Epidemiology Commons^™

Epidemiology Of Latency And Relapse In Plasmodium Vivax Malaria, Andrew A. Lover

Andrew Lover

Considerations For Comprehensive Analyses Of Sporozoite-Based Controlled Human Malaria Infection Studies, Andrew A. Lover

Andrew Lover

Short Report: Study Variability In Recent Human Challenge Experiments With Plasmodium Falciparum Sporozoites (Pfspz Challenge), Andrew A. Lover

Andrew Lover

Ideas For A Healthy Baby--Reducing Disparities In Use Of Publicly Reported Quality Data: Study Protocol For A Randomized Controlled Trial, Sarah L. Goff, Penelope S. Pekow, Katharine O. White, Tara Lagu, Kathleen M. Mazor, Peter K. Lindenauer

Peter Lindenauer MD

BACKGROUND: Publicly reported performance on quality measures is intended to enable patients to make more informed choices. Despite the growing availability of these reports, patients' use remains limited and disparities exist. Low health literacy and numeracy are two barriers that may contribute to these disparities. Patient navigators have helped patients overcome barriers such as these in other areas, such as cancer care and may prove useful for overcoming barriers to using publicly reported quality data. METHODS/DESIGN: The goals of this study are: to determine the efficacy of a patient navigator intervention to assist low-income pregnant women in the use of …

30-Year Trends In Patient Characteristics, Treatment Practices, And Long-Term Outcomes Of Adults Aged 35 To 54 Years Hospitalized With Acute Myocardial Infarction, Mayra Tisminetzky, David Mcmanus, Joel Gore, Jorge Yarzebski, Andrew Coles, Darleen Lessard, Robert Goldberg

Jorge L. Yarzebski

Much of our knowledge about the characteristics, clinical management, and postdischarge outcomes of acute myocardial infarction (AMI) is derived from clinical studies in middle-aged and older subjects with little contemporary information available about the descriptive epidemiology of AMI in relatively young men and women. The objectives of our population-based study were to describe >3-decade-long trends in the clinical features, treatment practices, and long-term outcomes of young adults aged 35 to 54 years discharged from the hospital after AMI. The study population consisted of 2,142 residents of the Worcester (Massachusetts) metropolitan area who were hospitalized with AMI at all central Massachusetts …

Decade-Long Trends In The Characteristics, Management And Hospital Outcomes Of Diabetic Patients With St-Segment Elevation Myocardial Infarction, Mayra Tisminetzky, Samuel Joffe, David Mcmanus, Chad Darling, Joel Gore, Jorge Yarzebski, Darleen Lessard, Robert Goldberg

Jorge L. Yarzebski

PURPOSE: Our objectives were to describe recent trends in the characteristics and in-hospital outcomes in diabetic as compared with non-diabetic patients hospitalized with ST-segment elevation myocardial infarction (STEMI).

METHODS: We reviewed the medical records of 2537 persons with (n = 684) and without (n = 1853) a history of diabetes who were hospitalized for STEMI between 1997 and 2009 at 11 medical centres in Central Massachusetts.

RESULTS: Diabetic patients were more likely to be older, female and to have a higher prevalence of previously diagnosed comorbidities. Diabetic patients were more likely to have developed important in-hospital complications and to have …

Trends In The Prevalence And Mortality Of Cognitive Impairment In The United States: Is There Evidence Of A Compression Of Cognitive Morbidity, Kenneth Langa, Eric Larson, Jason Karlawish, David Cutler, Mohammed Kabeto, Scott Kim, Allison Rosen

Jason Karlawish

BACKGROUND: Recent medical, demographic, and social trends might have had an important impact on the cognitive health of older adults. To assess the impact of these multiple trends, we compared the prevalence and 2-year mortality of cognitive impairment (CI) consistent with dementia in the United States in 1993 to 1995 and 2002 to 2004. METHODS: We used data from the Health and Retirement Study (HRS), a nationally representative population-based longitudinal survey of U.S. adults. Individuals aged 70 years or older from the 1993 (N = 7,406) and 2002 (N = 7,104) waves of the HRS were included. CI was determined …

Are We Prepared? A Cross Sectional Study Of Preparedness In Fayette County Kentucky For A Pediatric Mass Casualty Incident, Erich C. Maul Do, Mph

Erich C. Maul DO MPH

No abstract provided.

Striving For Cultural Competence In An Hiv Program: The Transformative Impact Of A Microsystem In A Larger Health Network, Judith N Sabino, Timothy Friel, Lynn Deitrick, Debbie Salas-Lopez

Debbie Salas-Lopez MD, MPH

No abstract provided.

