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Abstract
INTRODUCTION Adoption of telemedicine by healthcare facilities has dramatically increased since the start of coronavirus pandemic; yet, major differences exist in universal acceptance of telemedicine across different population groups. The goal of this study was to examine population-based factors associated with current and/or future use of telemedicine in Alabama. METHODS A cross-sectional survey was administered to 532 participants online or by phone, in four urban and eight rural counties in Alabama. Data were collected on: demographics, health insurance coverage, medical history, access to technology, and its use in accessing healthcare services. Generalized logit regression models were used to estimate the odds of choosing "virtual visit" and "phone communication" compared to "in-person visit" for the preferred choice of visit with the healthcare provider; as well as odds for willingness to participate in "virtual visit" in the future. RESULTS Our study sample had a mean age of 43 (±15) years, 72.9% women, 45.9% Black or African American; 59.4% population living in an urban county. The odds of "phone communication" were higher compared to the odds of "in-person visit", with a unit increase in age (odds ratio: 1.02, 95% confidence interval: 1.00-1.03), after adjusting for other covariates. Among participants with past experience of virtual communications, the odds for choosing "virtual visit" were significantly higher compared to choice of in-person visit (odds ratio for virtual visit: 3.23, 95% confidence interval: 2.01-5.18), adjusted for other covariates. Further, people with college or more education were 71% less likely to choose "No" compared to those with high school or lower general education development education for future virtual visit [odds ratio for college or more: 0.29, 95% confodence interval: 0.10-0.87). Likewise, participants residing in rural counties were 57% less likely to choose "No" compared to urban counties for future virtual visit (odds ratio for rural participants: 0.43, 95% confidence interval:0.19-0.97). DISCUSSION Our study found notable differences in age, education, and rurality for use and/or preference for telemedicine. Medical institutions and healthcare providers will need to account for these differences to ensure that the implementation of telemedicine does not exacerbate existing health disparities.
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Affiliation(s)
- Meghan Tipre
- Division of Preventive Medicine, Office of the Outreach and Engagement, O'Neal Comprehensive Cancer Center, School of Medicine, The University of Alabama at Birmingham (UAB), Birmingham, AL, USA
- O'Neal Comprehensive Cancer Center, UAB, Birmingham, AL, USA
| | - Isabel C Scarinci
- O'Neal Comprehensive Cancer Center, UAB, Birmingham, AL, USA
- Department of Obstetrics and Gynecology, UAB, Birmingham, AL, USA
| | - Vishruti N Pandya
- Division of Preventive Medicine, Office of the Outreach and Engagement, O'Neal Comprehensive Cancer Center, School of Medicine, The University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Young-Il Kim
- Division of Preventive Medicine, Office of the Outreach and Engagement, O'Neal Comprehensive Cancer Center, School of Medicine, The University of Alabama at Birmingham (UAB), Birmingham, AL, USA
- O'Neal Comprehensive Cancer Center, UAB, Birmingham, AL, USA
| | - Sejong Bae
- Division of Preventive Medicine, Office of the Outreach and Engagement, O'Neal Comprehensive Cancer Center, School of Medicine, The University of Alabama at Birmingham (UAB), Birmingham, AL, USA
- O'Neal Comprehensive Cancer Center, UAB, Birmingham, AL, USA
| | - Sylvia Peral
- Division of Preventive Medicine, Office of the Outreach and Engagement, O'Neal Comprehensive Cancer Center, School of Medicine, The University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Claudia Hardy
- O'Neal Comprehensive Cancer Center, UAB, Birmingham, AL, USA
| | - Monica L Baskin
- Division of Preventive Medicine, Office of the Outreach and Engagement, O'Neal Comprehensive Cancer Center, School of Medicine, The University of Alabama at Birmingham (UAB), Birmingham, AL, USA
- O'Neal Comprehensive Cancer Center, UAB, Birmingham, AL, USA
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Collins IC, Blanchard CT, Tipre M, Oben A, Robinson A, Kako T, Joly JM, Cribbs MG, Casey B, Tita A, Sinkey R. Breastfeeding Practices in Patients with Heart Disease Stratified by Area Deprivation Index. Breastfeed Med 2024; 19:256-261. [PMID: 38502815 DOI: 10.1089/bfm.2023.0295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Objective: We sought to evaluate breastfeeding (BF) practices in patients with maternal cardiac disease (MCD) stratified by area deprivation index (ADI) to identity communities at risk. Study Design: Retrospective cohort of patients managed by the University of Alabama at Birmingham (UAB) Cardio-Obstetrics Program. Patients were included if they had ≥1 prenatal visit with the Cardio-Obstetrics team, delivered at UAB, and had a street address on file. The primary outcome was BF rate at hospital discharge. Secondary outcomes included BF intent on admission and BF at the postpartum (PP) visit. ADI reports socioeconomic disadvantage at the census tract level; 1 = least deprived and 100 = most deprived. Baseline characteristics and BF rates were compared by ADI categories: Low (ADI 1-33), medium (ADI 34-66), and high (ADI 67-100). Results: One hundred and forty-eight patients were included: 14 (10%) low, 42 (28%) medium, and 92 (62%) high ADI. Patients in the high ADI category were younger relative to those in the medium or low ADI (26 versus 28 versus 32 years; p < 0.01) and less likely to be married or living with a partner (30.4% versus 58.5% versus 71.4%; p < 0.01), There was no difference in BF intent between the lowest, medium, and highest ADI categories (85.7% versus 85.4% versus 81.6%; p = 0.38) or BF rates at hospital discharge (100% versus 92.7% versus 85.6%, p = 0.23). However, there was a significant difference in BF rates at the PP visit (90% versus 63.0% versus 38.6%; p < 0.01) even after controlling for differences in baseline characteristics (odds ratio = 0.11 (95% confidence interval [0.01-0.93]), p = 0.043). Conclusions: There was an association between living in a resource-poor community and early cessation of BF in our population of patients with MCD. Community-based interventions targeting mothers with heart disease living in high ADI communities may help these individuals achieve higher BF rates.
