Medicine and Health Sciences Commons^™

Assessing Oral Health Curriculum In Us Family Medicine Residency Programs: A Cera Study, Hugh Silk, Ronnelle King, Ian M. Bennett, Alexander W. Chessman, Judith A. Savageau

Judith A. Savageau

BACKGROUND AND OBJECTIVES: During the past decade, national initiatives have called for improved oral health training for physicians. We do not know, however, how family medicine residency programs have answered this call. METHODS: Family medicine residency directors completed a survey that asked how many hours of oral health teaching are included in their programs in addition to what topics are covered and the perceived barriers to this education. The response rate was 35%. RESULTS: A total of 72% of respondents agreed that oral health is an important topic, but only 32% are satisfied with their residents' competency in oral health. …

An Ounce Of Prevention: How Are We Managing The Early Assessment Of Residents' Clinical Skills?: A Cera Study, Tracy Kedian, Lisa S. Gussak, Judith A. Savageau, Andreas Cohrssen, Ilene Abramson, Kelly Everard, Alison Dobbie

Judith A. Savageau

BACKGROUND AND OBJECTIVES: Clinical skills deficits in residents are common but when identified early can result in decreased cost, faculty time, and stress related to remediation. There is currently no accepted best practice for early assessment of incoming residents' clinical skills. This study describes the current state of early PGY-1 clinical skills assessment in US family medicine residencies.

METHODS: Eleven questions were embedded in the nationwide CERA survey to US family medicine residency directors regarding the processes, components, and barriers to early PGY-1 assessment. Responses are described, and bivariate analyses of the relationship between assessment variables and percentage of international …

Elevated Cardiovascular Risk Among Adults With Obstructive And Restrictive Airway Functioning In The United States: A Cross-Sectional Study Of The National Health And Nutrition Examination Survey From 2007 - 2010, Earl S. Ford, Ann G. Wheaton, David M. Mannino, Latitia Presley-Cantrell, Chaoyang Li, Janet B. Croft

David M. Mannino

Background

Reasons for the excess risk for cardiovascular disease among people with chronic obstructive pulmonary disease remain unclear. Our objective was to examine the cardiovascular risk profile for adults with obstructive and restrictive impairments of lung functioning in a representative sample of adults from the United States.

Methods

We used data from adults aged 20–79 years who participated in the National Health and Nutrition Examination Survey from 2007 to 2010 and had a pulmonary function test. The severity of obstructive impairment was defined by adapting the Global Initiative for Chronic Obstructive Lung Disease criteria.

Results

Among 7249 participants, 80.9% had …

Occupational Chronic Obstructive Pulmonary Disease: An Update, Enrique Diaz-Guzman, David M. Mannino, Shambhu Aryal

David M. Mannino

Chronic obstructive pulmonary disease represents a major cause of morbidity and mortality in industrialized and nonindustrialized countries. Although tobacco use remains the main factor associated with development of the disease, occupational risk factors represent an important and preventable cause. The most common occupationally related factors include exposure to organic dusts, metallic fumes, and a variety of other mineral gases and/or vapors. This article summarizes the literature on the subject and provides an update of the most recent advances in the field.

Epidemiology Of Comorbidities In Chronic Obstructive Pulmonary Disease: Clusters, Phenotypes And Outcomes, Shambhu Aryal, Enrique Diaz-Guzman, David M. Mannino

David M. Mannino

COPD is a complex multisystem disease often accompanied by multiple co-morbidities that contribute to symptoms, exacerbations, hospital admissions and mortality. Individual comorbidities can be grouped into clusters of common human pathology: inflammation/immune response (e.g., ischemic heart disease, metabolic syndrome), thrombosis/hemorrhage (e.g., cerebrovascular diseases, pulmonary embolism), fibrosis/cell proliferation (e.g., lung cancer and other malignancies) and apoptosis/necrosis (e.g., osteoporosis, skeletal muscle dysfunction). While the prevalence of the co-morbidities has been described in a number of observational studies, there is considerable variability in results; moreover characterization of cluster of co-morbidities with the most clinical significance in terms of morbidity and mortality is still …

Data Mining Of Pancreatic Cancer Protein Databases, Peter Revesz, Christopher Assi

CSE Conference and Workshop Papers

Data mining of protein databases poses special challenges because many protein databases are non- relational whereas most data mining and machine learning algorithms assume the input data to be a type of rela- tional database that is also representable as an ARFF file. We developed a method to restructure protein databases so that they become amenable for various data mining and machine learning tools. Our restructuring method en- abled us to apply both decision tree and support vector machine classifiers to a pancreatic protein database. The SVM classifier that used both GO term and PFAM families to characterize proteins gave …

Porque Mas Iberoamerica? De Lecciones Aprendidas Y Buenas Practicas., Diego A. Bernardini

Diego Bernardini MD, PhD

No abstract provided.

