Clinical Epidemiology Commons^™

Kidney Conditions Associated With Hypertension In Pregnancy, Immaculate Franklin Preethi Nevis

Open Access Dissertations and Theses

We defined hypertension in pregnancy as a composite of gestational hypertension, preeclampsia and eclampsia. The etiology of hypertension in pregnancy remains controversial. The three chapters of this thesis explore the risk of hypertension in pregnancy from various kidney conditions. Chapter 1 introduces the reader to the thesis. Chapter 2 is a systematic review that studied the risk of developing hypertension in pregnant women with chronic kidney disease but not on dialysis. We found that women with chronic kidney disease had at least a twofold higher relative risk of developing hypertension during pregnancy compared with women having no chronic kidney disease ...

Improved Survival After Heart Failure: A Community-Based Perspective, Kristy T. Webster, Samuel W. Joffe, David D. Mcmanus, Michael S. Kiernan, Darleen M. Lessard, Jorge L. Yarzebski, Chad E. Darling, Joel M. Gore, Robert J. Goldberg

Senior Scholars Program

Background: Heart failure is a highly prevalent, morbid, and costly disease with a poor long-term prognosis. Evidence-based therapies utilized over the past 2 decades hold the promise of improved outcomes, yet few contemporary studies have examined survival trends in patients with acute heart failure.

Objectives: The primary objective of this population-based study was to describe trends in short and long-term survival in patients hospitalized with acute decompensated heart failure (ADHF). A secondary objective was to examine patient characteristics associated with decreased long-term survival.

Methods and Results: We reviewed the medical records of 9,748 patients hospitalized with ADHF at all ...

Healthcare Seeking For Diarrhoea, Malaria And Pneumonia Among Children In Four Poor Rural Districts In Sierra Leone In The Context Of Free Health Care: Results Of A Cross-Sectional Survey, Theresa Diaz, Asha S. George, Sowmya R. Rao, Peter S. Bangura, John B. Baimba, Shannon A. Mcmahon, Augustin Kabano

Quantitative Health Sciences Publications and Presentations

BACKGROUND: To plan for a community case management (CCM) program after the implementation of the Free Health Care Initiative (FHCI), we assessed health care seeking for children with diarrhoea, malaria and pneumonia in 4 poor rural districts in Sierra Leone.

METHODS: In July 2010 we undertook a cross-sectional household cluster survey and qualitative research. Caregivers of children under five years of age were interviewed about healthcare seeking. We evaluated the association of various factors with not seeking health care by obtaining adjusted odds ratios and 95% confidence limits using a multivariable logistic regression model. Focus groups and in-depth interviews of ...

Cluster-Randomized Trial Of A Web-Assisted Tobacco Quality Improvement Intervention Of Subsequent Patient Tobacco Product Use: A National Dental Pbrn Study, Thomas K. Houston, Kathryn L. Delaughter, Midge N. Ray, Gregg H. Gilbert, Jeroan J. Allison, Catarina I. Kiefe, Julie E. Volkman

Quantitative Health Sciences Publications and Presentations

ABSTRACT:

BACKGROUND: Brief clinician delivered advice helps in tobacco cessation efforts. This study assessed the impact of our intervention on instances of advice given to dental patients during visits on tobacco use quit rates 6 months after the intervention.

METHODS: The intervention was cluster randomized trial at the dental practice level. Intervention dental practices were provided a longitudinal technology-assisted intervention, oralcancerprevention.org that included a series of interactive educational cases and motivational email cues to remind dental provides to complete guideline-concordant brief behavioral counseling at the point of care. In all dental practices, exit cards were given to the first ...

Frequency Of Private Spiritual Activity And Cardiovascular Risk In Post-Menopausal Women: The Women's Health Initiative, Elena Salmoirago Blotcher, George Fitchett, Kathleen M. Hovey, Eliezer Schnall, Cynthia Thomson, Christopher A. Andrews, Sybil Crawford, Mary Jo O'Sullivan, Stephen Post, Rowan T. Chlebowski, Judith K. Ockene

Cardiovascular Medicine Publications and Presentations

Purpose: Spirituality has been associated with better cardiac autonomic balance, but its association with cardiovascular risk is not well studied. We examined whether more frequent private spiritual activity was associated with reduced cardiovascular risk in postmenopausal women enrolled in the Women’s Health Initiative Observational Study.