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Affiliation(s)
- Isabel C Collins
- University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, Alabama, USA
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Christina T Blanchard
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Women's Reproductive Health, Birmingham, Alabama, USA
| | - Meghan Tipre
- Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ayamo Oben
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Women's Reproductive Health, Birmingham, Alabama, USA
| | - Ashton Robinson
- University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, Alabama, USA
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tavonna Kako
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Women's Reproductive Health, Birmingham, Alabama, USA
| | - Joanna M Joly
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Marc G Cribbs
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Brian Casey
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Women's Reproductive Health, Birmingham, Alabama, USA
| | - Alan Tita
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Women's Reproductive Health, Birmingham, Alabama, USA
| | - Rachel Sinkey
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Women's Reproductive Health, Birmingham, Alabama, USA
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Walcott MM, Tieu HV, Tipre M, Nandi V, Davis A, Wu E, Wheatle M, Frye V, Figueroa JP. Factors associated with discussing HIV pre-exposure prophylaxis (PrEP) among Jamaican medical providers. Int J STD AIDS 2024; 35:188-196. [PMID: 37966358 DOI: 10.1177/09564624231201187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND The Ministry of Health and Wellness of Jamaica has endorsed the use of pre-exposure prophylaxis (PrEP) as an HIV prevention strategy; however, PrEP was not included in the national HIV prevention program in 2021. METHODS A cross-sectional online study involving physicians in Jamaica was conducted in 2021 to describe PrEP awareness, beliefs, attitudes, and practices. The study also assessed individual and social factors associated with discussing PrEP with patients and willingness to prescribe PrEP. FINDINGS The mean age and standard deviation (SD) of the 69 physicians who completed the survey were 45.5 ± 13.6 years. Most of the participants (80%) reported that they were somewhat familiar with PrEP. PrEP attitude and perceived comfort in prescribing PrEP were moderate among participating physicians, with a mean and SD of 3.9 ± 0.8 and 3.6 ± 0.9 respectively. Six percent of physicians reported that they had prescribed PrEP and 17% had discussed PrEP with their patients in the past year. However, most (90%) reported that they were willing to prescribe PrEP after being informed about it. In the unadjusted model, identifying as Christian (compared to non-Christian) and reporting stronger homophobic beliefs were associated with reduced odds of discussing PrEP with patients. In the multivariable model, only homophobia remained statistically significant (OR, 0.24; 95% CI: 0.07-0.63). CONCLUSION The findings suggest that physicians in Jamacia may be willing to prescribe PrEP; however, homophobia is a barrier to discussions, underscoring the need for the Ministry of Health and Wellness to recognize the role that homophobia plays in the national HIV program to further reduce HIV incidence in Jamaica.
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Affiliation(s)
- Melonie M Walcott
- School of Public Health, University at Albany, Rensselaer, New York, USA
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA
| | - Hong-Van Tieu
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Meghan Tipre
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Vijay Nandi
- Laboratory of Data Analytics, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA
| | - Alissa Davis
- Social Intervention Group, Columbia School of Social Work, New York, NY, USA
| | - Elwin Wu
- Social Intervention Group, Columbia School of Social Work, New York, NY, USA
| | | | - Victoria Frye
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA
- Community Health and Social Medicine (CSOM), City University of New York, New York, NY, USA
| | - J Peter Figueroa
- Department of Columbia, University School of Social Work, New York, NY, USA
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Bail JR, Wilson J, Tipre M, Duck A, Hall K, Akinyele O, Bowman T, Hardy C, Garner M, Demark-Wahnefried W, Baskin M. Harvest for health in survivors of chronic disease: A demonstration project in the Alabama Black Belt and Mississippi Delta Region. Transl Behav Med 2024; 14:127-137. [PMID: 37824851 PMCID: PMC10849179 DOI: 10.1093/tbm/ibad062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023] Open
Abstract
This demonstration project expands upon the Harvest for Health vegetable gardening intervention for cancer survivors by: (i) including survivors of other chronic diseases (i.e. heart disease and diabetes); and (ii) targeting an area with known health inequities (Alabama Black Belt and Mississippi Delta Region). To assess: (i) gardening acceptability (engagement, satisfaction, sustainability, and safety); and (ii) changes over time in health behaviors (fruit and vegetable [F&V] intake, and physical activity) and outcomes (physical performance and anthropometrics). Chronic disease survivors (CDS) were recruited across 15 counties in Alabama and Mississippi and provided with gardening supplies and paired with a master gardener (MG). MGs mentored participants in planning, planting, and maintaining a vegetable garden over a 3-month period. Data collection consisted of an electronic survey (baseline, post-intervention, 6-month follow-up) and community-based physical assessments (baseline and post-intervention). Participants (n = 137; 92% African American; Mage = 65) included individuals with a history of diabetes (56%), heart disease (29%), and cancer (26%). Seventy-five percent of participants engaged in gardening ≥3 times a week. Significant improvements in F&V intake (+0.73, P = .04), physical activity (+49.6, P < .01), and 4 of 7 physical performance measures were observed, while positive trends were seen in others. Eighteen participants withdrew (13% attrition rate). No adverse events occurred. Participants were satisfied with their gardening experience (90%) and were still gardening at 6-month follow-up (85%). Seventy-two percent of participants expanded, or planned on expanding, their garden at 6-month follow-up. Harvest for Health was acceptable and associated with improved health behaviors and outcomes.
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Affiliation(s)
- Jennifer R Bail
- College of Nursing, University of Alabama in Huntsville, Huntsville, AL, USA
| | - Jeff Wilson
- North Mississippi Research and Extension Center, Verona, MS, USA
| | - Meghan Tipre
- Department of Medicine, University of Pittsburgh School of Medicine, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Angela Duck
- School of Nursing, University of Mississippi Medical Center, Jackson, MS, AL, USA
| | - Katherine Hall
- School of Nursing, University of Mississippi Medical Center, Jackson, MS, AL, USA
| | - Oluseun Akinyele
- Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tara Bowman
- O’Neal Comprehensive Cancer Center, Birmingham, AL, USA
| | - Claudia Hardy
- Department of Hematology/Oncology, O’Neal Comprehensive Cancer Center, Birmingham, AL, USA
| | - Marcus Garner
- Alabama Cooperative Extension Service, Huntsville, AL, USA
| | | | - Monica Baskin
- Department of Medicine, University of Pittsburgh School of Medicine, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
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Tipre M, Hardy C, Bowman T, Glover M, Gullet P, Baity D, Levy K, L Baskin M. Concept Mapping with Black Men: Barriers to Prostate Cancer Screening and Solutions. J Cancer Educ 2023; 38:1808-1815. [PMID: 37458874 DOI: 10.1007/s13187-023-02336-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/02/2023] [Indexed: 11/18/2023]
Abstract
A structured participatory approach of group concept mapping (GCM) was used to understand barriers and concerns around prostate cancer screening (PCS) among African American (AA) men. One-hundred thirteen AA men aged 35-70 years enrolled from one urban and three rural counties in Alabama. Eighty-five men brainstormed and generated 41 unique ideas in response to a single prompt. Participants (n = 70) sorted ideas into groups and rated them in terms of importance and feasibility to change opinions. Multi-dimensional scaling and cluster analysis were used to analyze the data. Participants (n=50) discussed visual concept maps during three focus-groups and recommended solutions to address key barriers. The mean age of respondents was 52 (±10), 50% were rural, 37% were college-educated, 56% with income <$44,500, and 22% with PROCASE Knowledge Index ≤5. Cluster analyses revealed eight clusters. Participants ranked barriers grouped under "fear of consequences of test," "lack of knowledge," and "costs/no insurance" as most important to improve PCS among AA men. The same three clusters along with "dislike for digital rectal exam (DRE)" were ranked as most difficult to change. No major differences were noted by urban/rural status. Solutions to address barriers included education at a younger age, alternate testing options and open discussion about DRE, and clear and precise messaging by peers and relatable role models. Our study identified specific barriers to PCS among AA with diverse sociodemographic backgrounds. Culturally sensitive interventions delivered by trained healthcare professionals, peers, and relatable role models, can potentially increase PCS among AA men.