The Effects Of Supplemental Fish Oil On Blood Pressure And Morning Cortisol In Normotensive Adults: A Pilot Study, Eric E. Noreen, Josef Brandauer

Health Sciences Faculty Publications

Purpose: To determine the effects of 6wk of supplementation with fish oil (FO) on blood pressure and the morning salivary cortisol concentration in normotensive adults.

Methods: Testing was performed following an overnight fast. Subjects (n=40; 35+/-13y, mean+/-SD) rested supine for 40 min, at which time blood pressure and heart rate were measured. Saliva was collected and analyzed for cortisol. Subjects were then randomly assigned to either: 4g/d of Safflower Oil (SO); pr 4g/d of FO supplying 1,600mg/d eicosapentaenoic acid and 800mg/d docosahexaenoic acid. Testing was repeated following 6wk treatment.

Results: Compared to SO, there was a significant decrease …

Effects Of Consuming Beans Before Or With A Meal On Satiety And Gastrointestinal Hormones Concentration In Obese Men And Women, Lisa Delia Griffith

Loma Linda University Electronic Theses, Dissertations & Projects

Background: Consuming beans and staggering meals may control energy intake. We examined the effect of consuming 0.5 cup of beans 15 minutes before a meal on gastrointestinal (GI) peptides concentrations in obese men and women.

Methods: A randomized crossover design was used to measure GI peptides response to two test meals in 28 healthy obese adults. Subjects consumed a standardized breakfast meal on each test day followed by one of two test meals: a meal incorporating 0.5 cup of beans (control bean meal), and an isocaloric meal (staggered bean meal) in which 0.5 cup of beans was consumed 15 minutes …

The Ratio Of Positive To Negative Affect, Flourishing, And Health Behavior, Michael Stuart Leibow

Loma Linda University Electronic Theses, Dissertations & Projects

The ratio between positive and negative affect, known as the positivity ratio (PR) is thought to be associated with flourishing (psychological and social well-being). However, little research has been done on how PR and flourishing relate to specific health behaviors. The relationships between PR and flourishing with health behavior i.e., physical activity, and diet (fruit, leafy green vegetables [LGV] and meat intake) were investigated in this study. We examined whether PR mediated the relationship between flourishing and health behaviors, and whether flourishing mediated the relationship between PR and these behaviors. Gender and ethnic differences for the above associations were examined …

Common Roots: A Contextual Review Of Hiv Epidemics In Black Men Who Have Sex With Men Across The African Diaspora, Gregorio A. Millett, William L. Jeffries 4h, John L. Peterson, David J. Malebranche, Tim Lane, Stephen A. Flores, Kevin A. Fenton, Patrick A. Wilson, Riley Steiner, Charles M. Heilig

David J Malebranche

Pooled estimates from across the African diaspora show that black men who have sex with men (MSM) are 15 times more likely to be HIV positive compared with general populations and 8·5 times more likely compared with black populations. Disparities in the prevalence of HIV infection are greater in African and Caribbean countries that criminalise homosexual activity than in those that do not criminalise such behaviour. With the exception of US and African epidemiological studies, most studies of black MSM mainly focus on outcomes associated with HIV behavioural risk rather than on prevalence, incidence, or undiagnosed infection. Nevertheless, black MSM …

Inquiring Into Our Past: When The Doctor Is A Survivor Of Abuse, Lucy M. Candib, Judith A. Savageau, Linda F. Weinreb, George W. Reed

Judith A. Savageau

BACKGROUND: Health care professionals like other adults have a substantial exposure to childhood and adult victimization, but the prevalence of abuse experiences among practicing family physicians has not been examined. Also unclear is the impact of such personal experiences of abuse on physicians' screening practices for childhood abuse among their patients and the personal and professional barriers to such screening. METHODS: We surveyed Massachusetts family physicians about their screening practices of adult patients for a history of childhood abuse and found that 33.6% had some experience of personal trauma, with 42.4% of women and 24.3% of men reporting some kind …

Investigation Of The Correlates And Effectiveness Of A Prison-Based Wellness Program, Monica L. Clouse, David M. Mannino, Philip R. Curd

David M. Mannino

In 2006, a comprehensive wellness intervention, titled Wellness Works, was implemented in an incarcerated male population at a 200-bed facility in LaGrange, Kentucky. The purpose of this study was to determine health risk factors and benefits of program participation by analyzing data from a pre-/post-participation health risk assessment (HRA). In total, 448 inmates completed the pre- HRA and 177 (40%) completed the post- HRA. Among program completers, two of the six measured domains (smoking and depression) showed significant improvement at the post- HRA while the other domains (exercise, nutrition, stress, and dental hygiene) did not show significant changes. Overall, this …

