2007 Funded Projects

A Global Information Systems (GIS) approach to waterborne infectious disease: Cryptosporidium

  1. Robert S. Burlage, Ph.D., Associate Professor, Clinical Laboratory Sciences, College of Health Sciences
  2. Changshan Wu, Ph.D., Assistant Professor, Department of Geography, College of Health Sciences
  3. Milwaukee Health Department
  4. Milwaukee River Basin Partnership

Abstract

Cryptosporidium is a parasite that causes a severe and occasionally fatal diarrhea in humans. It is persistent in the environment because it forms an inert particle (oocyst) that does not become active until it is ingested, at which time it matures into the invasive organism. These oocysts are typically found in water sources (streams and rivers) and represent a continual threat to the urban population. The 1993 outbreak in Milwaukee was clear evidence of this threat, which resulted in 400,000 cases of illness and over a hundred deaths.

Our laboratory has been searching for biomarkers of live oocysts, since it is currently difficult to determine whether they are alive or not. We have found a transcribed gene (i.e., an mRNA transcript) that is associated with the oocysts and quickly diminishes after exposure to gut conditions. We will collect oocysts from Milwaukee water sources and analyze them for viability using this method. We will also collect environmental data and create a unique graphic representation of the data using geographical information systems (GIS) analysis.

GIS will be integrated with non-point pollution runoff models to quantify the Cryptosporidium oocysts in stream sediments and track the loading from different locations along the water source. In particular, this project will construct a non-point runoff model including three steps, including 1) soil loss and runoff prediction, 2) sediment yield prediction, and 3) Cryptosporidium oocysts loading prediction. The resulting map is a critical step in the analysis of the movement of a pathogen through an environmental system and the associated risk assessment that differs markedly from analysis of other communicable diseases.

Fetal Infant Mortality Review (FIMR) Project of Racine

  1. Teresa S. Johnson, Ph.D., R.N., Associate Professor, College of Nursing
  2. Wheaton Franciscan Healthcare–All Saints
  3. City of Racine Health Department

Abstract

Infant mortality in the city of Racine is a serious problem. During 2004, infant mortality in the city of Racine was as follows: non-Hispanic black = 35/1000; non-Hispanic white = 4.0/1000. Although Racine is a small urban community, the rate of infant mortality is higher than that of Milwaukee. During 2005, 12 out of 16 that died were premature and weighed less than 1000 grams at birth. In 2002-2004, the disparity ratio for African-American infant mortality to that of whites was 3.5. In the state of Wisconsin, when all races and ethnicities are combined, the disparity ratio is only 1.3. African-American infants had a 3 times higher risk of dying than white infants.

This fall, a team of health care professionals in the city of Racine began meeting to explore the numbers, causes, and methods of the high infant mortality rate of African American infants. Dr. Teresa Johnson a professor from UW-Milwaukee College of Nursing has served as a nurse consultant for Wheaton Franciscan Healthcare – All Saints for the last 5 years. The community partners are the City of Racine Health Department and Wheaton Franciscan Healthcare–All Saints.

The purpose of the study is to obtain baseline data of fetal/infant deaths in the city of Racine. This funding will provide a Principal Investigator (Dr. Johnson) for Racine's Fetal and Infant Mortality Review (FIMR) project. The first phase of the study will be to collect data from birth certificates, death certificates, and hospital and outpatient records of fetal and infant deaths that occur during 2007. The second phase of this study is to interview families who have experienced a fetal or infant death. The following teams will be assembled as part of the FIMR structure to oversee the project: an advisory Steering Committee, a Case Review Committee and a Community Action Team. The Steering Committee will review processes and demographic integrity in order to implement continuous improvement. The Case Review Committee will assess the results, develop evidence-based policy and ensure quality assurance.

Feasibility of an academic partnership with Aurora Health Care's Information Technology/Care Management databases

  1. Timothy Patrick, Ph.D., Assistant Professor, Health Administration and Informatics, College of Health Sciences
  2. Dale Steber, Supervisor, Information Technology, Center for Urban Population Health

Abstract

The goal of this project originally was to determine the feasibility of an academic partnership with Aurora Health Care's Information Technology/Care Management databases, which may have included exploring the possibility of developing a “code book” for Aurora's Care Management database, integrating data bases and/or further development of a research database. The project was in part to serve as a first step to exploring development of a regional clinical research database through the Wisconsin Network for Health Research (WiNHR).

In February 2007, Dr. Patrick and Dale Steber met with Dr. Patrick Falvey, Director of Research and Care Management at Aurora Health Care, Inc. At the meeting, the focus of the project shifted to determination of which of several (expected to number between 5 and 10 fields) unused or under-utilized demographic fields in the IDX clinic billing data warehouse might be used for Aurora internal quality or outcomes patient population research purposes. Dr. Patrick and Mr. Steber were to recommend which fields might serve such research purposes, and to recommend standard code sets for those fields. Upon receiving the recommendations, Dr. Falvey would determine which recommendations to carry forward to Aurora Leadership. Later developments (not included in this project) would be to implement the fields, and to carry out, for quality control purposes, validity and reliability studies of data collected via them.

In July 2007, Dr. Floyd Frost, Health Services Researcher, joined the Aurora Health Care/Center for Urban Population Health. Since then, Dr. Frost, Dr. Patrick, Dr. Falvey, and Mr. Steber have met to further discuss plans for an Aurora Health Care research database. Dr. Frost contributes strong health care database and research database implementation expertise to this team.