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Affiliation(s)
- Meghan Tipre
- Division of Hematology and Oncology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
- UPMC Hillman Cancer Center, Office of Community Outreach and Engagement and Health Equity, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Claudia Hardy
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- O'Neal Comprehensive Cancer Center, Office of Community Outreach and Engagement, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tara Bowman
- O'Neal Comprehensive Cancer Center, Office of Community Outreach and Engagement, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marcus Glover
- O'Neal Comprehensive Cancer Center, Office of Community Outreach and Engagement, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Patricia Gullet
- O'Neal Comprehensive Cancer Center, Office of Community Outreach and Engagement, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Denise Baity
- O'Neal Comprehensive Cancer Center, Office of Community Outreach and Engagement, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kathy Levy
- O'Neal Comprehensive Cancer Center, Office of Community Outreach and Engagement, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Monica L Baskin
- Division of Hematology and Oncology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- UPMC Hillman Cancer Center, Office of Community Outreach and Engagement and Health Equity, University of Pittsburgh, Pittsburgh, PA, USA
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Tinglin J, McLeod MC, Williams CP, Tipre M, Rocque G, Crouse AB, Krontiras H, Gutnik L. Impact of Affordable Care Act provisions on the racial makeup of patients enrolled at a Deep South, high-risk breast cancer clinic. Res Sq 2023:rs.3.rs-3359906. [PMID: 37961144 PMCID: PMC10635303 DOI: 10.21203/rs.3.rs-3359906/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Purpose Black women are less likely to receive screening mammograms and are at a higher lifetime risk for developing breast cancer compared to their White counterparts. Affordable Care Act (ACA) provisions decreased cost sharing for women's preventive screening, potentially mitigating screening disparities. We examined enrollment of a high-risk screening program before and after ACA implementation stratified by race. Methods This retrospective, quasi-experimental study examined the ACA's impact on patient demographics at a high-risk breast cancer screening clinic from 02/28/2003-02/28/2019. Patient demographic data were abstracted from electronic medical records and descriptively compared in the pre- and post-ACA time periods. Interrupted time series (ITS) analysis using Poisson regression assessed yearly clinic enrollment rates by race using incidence rate ratios (IRR) and 95% confidence intervals (CI). Results 2,767 patients enrolled in the clinic. On average, patients were 46 years old (SD, ± 12), 82% were commercially insured, and 8% lived in a highly disadvantaged neighborhood. In ITS models accounting for trends over time, Prior to ACA implementation, White patient enrollment was stable (IRR 1.01, 95% CI 1.00-1.02) while Black patient enrollment increased at 13% per year (IRR 1.13, 95% CI 1.05-1.22). Compared to the pre-ACA enrollment period, the post-ACA enrollment rate remained unchanged for White patients (IRR 0.99, 95% CI 0.97-1.01) but decreased by 17% for Black patients (IRR 0.83, 95% CI 0.74-0.92). Conclusion Black patient enrollment decreased at a high-risk breast cancer screening clinic post-ACA compared to the pre-ACA period, indicating a need to identify factors contributing to racial disparities in clinic enrollment.
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Affiliation(s)
- Jillian Tinglin
- The University of Alabama at Birmingham Heersink School of Medicine
| | | | - Courtney P Williams
- UAB DOPM: The University of Alabama at Birmingham Division of Preventive Medicine
| | | | - Gabrielle Rocque
- UAB DOM: The University of Alabama at Birmingham Department of Medicine
| | - Andrew B Crouse
- The University of Alabama at Birmingham Hugh Kaul Precision Medicine Institute
| | - Helen Krontiras
- UAB Surgery: The University of Alabama at Birmingham Department of Surgery
| | - Lily Gutnik
- UAB Surgery: The University of Alabama at Birmingham Department of Surgery
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Ahmed AM, Hardy CM, Bowman T, Akinyele O, Tipre M, Richardson MB, Baskin ML, Niranjan SJ. Training and Dissemination of Lung Cancer Education Curriculum Among Community Health Advisors in the Deep South: a Program Evaluation. J Cancer Educ 2023; 38:538-544. [PMID: 35254629 DOI: 10.1007/s13187-022-02149-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/20/2022] [Indexed: 05/20/2023]
Abstract
Lung cancer is the leading cause of cancer mortality in the USA. In the rural Black Belt region of Alabama, high rates of lung cancer incidence and mortality coupled with disproportionate lack of access to health services stresses the need for navigating high risk and disproportionately affected groups towards successfully obtaining lung cancer screenings. We utilized our well-accepted Community Health Advisor (CHA) model for education and awareness. This study seeks to evaluate the results of the Alabama Lung Cancer Awareness, Screening, and Education (ALCASE) training on CHAs, program evaluation, and lessons learned. A total of 202 participants were eligible and enrolled for CHA training. One hundred thirty CHAs were included for the final analyses. Descriptive statistics were computed; differences in pre-test and post-test scores were compared across demographic characteristics of the participants using paired t-test/one-way ANOVA. Of the 130 CHAs, 46% were 65 years or older; 98% were African Americans, and 87% were female; 17% of participants were cancer survivors. The mean post-test scores were 2.2 points greater than mean pre-test scores, and the difference was significant (mean (SD): pre-test = 20.8 (2.8) versus post-test = 23 (2.2); p = 0.001). No notable difference in pre-test and post-test scores were observed by CHA's demographic characteristics except by their county of residence or work (p = 0.0019). We demonstrate the capability and value of successfully recruiting and training motivated community members to be able to serve educators to better reach medically underserved and historically excluded communities.
