• Analysis of the Proposed Implementation of a Public Health District in Maricopa County

      Hoffman, Laura; The University of Arizona College of Medicine - Phoenix; England, Bob; Barraza, Leila (The University of Arizona., 2016-03-25)
      Background: Since the number and variety of services that a public health department is able to provide is related to its financial resources, it is important that each department have secure funding. The Public Health District model, in which the public health department is mostly funded by a dedicated public tax, rather than as a dependent on the county’s overall budget, has been proposed as an option for the Maricopa County Department of Public Health (MCDPH). This model was implemented in neighboring Pinal County in 2007 and is funded by a 0.1% sales tax. Specific aims: Our study aims are: (1) analyze the current MCDPH funding structure in comparison to other similarly sized county-managed public health departments, as well as review the development and structure of the Pinal County Public Health Services District as a local reference; (2) project the likely financial effects of the implementation of a tax-based Public Health District in Maricopa County; and (3) assess the potential effects on MCDPH management and public health outcomes in Maricopa County. We hypothesize that the implementation of a Public Health District in Maricopa County will secure a source of stable and increased funding and allow for improved public health services. Methods: Specific Aim 1: Budget data for FY 2011-2012 was analyzed for revenue types and percent contribution for each county department in the comparison. Budget data for FY 2003- 2014 for Pinal and Maricopa counties was analyzed in a similar manner. Phone interview with Pinal County Director, Mr. Thomas Schryer, was completed regarding the development of the Public Health District model in Pinal County; Specific Aim 2: Revenue data from the Maricopa County Jail Excise Tax was reviewed and utilized as a proxy to estimate potential income generated by a 0.1% sales tax; Specific Aim 3: The 2012 Maricopa County Community Health Assessment was evaluated to identify areas of need. Results: Specific Aim 1: Funding structures varied greatly between county public health departments, though heavy reliance on government funds was a common theme. Pinal County demonstrated increased funding stability with an increase in overall revenue budget upon implementation of Public Health District model. Specific Aim 2: Estimated revenue from a 0.1% sales tax was calculated to be $70 million in FY 2014-2015, with potential average revenue of $92 million over the next ten years. Specific Aim 3: Top areas for health improvement in Maricopa County include obesity, diabetes, lung cancer, cardiovascular disease and access to care. Conclusion: The current funding structure of the MCDPH follows the trend of other similarly sized county-managed public health departments with a heavy reliance on government funds. The potential revenue generated from a 0.1% sales tax in Maricopa County would be sufficient to significantly decrease the department’s dependence on general county funds and government grants. The result is increased overall funding and financial stability, thus helping the department to better target area needs and improve public health outcomes.
    • Coccidioidomycosis as a Cause of Sarcoid in Arizona

      Yourison, Isaac; The University of Arizona College of Medicine - Phoenix; Kuberski, Tim (The University of Arizona., 2016-03-25)
      BACKGROUND AND SIGNIFICANCE: Sarcoidosis is a granulomatous disease of unknown etiology. Coccidioidomycosis is a granulomatous fungal infection due to Coccidioides immitis and Coccidioides Posadasii endemic to the Southwestern United States and the majority of the cases are reported from Arizona. The cause of sarcoidosis has been studied for over a hundred years without establishing an etiology. Establishing the cause of sarcoid would be a significant contribution to the understanding of an important multisystem disease. RESEARCH QUESTIONS: Based on clinical observations a group of patients with two granulomatous diseases – sarcoidosis and coccidioidomycosis led to the hypothesis for this Scholarly Project – can sarcoidosis be caused by the fungus Coccidioides? METHODS: A literature review was performed which resulted in 5 patient case reports, a medical record review was conducted of patients with sarcoidosis between 2004‐2014 at Maricopa Medical Center with a case‐control comparison to 68 matched patients, and PCR analysis of 34 sarcoid biopsy specimens from the 68 sarcoid patients identified from the medical record. Also, two main patients with sarcoidosis were studied, one prospectively and the other retrospectively, both patients had their diagnosis of sarcoidosis made in Arizona and both develop sarcoidosis. There was no evidence of an etiology for their sarcoidosis at the time of diagnosis, specifically no evidence of coccidioidomycosis. The prospective patient was followed for eight years before he developed coccidioidomycosis. Predicting correctly that a patient diagnosed with sarcoid in Arizona would eventually develop coccidioidomycosis provides strong evidence for an etiologic relationship between Coccidioides and sarcoidosis. INCOMPLETE STUDIES: There is one major study for this Project that has not been completed: 1. Genetic studies on patients with both sarcoidosis and coccidioidomycosis to determine if there is a genetic predisposition to disseminated coccidioidomycosis
    • Evaluation of Skin Cancer Screenings in Tucson, Arizona from 2006‐2013

