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November 11th


I. Dietary Inflammatory Index, Food Insecurity, Race, and Adolescent Non-Alcoholic Fatty Liver Disease+D13:D20

II. Assessing Healthcare Provider Knowledge of Human Trafficking

III. Public Health Impact of Complementary and Integrative Medicine Among Pediatric Clinicians

IV. Examining the Effect of Contraceptive Education on Self-Efficacy and Stress 

V. Veterinary Vaccine Hesitancy and Vaccine Risk Communication in Connecticut 

VI. COVID-19 Contact Tracing and Public Health Innovations 

VII. Exploring the Potential Role of Acetaminophen and Pesticides in the Developmental Origins of Autism Spectrum Disorder via an In-Silico Model 

VIII. Rapid Establishment of a Volunteer Contact Tracing Program for COVID-19: Outcomes and Lessons Learned

I. Dietary Inflammatory Index, Food Insecurity, Race, and Adolescent Non-Alcoholic Fatty Liver Disease+D13:D20

Description: Introduction: Non-Alcoholic fatty liver disease (NAFLD), a typically adult-onset condition, is an emerging public health concern in adolescents yet risk factors remain largely unexamined.

Methods: Cross-sectional data from 4714 adolescents (12-19 yrs) in the NHANES (2001-2006) were analyzed. NAFLD was defined as >30 u/L of alanine aminotransferease (ALT), a blood level of liver dysfunction. Food Insecurity (child, adult, household), the Dietary Inflammatory Index (DII), and demographic factors (race, sex, BMI) were tested using multivariate binary logistic regression with elevated ALT (no, yes) as the dependent variable.

Results: Elevated ALT was 1.25 times (95% CI 1.00-1.57) more likely to be found in Non-Hispanic Blacks compared to Non-Hispanic Whites. Higher DII quartiles (i.e., increasingly pro- inflammatory) showed a possible link with elevated ALT (i.e., Q2vsQ1: OR=1.23, 95% CI .95-1.59; Q3vsQ1: OR=1.31, 95% CI 1.01-1.69; Q4vsQ1: OR=1.14 95% CI .88-1.48). Findings regarding food security were inconclusive.

Authors: Kritika Shankar, Dr. Lina Jaradat, Dr. Angela Bermudez-Millan, Dr. Helen Swede; Department of Public Health Sciences, UConn School of Medicine 

II. Assessing Healthcare Provider Knowledge of Human Trafficking

Description: Human trafficking is a profound violation of human rights and a global health problem that must be addressed. Healthcare providers are in a unique position to serve as the first responders for victims of human trafficking; and while there are many resources available, no universal policies or protocols exist to guide responses. Additionally, there are limited studies detailing the amount of knowledge that healthcare providers have regarding this global issue. Therefore, we conducted a survey study to identify the self-reported knowledge levels of healthcare providers who would be in direct contact with a potential human trafficking victim. Our survey gained over 5,000 responses nationally from EMTs, fellows, medical assistants, medical students, nurses, nurse practitioners, nursing students, paramedics, physicians, physician assistants, physician assistant students, residents, and social workers. Our survey findings will be utilized to provide justification for the need of human trafficking education and training across the medical field to further provide a neutral and safe environment to allow access to much needed help and services available. . 

Authors: Nicole E. McAmis, B.S., Angela C. Mirabella, B.A., Elizabeth M. McCarthy, B.S., Cara A. Cama, MBA, Richard S. Feinn, PhD, Listy A. Thomas, MD, FACEP, and Ivelisse Rivera-Godreau, MD; Frank H. Netter MD School of Medicine, Quinnipiac University

III. Public Health Impact of Complementary and Integrative Medicine Among Pediatric Clinicians

Description: Introduction: Complementary and Integrative Medicine (CIM) is a group of diverse health therapies that serve as adjuncts to conventional medical. Our aim for this study was to evaluate the current awareness, public health impact and attitudes of pediatric clinicians regarding CIM
Methods: Clinicians from the pediatric unit of a large teaching hospital were surveyed, through self-administered questionnaires, to identify the beliefs about the impact of CIM.