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Affiliation(s)
- Amir M Ahmed
- University of Alabama School of Medicine, Birmingham, AL, USA
| | - Claudia M Hardy
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tara Bowman
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Olusean Akinyele
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Meghan Tipre
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Molly B Richardson
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Monica L Baskin
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Soumya J Niranjan
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, 1720 2nd Avenue South, 540A, Birmingham, AL, 35294, USA.
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Chandler-Laney P, Biggio JR, Tipre M, Carson TL, Bae S, Everett AB, Baskin ML. Relationship Between Race and Gestational Weight Gain in Pregnancy and Early Life in the South Birth-Cohort Study. Matern Child Health J 2023; 27:356-366. [PMID: 36662382 PMCID: PMC11092968 DOI: 10.1007/s10995-022-03584-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/18/2022] [Accepted: 12/23/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The goal of this study was to evaluate whether differences in gestational weight gain (GWG) and adverse perinatal outcomes exist for Black and White women who are overweight or have obesity (OW/OB) at entry to prenatal care. METHODS We enrolled 183 pregnant women with BMI 25-45 kg/m2 (71% black, 29% white) prior to 14 weeks gestation. Data were collected on demographic, medical history, diet and physical activity during pregnancy. Relationships between race and maternal outcomes and infant outcomes were assessed using multivariable logistic regression models. RESULTS The average age of pregnant women were 26 years (±4.8), with a mean BMI of 32.1 (±5.1) kg/m2 at the time of enrollment. At delivery, 60 women (33%) had GWG within Institute of Medicine recommendations and 69% had at least one comorbidity. No significant differences by race were found in GWG (in lbs) (11±7.5 vs. 11.4±7.3, p=0.2006) as well as other perinatal outcomes including maternal morbidity, LBW and PTB. Race differences were noted for gestational diabetes, total energy expenditure and average daily calorie intake, but these differences did not result in significant differences in GWG or maternal morbidity. CONCLUSION The lack of racial differences in GWG and perinatal outcomes demonstrated in this study differs from prior literature and could potentially be attributed to small sample size. Findings suggest that race differences in GWG and perinatal outcomes may diminish for women with a BMI in the overweight or obese range at conception.
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Affiliation(s)
- Paula Chandler-Laney
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Joseph R Biggio
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Meghan Tipre
- Division of Preventive Medicine, University of Alabama at Birmingham (UAB), 1717 11th Ave S, MT 618, 35294-4410, Birmingham, AL, USA
| | - Tiffany L Carson
- Department of Health Outcomes and Behavior, H. Lee Moffit Cancer Center & Research Institute, Tampa, FL, USA
| | - Sejong Bae
- Division of Preventive Medicine, University of Alabama at Birmingham (UAB), 1717 11th Ave S, MT 618, 35294-4410, Birmingham, AL, USA
| | - Alysha B Everett
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Monica L Baskin
- Division of Preventive Medicine, University of Alabama at Birmingham (UAB), 1717 11th Ave S, MT 618, 35294-4410, Birmingham, AL, USA.
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Girling IC, Blanchard CT, Oben A, Robinson A, Kako T, Tipre M, Joly JM, Cribbs M, Casey BM, Tita AT, Sinkey R. The effects of social determinants of health on breastfeeding practices in patients with heart disease. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Lobbous M, Abdelrashid M, Estevez-Ordonez D, Markert J, Tipre M, Brown E, Nabors L, Lewis C. EPID-12. REGIONAL VARIATIONS IN THE INCIDENCE OF BRAIN GLIOMA IN ADULTS IN ALABAMA. Neuro Oncol 2022. [PMCID: PMC9660307 DOI: 10.1093/neuonc/noac209.422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
BACKGROUND
Gliomas are the most common primary brain tumor in adults in the US with an annual age-adjusted incidence rate (AAA-IR) of 4.67 to 5.73 per 100,000 persons. There are several sources of carcinogenic contaminants in northeast Alabama and western Georgia with the Coosa River serving as the region’s primary water source. We aimed to examine the incidence rate of glioma, as well as tumor characteristics and overall survival, in northeast Alabama compared to the rest of the state.
METHODS
This is a retrospective cohort study using the UAB Neuro-Oncology clinic database including adult patients ( ≥ 20 years at diagnosis) with histologically confirmed diagnosis of glioma (ICD10: 71.9) residing in the state of Alabama at the time of diagnosis between January 2015 and December 2019. We calculated AAA-IR among residents in counties intersected by the Coosa River in northeast Alabama (exposed group) compared to the rest of the state (non-exposed group). The electronic medical records of the participants were reviewed for patient demographics, insurance status, tumor grade and molecular markers, as well as the vital status. The overall survival was graphically examined using Kaplan-Meier.
RESULTS
A total of 660 patients were included in this study (528 non-exposed, and 132 exposed). The AAA-IR of glioma in the exposed group was 4.76 per 100,000 persons vs 3.14 per 100,000 persons in the non-exposed group with a 50 % higher incidence rate of glioma in the exposed group (RR = 1.50; 95% CI, 1.22-1.89). There was no statistically significant difference between the two groups with respect to age at diagnosis, sex, race, surgery type, tumor grade, IDH status, or overall survival.
CONCLUSIONS
Our findings indicate a higher incidence of glioma in northeast Alabama. Future geospatial and population-based epidemiological investigations are needed to identify possible regional environmental risk factors and examine temporal sequence.
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Affiliation(s)
- Mina Lobbous
- Cleveland Clinic Foundation , Cleveland, OH , USA
| | | | | | - James Markert
- University of Alabama at Birmingham , Birmingham , USA
| | - Meghan Tipre
- University of Alabama at Birmingham , Birmingham , USA
| | | | - Louis Nabors
- University of Alabama at Birmingham , Birmingham , USA
| | - Cora Lewis
- University of Alabama at Birmingham , Birmingham , USA
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Tipre M, Bolaji B, Blanchard C, Harrelson A, Szychowski J, Sinkey R, Julian Z, Tita A, Baskin ML. Relationship Between Neighborhood Socioeconomic Disadvantage and Severe Maternal Morbidity and Maternal Mortality. Ethn Dis 2022; 32:293-304. [PMID: 36388861 PMCID: PMC9590600 DOI: 10.18865/ed.32.4.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Rates of severe maternal morbidity and maternal mortality (SMM/MM) in the United States are rising. Disparities in SMM/MM persist by race, ethnicity and geography, and could partially be attributed to social determinants of health. Purpose Utilizing data from the largest, statewide referral hospital in Alabama, we investigated the relationship between residence in disadvantaged neighborhoods and SMM/MM. Methods Data on all pregnancies between 2010 and 2020 were included; SMM/MM cases were identified using CDC definitions. Area deprivation index (ADI) available at the census-block group was geographically linked to individual records and categorized using quintile cutoffs; higher ADI score indicated higher socioeconomic disadvantage. Generalized estimating equation models were used to adjust for spatial autocorrelation and ORs were computed to evaluate the relationship between ADI and SMM/MM, adjusted for covariates including age, race, insurance, residence in medically underserved areas/population (MUAP), and urban/rural residence. Results Overall, 32,909 live-birth deliveries were identified, with a prevalence of 9.8% deliveries with SMM/MM with blood transfusion and 5.3% without blood transfusion, respectively. Increased levels of ADI were associated with increased odds of SMM/MM. Compared to women in the lowest quintile, the adjusted OR for SMM/MM among women in highest quintile was 1.78 (95%CI, 1.22-2.59, P=.0027); increasing age, non-Hispanic Black, government insurance and residence in MUAP were also significantly associated with increased odds of SMM/MM. Conclusion Our results suggest that residence within disadvantaged neighborhoods may contribute to SMM/MM even after adjusting for patient-level factors. Measures such as ADI can help identify the most vulnerable populations and provide points to intervene.
