1, 2, 3, Stop the Bleed: Analysis of a Bleeding Control Educational Course

Hemorrhaging, or uncontrolled bleeding, accounts for 40% of preventable deaths in the United States that occur after a traumatic injury. The Stop the Bleed campaign was launched in 2015 by the White House National Security Council to educate the public about methods to control and stop bleeding as well as empower individuals to take action if a traumatic accident occurs. The goal of this study was to evaluate the effectiveness of the “Stop the Bleed” bleeding control course to increase knowledge about the topic as well as increase confidence to take action and use the techniques that were taught during the course appropriately. Data was collected via a cross sectional pre-post survey design. At baseline, the participants were asked basic knowledge questions about bleeding control and techniques to use as well as how confident they felt using those skills. After being presented the bleeding control material and practicing the techniques in the hands-on portion of the course, the participants were asked to complete a post-test with similar questions to that of the pre-test. De-identified responses were collected to analyze the changes in the overall knowledge scores and overall confidence scores with the use of the paired-t statistical test on SPSS. The participants (N=32) were employees within the Thomas Jefferson University Campus Security department. The overall score for the knowledge-based questions were analyzed from pre to post and showed that the changes were statistically significant (8.163,

Prevalence of Asthma Severities in Children and Adolescents in a Wilmington, DE Hospital

Asthma affects over 24 million individuals in the US and the prevalence of the condition is increasing in the US and worldwide. The prevalence of severe persistent asthma, which incurs a significant health and economic burden, is still poorly understood in children and adolescents. We aimed to define the prevalence of asthma severities in children and adolescents in an urban hospital setting as a function of age, sex, race, and ethnicity by assessing prescribed medications as a proxy for asthma severity according to NIH guidelines for care. We found that a plurality of patients across all age groups, sexes, races, and ethnicities were severe persistent asthmatics. We also found that younger individuals as well as those who are African American have higher odds of being moderate to severe asthmatics. This information can be used to generate hypotheses for future studies and can be used to better address patient needs. In addition, these results suggest that a health disparity among African Americans exists that is consistent with other aspects of the condition. To reduce the prevalence of asthma in all populations, future research should place a greater emphasis on identifying more indicative risk factors for prevention, finding strategies to identify asthma at an earlier age, and developing more effective and personalized therapeutics

Medicinal Cannabis Use in Sickle Cell Anemia

Approximately 100,000 Americans suffer from sickle cell anemia (SCA), a severe hereditary form of anemia in which red blood cells can mutate into a sickled shape causing severe pain crises that can lead to ED visits, hospitalization, and negatively impact multiple organ systems. Pain crises greatly impact the quality of life for SCA patients. Living with SCA can be stressful and often affects patients’ mental health, causing anxiety or depression (National Heart, Lung, and Blood Institute, 2016). Opioids have been a treatment mainstay for the severe pain caused by SCA but the side effects of opioids, plus the risk of dependence, are issues that have led both patients and researchers to consider medicinal cannabis as a treatment option. While there is limited research addressing the treatment of sickle cell pain with cannabis some research does suggest that cannabis could have a beneficial effect on the management of both chronic pain and acute pain (Choo, Feldstein Ewing, & Lovejoy, 2016; Kroenke & Cheville, 2017). The aim of this study is to evaluate the association between medicinal cannabis use and quality of life for individuals with SCA. The primary goal of this pilot study is to gather a cohort of participants and administer a baseline survey that will be used in a larger study. The goal of the larger study is to assess the impact of medicinal cannabis available through Pennsylvania’s Department of Health-approved dispensaries in Philadelphia on the quality of life for individuals with sickle cell anemia (SCA)

Healthy Steps for Older Adults (HSOA) - A Falls Prevention Program Outcome Evaluation

