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Articles 1 - 25 of 25
Full-Text Articles in Medicine and Health Sciences
Racial Disparities In The Maintenance Of Healthy Lifestyles And Their Effect On Cumulative Blood Pressure Burden And Left Ventricular Mass In African Americans And Whites: Data From The Coronary Artery Risk Development In Young Adults (Cardia) Study, John N. Booth
All ETDs from UAB
The prevalence of healthy behaviors associated with optimal blood pressure (BP) levels and reduced risk for target-organ damage and cardiovascular disease (CVD) is lower in blacks compared with whites. Randomized controlled trials provide evidence that if healthy behaviors are maintained over the lifespan, including normal body weight, moderate physical activity, limited alcohol intake, limited sodium intake, adequate potassium intake and a rich diet of fruits and vegetables and low in high-fat dairy and saturated and total fat, then high BP may be preventable. The goal of this dissertation was to assess racial differences in the maintenance of healthy behaviors and …
The Association Between Cancer And Risk Of Sepsis Among Whites And Blacks In The Regards Cohort, Justin Xavier Moore
The Association Between Cancer And Risk Of Sepsis Among Whites And Blacks In The Regards Cohort, Justin Xavier Moore
All ETDs from UAB
Cancer is the second leading cause of morbidity and death in the United States corresponding to more than 1.7 million incident cases and responsible for more than 550,000 deaths annually. In addition, hospitalized cancer patients are nearly 10 times more likely to develop sepsis when compared to participants with no cancer history. As treatments and therapies for cancer continue to improve, the average 5-year survival is approaching 70% overall among the US population; however, to date there is very limited research that has examined the association between patients with a history of cancer and future risk of sepsis among a …
A Statistical Approach To Computed Tomography Perfusion, Seth Thomas Lirette
A Statistical Approach To Computed Tomography Perfusion, Seth Thomas Lirette
All ETDs from UAB
Stroke is, and will continue to be, a pervasive problem in the both the United States and across the world, and computed tomography (CT) perfusion scanning will continue to be a first-line diagnostic tool to quantify where and how much blood flow occlusion is present in the brain. CT perfusion maps displaying several scalar perfusion parameters for each brain voxel will continue to be used by radiologists and other clinicians. The goal of this dissertation is to examine and improve upon current standards of practice concerning CT perfusion. We first exhibit how software that constructs perfusion maps can be implemented …
Publc Hospital Conversions: A Question Of Social Capital?, Antionette Smith Epps
Publc Hospital Conversions: A Question Of Social Capital?, Antionette Smith Epps
All ETDs from UAB
ABSTRACT Between 1975 and 2015, the number of public hospitals decreased by 43%, from 1761 to 1003. Public hospitals have undergone changes in ownership status, structural and/or governance conversions and closures. Reasons for these changes are varied and numerous, however, many studies identify financial difficulties as a major reason that decision-makers consider an ownership change. Some public hospitals persist despite exhibiting financial issues. Therefore, there may be other factors contributing to the persistence of some public hospitals. This paper examines the potential role of social capital or community engagement and cohesion as a factor in determining if a public hospital …
The Benefits Of A Vegetable Gardening Intervention For Cancer Survivors, Mallory Gamel Cases
The Benefits Of A Vegetable Gardening Intervention For Cancer Survivors, Mallory Gamel Cases
All ETDs from UAB
Due to improvements in screening and treatment, the number of cancer survivors continues to increase. Cancer survivors are at increased risk for second malignancies, comorbidities, and functional decline. All three papers draw data from Harvest for Health, a 12-month home-based vegetable gardening intervention for cancer survivors. This dissertation aimed to (1) explore changes in physical functioning and physical health-related quality of life in 44 cancer survivors aged >65 years old pooled from two iterations of Harvest for Health; (2) examine predictors of continued gardening and garden expansion 12-months post-intervention; and (3) assess the capacity of sustainability of Harvest for Health …
Effect Of Antihypertensive Drugs On Left Ventricular Traits In Africam American, Anh N. Do