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Affiliation(s)
- Meghan Tipre
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, AL, Address correspondence to Meghan Tipre, DrPH MSPH; Department of Medicine, University of Alabama at Birmingham;
| | - Bolanle Bolaji
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, AL
| | - Christina Blanchard
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, AL
| | - Alex Harrelson
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, AL
| | - Jeff Szychowski
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, AL,Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, AL
| | - Rachel Sinkey
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, AL,Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, AL
| | - Zoe Julian
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, AL
| | - Alan Tita
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, AL,Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, AL
| | - Monica L. Baskin
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, AL
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Abstract
Background: Chronic psychological stress has been associated with several adverse health outcomes, including obesity. Black women report higher levels of psychological stress than White women and carry a disproportionate burden of chronic conditions associated with psychological stress, including obesity. Research also suggests that in addition to generic stressors, Black women also experience race- and gender-related stress. To further explore this, we conducted structured focus groups to examine Black women's perspectives about stress. Materials and Methods: Using the nominal group technique, three sessions (total, n = 33) were conducted exclusively with Black women to solicit responses to the following questions: (1) What are the top sources of stress for women? (2) What are the top stressors specifically for Black women? and (3) How do these stressors affect weight? Using a systematic method, participants ranked responses in order of importance. Responses were compiled and tabulated to identify which statements were viewed as most important by respondents. Results: Mean age and body mass index of participants were 43.0 ± 10.1 years and 35.1 ± 7.9 kg/m2, respectively. The top 3 responses for question 1 were health, family, and relationships. Safety of children and raising Black children, being the head of the family, and finances were the top responses for question 2. Emotional eating, not enough time for exercise, and eating fast food due to lack of time or money were voted as the top reasons as to how stressors influence women's weight. Discussion: Our findings are consistent with previous work reporting that, along with generic stress, race- and gender-related stress contribute to the overall experiences of Black women. This work adds qualitative depth to allow for a better understanding of the unique sources of stress for Black women. These gender- and race-related stressors should be considered when offering stress management interventions for weight loss and general health promotion among Black women.
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Affiliation(s)
- Meghan Tipre
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tiffany L. Carson
- Division of Population Sciences, Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute
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13
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Sathiakumar N, Bolaji BE, Brill I, Chen L, Tipre M, Leader M, Arora T, Delzell E. 1,3-Butadiene, styrene and lymphohaematopoietic cancers among North American synthetic rubber polymer workers: exposure-response analyses. Occup Environ Med 2021; 78:859-868. [PMID: 34108254 PMCID: PMC8606437 DOI: 10.1136/oemed-2020-107197] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 04/01/2021] [Accepted: 04/29/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate exposure-response between 1,3-butadiene, styrene and lymphohaematopoietic cancers in an updated cohort of workers at six North American plants that made synthetic rubber polymers. METHODS Employees were followed from 1943 through 2009 to determine mortality outcomes. Cox regression analyses estimated rate ratios (RRs) and 95% CIs by quartile of cumulative exposure to butadiene or styrene, measured in parts per million-years (ppm-years), and exposure-response trends for all leukaemia, lymphoid leukaemia, myeloid leukaemia, acute myeloid leukaemia, non-Hodgkin's lymphoma (NHL), multiple myeloma and all B-cell malignancies. RESULTS Among 21 087 workers, adjusted RRs for butadiene and all leukaemia (132 deaths) rose with increasing exposure, with an RR of 2.53 (95% CI 1.37 to 4.67) in the highest exposure quartile (≥363.64 ppm-years), and the exposure-response trend was statistically significant for all leukaemia (p=0.014) and for lymphoid leukaemia (52 deaths, p=0.007). Styrene exposure-response trends for all leukaemia and lymphoid leukaemia were less consistent than those for butadiene. Cumulative exposures to butadiene and styrene were not associated consistently with myeloid leukaemias or the B-cell malignancies, NHL and multiple myeloma. CONCLUSIONS We confirmed a positive exposure-response relationship between butadiene and all leukaemia among workers, most of whom had coexposure to styrene. Results supported an association between butadiene and lymphoid leukaemia, but not myeloid leukaemia, and provided little evidence of any association of butadiene or styrene exposures with major subtypes of B-cell malignancies other than lymphoid leukaemia, including NHL and multiple myeloma.
