Medicine and Health Sciences Commons^™

Epidemiology Of Hiv Among American Indians And Alaska Natives – United States, 2008-2011, Frances J. Walker, Jane M. Kelly, Mona Doshani, Neeraja Saduvala, Joseph Prejean

Journal of Health Disparities Research and Practice

American Indians/Alaska Natives (AI/AN) diagnosed with HIV infection have poorer survivorship and a higher percentage of Stage 3 (AIDS] diagnoses within one year of HIV diagnosis, compared to most race/ethnicity groups. National HIV surveillance data for 2008-2011 were used to determine diagnosis rates of HIV infection, persons living with HIV, and persons with a late diagnosis (Stage 3 within three months of HIV diagnosis) by selected characteristics for AI/AN and a combined other race/ethnicity group. The highest percentages of 862 AI/AN diagnosed with HIV infection were among males (75.7%), AI/AN aged 25-34 years (32.9%), persons living in large metropolitan areas …

Epidemiology News, Georgia Southern University

Epidemiology News (2012-2018)

• Georgia Southern Professor Recognized for Outstanding Contribution

Low-Intensity Physical Activity And Cardiometabolic Risk Factors Among Older Adults With Multiple Chronic Conditions, Yueyao Li

Theses and Dissertations

Introduction Cardiovascular disease (CVD) is the leading cause of death among older adults in the Unites States and is driven largely by cardiometabolic risk factors including elevated blood pressure and blood glucose. Studies have found the protective effect of moderate intensity physical activity (MIPA) and vigorous intensity physical activity (VIPA) on cardiometabolic risk factor; however, the association between light physical activity (LIPA) and cardiometabolic risk factor among older adults is not clear. Objectives 1). Examine the association between LIPA and cardiometabolic risk factors. 2). Examine whether the association between LIPA and cardiometabolic risk factor is moderated by multiple chronic conditions. …

Genetic And Epigenetic Variations In Asthma And Wheeze Illnesses, Todd M. Everson

Theses and Dissertations

Asthma, a chronic respiratory condition, is common worldwide with no cure and limited effective prevention strategies. It is well recognized that asthma has a multifaceted etiology, though many of the underlying mechanisms involved in asthma development, persistence and remission are still convoluted. Epigenetic mechanisms, such as DNA methylation, regulate gene-expression but are not related to changes in the actual DNA sequence. Recently, differential patterns of DNA methylation within many genes have been associated with asthma, particularly within genes involved in the differentiation of pro-inflammatory T-helper 2 (Th2) cells. DNA methylation patterns within less known biologic pathways undoubtedly are involved in …

Dietary Patterns And Prostate Cancer Aggressiveness In African-American And European-American Men, Lara Ryan Schneider

Theses and Dissertations

Several foods and nutrients have been linked to prostate cancer risk, but the effect of overall diet on prostate cancer outcomes is not well understood. Previous research has primarily examined a posteriori dietary patterns in relation to prostate cancer; studies that have used a priori dietary patterns and their relationship with prostate cancer have been inconclusive. Furthermore, racial differences in prostate cancer incidence and aggressiveness are not well understood. Data from the case-only North Carolina-Louisiana Prostate Cancer Project (PCaP) was used to examine the association between overall dietary pattern, as measured by the Mediterranean Diet (MED) score and the Dietary …

Physical Activity And Breast Cancer In South Carolina, Chisom Onyeuku

Theses and Dissertations

This study examined the relationship between breast cancer incidence and recreational physical activity. It was one of the first studies in the southeastern US to examine incident breast cancer and physical activity in an ethnically diverse cohort of women. In terms of physical activity, both lifetime and recent physical activity were analyzed. All physical activity data were from validated self-reported surveys. The study examined BMI, menopausal status and race as key confounders and effect modifiers. The study found evidence that for Black women, there was a positive relationship between the amount of lifetime physical activity and the odds of incident …

Individual- And Neighborhood-Level Determinants Of Emergency Department Utilization Among Patients With Diabetes In South Carolina, Charity B. Breneman

Theses and Dissertations

AIM: The primary aim of this study was to evaluate the geographic variation in emergency department (ED) use in South Carolina using geographical information systems (GIS) and to examine the effects of both individual- and neighborhood-level characteristics on frequent ED use among patients with diabetes. METHODS: ED discharge data for 2013 was geocoded based on patients’ residential ZIP code using GIS. Frequent ED use among patients with diabetes was defined as three or more ED visits between January 1, 2013 and December 31, 2013. The boundaries for each neighborhood were defined by the U.S. Census Bureau ZIP Code Tabulation Areas …

