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MPH 6903 Applied Field Placement

MPH 6903 is a field placement internship that is part of the core requirements of the MPH degree.  The internship will provide you with the experience and opportunity that you will need to integrate and demonstrate the application of academic knowledge with learned public health core competencies in professional practice settings through exposure to one or more core functions of essential public health services.  Students are required to complete at least 240 hours with their precepting site to complete the three-hour requirements for the course. No text is required.  

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Completion of all other MPH core coursework per concentration is required prior to enrolling in this class.  If student only lacks one core class and will be completed by the end of this course, the instructor has discretion for enrollment.

Pedagogical Approach

Collaborative

Learning Outcomes

I gained a better understanding of how social determinants of health affect asthma management and about the uncertainty about the diagnosis initially and the process of elucidating the etiology of respiratory conditions. I gained technical skill in using REDCap, which is a database platform that we are using the collect and analyze our data. This will skill will allow me to contribute well to future public health research.

Assessment

IRB exemption was requested and granted after review.

Data will be collected retrospectively from the ECU Asthma Clinic and entered into a REDCap database. Data points collected will include:

1.   Age of onset
2.   Symptoms
3.   Triggers
4.   Seasonal variations
5.   Asthma severity at the time of visit: Mild, moderate, severe
6.   Exacerbation history: number of exacerbations per year, severity of exacerbations
7.   Co-morbid conditions: Specifically, Vocal Cord Dysfunction, Allergic rhinitis, GERD and OSA
8.   Medications
9.   Smoking history
10. Living conditions: including carpeting, pets, exposure to mold
11. Occupation history
12. Vaccine status
13. Social history
14. Family history
15. Pertinent physical examination findings
16. Spirometry data
17. Asthma control test score INCLUDING score obtained in individual domains
18. Highest eosinophil count
19. FeNO levels (when available)
20. RAST (Immunocap) allergy profile and total IgE level
21. Chest imaging findings (when available)

Based on the above results, patients will be stratified into the two main asthma phenotypes (TH2-high and TH2-low). We will then assess the correlation between the ACT score and the physician’s assessment of control based on change in therapy.

For the Asthma Control Test: Data for Th2 high and Th2 low asthma will be assessed both:

  1. Dichotomously: Well controlled (>19) versus under controlled (≤19)
  2. Based on level of control: Well controlled (≥20), Not well-controlled (16-19) and Poorly controlled (≤15)

For the physician’s assessment of control: Therapy data for Th2 high and Th2 low asthma will be assessed as:

  1. Well controlled: Step down in therapy
  2. Stable control: no change in medication
  3. Poorly controlled: step up in therapy or use of OCS short term without exacerbation diagnosis
  4. Exacerbation visit: Use of OCS burst (increased steroid for ≥3 days)

Other data collected:
For all patients, serum IgE levels and eosinophil counts, allergy panel will be collected.
For some patients, results of fractional exhaled nitric oxide (FeNO), spirometry results will be collected.

The quantitative lab data will be used to stratify patients into Th2 high or Th2 low groups. Categorial variables will be assessed using Chi-Square test to test for correlation. Other statistical analyses will be performed depending on the sample size.

Other Information

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