Medicine and Health Sciences Commons^™

Associations Between Toenail Arsenic Concentration And Dietary Factors In A New Hampshire Ppopulation, Joann F. Gruber, Margaret R. Karagas, Diane Gilbert-Diamond, Pamela J. Bagley, M Scot Zens, Vicki Sayarath, Tracy Punshon, J Steven Morris, Kathryn L. Cottingham

Dartmouth Scholarship

Background: Dietary factors such as folate, vitamin B12, protein, and methionine are important for the excretion of arsenic via one-carbon metabolism in undernourished populations exposed to high levels of arsenic via drinking water. However, the effects of dietary factors on toenail arsenic concentrations in well-nourished populations exposed to relatively low levels of water arsenic are unknown.

Methods: As part of a population-based case-control study of skin and bladder cancer from the USA, we evaluated relationships between consumption of dietary factors and arsenic concentrations in toenail clippings. Consumption of each dietary factor was determined from a validated food frequency questionnaire. We …

The Symptom Of Fatigue In Primary Care: A Comparative Study Of Health Care Utilization Patterns Using Electronic Medical Records, Kathryn A. Nicholson

Electronic Thesis and Dissertation Repository

The experience of fatigue has been a common problem among community populations for decades. The symptom of fatigue is also a frequent health complaint in primary care practices. Fatigue patients have been shown to be significantly high users of health care resources, particularly when compared to non-fatigued patient populations. To date, an understanding of the presence and the impact of the symptom of fatigue within the context of the Canadian health care system has been understudied.

The objective of this research was to determine the number of patients who were suffering from the symptom of fatigue within a primary care …

Blood Fibrinogen As A Biomarker Of Chronic Obstructive Pulmonary Disease, Annelyse Duvoix, Jenny Dickens, Imran Haq, David M. Mannino, Bruce Miller, Ruth Tal-Singer, David A. Lomas

David M. Mannino

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a multicomponent condition that is characterised by airflow obstruction that is not fully reversible and is a major global cause of morbidity and mortality. The most widely used marker of disease severity and progression is FEV(1). However, FEV(1) correlates poorly with both symptoms and other measures of disease progression and thus there is an urgent need for other biological markers to better characterise individuals with COPD. Fibrinogen is an acute phase plasma protein that has emerged as a promising biomarker in COPD. Here we review the current clinical evidence linking fibrinogen with COPD …

Peran Juru Pantau Jentik Dalam Sistem Kewaspadaan Dini Demam Berdarah Dengue Di Indonesia, Diana Andriyani Pratamawati

Kesmas

Program pencegahan dan pemberantasan demam berdarah dengue (DBD) telah berlangsung sekitar 43 tahun dan berhasil menurunkan angka kematian dari 41,3% pada tahun 1968 menjadi 0,87% pada tahun 2010, tetapi belum berhasil menurunkan angka kesakitan. Bahkan, Indonesia menduduki urutan tertinggi kasus DBD di Association of Southeast Asian Nations (ASEAN) pada tahun 2010. Salah satu faktor belum efektifnya pencegahan DBD di Indonesia adalah masih lemahnya sistem kewaspadaan dini. Peran juru pantau jentik (jumantik) sangat penting dalam sistem kewaspadaan dini mewabahnya DBD karena berfungsi untuk memantau keberadaan dan menghambat perkembangan awal dari vektor penular DBD. Seiring masih tingginya angka kasus DBD di Indonesia, …

Konfirmasi Pemeriksaan Mikroskopik Terhadap Diagnosis Klinis Malaria, A. Arsunan Arsin, Heri Paerunan, Sri Syatriani