Effects Of Cost Sharing On Seeking Care For Serious And Minor Symptoms. Results Of A Randomized Controlled Trial, Martin Shapiro, John Ware, Cathy Sherbourne

Martin Shapiro

To estimate the effect of cost sharing on seeking care for serious and minor symptoms, we analyzed data for 3539 persons aged 17 to 61 from the Rand Health Insurance Experiment. Participants were randomly assigned to a free-care group or to insurance plans requiring them to pay part of the costs (cost-sharing group). Annual surveys were administered to determine if participants had serious and minor symptoms during the preceding month and whether they saw a physician. Serious symptoms were judged by a panel of physicians to warrant care in most instances; minor symptoms were judged neither to be severe nor …

Evidence For Using Immunosuppressive Treatments When Treating Idiopathic Non-Infectious Uveitis: A Systematic Review And Meta-Analysis, Hargurinder Singh

Electronic Thesis and Dissertation Repository

Idiopathic non-infectious uveitis is the spontaneous inflammation of the eye, which can lead to blindness if not treated correctly. Due to long-term side effects of corticosteroids, 4 classes of off-label immunosuppressive treatments are sometimes used (alkylating agents, inhibitors of T-lymphocyte signalling, antimetabolites and biological modifiers). We conducted a systematic review and meta-analysis to assess the effectiveness of different treatment classes on uveitis patients with similar characteristics. Results of the systematic review concurred with the conclusions from the meta-analysis, which found that all immunosuppressive treatments improved patient vision, with a statistically significant change in logMAR of -0.11 (95% CI of -0.152 …

Physical Exertion As A Risk Factor For Ventricular Arrhythmia: A Prospective Cohort Study, Harpreet S. Chahal

Electronic Thesis and Dissertation Repository

Episodes of physical exertion are associated with an immediately higher risk of cardiovascular events while physical activity over the long-term is cardioprotective. To assess the transient and long-term risk of ventricular arrhythmia (VA), we conducted a nested case-crossover study within a prospective cohort of 97 patients with implantable cardioverter-defibrillators (ICD). Within an hour of episodes of exertion, the risk of VA was 5.3 (95% CI 2.7 – 10.6) times greater compared to periods of rest. The association was higher among patients with aerobic fitness below the median (RR[relative risk]=17.5, 95% 5.2 – 58.5) than for patients with aerobic fitness above …

The Impact Of The 2008 Financial Crisis On Food Security And Food Expenditures In Mexico: A Disproportionate Effect On The Vulnerable, Mireya Vilar-Compte, Sebastian Sandoval-Olascoaga, Ana Bernal-Stuart, Sandhya Shimoga, Arturo Vargas-Bustamante

Department of Public Health Scholarship and Creative Works

Objective The present paper investigated the impact of the 2008 financial crisis on food security in Mexico and how it disproportionally affected vulnerable households. Design A generalized ordered logistic regression was estimated to assess the impact of the crisis on households' food security status. An ordinary least squares and a quantile regression were estimated to evaluate the effect of the financial crisis on a continuous proxy measure of food security defined as the share of a household's current income devoted to food expenditures. Setting Both analyses were performed using pooled cross-sectional data from the Mexican National Household Income and Expenditure …

Epidemiology News, Georgia Southern University

Epidemiology News (2012-2018)

• Georgia Southern Examines the Association between Arthritis and Depression

Prenatal Exposure To Perfluoroalkyl Acids And Serum Testosterone Concentrations At 15 Years Of Age In Female Alspac Study Participants, Mildred Maisonet, Antonia M. Calafat, Michele Marcus, Jouni J.K. Jaakkola, Hany Lashen

ETSU Faculty Works

Background: Exposure to perfluorooctane sulfonic acid (PFOS) or to perfluorooctanoic acid (PFOA) increases mouse and human peroxisome proliferator–activated receptor alpha (PPARα) subtype activity, which influences lipid metabolism. Because cholesterol is the substrate from which testosterone is synthesized, exposure to these substances has the potential to alter testosterone concentrations.

Objectives: We explored associations of total testosterone and sex hormone–binding globulin (SHBG) concentrations at age 15 years with prenatal exposures to PFOS, PFOA, perfluorohexane sulfonic acid (PFHxS), and perfluoronanoic acid (PFNA) in females.

