Vaccines, Children, and the Public Health Trust

Objectives Review the impact of immunizations on the public health over the past 50 years. Childhood Vaccines Now Describe the challenges associated with trying to eliminate “immunizable” diseases. Examples: Invasive Pneumoccal Disease, Neisseria meningitis The Futur

Needs Assessment: Northeast Philly Opioid Epidemic

Introduction: Philadelphia has the 3rd highest rate of opioid-related overdoses in the nation. This crisis is worsening in Northeast Philadelphia and the Department of Public Health lacks necessary information to intervene in an informed manner. Objective: This study aims to better understand the crisis in this community and to provide key information to guide future harm reduction interventions in the Northeast Philadelphia region. Methods: Using a designed discussion guide, qualitative interviews were completed with key stakeholders and community members. Information regarding personal experiences and opinions about the epidemic was gathered and interviews were analyzed using narrative analysis. In addition, needle counts were completed in public spaces. These counts were used to measure the free needle burden in this community. The findings of this study will be reported to the Department of Public Health. Results: Community member and stakeholder interviews produced a spectrum of opinions surrounding this issue. Major themes include the need for better access to needle exchange services and the idea that the harm reduction needed in this community differs from what would be accepted by its community members. The needle counts reveal that there is not a serious burden in the community, suggesting little need for further needle disposal kiosks in the area. Conclusion: In conclusion, future interventions should be centered around increasing needle exchange services and improving access and visibility of treatment centers in this community. Furthermore, further action should be taken to address the stigma of substance abuse in this community

Analysis of COVID-19 Pandemic Disease Metrics in Nebraska Counties with Large Meat Processing Plants

This poster analyzes COVID-19 disease metrics of counties with large meat processing facilities to counties with small or no meat processing facilities based on different time frames of the COVID-19 pandemic.https://digitalcommons.unmc.edu/surp2022/1009/thumbnail.jp

Why joint conservation and development projects often fail: An in-depth examination in the Peruvian Amazon

Conservation projects commonly claim to convert local people into long-term environmental stewards and improve their well-being. Yet, evidence frequently contradicts these win-win claims. The “multiple environmentalities” framework outlines distinct approaches that projects often use to foster environmental motivation and behavior: (1) neoliberal: constructing material incentives, (2) sovereign: imposing protective laws, and (3) disciplinary: fostering norms and values. We use a mixed method approach to examine how combinations of these environmentalities shape the land use motivations and behavior of 270 families living in 15 project settings in the Peruvian Amazon. We identify four direct reasons why these projects often fail to achieve their intended outcomes, regardless of the environmentalities employed: (1) self-selection of like-minded individuals, (2) limited ability of extrinsic motivators (i.e. material incentives and protective laws) to reduce reported deforestation behaviors, (3) limited internalization of motivations for conservation, and (4) ignored broader economic drivers of deforestation. We argue that these challenges stem from the typical external design of conservation projects based on fixed and limited interpretations of human motivation. Our findings point to the importance of deliberative processes that can support local and external actors to navigate and reframe competing motivations to co-design approaches to conservation governance at local and broader scales.</jats:p

Primary Care Physicians’ Experience and Confidence with Genetic Testing and Perceived Barriers to Genomic Medicine

Purpose: Genetic testing is progressing towards use of patients’ genomes for personalized medicine. Primary care physicians (PCPs) may use genetic tests to screen and assess risk. However, PCPs’ current preparedness for the expanding integration of genetics into practice is uncharacterized. We examined primary care physicians’ perceptions of and experience with genetic testing. Methods: An anonymous survey was mailed to PCPs across three regional health networks querying opinions of, experience with, confidence in, and perceived barriers to genetic testing. Results: The survey response rate was 37.8%. Respondents believed learning about new genetic advances was important to clinical practice (67.0%). A minority (19.0%) had ordered genetic testing in six months, with cancer risk testing the most frequently ordered. Respondents were not confident in the skills required for using genetic testing in practice. Few respondents felt that they had time to counsel about genetic risk (9.5%) or that most patients could comprehend the concept of risk (27.0%). Conclusions: Primary care physicians had a high opinion of using genetic testing in medicine, but reported little experience or confidence incorporating genetic testing into practice. A majority perceived time constraints and patient comprehension as barriers. These data demonstrate a need for genetics educational resources for physicians and patients