Kesmas

Penyakit malaria masih menjadi salah satu masalah kesehatan masyarakat yang penting di dunia. Di Indonesia, terutama di luar daerah Jawa dan Bali, sampai kini angka kesakitan malaria masih tergolong tinggi. Di Puskesmas Bunta Kabupaten Banggai, pada tahun 2008 Annual Malaria Incidence (AMI) dilaporkan mencapai 109,9‰. Penelitian ini bertujuan untuk membandingkan serta mengetahui hubungan gejala, tanda klinis, dan hasil pemeriksaan mikroskopik malaria. Desain studi yang digunakan adalah cross sectional. Pengumpulan data wawancara dan mengambil sediaan darah dilakukan pada 150 penderita suspect malaria di puskesmas dan rumah penduduk. Penderita malaria klinis dengan pemeriksaan mikroskopik malaria positif ditemukan sekitar 52%. Gejala dan tanda …

Faktor Risiko Kematian Neonatal Dini Di Rumah Sakit Bersalin, Andi Zulkifli Abdullah, M. Furqaan Naiem, Nurul Ulmy Mahmud

Kesmas

Angka kematian bayi di Indonesia masih tergolong tinggi, kematian neonatal 50% terjadi pada bayi berat lahir rendah (BBLR) dan lebih dari 50% kematian bayi adalah kematian neonatal dini. Penelitian ini bertujuan untuk mengetahui faktor-faktor antenatal care (ANC), status imunisasi Tetanus Toxoid (TT) ibu hamil, anemia pada saat hamil, berat lahir, status paritas, dan status hipotermia terhadap kematian neonatal dini. Penelitian meng- gunakan desain penelitian case control di Rumah Sakit Bersalin Kota Makassar dengan sampel 40 kasus dan 120 kontrol. Data diperoleh melalui wawancara langsung dengan responden. Hasil penelitian menunjukkan bahwa faktor risiko kejadian kematian neonatal dini meliputi ANC (nilai p …

Two Boundaries Separate Borrelia Burgdorferi Populations In North America, Gabriele Margos, Jean I. Tsao, Santiago Castillo-Ramirez, Yvette A. Girard, Anne G. Hoen

Dartmouth Scholarship

Understanding the spread of infectious diseases is crucial for implementing effective control measures. For this, it is important to obtain information on the contemporary population structure of a disease agent and to infer the evolutionary processes that may have shaped it. Here, we investigate on a continental scale the population structure of Borrelia burgdorferi, the causative agent of Lyme borreliosis (LB), a tick-borne disease, in North America. We test the hypothesis that the observed d population structure is congruent with recent population expansions and that these were preceded by bottlenecks mostly likely caused by the near extirpation in the 1900s …

Epidemiology News, Georgia Southern University

Epidemiology News (2012-2018)

• Georgia Southern Professors Receive Community Health Needs Assessment Grant

How To Minimize The Attack Rate During Multiple Influenza Outbreaks In A Heterogeneous Population, Isaac Chun-Hai Fung, Rustom Antia, Andreas Handel

Isaac Chun-Hai Fung

Background: If repeated interventions against multiple outbreaks are not feasible, there is an optimal level of control during the first outbreak. Any control measures above that optimal level will lead to an outcome that may be as sub-optimal as that achieved by an intervention that is too weak. We studied this scenario in more detail.
Method: An age-stratified ordinary-differential-equation model was constructed to study infectious disease outbreaks and control in a population made up of two groups, adults and children. The model was parameterized using influenza as an example. This model was used to simulate two consecutive outbreaks of the …

Selective Impact Of Hiv Disease Progression On The Innate Immune System In The Human Female Reproductive Tract., Timothy Lahey, Mimi Ghosh, John V. Fahey, Zheng Sheng, Lucy R. Mukura, Yan Song, Susan Cu-Uvin, Kenneth H. Mayer, Peter F. Wright, John C. Kappes, Christina Ochsenbauer, Charles R. Wira

Epidemiology Faculty Publications

Background

We have previously demonstrated intrinsic anti-HIV activity in cervicovaginal lavage (CVL) from HIV-infected women with high CD4 counts and not on antiretroviral therapy. However, the impact of HIV disease progression on CVL innate immune responses has not been delineated.