Stochastic Variation In Network Epidemic Models: Implications For The Design Of Community Level Hiv Prevention Trials, David Boren, Patrick Sullivan, Chris Beyrer, Stefan Baral, Linda-Gail Becker, Ron Brookmeyer

Ron Brookmeyer

Important sources of variation in the spread of HIV in communities arise from overlapping sexual networks and heterogeneity in biological and behavioral risk factors in populations. These sources of variation are not routinely accounted for in the design of HIV prevention trials. In this paper, we use agent based models to account for these sources of variation. We illustrate the approach with an agent based model for the spread of HIV infection among men who have sex with men (MSM) in South Africa. We find that traditional sample size approaches that rely on binomial (or Poisson) models are inadequate and …

Cluster Randomized Trials And Statistical Power, Stephen A. Lauer, Nicholas G. Reich

Nicholas G Reich

The cluster-randomized trial (CRT) is a common study design in public health research. In situations where dividing a group of individuals into treatment and controls is unethical or impossible, a CRT design maintains the strengths of a randomized study design. By comparing the outcomes of small populations (clusters), we can observe the impacts of interventions on the community as a whole. Public health researchers around the world have utilized CRTs to measure the effect of, for example, de-worming medication on school attendance, financial incentives on doctor absenteeism, and providing chlorine to waterholes. The CRT can be a potent tool, however …

Relative Roles Of Medical Interventions And Infrastructure In An Urban Community’S Infant Mortality Rate: 100 Years Of Infant Mortality In The City Of Worcester, Maya Y. Mauch, B. Dale Magee

B. Dale Magee

Background: The infant mortality rate (IMR), defined as the number of deaths in children under 1 year of age per 1000 live births, is regarded as a sensitive measure of population health (Blaxter). This reflects the overlap between those societal factors that impact infant mortality and those that affect the health of the larger community, such as SES, nutrition, living conditions, education, employment and access to health care. In 2003, Reidpath et al showed a strong linear relation between IMR and the disability adjusted life expectancy (DALE), a more comprehensive measure of population health. They concluded that either the IMR …

Depicting Estimates Using The Intercept In Meta-Regression Models: The Moving Constant Technique, Blair T. Johnson Dr., Tania B. Huedo-Medina Dr.

Blair T. Johnson

In any scientific discipline, the ability to portray research patterns graphically often aids greatly in interpreting a phenomenon. In part to depict phenomena, the statistics and capabilities of meta-analytic models have grown increasingly sophisticated. Accordingly, this article details how to move the constant in weighted meta-analysis regression models (viz. “meta-regression”) to illuminate the patterns in such models across a range of complexities. Although it is commonly ignored in practice, the constant (or intercept) in such models can be indispensible when it is not relegated to its usual static role. The moving constant technique makes possible estimates and confidence intervals at …

Their Bugs Are Worse Than Their Bite: Emerging Infectious Disease And The Human-Animal Interface, Michael Greger

Michael Greger, MD, FACLM

In the twenty-five years since that announcement, what we now know as AIDS has killed 20 million people (National AIDS Trust 2005). Where did the AIDS virus— and other emerging diseases, such as severe acute respiratory syndrome (SARS), Ebola, mad cow— come from?

Weight-Based Discrimination And Medication Adherence Among Low-Income African Americans With Hypertension: How Much Of The Association Is Mediated By Self-Efficacy?, Michael Richardson, Molly Waring, Monica Wang, Lisa Nobel, Yendelela Cuffee, Sharina Person, Sandral Hullett, Catarina Kiefe, Jeroan Allison

Monica L. Wang

OBJECTIVES: Much of the excessive morbidity and mortality from cardiovascular disease among African Americans results from low adherence to anti-hypertensive medications. Therefore, we examined the association between weight-based discrimination and medication adherence. METHODS: We used cross-sectional data from low-income African Americans with hypertension. Ordinal logistic regression estimated the odds of medication non-adherence in relation to weight-based discrimination adjusted for age, sex, education, income, and weight. RESULTS: Of all participants (n = 780), the mean (SD) age was 53.7 (9.9) years and the mean (SD) weight was 210.1 (52.8) lbs. Reports of weight-based discrimination were frequent (28.2%). Weight-based discrimination (but not …

The Role Of Multiple Sclerosis As A Risk Factor For The Development Of Osteoporosis, Christopher Perrone, Christine M. Foley, Linda C. Churchill, Sybil L. Crawford, Judith K. Ockene, Carolina Ionete

