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CDC-University Collaborative Seed Projects - Abstracts

Holley Wilkin, Ph.D. (GSU) and Candace Rutt, Ph.D. (CDC)

Individual and Community Health in Low Income neighborhoods: An Evaluation of Atlanta’s Beltline Project

The Atlanta Beltline is an urban redevelopment project that aims to connect 45 neighborhoods, developing a network of parks, a 33-mile multi-use trail, a 22-mile loop of light rail transit, and affordable housing. Changes to the built environment can potentially improve individual and community health, particularly in low income neighborhoods. This proposed research project will examine individual and community health outcomes related to on-going changes to the built environment as part of the Beltline Project. Specifically, we will use multiple methods to examine facilitators and barriers for using the Beltline trails and parks for individual and community health behaviors (e.g., physical activity, social gathering) among two Beltline communities. Specifically, we will: (1) collect observational data in order to document aspects of the built environment that may enable or constrain access to the trails and parks (e.g., heavy traffic roads, no/poorly conditioned sidewalks, lighting, safety issues, etc.); (2) conduct intercept surveys to learn more about the people using the parks; (3) randomly select adult residents to participate in surveys assessing current levels and retrospective self-reports of changes in perceptions of the Beltline and barriers/facilitators to use, health promoting behaviors related to the Beltline, and mental/physical health; (4) create GIS maps of the two Beltline communities to document health-related factors; and (5) collect air quality measurements to provide a more comprehensive picture of the built environment. The cross-sectional data collected will provide the ability to make comparisons between the communities, but also serve as baseline or reliminary data for future grant proposals to conduct a longitudinal study on individual and community health before and after the completion of the Beltline trails. It will also serve to assist the Beltline Inc. and Beltline Partnership to create healthier trails and parks as the Beltline is developed over the next 15 years and inform urban redevelopment projects in other cities.

Angela Snyder, Ph.D., M.P.H. and Ann DiGirolamo, Ph.D., M.P.H. (GSU) and Susanna Visser, Dr.P.H., M.S. (CDC)

Barriers to Evidence-based Behavioral Health Services for Young Children with ADHD

Findings from the 2010-11 National Survey of Children’s Health suggest that approximately 194,000 preschoolers (2-5 years of age) had a current attention-deficit/hyperactivity disorder diagnosis (ADHD). Among preschoolers with special health care needs who had a current diagnosis of ADHD, approximately 53% were receiving behavioral therapy and 40% were taking medication for treatment. These data have been corroborated using Medicaid claims data in the state of Georgia, in which 74% of 4-5 years olds with ADHD and 46% of 2-3 year olds with ADHD were receiving ADHD medication; 44% of 4-5 years olds with ADHD and 45% of 2-3 year olds with ADHD were receiving behavioral therapy. The American Academy of Pediatrics recommends behavioral therapy as first-line treatment for preschoolers (4-5 years of age) with ADHD. Therefore, these findings suggest that there is a misalignment between current practice and best practice for ADHD treatment. The purpose of this collaborative research project is to characterize potential barriers to the alignment of recommended best practices and current clinical practice. Hypothesized family barriers include stigma around family and child counseling or parent training, family preference for medication, and a lack of knowledge about the unique benefits of behavioral therapy for young children with ADHD. Hypothesized barriers among primary care providers include not knowing about the revised ADHD recommendation, physician preference, lack of knowledge about where to refer, and lack of knowledge about the value of behavioral therapy for the functional outcomes of young children with ADHD. This project utilizes qualitative methods to identify the barriers to the receipt of behavioral therapy among young children with ADHD so that programs and policies may be informed and the alignment between ADHD current practice and best practice may be improved. In doing so, we will improve the health and developmental outcomes of children diagnosed with ADHD and reduce the frequency with which negative health side effects of ADHD medications are experienced among preschoolers, including emotional liability, appetite loss, trouble sleeping, stomachaches, social withdrawal, and lethargy.

Mark Tompkins, Ph.D. (UGA) and Mark Papania, M.D.,M.P.H. (CDC)

Efficacy of Thermostable Intranasal Dry Powder Live-Attenuated Influenza Vaccine in Ferrets

Although current influenza vaccines reduce morbidity and mortality, their distribution may be limited by logistical difficulties, especially in the developing world and in pandemic settings. A thermostable dry powder live attenuated influenza vaccine (LAIV) would eliminate two difficulties, cold chain requirements and the liquid delivery format which gives suboptimal deposition and for some LAIVs requires onsite reconstitution.

The goal of the project is to assess dry powder nasal aerosol delivery of (LAIV) in the ferret model. The objectives are: 1) Stabilize LAIV as a dry micronized powder and package into nasal delivery devices, 2) Assess the potency and long term thermostability of powder LAIV and 3) Vaccinate ferrets with powder LAIV and compare immune response and protection from homologous and heterologous virus challenges with the results achieved with standard liquid LAIV. CDC will work with industry partners to procure LAIV, have it preserved as a powder, micronized and packaged into nasal delivery devices. CDC will test the potency and long term thermostability of powder LAIV. UGA will assess immune response in the ferret model. Side by side collaboration between CDC and UGA will occur in the in dry powder vaccination of ferrets. UGA will conduct the ferret studies, comparing dry powder LAIV vaccine to standard liquid LAIV, and perform the serologic analyses and viral challenge studies. If the projected outcome of dry powder LAIV immunogenicity and protection comparable to liquid LAIV is achieved, the results will be used to seek funding for development and testing of thermostable dry powder LAIV.