Methods

CVL from 57 HIV-infected women not on antiretroviral therapy were collected by washing the cervicovaginal area with 10 ml of sterile normal saline. We characterized subject HIV disease progression by CD4 count strata: >500 cells/µl, 200–500 cells/µl, or <200 cells/µl of blood. To assess CVL anti-HIV activity, we incubated TZM-bl cells with HIV plus or minus CVL. Antimicrobials, cytokines, chemokines and anti-gp160 HIV IgG antibodies were measured by ELISA and Luminex.

Results

CVL exhibited broad anti-HIV activity against multiple laboratory-adapted and transmitted/founder (T/F) viruses, with anti-HIV activity ranging from 0 to 100% …

Epidemiology News, Georgia Southern University

Epidemiology News (2012-2018)

• Disparities in Breast Cancer

Change-Point Analysis Of Paired Allele-Specific Copy Number Variation Data, Yinglei Lai

GW Biostatistics Center

The recent genome-wide allele-specific copy number variation data enable us to explore two types of genomic information including chromosomal genotype variations as well as DNA copy number variations. For a cancer study, it is common to collect data for paired normal and tumor samples. Then, two types of paired data can be obtained to study a disease subject. However, there is a lack of methods for a simultaneous analysis of these four sequences of data. In this study, we propose a statistical framework based on the change-point analysis approach. The validity and usefulness of our proposed statistical framework are demonstrated …

Characteristics Of Children With Type 1 Diabetes And Persistent Suboptimal Glycemic Control., Hyuntae Kim, Angelo Elmi, Celia L. Henderson, Fran R. Cogen, Paul B. Kaplowitz

Epidemiology Faculty Publications

Objective: This study aims to determine the relationship between the duration of persistent poor glycemic control in type 1 diabetes mellitus (T1DM) children and the likelihood of subsequent improvement.

Methods: A retrospective cohort study was conducted on T1DM patients aged 6-18 years, followed for at least six visits at Children’s National Medical Center (Washington, DC) with at least one hemoglobin A1c (HbA1c) ≥10% after the first year since the initial visit (n=151). Medical records of patients with subsequently improved glycemic control were reviewed (n=39).

Results: Patients aged 12-18 years, females, and Medicaid patients were twice as likely to be in …

Estimating The Impact Of Community-Level Interventions: The Search Trial And Hiv Prevention In Sub-Saharan Africa, Laura Balzer, Maya Petersen, Joshua Schwab, Mark Van Der Laan

Laura B. Balzer

Evaluation of community level interventions to prevent HIV infection presents significant methodological challenges. Even when it is feasible to randomly assign a treatment versus control level of the intervention to each community in a sample, measurement of incident HIV infection remains difficult. In this talk we describe an experimental design developed for the SEARCH Trial, a large community randomized trial that will evaluate the impact of expanded treatment on incident HIV and other outcomes. Regular community-wide testing campaigns are conducted and a random sample of community members who fail to attend a campaign are tracked. The data generated by this …

Surveillance Of Infectious Diseases Among American Indians And Alaska Natives, Jeanne Bertolli, Amy Roussel, Jennie Harris, Dan Lentine, Julia Gable, Ron Fichtner, Joann Kauffman, Michael Landen, Ralph T. Bryan

Journal of Health Disparities Research and Practice

We assessed participation in public health surveillance networks among Indian Health Service, tribal, and urban (I/T/U) Indian health facilities for a group of infectious diseases, and barriers to participation. We conducted surveys of I/T/U facilities and key informant interviews with representatives of tribal, urban, and national American Indian/Alaska Native (AI/AN) agencies. For the surveys, frequencies and percentages of responses in each response category were calculated. Qualitative methods were used to analyze interview content. The proportion of facilities participating in case reporting is suboptimal across facility types and diseases. Even when reporting is occurring, there is little feedback to tribal agencies. …