Results: We sampled 70 participants with a response rate of 99%. Regarding use, 43% reported using CIM while 47% had a family member who had used CIM in the past year. Respondents were most familiar with massage (70%) and yoga (69%), least familiar with Ayurvedic medicine (80%) and Qi Gong (76%). Regarding public health impact, 67% believed that some CIM therapies hold promise for the treatment of symptoms while 59% believed that incorporation of CIM would increase patient satisfaction. Most of the respondents indicated that they did not have easy access to clinical information on many CIM treatment modalities. Nurses had significantly higher scores on familiarity (p=.024), attitudes & beliefs (p=.001), and impact (p=.002) compared to physicians, even when controlled for gender.

Conclusion: This study highlights increasing public use of CIM. Clinicians must be constantly aware about this. There is need to bridge the gap in evidence based medicine and clinician’s knowledge with the rise in CIM use. 

Authors: Olohirere Ezomo, MPH, Nicole Casbarro, MSN, FNP, NP-c, Katherine Woolley, B.A. , Ryan Smith, B.S., Claire Hardin, DNP, FNP, Richard Feinn, PhD, Karen Myrick, DNP, APRN, FNP-BC, ANP-BC; Community Health Center Inc., Frank H. Netter School of Medicine, Quinnipiac University, Colorado Children's Hospital, Pediatric Emergency Department, University of Saint Joseph, Connecticut, School of Interdisciplinary Health and Science

IV. Examining the Effect of Contraceptive Education on Self-Efficacy and Stress 

Description: Introduction: Currently there is no mandated comprehensive sexual health curriculum in Connecticut. There is a lack of self-efficacy in the use of contraceptives in college students, derived from inadequate education. Self-efficacy concerning contraceptives can potentially be improved through comprehensive sexual health education policy.

Objective: To determine how college students previously learned about contraceptives, their perceived current level of self-efficacy towards contraceptives and their perceived level of stress due to possible misuse, both before and after having a comprehensive lecture on contraceptives.

Methods: A quantitative study using a custom survey and convenience sampling of 41 students was conducted during the Spring 2020 semester at Southern CT State University.

Results: The average amount of confidence reported from the pre-test was 7.5 and this increased to 9.3 post-test, p=.0000132031. The average amount of stress students reported for the pre-test was 5 and this decreased to 3.3 post-test, p=0.012336831.

Conclusion: There was a significant increase in confidence and a decrease in stress indicating that comprehensive education has a positive impact on students’ knowledge of contraceptives. Currently, Connecticut does not mandate comprehensive sexual health education. Comprehensive contraceptive education policy should be examined and mandated at the state level to be a part of school curriculums. 

Authors: Reaghan Bathrick and Marian Evans, MD, MPH, Southern Connecticut State Universit

V. Veterinary Vaccine Hesitancy and Vaccine Risk Communication in Connecticut  

Description: Vaccine hesitancy is a top threat to global health. Increases in veterinary vaccine hesitancy mirroring trends in human health have been reported in several countries.

This study aimed to gather epidemiologic data on Connecticut companion animal under-vaccination and veterinarians’ beliefs, behaviors, and experience with vaccine-hesitant pet owners.

A veterinary vaccine hesitancy survey adapted from WHO materials was deployed during winter 2020 to 121 veterinary practices in Fairfield County, Connecticut.

Survey response rate was 48%. 62% of veterinarians believe vaccine hesitancy is more common now than in previous years and 94% report being impacted by it. 43% of veterinarians indicate “crossover” of vaccine skepticism from human medicine is also a top contributor. Veterinarians' opinions about the importance of animal and human under-vaccination are related. A minority of veterinarians (12%) self-characterize as inadequately-prepared to overcome vaccine hesitancy, but 42% of respondents would welcome resources including science-based websites, pamphlets or videos to support vaccination efforts.

One Health offers a conceptual model for multi-sector solutions to global infectious diseases. Veterinarians appear more confident about vaccine counseling than physician counterparts but are similarly challenged by widespread misinformation and complacency. Human and veterinary vaccine hesitancy associations present opportunities for synergistic public health communications and risk-management interventions. 