Improving the Health of Children with Special Needs in Birth to 3 Programs Through Health Literacy and Maternal Depression Screening

  1. Jennifer Runquist, Ph.D., R.N., Assistant Professor, College of Nursing
  2. Kris A. Barnekow, Ph.D., Assistant Professor, Department of Occupational Therapy, College of Health Sciences
  3. Timothy B. Patrick, Ph.D., Assistant Professor, Health Administration and Informatics, College of Health Sciences
  4. Paula M. Rhyner, Ph.D., Associate Professor, Department of Communication Sciences and Disorders, College of Health Sciences
  5. Susan E. Cashin, Ph.D., Clinical Assistant Professor, Associate Scientist, College of Health Sciences
  6. Lutheran Social Services of Wisconsin and Upper Michigan, Inc. (LSS)

Abstract

Postpartum depression (PPD) is a mood disorder that goes unrecognized in 50 percent of women. PPD has garnered federal, state, and local attention as a major public health problem, not only for the negative health outcomes that untreated PPD may have on mothers, infants, and families, but also for its link with health disparities. This proposal is designed to respond to calls for innovative, interdisciplinary, community-centered care models that may reach Milwaukee families at risk for PPD. Lutheran Social Services Birth to 3 Program has volunteered to partner with UWM faculty to implement a plan to detect risk for PPD in urban Milwaukee mothers of children with special needs. This plan will be informed by the results of a pilot research study that will assess levels of health literacy and symptoms of maternal depression and posttraumatic stress in Birth to 3 program clients. Additionally, this proposal will move the work of maternal depression screening to the systems level through development of the structural components needed to support the input of depression screening information into the Early Childhood Integrated Database System (ECIDS). Future funding will be sought to expand the screening plan to the wider Milwaukee County Birth to 3 Program.

Piloting a Community Based Participatory Research Approach to Investigate the Health Issues and Resource Needs of Latinas Living with HIV

  1. Patricia E. Stevens, Ph.D., R.N., F.A.A.N., Professor, UWM College of Nursing
  2. Loren Galvao, MD, MPH, Director – Community Partnerships, Center for Urban Population Health & Associate Scientist, UWM College of Nursing
  3. Members of a Project Advisory Committee

Abstract

The goal of the project is to pilot a community based participatory research (CBPR) approach to investigate the health issues and resource needs of urban HIV-infected Latinas in Milwaukee. Specific aims are to: a) explore the impact of HIV in the lives of 15 HIV-infected women through qualitative interviews (conducted in participants' primary language); and b) integrate the dynamic involvement of a community advisory board throughout all stages including research design, sample recruitment, data collection, translation and analysis, dissemination of results, and generation of policy and practice recommendations. Upon completion, we will have submitted for publication a data-based manuscript reporting findings, demonstrated the feasibility of our community involvement strategies, developed a strong interdisciplinary research team consisting of professional researchers and community stakeholders, and drafted an R01 proposal for a much larger longitudinal CBPR study of Latinas living with HIV that builds on the PI's previous NIH-funded research. In this R01 proposal we will a) increase the ethnic diversity represented in the original study, b) extend methods to incorporate local community knowledge and cultural wisdom, and c) engage community members as active contributors and agents capable of analyzing their own situations and devising policies and programs to reduce health disparities.

"Utilizing Tailored Step-Count Feedback to Enhance Physical Activity in the Elderly"

  1. Scott J. Strath, Ph.D., Assistant Professor, Human Movement Sciences, College of Health Sciences
  2. Daniel Romanowich, UWM Graduate Student
  3. Health Aging Clinics in the VA
  4. Milwaukee County Department on Aging

Abstract

The proportion of the United States population aged 65 years or older is projected to double in the next 30 years (U.S. Census Bureau, 1996). This dramatic rise in the number of older adults will place an increased demand on public health and medical services. Chronic conditions, such as coronary heart disease, diabetes, hypertension, arthritis, and depression affect the elderly segment of society disproportionately (Berg, 1990; Hoffman, 1996), much of which is preventable. These conditions, either in isolation, or in conjunction with one another contribute to disability, a reduced quality of life, and increased health care costs. It is estimated that 88 percent of adults over age 65 have at least one chronic health condition, and that 21 percent of adults over age 65 have a chronic disability (CDC, 2003). Therefore, public health programs need to respond to the growing prevalence of older adults, and proactively address the increased burden of chronic diseases, disabilities, and growing health care costs. Recent randomized controlled trials (RCTs) have demonstrated that intensive dietary and exercise interventions can prevent or at least delay the onset of chronic diseases, such as within people at high risk for developing type 2 diabetes (Knowler, 2002; Tuomilehto, 2001). However, these interventions are generally so complex and expensive that they are not feasible in a community or primary care settings. Studies of less intensive counseling interventions have failed to demonstrate effectiveness (Whitlock, 2002). Therefore, to realize the dramatic benefits observed in physical activity (PA) efficacy studies, we must develop effective and feasible low-cost interventions that can produce sustained improvements in PA. We propose to develop and test a program to motivate patients at risk for chronic disease to increase their walking using objectively measured step-count feedback and motivationally matched messaging. Our goal is to provide community partners and primary care providers with an effective and practical intervention to help sedentary patients at risk for chronic disease become more active, in an attempt to increase the health and well-being of older adults.

Our Address

Center for Urban Population Health 1020 North 12th Street, Suite 4180, Milwaukee, WI 53233 414-219-5100 (Phone) 414-219-6563 (Fax)

Our Partners

  • University of Wisconsin School of Medicine and Public Health
  • University of Wisconsin–Milwaukee
  • Aurora Health Care