Molecular Epidemiology Of Hiv-Associated Tuberculosis In Dar Es Salaam, Tanzania: Strain Predominance, Clustering, And Polyclonal Disease, Lisa V. Adams, Barry N. Kreiswirth, Robert D. Arbeit, Hanna Soini, Lillian Mtei, Mecky Matee, Muhammad Bakari, Timothy Lahey, Wendy Wieland-Alter

Dartmouth Scholarship

Molecular typing of Mycobacterium tuberculosis can be used to elucidate the epidemiology of tuberculosis, including the rates of clustering, the frequency of polyclonal disease, and the distribution of genotypic families. We performed IS6110 typing and spoligotyping on M. tuberculosis strains isolated from HIV-infected subjects at baseline or during follow-up in the DarDar Trial in Tanzania and on selected community isolates. Clustering occurred in 203 (74%) of 275 subjects: 124 (80%) of 155 HIV-infected subjects with baseline isolates, 56 (69%) of 81 HIV-infected subjects with endpoint isolates, and 23 (59%) of 39 community controls. Overall, 113 (41%) subjects had an …

Why Match In Individually And Cluster Randomized Trials?, Laura B. Balzer, Maya L. Petersen, Mark J. Van Der Laan

Laura B. Balzer

The decision to match individuals or clusters in randomized trials is motivated by both practical and statistical concerns. Matching protects against chance imbalances in baseline covariate distributions and is thought to improve study credibility. Matching is also implemented to increase study power. This article compares the asymptotic efficiency of the pair-matched design, where units are matched on baseline covariates and the treatment randomized within pairs, to the independent design, where units are randomly paired and the treatment randomized within pairs. We focus on estimating the average treatment effect and use the efficient influence curve to understand the information provided by …

Association Between The Fast-Food Environment And Obesity In Canada: A Cross-Sectional Analysis, Simon Hollands

Electronic Thesis and Dissertation Repository

Frequent fast-food consumption is associated with weight gain therefore it is hypothesized that relative availability of fast-food is a risk factor for obesity. This thesis examined the association between the neighbourhood-level density of fast-food outlets and adult body mass index (BMI) in Canada. Population-based data on BMI and socio-economic variables from the 2008 Canadian Community Health Survey [CCHS] and selected neighbourhood-level socio-economic data from 2006 Canadian Census were merged with a commercial database containing geographic locations of all restaurants in Canada. The association between BMI and fast-food density (per 10,000 people in CCHS respondent’s FSA) was analyzed using ordinary least …

Relationships And Context As A Means For Improving Disease Prevention And Sexual Health Messages, Lisa D. Lieberman

Department of Public Health Scholarship and Creative Works

In many ways, the HIV epidemic changed the discourse about sex in the United States and worldwide (Ehrhardt, 1992; Everett, 1986) and continues to drive approaches to sex education. After a period of rapid growth in the late 1980s (approximately 150,000 new infections per year), by the late 1990s, HIV rates in the United States slowed to some 40,000 new infections annually (Centers for Disease Control and Prevention [CDC], 2001), and new HIV infections continue to hover around that number. The first successful examples of behavior change that resulted in decreased HIV transmission emerged from …

Final Report From The Black, African And Caribbean Canadian Health (Blacch) Study, Shamara Baidoobonso, Harina Mokanan, Leah Meidinger, Daniel Pugh, Greta Bauer, Mercy Nleya-Ncube, Julius Ehiemua

Shamara M Baidoobonso, PhD

Originating in southwestern Ontario, the Black, African and Caribbean Canadian Health (BLACCH) Study began its work in 2009. The BLACCH Study is a mixed-methods community-based research project designed with the goal of improving health care access and the health status of Black people from Canada, Africa, the Caribbean and other parts of the world, who reside in London and Middlesex County, Ontario. The research team includes The University of Western Ontario, the Regional HIV/AIDS Connection, and the London Cross Cultural Learner Centre. The purpose behind this report is to shed light on the findings and outcomes that have emerged from …

