Our research study focused on the adolescents that are living with chronic health conditions that encounter barriers to dental care during the transition from child-centered dental care to adult-centered dental care. My part of the qualitative study focused on dental transitions for adolescents with chronic conditions from the perspective of dentists. We conducted semi-structured interviews with a total of 13 dentists (7 pediatric dentists and 6 general dentists). I coded the interview transcripts and analyzed the interviews using NVivo. My main findings from the dentist-reported transition barriers included 1) the type of insurance e.g. Medicaid, 2) the lack of providers to treat individuals with chronic health conditions and 3) disturbance in the patient’s routine and comfort-level that may result from transitions. The proposed recommendations that I found from the providers were open communication between pediatric and general dentists, raising awareness amongst providers about this special population, and additional clinical training for general dentists to treat patients with chronic health conditions to facilitate dental transitions. The findings from my part of the study suggests that in order to improve dental transitions for adolescents with chronic health conditions, adult dental care for Medicaid must be covered nationwide. This will increase the likelihood that adolescents will be able to access dental care in young adulthood. Changes in the dental school curriculum, including additional training on how to treat patients with chronic health conditions, will help to improve dentists’ comfort in treating medically compromised patients.

Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death in the United States. About 50% of people who suffer from COPD die from cardiovascular diseases (CVD). The Metabolic Syndrome (MS), a group of risk factors associated with CVD, is increasingly recognized in COPD. In the general population, fatty liver disease (FL) is a risk factor for MS. The goal of this project was to assess the association between FL and MS in smokers at risk for and with COPD. We also sought to determine the relationship between FL and inflammation biomarkers. We measured the liver and spleen attenuations on CT scans from two large epidemiological studies in smokers. Study A enrolled smokers 45-80 years old in 21 centers across the US. Study B enrolled smokers 45-85 years old in the US and European countries. The liver to spleen attenuation (LSR) was calculated by dividing liver attenuation by spleen attenuation. FL is defined as a LSR ≤1.10 (approx≥30% infiltration of fat). In Study B we used the Spearman Correlation Coefficients to assess the correlation between LSR and inflammatory biomarkers in order to understand a potential mechanism linking FL and MS. In Study A, 18% had FL. FL was significantly associated with diabetes (odds ratio [OR] 2.49 [95% confidence interval [CI] 1.59-3.89]), hypertension (OR 1.52 [1.06-2.17]), and overweight/obesity (OR 2.24 [1.49-3.39]) in adjusted models. Female subjects in Study B, LSR was significantly associated with highly sensitive C-reactive protein (r, -0.41; P<0.021) and fibrinogen (R, -0.40; P<0.020). No such associations were observed in males. In smokers with and without COPD, FL increases the risk for MS. In females, inflammation may be involved in the association between FL and MS.

 My project is a collection opinions and stories regarding both the Affordable Care Act and welfare viewed from both an American and Danish perspective. It consists of the opinions of others I meet, opinions of others I am exposed to through media and other outlets, and the opinions that I am beginning to form myself. What I’m trying to do in my project is capture a pivotal moment in time, and form a personal narrative around it. While studying abroad I was faced with the question of why social welfare works in Denmark but not in our own country. I want to look into why--what ideology or socioeconomic situation would have to change to allow us to achieve a Danish level of support? This project is my attempt to address questions, and collect the voices of others who will hopefully help me in answering them. I hope to be able to see more clearly the problems facing the Affordable Care Act firsthand, and meet these concerns with examples of how it has been done in Scandinavia.

 According to the World Health Organization, low-income countries have ten times fewer physicians than high-income countries. This gap in health care access contributes to numerous global health disparities, including differences in mortality rates, disease transmission, and life expectancy. In Madagascar, health care access has improved due to the implementation of integrated health care systems, which incorporate traditional medical practices with allopathic health care strategies. My research uses qualitiative data gathered from interviews and lectures to explore the ways in which these systems in Madagascar provide health care in an affordable and accessible manner, while also promoting cultural sustainability and the conservation of biodiversity. Understanding and implementing integrated health care systems can lead to further discoveries of new medical treatments, the protection of biodiversity, advancements in traditional and allopathic remedies, and ultimately, improved access to health care.

The use of online news reports and social media as a means of public health surveillance such as the HealthMap web and smart phone applications have successfully provided real-time information to both the public and health officials. Providing up-to-date disease outbreak alerts relies heavily on compiling and processing large volumes of data from various official and unofficial news sources, and different settings require different techniques. For some regions of the world, global surveillance networks like HealthMap have had difficulty collecting data for use in their systems. We describe the process by which real simple syndication (RSS) feeds are integrated into the existing HealthMap infrastructure to increase incoming data from an area of comparatively limited coverage in the HealthMap system, Francophone Africa. Using integration of RSS feeds allowed for the collection of 143% more data than the traditional method of scraping Google News. While much of this data was irrelevant, as it was not related to disease events, this approach detected several disease-related events which were missed by the established approach. With additional refinement to reduce the volume of irrelevant alerts, the newly developed system will supplement the existing approach by capturing events that would otherwise be missed, thereby improving the overall sensitivity of the system.

American Indians and Alaska Natives suffer disproportionately from end-stage renal disease. For those with chronic kidney disease, transplantation may be the most effective treatment option. However, Native people do not donate organs at a rate that is commensurate with the need in the population. We developed a semi-structured, 10-question interview guide and used it to facilitate interviews with American Indians on their experiences with community activities to promote awareness of organ and tissue donation. Our nine key informants were project partners at Tribal Colleges and Universities and other tribal leaders. According to our informants, successful strategies to promote donation awareness included community engagement and active listening. Challenges included cultural beliefs and fear of discussing organ donation and death. However, community perceptions of living donation were positive, and key informants felt that living donation should be emphasized in future efforts. More education on organ and tissue donation is needed in Native communities. Information on living donation should be included in future educational efforts as part of the strategy to reduce donor shortages.

University students suffering from tension-type headaches and/or migraines report a profound impact upon their ability to study, perform in school, and participate in social activities. Despite this, few people consult their doctor regarding headaches, and previous research points to headaches not necessarily being conceived of as a symptom of disease or pathology. Furthermore, there is stigma attached to some headache disorders, such as migraine, that chronically interfere with productivity. In order to ascertain what resources and coping strategies university students with headaches use, I conducted 10 semi-structured ethnographic interviews with UW undergraduate students who identified as 'struggling with headaches' recently. Interviews ranged from 20-55 minutes in length. Students were asked what type of headaches they experienced and what difficulties headaches created for them in their day-to-day lives, among other questions. All students reported difficulty studying and concentrating while experiencing headaches; many students missed classes and some missed deadlines. Very few of the students interviewed utilized campus resources such as Hall Health, Disability Services or the Student Counseling Center, directly concerning their headaches. My initial analysis of student interviews demonstrates that the stigma surrounding headaches is of the type Goffman called 'flaw of the character', meaning a person with a stigmatized trait is perceived as weak, dishonest, lazy or having other negative personal attributes regardless of their behavior. This stigma, along with students' conception of headaches themselves, may lead to a disconnect between needs and services on campus for students struggling with headache.