Department of Homeland Security. Includes the following relevant entities: o ICE: Immigration and Customs Enforcement SEVP: Student and Exchange Visitor Program SEVIS: Student and Exchange Visitor Information System, houses records of F-1 students, J-1 exchange visitors, and their dependents SEVIS RTI: real-time web-based SEVIS interface Batch: SEVIS reporting via XML files containing multiple records o U...
Significance Statement. The interdisciplinary approach of this study is critical to a patient’s experience during and after labor is affected by the telehealth services offered by various members of the healthcare workforce during the pandemic. Additionally, the study approach, including screening and in-depth interview questionnaires, can be applied to future studies. This study will provide data and information to help in the assessment of if telehealth can improve pregnant persons’ access to care and their satisfaction of care. Research findings will furthermore strengthen information on patient attitudes towards telehealth and how they differ across locations in Georgia to improve telehealth services offered by providers of perinatal care in Georgia.