Authors: Aarti Chandawarkar, MDJulia Bentley, DVM, Richelle deMayo, MD, CM; Ohio State University School of Medicine, Nationwide Children's Hospital and University of Connecticut School of Medicine, Connecticut Children's Medical Center

VI. COVID-19 Contact Tracing and Public Health Innovations 

Description: As per the most recent data from CT DPH, there have been 39,208 positive cases and 3,582 death related to COVID-19. Wide range of symptoms (mild to severe illness) have been reported in people who were infected with coronavirus (SARS-CoV-2). These symptoms may appear 2-14 days after being exposed to coronavirus and result in illness known as COVID-19.
While there is no CDC-approved serological testing for COVID-19, isolation of positive cases, prompt evaluation, and contact tracing can further prevent the spread of the COVID-19 illness within communities.Contact tracing is an important epidemiological tool to better understand the community wide transmission of the SARS-CoV-2. It also serves as an important indicator when making decisions related to re-opening of economy.

Since COVID-19 is a reportable disease in CT, we plan to collect the data and interview laboratory confirmed COVID-19 cases. If we are able to identify 95% of symptomatic cases and successfully track those who came in contact within 72 hours, we can potentially identify new cases and reduce further transmission within communities. We plan to develop detailed interview questionnaire that will identify close contacts so they can implement self-isolation to prevent further spread. We also plan to collect and analyze this data from the residents of city of West Haven and town of Orange. After analyzing various demographic and personal risk factors, we will be able to describe who infected most and which factors are likely attributable to community spread of virus. This information will help to identify and implement successful public health interventions in controlling the ongoing and future pandemic within our region. 

Authors: Sumaira Durrani, MD, Amir Mohammad, MD, MPH and Maureen Lillis, MPH, Southern Connecticut State University  

Description: Acetaminophen is the only non-prescription analgesic approved for use among pregnant women. Epidemiological data shows that prenatal exposure to acetaminophen is associated with an increased risk of Autism Spectrum Disorder (ASD). Still, the etiology of ASD remains under debate. Pesticides—often designed as neurotoxins—frequent pregnant women’s diets. Synergism between acetaminophen and pesticides could enhance each other’s impairment on fetal brain development and contribute to the increased prevalence of ASD. Examining the combined genetic effects of these two substances could reveal novel hypotheses on the etiology of ASD. Various molecular databases were used to find genes associated with acetaminophen, pesticides and ASD for a network topological analysis. Resulting clusters were annotated for biological pathways. Molecular database results were complemented with a literature analysis. Six genes were identified using the molecular analysis and 16 via the complementary literature analysis. Clusters in these analyses related to apoptosis, carbohydrate metabolism, regulation of cell growth and death, and metabolism of reactive oxygen species (FDR p <0.01). These findings support the hypothesis that cell death processes and carbohydrate metabolism, which may be targeted by acetaminophen and pesticides, contribute to the etiology of ASD. These findings also suggest that acetaminophen and pesticides have negative synergistic interactions. 

Authors: Tristan Furnary, Rolando Garcia-Milian, MLS, AHIP, and Vasilis Vasiliou PhD,Yale School of Public Health and Yale School of Medicine

Description: Herein, we describe the successes and challenges for a volunteer-driven COVID-19 contact tracing program established in partnership between the New Haven Health Department (NHHD) and Yale School of Public Health. This program consisted of two volunteer teams: one that interviewed cases and another that notified contacts. These teams began making calls on behalf of the city of New Haven on April 4, 2020. From then to the end of May, over 1,000 cases were successfully interviewed that met follow-up criteria, and over 1,000 contacts were notified of their exposure by the contact tracing team.

Multiple methods are used to evaluate the rapid establishment and implementation of this program. Quantitatively, we describe the proportion of cases and contacts that were identified and reached, and the time between each step in the contact tracing cascade. Qualitatively, we report findings from focus group discussions with volunteers and interviews with cases and contacts that explore the challenges and successes from the perspective of these participants. Successes include the direct impact on contact tracing efforts, as well as the strengthening of academic and public health partnerships. Challenges include limited resources and time, as well as the need to rapidly establish community engagement and trust. 

Authors: Maritza Bond, Brian Weeks, Jennifer Vazquez, Linda Niccolai, Luke Davis, Lauretta Grau, Amanda Meyer, Tyler Shelby, Chris Schenck, Justin Goodwin, Rachel Hennein, Cailin Arechiga, and Katie Clark; New Haven Health Department, Yale School of Public Health, and Yale School of Medicine

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