Effect Of Antihypertensive Drugs On Left Ventricular Traits In Africam American, Anh N. Do
All ETDs from UAB
The purpose of this dissertation is to evaluate the association of antihypertensive treatment as well genomic variants with left ventricular (LV) hypertrophy (LVH) -related traits among African Americans (AAs) in five cross-sectional epidemiology cohorts from the United States. AAs especially those with hypertension, are overburdened by left ventricular (LV) hypertrophy (LVH) compared to other ethnic groups. LVH is associated with increased risk for cardiovascular morbidity and mortality. Antihypertensive treatments have been found to improve LVH and related echocardiographic measures (i.e. LV traits) among hypertensive patients. However, the effect of antihypertensive treatments on LVH and related traits in AAs has not …
Effective Recruiting For Subgroups In The Systolic Blood Pressure Intervention Trial (Sprint), Thomas Marshall Ramsey
Effective Recruiting For Subgroups In The Systolic Blood Pressure Intervention Trial (Sprint), Thomas Marshall Ramsey
All ETDs from UAB
EFFECTIVE RECRUITING FOR SUBGROUPS IN THE SYSTOLIC BLOOD PRESSURE INTERVENTION TRIAL (SPRINT) THOMAS MARSHALL RAMSEY HEALTH EDUCATION / HEALTH PROMOTION ABSTRACT Background: The Systolic Blood Pressure Intervention Trial (SPRINT) recruitment focused on participants > 50 years old with systolic blood pressure of > 140 mm Hg (hypertension) with no evidence of diabetes or previous stroke. Priority participants were targeted in non-clinical subgroups (women and minorities) as well as three clinical subgroups (pre-existing cardiovascular disease, pre-existing chronic kidney disease, > 75 years old). Objective: The objective of this secondary analysis is to determine which of the five recruiting strategies was most effective? Which recruitment …
Implementation Of Repeat Hiv Testing During Pregnancy In Kenya, Anna Joy Graves Rogers
Implementation Of Repeat Hiv Testing During Pregnancy In Kenya, Anna Joy Graves Rogers
All ETDs from UAB
It is estimated that a third of all mother-to-child transmission (MTCT) of HIV occurs in women with incident HIV infection during pregnancy, potentially contributing to over 37,000 pediatric HIV infections globally and 4,300 infections in Kenya on an annual basis. Since most pregnant women with acute HIV infection test negative for HIV during routine early-pregnancy antenatal testing, they may not receive access to life-saving antiretroviral therapy (ART) for their own sake, as well as to prevent perinatal HIV transmission. A comprehensive strategy to eliminate MTCT will require identifying and addressing incident HIV infection. International recommendations suggest that pregnant women in …
Comparative Performance And Clinical Utility Of Indirect Treatment Comparison Estimators, William Hillegass
Comparative Performance And Clinical Utility Of Indirect Treatment Comparison Estimators, William Hillegass
All ETDs from UAB
In the clinical decision between two or more discrete competing diagnostic or therapeutic patient care strategies, the main consideration is typically the expected difference in the primary outcome of interest. When head-to-head randomized trial results are unavailable or insufficient, this expected difference in outcome can be estimated with an indirect comparison in some settings. Publication of formalized indirect comparisons and proposed statistical methods in the medical literature began in 1993. Despite growing acceptance of indirect treatment comparisons as credible evidence, the statistical underpinnings, properties, and performance of these methods both individually and comparatively remain incompletely explored and defined. This dissertation …
Quality Of Care And Racial Disparities In Head And Neck Cancer Treatment, Siddharth Jain
Quality Of Care And Racial Disparities In Head And Neck Cancer Treatment, Siddharth Jain
All ETDs from UAB
PURPOSE: Intensity-modulated radiotherapy (IMRT) is a development of conventional radiotherapy in the treatment for most Head and Neck Cancers (HNC). There is no sufficient evidence to suggest that some physicians are associated with better outcomes in HNC patients. Also, there is limited data that showed that African Americans have poor outcomes compared to other races among HNC patients. We conducted a cross-sectional analysis to evaluate the effect of radiation oncologist characteristics on outcomes in HNC patients treated with IMRT, and factors associated with racial disparities in the treatment outcomes. METHODS: The study used Surveillance Epidemiology and End Results (SEER)-Medicare linked …