Sybil L. Crawford

Background: Osteoporosis is the most common bone disease in the United States, and it is particularly common among women with multiple sclerosis (MS). However, despite this association, the temporal relationship between these two conditions has not been previously studied. Data from the Women’s Health Initiative provides a unique opportunity to examine the risk of developing osteoporosis over time in individuals diagnosed with MS. Objective: The purpose of this study is to refine the relationship between MS and osteoporosis, clarifying the impact of environmental and pharmacologic factors on each condition, as well as addressing treatment and preventative efforts for a patient …

Accelerated Resolution Therapy For Treatment Of Pain Secondary To Symptoms Of Combat-Related Posttraumatic Stress Disorder, Kevin E. Kip, Laney Rosenzweig, Diego F. Hernandez, Amy Shuman, David M. Diamond, Sue Ann Girling, Kelly L. Sullivan, Trudy R. Wittenberg, Ann M. Witt, Cecile A. Lengacher, Brian Anderson, Susan C. Mcmillan

Kelly L. Sullivan

Background: As many as 70% of veterans with chronic pain treated within the US Veterans Administration (VA) system may have posttraumatic stress disorder (PTSD), and conversely, up to 80% of those with PTSD may have pain. We describe pain experienced by US service members and veterans with symptoms of PTSD, and report on the effect of Accelerated Resolution Therapy (ART), a new, brief exposure-based therapy, on acute pain reduction secondary to treatment of symptoms of PTSD.
Methods: A randomized controlled trial of ART versus an attention control (AC) regimen was conducted among 45 US service members/veterans with symptoms of combat-related …

From The Centers For Disease Control And Prevention. Prevalence Of Penicillin-Resistant Streptococcus Pneumoniae--Connecticut, 1992-1993, E. Simpson

E. Hatheway Simpson

To determine the extent of antimicrobial susceptibility testing of Streptococcus pneumoniae and the prevalence of penicillin resistance among pneumococcal isolates from July 1992 through June 1993, in August 1993 the Connecticut Department of Public Health and Addiction Services (DPHAS) surveyed all 44 hospitals with clinical microbiology laboratories in Connecticut. This report summarizes the results of that survey.

The Impact Of Cardiac And Noncardiac Comorbidities On The Short-Term Outcomes Of Patients Hospitalized With Acute Myocardial Infarction: A Population-Based Perspective, Han-Yang Chen, Jane S. Saczynski, David D. Mcmanus, Darleen M. Lessard, Jorge L. Yarzebski, Kate L. Lapane, Joel M. Gore, Robert J. Goldberg

Jorge L. Yarzebski

OBJECTIVES: The objectives of our large observational study were to describe the prevalence of cardiac and noncardiac comorbidities in a community-based population of patients hospitalized with acute myocardial infarction (AMI) at all medical centers in central Massachusetts, and to examine whether multiple comorbidities were associated with in-hospital death rates and hospital length of stay. METHODS: The study sample consisted of 2,972 patients hospitalized with AMI at all eleven greater Worcester medical centers in central Massachusetts during the three study years of 2003, 2005, and 2007. RESULTS: The average age of this hospitalized population was 71 years, 55% were men, 93% …

Heterosexual And Homosexual Patients With The Acquired Immunodeficiency Syndrome: A Comparison Of Surveillance, Interview, And Laboratory Data, Mary Guinan, Pauline A. Thomas, Paul F. Pinksy, James T. Goodrich, Richard M. Selik, H W. Jaffe, H W. Haverkos, Gary Noble, J W. Curran

Gary Noble

Homosexual and heterosexual patients with the acquired immunodeficiency syndrome were compared by risk group. Race; diagnoses; history of sexually transmitted diseases, sexual behavior, and drug use; and socioeconomic indicators differed considerably among the risk groups, suggesting different risk factors for acquisition of the syndrome. Patients in the homosexual, intravenous drug user, and Haitian risk groups differed in their serologic response to cytomegalovirus and syphilis testing, presumably due to lifestyle-related exposures. Differences in the rate of recovery of cytomegalovirus, serum levels of IgA and IgG, and antibody titers to Epstein-Barr virus were noted among patients with different diagnoses. We conclude that …

Adaptive Pair-Matching In The Search Trial And Estimation Of The Intervention Effect, Laura Balzer, Maya L. Petersen, Mark J. Van Der Laan

Laura B. Balzer

In randomized trials, pair-matching is an intuitive design strategy to protect study validity and to potentially increase study power. In a common design, candidate units are identified, and their baseline characteristics used to create the best n/2 matched pairs. Within the resulting pairs, the intervention is randomized, and the outcomes measured at the end of follow-up. We consider this design to be adaptive, because the construction of the matched pairs depends on the baseline covariates of all candidate units. As consequence, the observed data cannot be considered as n/2 independent, identically distributed (i.i.d.) pairs of units, as current practice assumes. …