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Affiliation(s)
- Nalini Sathiakumar
- Epidemiology, The University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Bolanle E Bolaji
- Epidemiology, The University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Ilene Brill
- Epidemiology, The University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Ligong Chen
- Biostatistician, The University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Meghan Tipre
- Medicine, The University of Alabama at Birmingham Department of Medicine, Birmingham, Alabama, USA
| | - Mark Leader
- Epidemiology, The University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Tarun Arora
- Epidemiology, The University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Elizabeth Delzell
- Epidemiology, The University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
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14
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Scarinci IC, Pandya VN, Kim YI, Bae S, Peral S, Tipre M, Hardy C, Hansen B, Baskin ML. Factors Associated with Perceived Susceptibility to COVID-19 Among Urban and Rural Adults in Alabama. J Community Health 2021; 46:932-941. [PMID: 33751308 PMCID: PMC7983968 DOI: 10.1007/s10900-021-00976-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 11/30/2022]
Abstract
We examined factors associated with and reasons for perceived susceptibility to COVID-19 among urban and rural adults in Alabama. We surveyed 575 eligible participants’ engagement in preventive behaviors, concern about COVID-19 in their communities, perceived susceptibility to the virus, and reasons for susceptibility across three response options (Yes, No, and Don’t Know/Not Sure). Bivariate analyses compared characteristics by level of perceived susceptibility to COVID-19. A multinomial logistic regression model evaluated the association of demographics, health insurance coverage, and chronic illness status with perceived susceptibility. Participants’ race, gender, and educational attainment were significantly associated with perceived susceptibility to COVID-19. African Americans and males had higher odds of responding ‘No’, compared to ‘Yes’ and ‘Don’t Know/Not Sure’ than Whites and females. Participants with a high school education and lower had higher odds of responding ‘Don’t Know/Not Sure’ versus ‘Yes’ compared to those with college or higher education. Those unconcerned about COVID-19 in their community had higher odds of responding ‘No’ (OR = 2.51, CI 1.35–4.68) and ‘Don’t Know/Not Sure’ (OR = 2.51, CI 1.26–4.99) versus ‘Yes’, as compared to those who were concerned. Possibility of exposure at work was the most frequent reasons for perceiving themselves susceptible to COVID-19, engagement in recommended preventive measures was the most frequent reason among respondents who indicated ‘No’, and uncertainty/perception that everyone is at risk was the most frequent reason among the ones who indicated ‘Don’t Know/Not Sure’. Results indicate that tailored efforts to heighten perceived susceptibility to COVID-19 among specific demographics are needed.
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Affiliation(s)
- Isabel C Scarinci
- Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Ave South, Birmingham, AL, 35205, USA. .,O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, 1824 6th Ave South, Birmingham, AL, 35233, USA.
| | - Vishruti N Pandya
- Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Ave South, Birmingham, AL, 35205, USA
| | - Young-Il Kim
- Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Ave South, Birmingham, AL, 35205, USA.,O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, 1824 6th Ave South, Birmingham, AL, 35233, USA
| | - Sejong Bae
- Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Ave South, Birmingham, AL, 35205, USA.,O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, 1824 6th Ave South, Birmingham, AL, 35233, USA
| | - Sylvia Peral
- Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Ave South, Birmingham, AL, 35205, USA
| | - Meghan Tipre
- Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Ave South, Birmingham, AL, 35205, USA.,O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, 1824 6th Ave South, Birmingham, AL, 35233, USA
| | - Claudia Hardy
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, 1824 6th Ave South, Birmingham, AL, 35233, USA
| | - Barbara Hansen
- Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Ave South, Birmingham, AL, 35205, USA
| | - Monica L Baskin
- Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Ave South, Birmingham, AL, 35205, USA.,O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, 1824 6th Ave South, Birmingham, AL, 35233, USA
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15
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Niranjan SJ, Hardy C, Bowman T, Bryant J, Richardson M, Tipre M, Baskin ML. Rural Cancer Health During the COVID-19 Pandemic. J Cancer Educ 2020; 35:862-863. [PMID: 32860181 PMCID: PMC7455094 DOI: 10.1007/s13187-020-01858-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Soumya J Niranjan
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Claudia Hardy
- Office of Community Outreach and Engagement, O'Neal Comprehensive Cancer Center University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tara Bowman
- Office of Community Outreach and Engagement, O'Neal Comprehensive Cancer Center University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joseph Bryant
- Division of Preventive Medicine, University of Alabama at Birmingham, Medical Towers 618, 1717 11th Avenue South, Birmingham, AL, 35205, USA
| | - Molly Richardson
- Division of Preventive Medicine, University of Alabama at Birmingham, Medical Towers 618, 1717 11th Avenue South, Birmingham, AL, 35205, USA
| | - Meghan Tipre
- Division of Preventive Medicine, University of Alabama at Birmingham, Medical Towers 618, 1717 11th Avenue South, Birmingham, AL, 35205, USA
| | - Monica L Baskin
- Division of Preventive Medicine, University of Alabama at Birmingham, Medical Towers 618, 1717 11th Avenue South, Birmingham, AL, 35205, USA.
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16
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Sathiakumar N, Tipre M, Wickremasinghe R, Bhat V, Kadir MM, Coggon D, Pathemeswaran A, Kamath R, Arunkumar G, Fatmi Z, Smith TL, Pattanshetty SM, Delzell E. Building global partnerships through shared curricula for an MPH programme in India and Sri Lanka. Glob Public Health 2019; 14:1360-1371. [PMID: 30773110 DOI: 10.1080/17441692.2019.1579850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To design and implement a locally relevant competency- based MPH programme. METHODS The demand for trained public health professionals in South Asia is enormous and growing, which created a unique opportunity for a Fogarty International Center-funded University of Alabama at Birmingham-South Asia [Aga Khan University, Pakistan; Manipal Academy of Higher Education, India; and University of Kelaniya, Sri Lanka] international research training in environmental and occupational health (ITREOH) programme. In 2009, a Master of Public Health (MPH) degree programme was designed using a combination of competencies developed by the Association of School of Public Health, the World Health Organization and the Centers for Disease Control and Prevention. RESULTS A competency- based curriculum was developed with two specialty tracks in applied epidemiology and environmental and occupational health, emphasising applied practice and research. CONCLUSIONS This is the most comprehensive skill-based MPH programme in the region, which positions each institution as a regional leader in public health training. The success of the programme has been amply demonstrated by placements of graduated MPH students in leadership roles in public, private and academic sectors within their countries.