Sample Size Re-Estimation For Confirmatory Two-Stage Multi-Arm Trials With Normal And Binary Outcomes, Yan Li
All ETDs from UAB
Multi-arm clinical trials comparing several treatments against a common control are more efficient than traditional multiple two-arm trials. Several flexible multi-arm designs which utilize the closed test procedure for strong familywise error rate control have been proposed to allow treatment selection and sample size re-estimation (SSR) at the interim analysis. Because of the interdependence among hypothesis tests for each treatment induced by the closed test procedure, SSR methods for two-arm trials are not directly applicable to multi-arm trials. Further, there is limited literature on methods for SSR in multi-arm trials. In paper 1, we derive SSR procedures based on the …
Modeling Depression Treatment Strategies For Human Immunodeficiency Virus (Hiv) Positive Patients, Rongbing Xie
Modeling Depression Treatment Strategies For Human Immunodeficiency Virus (Hiv) Positive Patients, Rongbing Xie
All ETDs from UAB
This dissertation empirically examines the associations between depression and HIV-related outcomes, simulates both care and outcomes under different depression care strategies, and compares the cost effectiveness of various depression care strategies to the current care strategy. The empirical investigations reveal the negative associations between depression and HIV-related outcomes using two longitudinal patient-level databases. Furthermore, the patterns and outcomes of depression care are identified and simulated using agent-based modeling. Finally, simulated costs and effectiveness are used to evaluate different depression care strategies for reducing new HIV infections and improving quality of life. The current standard of care for depression among patients …
Statistical Methods In Cancer Survival Prediction And Microbiome Data Analysis, Xinyan Zhang
Statistical Methods In Cancer Survival Prediction And Microbiome Data Analysis, Xinyan Zhang
All ETDs from UAB
This dissertation focused on developing statistical methods in two areas, cancer survival prediction and microbiome data analysis. Heterogeneity in terms of tumor characteristics, prognosis, and survival has been a persistent problem in cancer prediction and prognosis for many decades. One of the main shortcomings of past studies is the failure to incorporate prior biological information into the predictive model, given strong evidence of pathway-based genetic nature of cancer. In paper 1, to address this problem, we propose a two-stage approach to incorporate pathway information into the prognostic modeling using large-scale gene expression data. In the first stage, we fit all …
Phenotypic Characteristics And Dietary Treatment Of Pediatric Non-Alcoholic Fatty Liver Disease, Shima Dowla
Phenotypic Characteristics And Dietary Treatment Of Pediatric Non-Alcoholic Fatty Liver Disease, Shima Dowla
All ETDs from UAB
Background: Non-alcoholic fatty liver disease (NAFLD) is the most common liver disorder among children in the developed world and can progress to cirrhosis, hepatocellular carcinoma, and liver failure. Objectives: The primary objectives of this dissertation were to (1) review advances in the field of pediatric NAFLD, (2) describe the demographic, anthropometric and metabolic characteristics of children with NAFLD and evaluate whether differences existed based on ethnicity and diagnostic method, and (3) compare the effect of a carbohydrate restricted diet vs fat reduced diet on improvement in hepatic steatosis over an 8-week period among overweight and obese children diagnosed with NAFLD. …
Development And Pilot Testing Of A Behavioral Intervention For Chronic Pain Tailored To Individuals With Hiv, Jessica Merlin
Development And Pilot Testing Of A Behavioral Intervention For Chronic Pain Tailored To Individuals With Hiv, Jessica Merlin
All ETDs from UAB
Background. Chronic pain is a common and disabling comorbidity in individuals living with HIV. Behavioral interventions are among the most effective and safe nonpharmacologic treatments for chronic pain. However, the success of a behavioral intervention is influenced by how well it is tailored to the target population’s biological, psychological, and social context. Given well-documented psychosocial vulnerabilities among persons with HIV, it is critical to develop a behavioral intervention for chronic pain tailored to this population. Objective. To use qualitative methods to investigate patient preferences for the structure and delivery of a behavioral intervention for chronic pain in individuals with HIV. …