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 …

Racial Differences In Preventive And Complementary Health Behaviors And Attitudes, Steven E. Shive, Grace X. Ma, Yin Tan, Jamil I. Toubbeh, Lalitha Parameswaran, Lalitha Parameswaran, Joe Halowich

Journal of Health Disparities Research and Practice

Screening tests have been developed for many diseases—the presence of cancer, especially—but are differentially utilized among racial/ethnic groups. In addition to standard medical screening techniques, some patients opt to use Complementary and Alternative Medicine (CAM) for prevention and treatment. The purpose of the current study is to examine racial/ethnic disparities in primary and secondary preventive health behaviors, determine differences in use of complementary and alternative health regimens, and determine which health attitudes and health self-management factors are associated with use of complementary alternative medicine. If differences among ethnic/racial groups in perceived health status, preventive health care behaviors, and use of …

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 …

Fibrinogen, Copd And Mortality In A Nationally Representative U.S. Cohort, David M. Mannino, Deepa Valvi, Hana Mullerova, Ruth Tal-Singer

David M. Mannino

BACKGROUND:

Fibrinogen is a marker of systemic inflammation and may represent an important biomarker for the progression of chronic obstructive pulmonary disease (COPD).

METHODS:

We used baseline data from the Third National Health and Nutrition Examination Survey (NHANES III) and follow-up mortality data to determine the relation between fibrinogen levels and COPD and to examine how fibrinogen levels at baseline affected long-term outcomes. Elevated fibrinogen was defined as the upper 10% of the fibrinogen level distribution.

RESULTS:

Our study sample included 8,507 subjects, including 245 with Stage 3 or 4 COPD and 826 with Stage 2 COPD. Then, 3,290 of …

Sick With Fear: Popular Challenges To Scientific Authority In The Vaccine Controversies Of The 21st Century, Ellen Watkins

Annual Undergraduate Conference on Health and Society

In the 20th century, vaccines were heralded as one of the greatest medical inventions in history. In the late 1990’s, however, the myth of vaccine-caused autism caught fire. Despite mountains of evidence disproving the link, panicking Americans eschewed vaccines and turned against their physicians. Why did Americans turn their backs on doctors, scientists, and the health industry? This paper follows the vaccine controversy of the last thirty years, looking in particular at the relationship between science and the media. This paper analyzes the contrast between discussion of the hypothesized link in scientific circles and in popular news sources, seeking to …

Fibrinogen, Chronic Obstructive Pulmonary Disease (Copd) And Outcomes In Two United States Cohorts, Deepa Valvi, David M. Mannino, Hana Mullerova, Ruth Tal-Singer

David M. Mannino

Background

Fibrinogen is a marker of systemic inflammation and may be important in the pathogenesis and progression of chronic obstructive pulmonary disease (COPD).

Methods

We used baseline data from Atherosclerosis Risk in Communities and Cardiovascular Health Studies to determine the relation between fibrinogen levels and COPD and to examine how fibrinogen levels at baseline affected outcomes of death, development of COPD, lung function decline, and COPD-hospitalizations.

Results

Our study sample included 20,192 subjects, of whom 2995 died during the follow-up period. The mean fibrinogen level was 307.6 mg/dL and 10% of the sample had levels >393.0 mg/dL. Subjects with Stage …

Impact Of A Medically Supervised Weight Management Program On Obese And Morbidly Obese Persons, Gemechu Abraham Kurfessa

Loma Linda University Electronic Theses, Dissertations & Projects

Background: Overweight and obesity represent a major public health problem. While some studies indicate that a clinic-based, healthy-lifestyle program can result in significant weight loss, a systemic review of major commercial weight loss programs concluded that the evidence to support the use of such programs is minimal. While few argue for the need for weight loss in obese individuals it is important to identify factors associated with successful weight loss. These factors could include financial incentives, frequency of intervention sessions, use of adjunctive weight loss medications and supplemental diet products, and availability of group vs. individual therapy sessions. In addition, …

Neighborhood Socioeconomic Deprivation And Mortality: Nih-Aarp Diet And Health Study, Jacqueline M. Major, Chyke A. Doubeni, Neal D. Freedman, Yikyung Park, Min Lian, Albert R. Hollenbeck, Arthur Schatzkin, Barry I. Graubard, Rashmi Sinha

Chyke A. Doubeni

PURPOSE: Residing in deprived areas may increase risk of mortality beyond that explained by a person's own SES-related factors and lifestyle. The aim of this study was to examine the relation between neighborhood socioeconomic deprivation and all-cause, cancer- and cardiovascular disease (CVD)-specific mortality for men and women after accounting for education and other important person-level risk factors. METHODS: In the longitudinal NIH-AARP Study, we analyzed data from healthy participants, ages 50-71 years at study baseline (1995-1996). Deaths (n = 33831) were identified through December 2005. Information on census tracts was obtained from the 2000 US Census. Cox models estimated hazard …