Dynamics Of Land Use/Land Cover Changes And Its Implication On Food Security In Anyigba, North Central, Nigeria, Tokula E. Arome, Sunday P. Ejaro (Phd)

Confluence Journal Environmental Studies (CJES), Kogi State University, Nigeria

This study assessed land use/land cover changes and its effect on Agricultural land in Anyigba. The objectives were to identify and delineate different land use / land cover categories, assess the rate of change that occurred and examine the impact of land use/land cover change on food security using satellite remote sensing data collected at three different years (1987 Land sat TM, 2001 Land Sat TM and 2011 Land Sat ETM). The study utilized GIS software such as Idrisi Andes academic and ArcGIS 9.3. The study area covers approximately 31.8km2, and four major land use/cover classes were utilized (built up, …

Dna Methylation Arrays As Surrogate Measures Of Cell Mixture Distribution, Eugene Houseman, William P. Accomando, Devin C. Koestler, Brock C. Christensen, Carmen J. Marsit

Dartmouth Scholarship

There has been a long-standing need in biomedical research for a method that quantifies the normally mixed composition of leukocytes beyond what is possible by simple histological or flow cytometric assessments. The latter is restricted by the labile nature of protein epitopes, requirements for cell processing, and timely cell analysis. In a diverse array of diseases and following numerous immune-toxic exposures, leukocyte composition will critically inform the underlying immuno-biology to most chronic medical conditions. Emerging research demonstrates that DNA methylation is responsible for cellular differentiation, and when measured in whole peripheral blood, serves to distinguish cancer cases from controls.

A Mathematical Model For Dengue Fever In A Virgin Environment, Jason K. Bowman

Senior Honors Projects

Dengue is a mosquito-borne viral infection found in tropical and subtropical regions around the world. The disease was named in 1779 and the first recorded epidemic of it occurred simultaneously on three continents within the following decade. Dengue is characterized by flu-like symptoms and, while its symptoms are generally reported as quite unpleasant, is rarely fatal. However, in some cases patients can contract a more serious form of the disease, known as Dengue Hemorrhagic Fever, which is far more dangerous. The World Health Organization estimates that today over 2.5 billion people are at risk for Dengue (over 40% of the …

Predictors Of Contralateral Breast Cancer In Brca Negative Women, Ann E. Simmons

Dissertations & Theses (Open Access)

Breast cancer is the most common cancer diagnosis and second leading cause of death in women. Risk factors associated with breast cancer include: increased age, alcohol consumption, cigarette smoking, white race, physical inactivity, benign breast conditions, reproductive and hormonal factors, dietary factors, and family history. Hereditary breast and ovarian cancer syndrome (HBOC) is caused by mutations in the BRCA1 and BRCA2 genes. Women carrying a mutation in these genes are at an increased risk to develop a second breast cancer. Contralateral breast cancer is the most common second primary cancer in patients treated for a first breast cancer. Other risk …

Modeling The Effects Of Substance Dependence On General Self-Reported Health Using Nominal Regression, Taylor Moseley

UNLV Theses, Dissertations, Professional Papers, and Capstones

The goal of this research project was to produce a model of the effects of drug dependence on general self-rated health. Due to power issues, two additional models, one for cocaine and one for heroin, were required. The models used data from the 2005-2009 National Survey on Drug Use and Health. The result of this effort was a ranking of the effects of drug dependence on general health for individuals and for the study population. The model controlled for infectious, chronic and mental illness as well as sociodemographic variables. Significantly increased odds ratios were found for alcohol, marijuana, analgesics, and …

Variables Associated With Critical Illness Among Clark County Residence Hospitalized With H1n1 Influenza A Virus During The 2009 Influenza Season., Jonathan P. Hyatt

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background:In 2009, a novel H1N1 Influenza A virus was detected in the population. Because it can potentially affect a different population than the influenza strains circulating for the past 35 years, it is critical for physicians, practitioners and public health organizations to understand who is susceptible to this disease, and which sub-populations are most likely to suffer critical illness. The objective of this study was to examine the factors unique to 2009 H1N1 infection, with the goal of finding the variables associated with ICU admission (Critical Illness) in the Clark County 2009 H1N1 patient.