Fall prevention is an increasingly important area in the realm of public health and prevention medicine. Falls continue to be the leading cause of fatal injury and the most common cause of non-fatal trauma-related hospital admissions among older adults in the United States, causing over 2.8 million injuries, over 800,000 hospitalizations, and more than 27,000 deaths annually (NCOA, 2018).As the average age of the population increases, the need for programs that inform the public about their risks of falls has begun to increase. The following study is an evaluation of one such program, Healthy Steps for Older Adults (HSOA). Twenty individuals ages 58 and older were recruited to partake in a two-day informational and interactive session designed to teach those participants about falls, to help them evaluate their own risk of falls, and to provide solutions to reduce fall risk. Questionnaires given a at the start of the intervention on day one, at the conclusion of the intervention on day two, and four weeks after completing the program were used to assess changes in knowledge about falls and fall risk and behavior changes to reduce risks of falling. Participants also completed a “Physical Skill screening” on the second day that included three exercises to identify their relative fall risk. Out of the twenty participants, fourteen responded to the follow-up phone interview. Of those fourteen individuals, 85.71% changed at least one behavior to help reduce their risk of falls by the time they were contacted to complete the four-week post-intervention follow-up questionnaire, and the program is therefore an effective falls-prevention program based on our definition (at least 50% of participants changed at least one behavior to reduce their risk of falls). Additional analysis supports the claim that there may be a lower limit age for which the program is effective, and that being placed in a moderate or high risk fall category may be associated with increased likelihood of making a positive behavior change to reduce fall risk. However, more data is needed to establish statistical significance. Areas of concern reflect a suggested need to incorporate family members into the intervention, establish a standardized benchmark for determining program effectiveness, and improve comparability between pre- and post-intervention questionnaires. Overall, the program by our definition was successful, but specific limitations regarding the logistical implementation and evaluation of the program should be addressed if the program were to be run again

Screening, Brief Intervention, and Referral to Treatment (SBIRT) Training for TJUH Trauma Staff

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a proven public health approach for early intervention and referral to treatment for people with existing, or who are at risk of developing, substance abuse disorders. The Pennsylvania Trauma Systems Foundation (PTSF) includes SBIRT completion as an accreditation requirement under Standard 6 “Performance Improvement & Patient Safety Program.” In the 2016 PTSF site survey, Thomas Jefferson University Hospital (TJUH) Trauma Unit did not pass on the SBIRT requirement. The PTSF benchmark of completion is 80%; a data analysis of medical records from the TJUH Trauma Unit showed the 2017 completion rate to be 42%. A survey of the Trauma Staff reported that 62% had never heard of SBIRT. The goal of this project was to create a training module on SBIRT for the TJUH Trauma Staff to help them achieve the PTSF standard by the April 2019 site survey. The staff-training module was provided at the New Waves in Trauma Conference in October 2018, and it was delivered via email to the staff who did not attend the conference. Employees responded to a post-training quiz immediately following the training to assess its effectiveness on increasing knowledge and awareness of SBIRT. Ninety-eight percent of the staff said that the training informed them of their role in the TJUH SBIRT workflow, while 97% said that the training made them feel more confident in using the SBIRT with their patients. The results suggest that the SBIRT training was effective in its goals of educating the Trauma Staff, and can be used as an argument for the TJUH Trauma Unit to implement annual, mandatory SBIRT training

An Examination of the Cumulative Effect Model of Adverse Childhood Experiences: Are All ACEs Created Equal?

Adverse childhood experiences have been linked to a wide variety of physical and mental/behavioral health outcomes later in life by many studies since a major research effort by Dr. Vincent Felitti in 1998. The majority of this research has used a cumulative model of the ACEs of participants, or what is known as an ACE score, and has linked a higher ACE score to an increased likelihood of negative health outcomes later in life. Other predictive models involving health conditions such as the LACE hospital readmission model and Charlson Comorbidity Index weight different factors of their models in the predictive assessments. The purpose of this Capstone project is to demonstrate that the cumulative ACE model may require revision in its assumption that all ACEs contribute equally to an ACE score, and that different ACEs may contribute more or less significantly than others. To accomplish this goal, the Behavioral Risk Factor Surveillance System (BRFSS) data from 2009 to 2012 was coded in a way that allowed for binary logistic regressions to be performed on single, 2 combination, and 3 combinations compared to those with no ACEs to create odds ratios of having angina/coronary artery disease or a smoking habit later in life. These odds ratios were then grouped in frequencies to show that different combinations varied widely in their odds ratio compared to the generic ACE score. Further research into this is necessary, especially if specific weights are to be created in order to revise the model, but it helps demonstrate that the cumulative effects model may be incorrect in assuming that all ACEs contribute equally