Schools As Potential Vaccination Venue For Vaccines Outside Regular Epi Schedule: Results From A School Census In Pakistan., Sajid Bashir Soofi, Inam-Ul Haq, M. Imran Khan, Muhammad Bilal Siddiqui, Mushtaq Mirani, Rehman Tahir, Imtiaz Hussain, Mahesh K Puri, Zamir Hussain Suhag, Asif R Khowaja, Abdul Razzaq Lasi, John D Clemens, Michael Favorov, R. Leon Ochiai, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: Vaccines are the most effective public health intervention. Expanded Program on Immunization (EPI) provides routine vaccination in developing countries. However, vaccines that cannot be given in EPI schedule such as typhoid fever vaccine need alternative venues. In areas where school enrolment is high, schools provide a cost effective opportunity for vaccination. Prior to start of a school-based typhoid vaccination program, interviews were conducted with staff of educational institutions in two townships of Karachi, Pakistan to collect baseline information about the school system and to plan a typhoid vaccination program. Data collection teams administered a structured questionnaire to all schools …

Design Of A Fuzzy-Based Decision Support System For Coronary Heart Disease Diagnosis, Awang Bulgiba

Awang Bulgiba Awang Mahmud

In the present paper, a fuzzy rule-based system (FRBS) is designed to serve as a decision support system for Coronary heart disease (CHD) diagnosis that not only considers the decision accuracy of the rules but also their transparency at the same time. To achieve the two above mentioned objectives, we apply a multi-objective genetic algorithm to optimize both the accuracy and transparency of the FRBS. In addition and to help assess the certainty and the importance of each rule by the physician, an extended format of fuzzy rules that incorporates the degree of decision certainty and importance or support of …

The Clinical Gaze In The Practice Of Migrant Health: Indigenous Mexican Migrants In The United States, Seth M. Holmes Phd, Md

Seth M. Holmes PhD, MD

This paper utilizes eighteen months of ethnographic and interview research undertaken in 2003 and 2004 as well as follow-up fieldwork from 2005 to 2007 to explore the sociocultural factors affecting the interactions and barriers between U.S. biomedical professionals and their unauthorized Mexican migrant patients. The participants include unauthorized indigenous Triqui migrants along a transnational circuit from the mountains of Oaxaca, Mexico, to central California, to northwest Washington State and the physicians and nurses staffing the clinics serving Triqui people in these locations. The data show that social and economic structures in health care and subtle cultural factors in biomedicine keep …

Health Disparities Experienced By People With Disabilities In The United States: A Behavioral Risk Factor Surveillance System Study, Jennifer Renee Pharr, Timothy J. Bungum

Public Health Faculty Publications

The Americans with Disabilities Act became law in 1990; since then research has shown that people with disabilities continue to experience barriers to health care. The purpose of this study was to compare utilization of preventive services, chronic disease rates, and engagement in health risk behaviors of participants with differing severities of disabilities to those without disabilities. This study was a secondary analysis of 2010 data collected in the Behavioral Risk Factor Surveillance System national survey in the United States. Rao Chi square test and logistic regression were employed. Participants with disabilities had significantly higher adjusted odds ratios for all …

Syllabus - Cph 911 Epidemiology Seminar I, David M. Mannino

David M. Mannino

No abstract provided.

Long Term Weight Variability In Adults Of Adventist Health Study 1 And 2, Namgyal Lhawang Kyulo

Loma Linda University Electronic Theses, Dissertations & Projects

Background: The effect of overweight and obesity on the risk of fatal disease tends to attenuate with age. One plausible explanation is that a proportion of elderly people in the ideal weight category (19 to 25 kg/m ) experienced disease-related weight loss - an effect that will attenuate health risk related to overweight and obesity. One potential approach to controlling for this bias would be to examine fluctuations in weight during the adult lifespan by considering multiple measures of weight or recall of body weight during adulthood. Some of these measures are available in the Adventist Health Study cohorts and …

Parents, Peers And Pornography: The Influence Of Formative Sexual Scripts On Adult Hiv Sexual Risk Behaviour Among Black Men In The Usa, Sophia A. Hussen, Lisa Bowleg, Thurka Sangaramoorthy, David J. Malebranche

David J Malebranche

Black men in the USA experience disproportionately high rates of HIV infection, particularly in the Southeastern part of the country. We conducted 90 qualitative in-depth interviews with Black men living in the state of Georgia and analysed the transcripts using Sexual Script Theory to: (1) characterise the sources and content of sexual scripts that Black men were exposed to during their childhood and adolescence and (2) describe the potential influence of formative scripts on adult HIV sexual risk behaviour. Our analyses highlighted salient sources of cultural scenarios (parents, peers, pornography, sexual education and television), interpersonal scripts (early sexplay, older female …