Autism Spectrum Disorders And Social-Ecological Models: Understanding How Context Drives Prevalence, Anne Elizabeth Brisendine
Autism Spectrum Disorders And Social-Ecological Models: Understanding How Context Drives Prevalence, Anne Elizabeth Brisendine
All ETDs from UAB
Background: While there has been significant work done to explore disparities in autism spectrum disorder (ASD) diagnoses with respect to individual characteristics, little work has been done to examine the overall system and structure of the environment in which ASD identification is made and how it is related to diagnosis and services. The purpose of this study is to better understand the social-ecological factors that impact ASD diagnoses at the population level. Methods: In the first aim of this dissertation, a tailored social ecological model was developed and examined across variables in the 2011/12 National Survey of Children’s Health. In …
Alternative Methodological Approaches For Quantifying Dental Caries And Non-Water Beverage Consumptions For The Improvement Of Caries Risk Analyses In Children, Kelsey Harris Jordan
Alternative Methodological Approaches For Quantifying Dental Caries And Non-Water Beverage Consumptions For The Improvement Of Caries Risk Analyses In Children, Kelsey Harris Jordan
All ETDs from UAB
Researchers assume caries progress constantly, all crowned/extracted tooth surfaces are carious, and non-water beverage consumption (NWBC) habits are similar by relying on increments, dmfs scoring, and consumption frequencies, respectively. These assumptions are likely inaccurate. The purpose of this research was to evaluate and modify the use of 1) longitudinal caries disease assessment, 2) the dmfs score and 3) NWBC variables to more accurately estimate disease and identify risk factors. To investigate, young (8-18 months at baseline), healthy, poor, rural, African American, Alabamian children were observed annually for five years. Three calibrated dentists performed oral examinations (without radiographs), calculating the number …
Univariate Frailty Model For Competing Risks Data Analysis, Yuliang Liu
Univariate Frailty Model For Competing Risks Data Analysis, Yuliang Liu
All ETDs from UAB
Unobserved individual heterogeneity, that is frailty, is a major concern in the application of analysis for competing risks data. Unlike the study of clustered competing risks data using multivariate frailty models, we have not found a study of non-clustered competing risks data using univariate frailty model. This dissertation focuses on developing frailty models for the analysis of non-clustered competing risks data. The estimation of the effects of covariates by a parametric univariate frailty model could be a useful approach when heterogeneity must be considered in the non-clustered competing risks setting. In paper 1, we compared the performance of the Cox, …
Reducing Acute Cardiovascular Hospitalizations With A Weight Management Program (Reach), Laura A. Graham
Reducing Acute Cardiovascular Hospitalizations With A Weight Management Program (Reach), Laura A. Graham
All ETDs from UAB
Reducing cardiovascular (CVD) risk factors such as obesity through lifestyle and behavioral interventions like weight management programs should result in better cardiovascular health. However, there is conflicting evidence on the effectiveness of these interventions in reducing long-term CVD outcomes such as acute myocardial infarction or stroke. This reflects an important gap in our understanding about factors affecting recruitment and engagement in these programs and how these factors relate to improvement in long-term cardiovascular health. To address this gap, we will use a retrospective study with up to 11 years of follow up data from the nation’s largest health care system-associated …
Comparative Analysis Of New Techniques For Hearing Conservation Program Selection, Laura Hurst
Comparative Analysis Of New Techniques For Hearing Conservation Program Selection, Laura Hurst
All ETDs from UAB
Hazardous noise is a widespread problem in industry and recreation. Noise induced hearing loss is one of the most frequently reported occupational health claims worldwide. While there has been much research on noise, its effects, and how to prevent hearing loss in industry, there is limited research available to help quantify the difference that monitoring noise at a lower threshold might create in the measured exposure estimate. Additionally, the studies involving the use of different noise monitoring settings do not attempt to explain how the results might change the outcomes when using data and statistical techniques to classify similar exposure …