Department of Internal Medicine-Pediatrics Posters - 2019

Department of Internal Medicine-Pediatrics Posters - 2019https://scholarlycommons.libraryinfo.bhs.org/research_education/1012/thumbnail.jp

Evidence to guide the optimal timing for pre-chemotherapy blood tests for early breast, colorectal cancer and diffuse large B-cell lymphoma

Background: Re-designing services and processes to meet growing demands in chemotherapy services is necessary with increasing treatments. There is little evidence guiding the timing and thresholds to be attained of pre-chemotherapy blood assessments, namely neutrophils. // Methods: A survey was developed and distributed to health professionals in the United Kingdom (UK) to examine current practice in timing and threshold values of neutrophils and platelets before treatment administration. This was followed by a retrospective cohort study, using data from electronic patient record systems; including patients initiating treatment between January 2013 and December 2018, to determine a safe timeframe for blood assessments; comparing neutrophil, platelet, creatinine and bilirubin levels at different time points. // Results: The survey captured 25% of hospitals in the UK and variations were apparent in both the timing of assessments and thresholds needed, particularly for neutrophils. 616 (6.5%) of 4007 patients included had neutrophil levels measured twice within 7 days of treatment (with the first level taken beyond 3 days and the second test being within 3 days of treatment- the UK standard). Of the patients that attained an acceptable neutrophil level at their first test, five of the 616 (0.8%) became ineligible for administration from the test 2 level. 23% of patients improved their grade and became eligible for treatment. Little difference was observed for platelets. // Conclusions: We have demonstrated that extending the timeframe for blood tests can be safe, however, this practice may cause unnecessary delays for patients if only an early test is relied on for eligibility

Development and validation of a risk score (Delay-7) to predict the occurrence of a treatment delay following cycle 1 chemotherapy

BACKGROUND: The risk of toxicity-related dose delays, with cancer treatment, should be included as part of pretreatment education and be considered by clinicians upon prescribing chemotherapy. An objective measure of individual risk could influence clinical decisions, such as escalation of standard supportive care and stratification of some patients, to receive proactive toxicity monitoring. PATIENTS AND METHODS: We developed a logistic regression prediction model (Delay-7) to assess the overall risk of a chemotherapy dose delay of 7 days for patients receiving first-line treatments for breast, colorectal and diffuse large B-cell lymphoma. Delay-7 included hospital treated, age at the start of chemotherapy, gender, ethnicity, body mass index, cancer diagnosis, chemotherapy regimen, colony stimulating factor use, first cycle dose modifications and baseline blood values. Baseline blood values included neutrophils, platelets, haemoglobin, creatinine and bilirubin. Shrinkage was used to adjust for overoptimism of predictor effects. For internal validation (of the full models in the development data) we computed the ability of the models to discriminate between those with and without poor outcomes (c-statistic), and the agreement between predicted and observed risk (calibration slope). Net benefit was used to understand the risk thresholds where the model would perform better than the ‘treat all’ or ‘treat none’ strategies. RESULTS: A total of 4604 patients were included in our study of whom 628 (13.6%) incurred a 7-day delay to the second cycle of chemotherapy. Delay-7 showed good discrimination and calibration, with c-statistic of 0.68 (95% confidence interval 0.66-0.7), following internal validation and calibration-in-the-large of −0.006. CONCLUSIONS: Delay-7 predicts a patient’s individualised risk of a treatment-related delay at cycle two of treatment. The score can be used to stratify interventions to reduce the occurrence of treatment-related toxicity