Methods: Prenatal concentrations of the perfluoroalkyl acids (PFAAs) were measured in serum collected from pregnant mothers at enrollment (1991–1992) …

Associations Of Perfluoroalkyl Substances (Pfass) With Lower Birth Weight: An Evaluation Of Potential Confounding By Glomerular Filtration Rate Using A Physiologically Based Pharmacokinetic Model (Pbpk), Marc-André Verner, Anne E. Loccisano, Nils-Halvdan Morken, Miyoung Yoon, Huali Wu, Robin Mcdougall, Mildred Maisonet, Michele Marcus, Reiko Kishi, Chihiro Miyashita, Mei-Huei Chen, Wu-Shiun Hsieh, Melvin E. Andersen, Harvey J. Clewell Iii, Matthew P. Longnecker

ETSU Faculty Works

Background: Prenatal exposure to perfluoroalkyl substances (PFAS) has been associated with lower birth weight in epidemiologic studies. This association could be attributable to glomerular filtration rate (GFR), which is related to PFAS concentration and birth weight.

Objectives: We used a physiologically based pharmacokinetic (PBPK) model of pregnancy to assess how much of the PFAS–birth weight association observed in epidemiologic studies might be attributable to GFR.

Methods: We modified a PBPK model to reflect the association of GFR with birth weight (estimated from three studies of GFR and birth weight) and used it to simulate PFAS concentrations in maternal and cord …

Factors Impacting Transgender Patients’ Discomfort With Their Family Physicians: A Respondent-Driven Sampling Survey, Greta R. Bauer, Xuchen Zong, Ayden I. Scheim, Rebecca Hammond, Amardeep Thind

Epidemiology and Biostatistics Publications

BACKGROUND: Representing approximately 0.5% of the population, transgender (trans) persons in Canada depend on family physicians for both general and transition-related care. However, physicians receive little to no training on this patient population, and trans patients are often profoundly uncomfortable and may avoid health care. This study examined factors associated with patient discomfort discussing trans health issues with a family physician in Ontario, Canada.

METHODS: 433 trans people age 16 and over were surveyed using respondent-driven sampling for the Trans PULSE Project; 356 had a family physician. Weighted logistic regression models were fit to produce prevalence risk ratios (PRRs) via …

Microrna Molecular Profiling From Matched Tumor And Bio-Fluids In Bladder Cancer, David A. Armstrong, Benjamin B. Green, John D. Seigne, Alan R. Schned, Carmen Marsit

Dartmouth Scholarship

MicroRNAs have been identified as potential cancer biomarkers due to their presence and stability in many body fluids including urine and plasma, but the relationship of the pattern of expression of these messengers across various biological media has not been addressed and could provide important information in order to translate these biomarkers for epidemiologic or clinical use. We analyzed microRNA of matched FFPE-tumor tissue, plasma, urine exosomes (n = 16) and WBCs (n = 11) from patients with bladder cancer, using Nanostring miRNA assays and droplet digital PCR for validation. Pearson correlations were used to compare expression between …

Survival Outcomes And Treatment Utilization Among Patients With Known And Unknown Primary Tumours In Ontario., Chong Sung Kim

Electronic Thesis and Dissertation Repository

I identify two cohorts of cancer patients with known and unknown primary tumours. Cancer of unknown primary (CUP) is defined by the presence of pathologically identified metastatic disease without clinical or radiological evidence of a primary tumour. Using the Ontario Cancer Registry, Same Day Surgery/Discharge Abstract Database and Ontario Health Insurance Plan, a novel linkage strategy was developed to cross-validate diagnoses. I found CUP patients represent a significant portion of all metastatic cancers. CUP patients with histological confirmed disease, squamous cell histology, or metastases localized to nodal regions had significantly better survival than other CUP patients. Knowledge of the primary …

Nested Partially-Latent, Class Models For Dependent Binary Data, Estimating Disease Etiology, Zhenke Wu, Maria Deloria-Knoll, Scott L. Zeger

Johns Hopkins University, Dept. of Biostatistics Working Papers

The Pneumonia Etiology Research for Child Health (PERCH) study seeks to use modern measurement technology to infer the causes of pneumonia for which gold-standard evidence is unavailable. The paper describes a latent variable model designed to infer from case-control data the etiology distribution for the population of cases, and for an individual case given his or her measurements. We assume each observation is drawn from a mixture model for which each component represents one cause or disease class. The model addresses a major limitation of the traditional latent class approach by taking account of residual dependence among multivariate binary outcome …

Physical Activity Levels And Health Of Passamaquoddy Tribe At Indian Township, Michael R. Best

Electronic Theses and Dissertations

This study focuses on reporting the occupational, household, transportation and leisure time physical activity of the Passamaquoddy Tribe at Indian Township. This study also focuses on health measures and the presence of chronic disease and how they are affected by physical activity, risk factors, and other health related measures.