Nicole Gottdenker, D.V.M, M.S., Ph.D., Dipl. ACVP (UGA) and Andrew Dent, M.A., M.B.A. (CDC)

Integrating Anthropology, Ecoepidemiology, and Veterinary Science to Define Drivers of Vector-Borne Zoonotic Disease Transmission in Changing Landscapes

Emergence of zoonotic diseases is associated with deforestation, but less is known about the human – environment relationships that increase exposure to those pathogens. In this study we seek to identify drivers of increased prevalence of two vector-borne zoonotic diseases, Chagas disease (American trypanosomiasis) and acute cutaneous leishmaniasis (ACL), in Panama, in the context of deforestation. We hypothesize that socioeconomically marginalized households are more at risk for T. cruzi and leishmania infection, and that communities or households located close to recently deforested areas will have the highest pathogen exposure/infection risk. In particular, we include socio-cultural drivers and anthropogenic landscape change to understand the mechanism and context of how these are linked to increased risk of disease to the human population and domesticated animals. In this preliminary research we propose to use domestic dogs as sentinels for human Chagas and leishmaniasis exposure in 9 communities. This research combines veterinary medicine, public health, anthropology, and geospatial techniques to better quantify the burden of disease in this area and to understand actual and perceived risk to the local populace. As an international, interdisciplinary team, UGA, CDC, and Gorgas Institute collaborators will use the results from this preliminary research to develop more extensive, interdisciplinary proposals to the NIH and NSF, towards improved understanding of ecological and social complexities that drive vector-borne zoonotic disease transmission in changing landscapes.

Rosa I. Arriaga, Ph.D. (GT) and Suzanne Beavers, M.D. (CDC)

Community-based Text Intervention to Improve Health Outcomes in Minority Persons with Asthma

Asthma is a chronic airway disease that affects 25 million Americans. The burden of asthma varies by race; African-Americans are more likely than white persons to have asthma, to have an asthma-related ED visit or hospitalization, and to die of asthma. Two difficulties in asthma management are lack of patient knowledge regarding the importance of taking controller medications even when asymptomatic and lack of community interventions to support the patient’s management of his or her disease. CDC and Georgia Tech will partner with Not One More Life (NOML), a community organization that works to decrease the asthma burden in the Atlanta African-American community to assess the effectiveness of text messaging on improving asthma management. Participants attending the community outreach sessions who have access to text messaging will be recruited to participate in a three month randomized controlled study. The three groups are: control group (no texts), symptom and knowledge text group, and attention control text group (texts about NOML information sessions). We expect to see improvements from pre- to post-assessment in the text groups (attention control and symptom/knowledge) conditions compared to the control condition on psychological (asthma control, self-efficacy and quality of life assessment), physiological (lung function tests), and perceived adherence to medication outcome measures.

May Wang, Ph.D. (GT) and Barbara A. Zehnbauer, Ph.D., FACMG, FACB (CDC)

PTT AdvisorPlus: Development and Evaluation of a Clinical Decision Support Tool Mobile Application for Management of Anticoagulants

This proposal addresses one of the three research priorities "health information technologies HIT) and strategies to improve community-clinical linkages," where we will design a clinical decision workflow management system to assist physicians in providing better surveillance for patients with greater risk of developing arterial or venous blood clots and subsequent embolization downstream. These patients have higher possibility of stroke, pulmonary embolism, or arterial insufficiency, and need anticoagulant drugs prescription to reduce the possibility of clot formation. However historically, the clinical decision making workflow in determining the correct type and dosage of anticoagulant(s) is part science and part art. To address this problem, Centers for Disease Control and Prevention (CDC) had piloted an Apple app in 2012 to help clinicians choose the most appropriate and helpful follow-up clotting tests for patients with a common clotting profile--an abnormally long PTT (Partial Thromboplastin Time) and normal Prothrombin Time (PT). During the incoming two years, we propose to develop PTT AdvisorPlus, an intelligent clinical decision workflow management system on iOS-based mobile devices to assist physicians in providing personalized care for patients with one of four common conditions requiring anticoagulants: (1) longterm anticoagulation of patients with certain mechanical heart valves; (2) acute heparin-induced thrombocytopenia; (3) arterial thrombotic events such as a stroke, mini-stroke, or arterial blood clot; and (4) switching patients from one anticoagulant drug to another. Specifically, the PTT AdvisorPlus will select the right laboratory test(s) that will point to the best anticoagulant drug, determine its proper dose and formulation adjusted for other existing conditions, and monitor the anticoagulation effect of the drug in the patients. This intelligent clinical decision workflow management system will be jointly designed and developed by medical professional in CDC and engineers at Georgia Tech, and will be evaluated by physicians for ease-of-use, robustness, flexibility, and scalability. Eventually, it will be deployed and shared in both physician community and developer community.

Kelly Bartlett, Ph.D. (GT) and Melissa Danielson, MSPH (CDC)

Assessing Adherence to Evidence-based Care Practice for Children Diagnosed with ADHD in the Medicaid System

The objective of this proposal is to evaluate adherence to evidence-based care practice for attention deficit/hyperactivity disorder (ADHD) for Medicaid-enrolled children. The analysis can support targeted interventions (e.g., education, network changes) and lead to better health outcomes and/or lower cost.

Specifically, this proposal will result in a set of validated algorithms that:

  1. Derive utilization profiles of patients diagnosed with ADHD stratified by complex conditions;
  2. Quantify measures of adherence of providers to evidence-based guidelines and characterize the measures for different provider types and geographically; and
  3. Evaluate the impact of interventions to improve adherence to recommended care practices.

Additionally, we will perform detailed analysis on Medicaid data from 2005-2011 in North Carolina and Georgia and propose and evaluate intervention strategies in these states. Algorithms will be prototyped on Medicaid data and translated for implementation at CDC for additional states and years of data. The research thus builds research capacity while adding to scientific knowledge and informing policy.

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