Doença Renal Policística Autossômica Dominante Em Pacientes Em Hemodiálise No Sul Do Brasil; Autosomal Dominant Polycystic Kidney Disease In Hemodialysis Patients In Southern Brazil, Everton Fernando Alves

Everton Fernando Alves

Introdução: A doença renal policística autossômica dominante é a enfermidade renal hereditária mais comum em seres humanos. Objetivo: Analisar a prevalência, características clínicas e laboratoriais de pacientes com rins policísticos e relacionar as manifestações da doença por gênero. Métodos: Trata-se de um estudo observacional e retrospectivo. Foram revisados todos os prontuários médicos de pacientes com rins policísticos admitidos para hemodiálise entre 1995 e 2012, em quatro centros que atendem a área de abrangência da 15ª regional de saúde do Paraná, Brasil. Resultados: Fizeram parte do estudo 48 pacientes com rins policísticos, causa primária da doença renal crônica (DRC) estágio 5. …

Applying A Causal Road Map In Settings With Time-Dependent Confounding: Commentary On “The Parametric G-Formula For Time-To-Event Data: Toward Intuition With A Worked Example.", Maya Petersen

Maya Petersen

No abstract provided.

Causal Models And Learning From Data: Integrating Causal Modeling And Statistical Estimation, Maya Petersen, M J. Van Der Laan

Maya Petersen

No abstract provided.

Treatment Of Neurodegenerative Ataxias With Intravenous Immune Globulin, Theresa A. Zesiewicz, Seok Hun Kim, Kelly L. Sullivan, Jeannie Stephenson, Israt Jahan, Susan L. Perlman, Jessica D. Shaw, Tuan Vu, Clifton L. Gooch

Kelly L. Sullivan

Background: Neurodegenerative ataxias, including spinocerebellar ataxias (SCAs), are progressive diseases without effective treatment. There is preclinical evidence that inflammation may contribute to neuronal injury in several neurodegenerative ataxias. Intravenous immune globulin (IVIG) is a therapeutic modality that is used as treatment of several autoimmune and inflammatory disorders.
Methods: The primary objective of this open-label pilot study was to assess the effect of IVIG on neurodegenerative ataxias as measured by total scale for the assessment and rating of ataxia (SARA) score. Three patients received IVIG (2 g/kg of body weight, divided over 5 days) once monthly for 3 months, and were …

Premorbid Personality And The Risk Of Parkinson's Disease, Kelly L. Sullivan, James A. Mortimer, Wei Wang, Theresa A. Zesiewicz, James H. Brownlee Jr., Amy R. Borenstein

Kelly L. Sullivan

Background: Previous studies support the hypothesis that premorbid personality characteristics may be associated with the risk of Parkinson’s disease (PD). However, most of these relied upon subjective reports of premorbid personality earlier in life, which may be subject to recall bias. The objective of the current study was to evaluate the association of PD with risk-taking, routinization, smoking and alcohol consumption in early-adult life as indicators of premorbid personality.
Methods: In-person interviews were conducted with 89 PD patients and 99 controls from a university-based medical center. Associations between indicators of early-adult personality and risk of PD were examined using logistic …

Spatial Epidemiology And Climatic Predictors Of Paediatric Dengue Infections Captured Via Sentinel Site Surveillance, Phnom Penh Cambodia 2011–2012, Andrew A. Lover, Philippe Buchy, Anne Rachline, Duch Moniboth, Rekol Huy, Chour Y. Meng, Yee Sin Leo, Kdan Yuvatha, Ung Sophal, Ngan Chantha, Bunthin Y, Veasna Duong, Sophie Goyet, Jeremy Brett, Arnaud Tarantola, Philippe Cavailler

Andrew Lover

Retention And Risk Factors For Attrition In A Large Public Health Art Program In Myanmar: A Retrospective Cohort Analysis, Aye Thida, Sai Thein Than Tun, Sai Ko Ko Zaw, Andrew A. Lover, Philippe Cavailler, Jennifer Chunn, Mar Mar Aye, Par Par, Kyaw Win Naing, Kaung Nyunt Zan, Myint Shwe Shwe, Thar Tun Kyaw, Zaw Htoon Waing, Philippe Clevenbergh

Andrew Lover

Note On The Origin Of The Madagascar Strain Of Plasmodium Vivax, Andrew A. Lover

Andrew Lover

Demographic And Spatial Predictors Of Anemia In Women Of Reproductive Age In Timor-Leste: Implications For Health Program Prioritization, Andrew A. Lover, Mikael Hartman, Kee Seng Chia, David L. Heymann

Andrew Lover