Breaking the Cycle of Addiction: Post Event Intervention Strategies

Opioid overdoses in the United States continue to persist as a significant public health problem and cause of morbidity and mortality. Pennsylvania and Philadelphia have some of the highest rates of overdose death nationwide. Patients who experience and survive an overdose event are at high risk for experiencing another. The objective of this study was to identify secondary prevention strategies used throughout the United States to engage opioid users and direct them to definitive treatment for addiction. Programs throughout the United States provided by hospitals, non-profits, and government agencies were queried using search terms “post overdose care” and “overdose follow up”. Results where then characterized by patient engagement strategy. Three predominant patient strategies were identified: “warm hand off”, “field provider facilitated”, and “follow up.” Similar resources in Philadelphia were then searched for and results were compared with the strategies identified at the national level. Philadelphia was found to have one program using the “field provider facilitated” engagement strategy, but no programs utilizing “warm hand off” or “follow up.” Philadelphia’s public health institutions looking to engage a larger audience of high-risk opioid users should consider implementation of secondary prevention strategies such as “warm hand off” and “follow up.

Improving Hypertension Knowledge among Formerly Incarcerated Individuals: An Assessment of a Health Education Program during Community Reentry

The prevalence of hypertension (HTN) among adults in the United States is a serious public health concern. Individuals who are currently, or were recently, incarcerated are found to be at greater risk for HTN than those without a history of incarceration. Although previous HTN prevention and self-management interventions have targeted high-risk populations, there is a lack of research regarding the utility of such programs among formerly incarcerated persons. The purpose of the present study was to determine whether Blood Pressure Understanding and Management Progaram (BUMP), a four-week educational program developed for formerly incarcerated persons, would effectively increase participants’ knowledge of HTN and blood pressure self-management. Four weekly, 60-minute sessions were held at the Institute for Community Justice in Philadelphia. Nine participants completed all four sessions. BUMP classes focused on defining medical terms related to blood pressure, interpreting blood pressure readings, explaining causes and complications of high blood pressure, selecting healthy food options, and discussing lifestyle modifications to manage blood pressure. Participants were asked to complete pre-and post-intervention knowledge assessments consisting of 14 items related to topics covered in the BUMP curriculum. Analyses demonstrated a significant improvement in the mean knowledge assessment score after completion of the four sessions. Further, the percentage of correct responses improved across nine assessment items, while two items remained the same, and only one item declined. These findings demonstrate the potential for community-based educational programs to enhance HTN knowledge among formerly incarcerated persons. Future research should focus on how improvement in knowledge relates to changes in health behaviors and outcomes among this population

The Health and Healthy Behaviors Program at Siraba School in Mali

The Siraba School Village (SSV), a non-profit organization, works to support the educational efforts at Siraba School in Mali, Africa. Siraba School is located in an under-resourced community and supports students in 1st to 6th grades and is connected to a local middle school with students in 7th to 9th grades. SSV runs the Health and Healthy Behaviors Program (HHB) at Siraba School and the middle school to address the knowledge gap around puberty, nutrition, and hygiene. This educational initiative provides monthly health classes to students to address the lack of health education. The program had not been evaluated and students in this setting were not accustomed to pencil and paper (P&P) tests. SSV designed P&P baseline and follow-up quizzes for 4th through 9th grades to assess effectiveness of the curriculum. The lessons focus on 1) women’s reproductive health and puberty; and 2) water and hygiene. Test data was collected and entered in Qualtrics. While the focus of the study was to assess the feasibility of conducting future evaluations using P&P, analysis of pilot baseline and follow-up test scores demonstrated that students had some subject knowledge before each lesson, but were unable to answer short answer questions. Following lessons, students were able to answer short answer questions. P&P tests were well received in this setting and will likely be a useful tool for future HHB evaluations. A report from the pilot assessment was generated for the SSV team and recommendations were provided for the HHB curriculum and future assessments

Human Trafficking: A Curriculum for Public Health Students

Human trafficking is a global issue spanning the entire world through the transportation and purchase of men, women and children for exploitation. Due to overwhelming statistics that victims of trafficking are seen by a healthcare professional; it is important to implement courses into public health curriculum with the hope that the knowledge and attitude changes will create better informed healthcare professionals, with the ability to identify and intervene in clinical settings. This capstone reviews the public health implications of this phenomenon and demonstrates the importance of educating public health students on human trafficking risk factors, identification in medical settings and intervention and prevention strategies. It also develops and provides an educational module for the MPH curriculum to educate Thomas Jefferson students on this fast-growing public health crisis, through a thirty-minute voiceover PowerPoint educational module. In addition, a fact sheet and resource guide is added to the paper so that students in the greater Philadelphia area are aware of the risk factors and who to contact if they do suspect a patient as a victim of human trafficking