Methods:Factors that were assessed in this …

Why Match In Individually And Cluster Randomized Trials?, Laura Balzer, Maya Petersen, Mark Van Der Laan

Laura B. Balzer

The decision to match individuals or clusters in randomized trials is motivated by both practical and statistical concerns. Matching protects against chance imbalances in baseline covariate distributions and is thereby thought to improve study credibility. Matching is also implemented to increase study power. Analogue to Rose and van der Laan (2009), this article investigates the asymptotic efficiency of pair-matching individuals or clusters relative to not matching in randomized trials. We focus on estimating the average treatment effect. We use the efficient influence curve to understand the information provided by each design for estimation of the target causal parameter. Our approach …

Worldwide Patterns Of Bronchodilator Responsiveness: Results From The Burden Of Obstructive Lung Disease Study, Wan C. Tan, William M. Vollmer, Berned Lamprecht, David M. Mannino, Anamika Jithoo, Ewa Nizankowska-Mogilnicka, Filip Mejza, Thorarinn Gislason, Peter Burney, A Sonia Buist

David M. Mannino

Rationale: Criteria for a clinically significant bronchodilator response (BDR) are mainly based on studies in patients with obstructive lung diseases. Little is known about the BDR in healthy general populations, and even less about the worldwide patterns.

Methods: 10 360 adults aged 40 years and older from 14 countries in North America, Europe, Africa and Asia participated in the Burden of Obstructive Lung Disease study. Spirometry was used before and after an inhaled bronchodilator to determine the distribution of the BDR in population-based samples of healthy non-smokers and individuals with airflow obstruction.

Results: In 3922 healthy never smokers, the weighted …

Permasalahan Lanjut Usia Di Daerah Perdesaan Terpencil, Laurentius Aswin Pramono, Cornellesi Fanumbi

Kesmas

Dalam kurun waktu 35 tahun sejak tahun 1990, jumlah lanjut usia (lansia) di Indonesia meningkat 414% dan akan berada pada peringkat kelima negara dengan lansia terbesar pada tahun 2025. Seperti umumnya di negara berkembang, lebih dari dua per tiga lansia hidup di wilayah perdesaan terpencil. Penelitian ini bertujuan untuk mendeskripsikan dan membahas berbagai masalah gangguan kesehatan, sosial budaya, pelayanan, dan program-program kesehatan lansia di Kepulauan Tanimbar Provinsi Maluku. Penelitian dengan metode kualitatif melalui observasi, partisipasi, dan wawancara terhadap 30 lansia di dua wilayah semiurban dan 6 wilayah perdesaan terpencil di kepulauan Tanimbar Provinsi Maluku pada bulan April-Juni 2010. Pengumpulan data, …

Kadar Interferon Gamma Pada Kontak Serumah Dengan Penderita Tuberkulosis, Sri Andarini Indreswari, Suharyo Suharyo

Kesmas

Menurut World Health Organization sekitar sepertiga penduduk dunia telah terinfeksi kuman tuberkulosis dan deteksi dini pada kontak serumah dengan penderita memungkinkan upaya pengobatan dan pencegahan dilakukan dengan efektif. Penelitian ini bertujuan untuk membandingkan hasil pemeriksaan tes Mantoux dengan pemeriksaan serologis kadar interferon gamma (IFN - γ) pada kelompok kontak serumah dengan penderita tuberkulosis yang mempunyai hasil pemeriksaan basil tahan asam (BTA) positif. Penelitian ini menggunakan desain kohort pada kelompok terpajan dan tidak terpajan pada penderita tuberkulosis (umur > 15 tahun). Pemilihan subjek dilakukan secara acak sederhana dan jumlah yang digunakan adalah 34 orang pada masing-masing kelompok. Penelitian ini menggunakan tes Mantoux …