An interview-administered questionnaire, developed by the CDC, was given to participants age 25-44 years old, with one small change. The original Intertribal Heart Project (ITHP) questionnaire used a shortened version of the WHO’s Monica Optional Study of Physical Activity (MOSPA), in order to reduce the time it takes to administer the …

Determinants And Disparities Of Survival In Triple-Negative Breast Cancer Patients: A Population-Based Retrospective Longitudinal Cohort Design Utilizing The Cox Proportional Hazard Analytical Model, Michael C. Belcon

FIU Electronic Theses and Dissertations

A significant racial disparity in breast cancer mortality exists among women in the United States. Triple-negative breast cancer (TNBC) is a breast cancer phenotype that may explain, in part, this disparity between white and African American women. The objective of this study was to determine the predictors of survival in TNBC and non-triple-negative breast cancer (NTNBC) patients.

Data on 168,756 female patients with a diagnosis of invasive breast cancer in the Surveillance Epidemiology and End Results (SEER) program were stratified based on breast cancer receptor phenotypes in this retrospective longitudinal cohort study design. Multiple logistic regressions were used for exploring …

Identification And Survival Outcomes Of A Cohort Of Patients With Cancer Of Unknown Primary In Ontario, Canada., Chong S Kim, Malek B Hannouf, Sisira Sarma, George B Rodrigues, Peter K Rogan, Salaheddin M Mahmud, Eric Winquist, Muriel Brackstone, Gregory S Zaric

Epidemiology and Biostatistics Publications

BACKGROUND: Cancer of unknown primary origin (CUP) is defined by the presence of pathologically identified metastatic disease without clinical or radiological evidence of a primary tumour. Our objective was to identify incident cases of CUP in Ontario, Canada, and determine the influence of histology and sites of metastases on overall survival (OS).

MATERIAL AND METHODS: We used the Ontario Cancer Registry (OCR) and the Same-Day Surgery and Discharge Abstract Database (SDS/DAD) to identify patients diagnosed with CUP in Ontario between 1 January 2000, and 31 December 2005. Patient diagnostic information, including histology and survival data, was obtained from the OCR. …

Factors Associated With High Risk Infant Follow-Up Attendance, Martha Grant Fuller

Dissertations

Prematurity is a significant public health problem and preterm infants face well described risks of adverse neurodevelopmental outcomes. Bronfenbrenner’s bioecological theory of development describes interactions between biological and environmental factors and explains how these interactions can impact development. Systematic follow-up of preterm, high-risk infants is recommended for early identification of problems and provision of interventions and support services. Most research on follow-up attendance has involved small, single sites. A retrospective analysis of population based data available in the California Children’s Services High Risk Infant Follow-up Quality of Care Initiative (HRIF-QCI) data system was performed to examine factors associated with attendance …

Knowledge, Attitudes, Beliefs And Behaviors (Kabb) Of Diabetes Among Afro-Caribbeans Near Brooklyn, New York, Sophia Allen

Sophia I. Allen, Ph.D.

Diabetes is an epidemic in the U.S. that unduly affects minority groups. African Americans are more than two times as likely to die from diabetes than whites. Literature previously established that some population groups have a negative perception toward medical professionals and visiting a doctor's office and/or hospital when a health problem occurs. In New York City, where a large group of Afro-Caribbeans live, diabetes prevalence more than doubled over the past 10 years with over half a million adults diagnosed. Due to a gap in literature in the U.S. on type 2 diabetes among English-speaking Afro-Caribbeans, this study recruited …

Colon Cancer Care And Survival: Income And Insurance Are More Predictive In The Usa, Community Primary Care Physician Supply More So In Canada, Kevin M. Gorey, Sindu M. Kanjeekal, Frances C. Wright, Caroline Hamm, Isaac N. Luginaah, Emma Bartfay, Guangyong Zou, Erc J. Holowaty, Nancy L. Richter

Social Work Publications

Background: Our research group advanced a health insurance theory to explain Canada’s cancer care advantages over America. The late Barbara Starfield theorized that Canada’s greater primary care-orientation also plays a critically protective role. We tested the resultant Starfield-Gorey theory by examining the effects of poverty, health insurance and physician supplies, primary care and specialists, on colon cancer care in Ontario and California.