Individual And Institutional Level Factors That Influence Hiv Testing And Counseling Utilization During Antenatal Care In Nigeria, Modupeoluwa O. Durojaiye
Individual And Institutional Level Factors That Influence Hiv Testing And Counseling Utilization During Antenatal Care In Nigeria, Modupeoluwa O. Durojaiye
All ETDs from UAB
Of the estimated 150,000 new HIV infections in children in 2015, 122,000 occurred in sub-Saharan Africa (SSA), with Nigeria accounting for a third of all cases. Most of these infections were acquired via mother-to-child transmission (MTCT). HIV testing and counseling, a critical first step in the prevention of MTCT (PMTCT), can ensure that HIV-positive women access services that can reduce HIV transmission risk. Incorporating HIV testing and counseling into antenatal care (ANC) is an integral component of the World Health Organization (WHO) strategies. This dissertation aims to understand factors that influence HIV testing and counseling during ANC. It is comprised …
Statistical Tests For Confounding, Falynn Cartmill Turley
Statistical Tests For Confounding, Falynn Cartmill Turley
All ETDs from UAB
The use of propensity score methods have increased tremendously in the last several years. Propensity scores are used as a tool to correct the effects of confounding that can result in biased estimates of treatment effects. However, there is more than one method that employs propensity scores, and there is no guide in choosing the optimal method, in terms of Type I error and statistical power. This research aims to assess these attributes through a complex simulation study of a five variable model. The results of the simulations indicate performance of a particular propensity score method is dependent
Statin Prescribing, Adherence, And Recurrent Vascular Events: A Study Of Ischemic Stroke Survivors, Karen C. Albright
Statin Prescribing, Adherence, And Recurrent Vascular Events: A Study Of Ischemic Stroke Survivors, Karen C. Albright
All ETDs from UAB
Due to increase in incidence and improvements in stroke mortality, the number of stroke survivors will increase over the next decade; each stroke survivor is at risk for recurrent stroke. Thus, identifying populations with the highest risk and ensuring they receive evidence-based secondary stroke prevention (SSP) is paramount. This includes ensuring access and adherence to statins. The American Heart Association (AHA)/American Stroke Association (ASA) Scientific Statement on Racial-Ethnic Disparities in Stroke Care reported that recurrent stroke risk is higher among blacks than whites and suggested that lower adherence to current standards of SSP in blacks might help explain these discrepancies. …
Formaldehyde Emissions From Laminate Flooring, Stephanie Latisha Marzette
Formaldehyde Emissions From Laminate Flooring, Stephanie Latisha Marzette
All ETDs from UAB
In recent years, several incidents have caused public concern about the levels of formaldehyde present in residential homes. It is one of the most prevalent and regularly detected pollutants in an indoor environment. This is due to the presence of formalde-hyde in many common products, such as household cleaners and paints, as well as build-ing materials. Formaldehyde exposure can lead to sore throat, coughing, eye and airway irritation, and increased occurrences of asthma symptoms. Due to the public health con-cerns, this research was designed to investigate the distinctive nature of formaldehyde emissions from laminate flooring and test the reliability of …
Associations Of Food Environment, Mediterranean Diet And Obesity In United States: A Geographic Information System (Gis) Analysis, Meifang Chen
All ETDs from UAB
Given the growing obesity epidemic in the U.S., modifying current obesogenic food environment, and identifying and promoting an obesity-modifying dietary approach that fits in the food environment context are urgent. Emerging evidence indicates that Mediterranean diet (MD) could be a beneficial dietary pattern to protect against overweight/obesity. However, as a relatively new dietary pattern in the U.S., how the unique food environment influences MD adherence, and whether consuming a MD can mediate the relationship between food environment and obesity among the population remain unknown. This dissertation, applying Geographic Information System (GIS) and path analytical methods using data from the REasons …