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Affiliation(s)
- Nalini Sathiakumar
- a Department of Epidemiology, University of Alabama at Birmingham , Birmingham , USA
| | - Meghan Tipre
- a Department of Epidemiology, University of Alabama at Birmingham , Birmingham , USA
| | | | - Vinod Bhat
- c Department of Community Medicine, Manipal Academy of Higher Education University , Manipal , India
| | | | - David Coggon
- e Faculty of Medicine, University of Southampton , Southampton , UK
| | | | | | - G Arunkumar
- c Department of Community Medicine, Manipal Academy of Higher Education University , Manipal , India
| | - Zafar Fatmi
- d Department of Community Health Science, Aga Khan University , Karachi , Pakistan
| | - Tamika L Smith
- a Department of Epidemiology, University of Alabama at Birmingham , Birmingham , USA
| | - Sanjay M Pattanshetty
- c Department of Community Medicine, Manipal Academy of Higher Education University , Manipal , India
| | - Elizabeth Delzell
- a Department of Epidemiology, University of Alabama at Birmingham , Birmingham , USA
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Tipre M, Kingsley P, Smith T, Leader M, Sathiakumar N. Melioidosis in India and Bangladesh: A review of case reports. ASIAN PAC J TROP MED 2018. [DOI: 10.4103/1995-7645.233179] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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18
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Sathiakumar N, Tipre M, Turner-Henson A, Chen L, Leader M, Gohlke J. Post-deepwater horizon blowout seafood consumption patterns and community-specific levels of concern for selected chemicals among children in Mobile County, Alabama. Int J Hyg Environ Health 2017; 220:1-7. [DOI: 10.1016/j.ijheh.2016.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/15/2016] [Accepted: 08/23/2016] [Indexed: 10/21/2022]
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Kingsley PV, Leader M, Nagodawithana NS, Tipre M, Sathiakumar N. Melioidosis in Malaysia: A Review of Case Reports. PLoS Negl Trop Dis 2016; 10:e0005182. [PMID: 28005910 PMCID: PMC5179056 DOI: 10.1371/journal.pntd.0005182] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 11/10/2016] [Indexed: 01/07/2023] Open
Abstract
Background Melioidosis is a tropical infectious disease associated with significant mortality due to early onset of sepsis. Objective We sought to review case reports of melioidosis from Malaysia. Methods We conducted a computerized search of literature resources including PubMed, OVID, Scopus, MEDLINE and the COCHRANE database to identify published case reports from 1975 to 2015. We abstracted information on clinical characteristics, exposure history, comorbid conditions, management and outcome. Results Overall, 67 cases were reported with 29 (43%) deaths; the median age was 44 years, and a male preponderance (84%) was noted. Forty-one cases (61%) were bacteremic, and fatal septic shock occurred in 13 (19%) within 24–48 hours of admission; nine of the 13 cases were not specifically treated for melioidosis as confirmatory evidence was available only after death. Diabetes mellitus (n = 36, 54%) was the most common risk factor. Twenty-six cases (39%) had a history of exposure to contaminated soil/water or employment in high-risk occupations. Pneumonia (n = 24, 36%) was the most common primary clinical presentation followed by soft tissue abscess (n = 22, 33%). Other types of clinical presentations were less common—genitourinary (n = 5), neurological (n = 5), osteomyelitis/septic arthritis (n = 4) and skin (n = 2); five cases had no evidence of a focus of infection. With regard to internal foci of infection, abscesses of the subcutaneous tissue (n = 14, 21%) was the most common followed by liver (18%); abscesses of the spleen and lung were the third most common (12% each). Seven of 56 males were reported to have prostatic abscesses. Mycotic pseudoaneurysm occurred in five cases. Only one case of parotid abscess was reported in an adult. Of the 67 cases, 13 were children (≤ 18 years of age) with seven deaths; five of the 13 were neonates presenting primarily with bronchopneumonia, four of whom died. Older children had a similar presentation as adults; no case of parotid abscess was reported among children. Conclusions The clinical patterns of cases reported from Malaysia are consistent for the most part from previous case reports from South and Southeast Asia with regard to common primary presentations of pneumonia and soft tissue abscesses, and diabetes as a major risk factor. Bacteremic melioidosis carried a poor prognosis and septic shock was strong predictor of mortality. Differences included the occurrence of: primary neurological infection was higher in Malaysia compared to reports outside Malaysia; internal foci of infection such as abscesses of the liver, spleen, prostate, and mycotic pseudoaneurysms were higher than previously reported in the region. No parotid abscess was reported among children. Early recognition of the disease is the cornerstone of management. In clinical situations of community-acquired sepsis and/or pneumonia, where laboratory bacteriological confirmation is not possible, empirical treatment with antimicrobials for B. pseudomallei is recommended. Melioidosis is a bacterial infection occurring in tropical regions of the world. It has been regularly reported from Southeast Asia and Northern Australia and in recent years, reported from South Asia, China and Brazil. The disease can affect any organ in the body, and commonly presents as a lung infection and/or multiple abscesses in internal organs; diabetes is the most common predisposing factor. Melioidosis is associated with a high rate of death because of the early spread of infection to the blood. Although the general clinical presentations of the disease are similar across regions, some regional differences are reported. Therefore, we reviewed case reports of melioidosis from Malaysia. The cases reported from Malaysia were similar to cases reported from South and Southeast Asia with regard to main presentations of pneumonia and soft tissue abscesses and diabetes as a major risk factor; spread of infection to the bloodstream resulted in a greater likelihood of death. Differences were a higher occurrence of neurological presentations, and abscesses of prostate gland, liver and spleen and aneurysms of major blood vessels than previously reported. Abscess of the parotid gland in children was not common. Early diagnosis and treatment including initiating treatment in suspicious cases is crucial to prevent death.
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Affiliation(s)
| | - Mark Leader
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- * E-mail: (PVK); (ML)
| | | | - Meghan Tipre
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Nalini Sathiakumar
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
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20
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Vandana KE, Mukhopadhyay C, Tellapragada C, Kamath A, Tipre M, Bhat V, Sathiakumar N. Seroprevalence of Burkholderia pseudomallei among Adults in Coastal Areas in Southwestern India. PLoS Negl Trop Dis 2016; 10:e0004610. [PMID: 27078156 PMCID: PMC4831803 DOI: 10.1371/journal.pntd.0004610] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 03/15/2016] [Indexed: 11/18/2022] Open
Abstract
Background Although melioidosis, is an important disease in many Southeast Asian countries and Australia, there is limited data on its prevalence and disease burden in India. However, an increase in case reports of melioidosis in recent years indicates its endemicity in India. Aims and methods A population-based cross-sectional seroprevalence study was undertaken to determine the seroprevalence of B. pseudomallei by indirect haemagglutination assay and to investigate the associated risk determinants. Subjects were 711 adults aged 18 to 65 years residing in Udupi district, located in south-western coast of India. Key results Overall, 29% of the study subjects were seropositive (titer ≥20). Females were twice as likely to be seropositive compared to males. Rates of seroprevalence were similar in farmers and non-farmers. Besides gardening, other factors including socio-demographic, occupational and environmental factors did not show any relationship with seropositive status. Major conclusions There is a serological evidence of exposure to B. pseudomallei among adults in India. While the bacterium inhabits soil, exposure to the agent is not limited to farmers. Non-occupational exposure might play an important role in eliciting antibody response to the bacterium and may also be an important factor in disease causation. Melioidosis is an underdiagnosed and underreported disease in India with protean clinical manifestation and high fatality. Causative agent B. pseudomallei, after environmental exposure, may cause disease or survive unnoticed for a long time in human and animal hosts. Individuals with diabetes and renal disease develop melioidosis with greater intensity and fatality. Recent increase in case reports of melioidosis in India might only be a tip of iceberg and represent small portion of a larger public health problem in the background of large number of diabetic population in the country. The paucity of data on disease prevalence has prompted us to undertake this sero-epidemiological study in a site located along the west coast of south India with heavy rainfall and rice farming as predominant agricultural activity. This site serves as a catchment for Kasturba Medical College and Hospital, Manipal, where nearly 20 to 30 cases of melioidosis are diagnosed each year. This first ever population-based seroprevalence study in India demonstrated a 29% seropositivity that is comparable with other endemic regions in Southeast Asia and Australia. Non-farmers were as likely to be seropositive as farmers. We also found a uniform seropositive status across various age groups and skill level of jobs. Females demonstrated higher seropositivity. Activities exposing the individual to environment such as gardening emerged as risk determinants of seropositivity.