Methods: We analyzed registry data for people with non-metastasized colon cancer from Ontario (n = 2,060) and California (n = 4,574) diagnosed between 1996 and 2000 and followed to 2010. We obtained census tract-based socioeconomic data from population …

Epidemiology News, Georgia Southern University

Epidemiology News (2012-2018)

• Georgia Southern Examines the role of Adiposity

The Statistics Of Sensitivity Analyses, Alexander R. Luedtke, Ivan Diaz, Mark J. Van Der Laan

Alex Luedtke

Suppose one wishes to estimate a causal parameter given a sample of observations. This requires making unidentifiable assumptions about an underlying causal mechanism. Sensitivity analyses help investigators understand what impact violations of these assumptions could have on the causal conclusions drawn from a study, though themselves rely on untestable (but hopefully more interpretable) assumptions. Díaz and van der Laan (2013) advocate the use of a sequence (or continuum) of interpretable untestable assumptions of increasing plausibility for the sensitivity analysis so that experts can have informed opinions about which are true. In this work, we argue that using appropriate statistical procedures …

Dynapenic Obesity And The Effect On Long-Term Physical Function And Quality Of Life: Data From The Osteoarthritis Initiative, John A. Batsis, Alicia J. Zbehlik, Dawna Pidgeon, Stephen J. Bartels

Dartmouth Scholarship

Obesity is associated with functional impairment, institutionalization, and increased mortality risk in elders. Dynapenia is defined as reduced muscle strength and is a known independent predictor of adverse events and disability. The synergy between dynapenia and obesity leads to worse outcomes than either independently. We identified the impact of dynapenic obesity in a cohort at risk for and with knee osteoarthritis on function.

Risk Of Arrhythmia And Mortality From Macrolide Antibiotic Prescription: A Population-Based Cohort Study, Mai H. Trac

Electronic Thesis and Dissertation Repository

Many respiratory tract infections are treated with macrolide antibiotics. Regulatory agencies warn that these antibiotics increase the risk of ventricular arrhythmia. This population-based retrospective cohort study examined the 30-day risk of a hospital encounter with ventricular arrhythmia and all-cause mortality in 503,612 matched pairs of older adults who received a new outpatient prescription for an oral macrolide antibiotic and those prescribed referent antibiotics from 2002 to 2013 in Ontario. Conditional logistic regression was used to measure the association between macrolide exposure and outcomes. Macrolide antibiotics compared with referent antibiotics were not associated with a higher 30-day risk of ventricular arrhythmia …

The Statistics Of Sensitivity Analyses, Alexander R. Luedtke, Ivan Diaz, Mark J. Van Der Laan

U.C. Berkeley Division of Biostatistics Working Paper Series

Suppose one wishes to estimate a causal parameter given a sample of observations. This requires making unidentifiable assumptions about an underlying causal mechanism. Sensitivity analyses help investigators understand what impact violations of these assumptions could have on the causal conclusions drawn from a study, though themselves rely on untestable (but hopefully more interpretable) assumptions. Díaz and van der Laan (2013) advocate the use of a sequence (or continuum) of interpretable untestable assumptions of increasing plausibility for the sensitivity analysis so that experts can have informed opinions about which are true. In this work, we argue that using appropriate statistical procedures …

El Impacto De Los Lazos Familiares En La Salud Física, Emocional Y Espiritual En Cuidados Paliativos: Un Estudio De La Clínica Familia, Max Meyerhoff

Independent Study Project (ISP) Collection

Research Question: How do Chilean family ties impact the physical, emotional and spiritual health of patients in a palliative care facility?

Objective: Understand the role that the tight-knit Chilean family structure plays during the palliative care process and how these family ties affect the physical, emotional and spiritual well being of the patient.

Background: Chile has recently gone through an epidemiological transition. Due to improved access to primary care fewer people are dying from infectious diseases. However, because they are now living longer, more Chileans are now dying from slow-acting noncommunicable diseases. Due to these slower acting …