      Romano, Gianna; The University of Arizona College of Medicine - Phoenix; Harris, Robin (The University of Arizona., 2016-03-25)
      Background: One out of every three cancer diagnoses is a skin cancer, and the incidence of both melanoma and non‐melanoma type skin cancers is increasing. Skin cancers, including melanoma, are typically treatable if detected early. However, there is insufficient evidence to support recommendations to establish population based skin cancer screening programs. The specific aims of this study are 1) to evaluate characteristics of participants who attend a community skin cancer screening event and who are referred for follow up due to suspicious lesions, 2) to determine the proportion of participants with suspicious lesions identified at a community skin cancer screening event who complied with a request to visit a dermatologist or primary care physician, and 3) to evaluate attitudes toward sun protection practices, and perceived risk of developing skin cancer among participants who attend a community skin cancer screening and have a suspicious skin lesion. Methods: The Skin Cancer Institute sponsored a series of community skin cancer screening events in Tucson, Arizona from 2006 to 2013. Participants completed an American Academy of Dermatology screening form prior to a skin examination by a dermatologist. Participants with suspicious lesions identified at the examination who agreed to be contacted again received questionnaires 4 months after the initial screening to assess compliance with follow‐up recommendations, and their sun protection practices and risk perceptions. Results: 1979 community members attended the skin cancer screenings. The majority of the participants were Caucasian, females, had blue eyes and brown hair, were college educated, had no prior personal or family history of skin cancer, had health insurance but did not have a regular dermatologist, reported that they had never been to a skin cancer screening before, and stated that without this screening that they would not have their skin examined. 748 (37.8%) of community members were referred and instructed to see a dermatologist for further evaluation of a skin lesion. Of the 441 participants with a suspicious lesion who consented to participate in the follow‐up study, 120 returned a questionnaire; 90 (75%) reported that they followed up with a dermatologist or physician, and 30 (25%) did not. Of the 90 participants who followed up, 53% received a skin biopsy. The self reported diagnoses from the biopsies of the suspicious skin lesions were the following: 1% atypical or dysplastic nevus, 21% actinic keratosis, 16% basal cell carcinoma, 8% squamous cell carcinoma, 2% melanoma, and 38% did not have skin cancer. Conclusions/Impact: This study demonstrated that 38% of community skin cancer screening participants were referred for follow up due to a suspicious skin lesion being identified during a skin cancer screening event. It also appeared that 75% of those who responded to the follow‐up questionnaire complied with the request within four months, although the response rate for the follow‐up questionnaire was low. Therefore, implementing a formal reminder system following the skin cancer screenings may increase the percentage of participants who follow up with a primary care physician or dermatologist after the screening for further evaluation of their suspicious skin lesion.
    • Expedited Partner Therapy, Addressing Increased STD Infection Rates in Arizona

      Wade, Laura; The University of Arizona College of Medicine - Phoenix; Manriquez, Maria (The University of Arizona., 2016-03-25)
      Introduction: Chlamydia and gonorrhea are the two most reported sexually transmitted diseases (STDs) in Maricopa County.1 Effective treatment of the sex partner(s) of patients diagnosed with these STDs is an important step in preventing repeated infections. Expedited partner therapy (EPT) is the practice of prescribing antibiotics to the sex partner(s) of a patient diagnosed with a STD. EPT is recommended by the CDC in cases of uncomplicated chlamydia or gonorrhea infection.2 On September 26, 2008, Arizona statue was revised to allow for the use of EPT.3 Our study seeks to determine whether the use of EPT results in fewer repeat infections of chlamydia or gonorrhea within six months of initial diagnosis. Methods: We performed a retrospective chart review of 200 female patients diagnosed with chlamydia or gonorrhea between 2010 and 2013. We recorded how partner treatment was addressed, whether or not the patient had a repeat infection within six months, provider specialty and additional demographic information. Data was analyzed using One‐Way ANOVA or Wilcoxon Rank‐Sum for continuous variables and Chi‐Squared or Fisher’s Exact was used for categorical variables. Results: Overall documented percent repeat infection of 14.7% (n=20) out of 136 patients with follow up testing within 6 months. Loss to follow up of 32% (n=64). Percent repeat infection in EPT 0.0% (n=0), partner referral 16.1% (n=9), partner notification 20.9% (n=9) and not documented 16.7% (n=2). When comparing percent repeat infection in EPT (0.0%) to all other treatments combined (14.7%) the difference is statistically significant with p=0.025. Conclusions: The use of EPT results in fewer repeat infections in patients diagnosed with chlamydia. Limitations include loss to follow up and incomplete documentation in the electronic health record. Further investigation into the barriers to EPT is warranted to increase utilization of this strategy for partner treatment.
    • Racial/Ethnic Disparities in HIV Survival Among People Diagnosed with HIV in Arizona, 1998‐2012

      Mun, Elijah; The University of Arizona College of Medicine - Phoenix; Gonzalez, Jonathan (The University of Arizona., 2016-03-25)
      Objectives. We described the racial/ethnic disparities in survival among people diagnosed with HIV in Arizona from 1998 to 2012. We determined whether these disparities widened when adjusting for AIDS diagnosis, age at diagnosis, year of diagnosis, and gender. Methods. We compared survival from all causes between Whites and Blacks, Hispanics, Native Americans, Asians, and Multiple/Other races via Kaplan‐Meier survival curves and Cox proportional hazard models controlling for various clinical factors. Results. Multiple/Other races (1.85), Native Americans (1.28), and Blacks (1.19) have statistically significant higher hazard ratios in all‐cause mortality than Whites. When adjusting for AIDS diagnosis, these disparities widened and also showed Hispanics to have greater mortality [Multiple/Other races (2.53), Native Americans (1.44), Blacks (1.43), and Hispanics (1.22)]. Conclusions. Racial/ethnic minorities with HIV, specifically Black, Native Americans, and Multiple races, have significantly decreased overall survival. These disparities widen when considering the AIDS population. Further studies and resources could help identify the cause of these disparities and help generate a solution to diminish the survival gap.