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Affiliation(s)
- Kalwaje Eshwara Vandana
- Department of Microbiology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
- * E-mail:
| | - Chiranjay Mukhopadhyay
- Department of Microbiology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Chaitanya Tellapragada
- Department of Microbiology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Asha Kamath
- Department of Community Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Meghan Tipre
- Department of Epidemiology, University of Alabama, Birmingham, Alabama, United States of America
| | - Vinod Bhat
- Department of Community Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Nalini Sathiakumar
- Department of Epidemiology, University of Alabama, Birmingham, Alabama, United States of America
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Bhat HV, Kamath R, Arunkumar G, Delzell E, Tipre M, Upadhyay DK, Sathiakumar N. MPH program at Manipal University, India-experiences, challenges, and lessons learned. Am J Ind Med 2013; 56:20-8. [PMID: 22467350 DOI: 10.1002/ajim.22045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2012] [Indexed: 11/05/2022]
Abstract
BACKGROUND The UAB-ITREOH program has initiated a skill-based MPH program at Manipal University (MU), India, in 2009, to address the critical need for trained public health professionals and build institutional public health training capacity in the country. METHODS Funds from Fogarty have supported the curriculum development and specialized training of MU faculty to teach in the MPH program. RESULTS The program has been successfully launched and is gaining momentum. The lessons learned from our experiences as well as several challenges faced from the initialization to execution of the program are described in the article. CONCLUSIONS Government support is crucial for raising the profile of this program by accreditation, creating job opportunities and by recognizing these professionals as leaders in the public health sector.
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Affiliation(s)
- Hattangadi Vinod Bhat
- Department of Community Medicine, Kasturba Medical College, Manipal University, Karnataka, India.
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Wickremasinghe AR, Peiris-John R, Nandasena S, Delzell E, Tipre M, Sathiakumar N. Capacity building in environmental and occupational health in Sri Lanka. Am J Ind Med 2013; 56:1-10. [PMID: 22213343 DOI: 10.1002/ajim.21999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2011] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although environmental and occupational health (EOH) research and services in Sri Lanka have a long history, policies related to EOH are outdated. METHODS We review the International Training and Research in Environmental and Occupational Health (ITREOH) program in Sri Lanka that commenced in 2006 as a collaboration between the University of Alabama at Birmingham and the Faculty of Medicine of the University of Kelaniya, Sri Lanka. RESULTS The program has trained over 20 scientists in conducting EOH research. New pioneering research in EOH was initiated. The program was instrumental in furthering the training and research in EOH by initiating a MPH degree program, the first in the country. CONCLUSIONS The program has established North-South, South-South and in-country collaborations between institutions and scientists, increasing the visibility of EOH in the future.
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Janjua NZ, Kadir MM, Lutfi S, Tipre M, Sathiakumar N. Tasman Spirit oil spill in Pakistan: research response and lessons learned. Am J Ind Med 2013; 56:124-31. [PMID: 22473418 DOI: 10.1002/ajim.22039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND This article presents lessons learned from an investigation of the acute human health effects of the "Tasman Spirit" oil spill from a perspective of conducting rapid response investigations in developing countries. METHODS We reviewed various steps in our investigation, other studies on oil spills in Pakistan and around the world, and reflected upon our discussions and interactions with various stakeholders. RESULTS The article highlights the importance of applying a public health, legal, and ethical framework for conducting rapid response investigations, developing a pre-established funding mechanism, and addressing study design issues, exposure and outcome measurements, political issues, community engagement, and communication of results. CONCLUSION There is need to develop ethical and legal framework and funding mechanism for conducting rapid response research in developing countries. A repository of study protocols, validated tools, and laboratory methods for exposure and outcome assessment would be greatly beneficial.
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Affiliation(s)
- Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, Canada.
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Gohlke JM, Doke D, Tipre M, Leader M, Fitzgerald T. A review of seafood safety after the deepwater horizon blowout. Environ Health Perspect 2011; 119:1062-9. [PMID: 21561832 PMCID: PMC3237364 DOI: 10.1289/ehp.1103507] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 04/29/2011] [Indexed: 05/20/2023]
Abstract
BACKGROUND The Deepwater Horizon (DH) blowout resulted in fisheries closings across the Gulf of Mexico. Federal agencies, in collaboration with impacted Gulf states, developed a protocol to determine when it is safe to reopen fisheries based on sensory and chemical analyses of seafood. All federal waters have been reopened, yet concerns have been raised regarding the robustness of the protocol to identify all potential harmful exposures and protect the most sensitive populations. OBJECTIVES We aimed to assess this protocol based on comparisons with previous oil spills, published testing results, and current knowledge regarding chemicals released during the DH oil spill. METHODS We performed a comprehensive review of relevant scientific journal articles and government documents concerning seafood contamination and oil spills and consulted with academic and government experts. RESULTS Protocols to evaluate seafood safety before reopening fisheries have relied on risk assessment of health impacts from polycyclic aromatic hydrocarbon (PAH) exposures, but metal contamination may also be a concern. Assumptions used to determine levels of concern (LOCs) after oil spills have not been consistent across risk assessments performed after oil spills. Chemical testing results after the DH oil spill suggest PAH levels are at or below levels reported after previous oil spills, and well below LOCs, even when more conservative parameters are used to estimate risk. CONCLUSIONS We recommend use of a range of plausible risk parameters to set bounds around LOCs, comparisons of post-spill measurements with baseline levels, and the development and implementation of long-term monitoring strategies for metals as well as PAHs and dispersant components. In addition, the methods, results, and uncertainties associated with estimating seafood safety after oil spills should be communicated in a transparent and timely manner, and stakeholders should be actively involved in developing a long-term monitoring strategy.
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Affiliation(s)
- Julia M Gohlke
- Department of Environmental Health, University of Alabama at Birmingham, Birmingham, Alabama, 35294 USA.
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