Methods: Frequency of private spiritual activity (prayer, Bible reading, and meditation) was selfreported at year 5 of follow-up. Cardiovascular outcomes were centrally adjudicated, and cardiovascular risk was estimated from proportional hazards models.

Results: Final models included 43,708 women (mean age: 68.9±7.3; median follow-up: 7.0 years) free of cardiac disease ...

The Net Reclassification Index (Nri): A Misleading Measure Of Prediction Improvement With Miscalibrated Or Overfit Models, Margaret Pepe, Jin Fang, Ziding Feng, Thomas Gerds, Jorgen Hilden

UW Biostatistics Working Paper Series

The Net Reclassification Index (NRI) is a very popular measure for evaluating the improvement in prediction performance gained by adding a marker to a set of baseline predictors. However, the statistical properties of this novel measure have not been explored in depth. We demonstrate the alarming result that the NRI statistic calculated on a large test dataset using risk models derived from a training set is likely to be positive even when the new marker has no predictive information. A related theoretical example is provided in which a miscalibrated risk model that includes an uninformative marker is proven to erroneously ...

Individuals With Single Versus Multiple Suicide Attempts Over 10 Years Of Prospective Follow-Up, Christina L. Boisseaua, Shirley Yen, John C. Markowitz, Carlos M. Grilo, Charles A. Sanislow, M. Tracie Shea, Mary C. Zanarini, Andrew E. Skodol, John G. Gunderson, Leslie C. Morey, Thomas H. Mcglashan

Division II Faculty Publications

Background: The study attempted to identify characteristics that differentiate multiple suicide attempters from single attempters in individuals with personality disorders (PDs) and/or major depression.

Method: Participants were 431 participants enrolled in the Collaborative Longitudinal Study of Personality Disorders from July 1996 to June 2008. Suicide attempts were assessed with the Longitudinal Interval Follow-up Evaluation at 6 and 12months, then yearly through 10years. Logistic regression was used to compare single attempters to multiple attempters on Axis I and II psychiatric disorders and personality trait variables.

Results: Twenty-one percent of participants attempted suicide during the 10years of observation, with 39 (9 ...

Socioeconomic-Status And Mental Health In A Personality Disorder Sample: The Importance Of Neighborhood Factors, Zach Walsh, M. Tracie Shea, Shirley Yen, Emily B. Ansell, Carlos M. Grilo, Thomas H. Mcglashan, Robert L. Stout, Donna S. Bender, Andrew E. Skodol, Charles A. Sanislow, Leslie C. Morey, John G. Gunderson

Division II Faculty Publications

This cross-sectional study examined the associations between neighborhood-level socioeconomic-status (NSES), and psychosocial functioning and personality pathology among 335 adults drawn from the Collaborative Longitudinal Personality Disorders Study. Participants belonged to four personality disorder (PD) diagnostic groups: Avoidant, Borderline, Schizotypal, and Obsessive Compulsive. Global functioning, social adjustment, and PD symptoms were assessed following a minimum two-year period of residential stability. Residence in higher-risk neighborhoods was associated with more PD symptoms and lower levels of functioning and social adjustment. These relationships were consistent after controlling for individual-level socioeconomic-status and ethnicity; however, the positive association between neighborhood-level socio-economic risk and PD symptoms was ...

Statistical And Methodological Issues On Covariate Adjustment In Clinical Trials, Rong Chu

Open Access Dissertations and Theses

Background and objectives

We investigate three issues related to the adjustment for baseline covariates in late phase clinical trials: (1) the analysis of correlated outcomes in multicentre RCTs, (2) the assessment of the probability and implication of prognostic imbalance in RCTs, and (3) the adjustment for baseline confounding in cohort studies.

Methods

Project 1: We investigated the properties of six statistical methods for analyzing continuous outcomes in multicentre randomized controlled trials (RCTs) where within-centre clustering was possible. We simulated studies over various intraclass correlation (ICC) values with several centre combinations.

Project 2: We simulated data from RCTs evaluating a binary ...

Chhs November 2012 E-Newsletter, Dr. John Bonaguro, Dean, Vashon S. Wells, Editor, College Of Health And Human Services, Western Kentucky University

College of Health & Human Services Publications

No abstract provided.

Model-Based Cost-Consequence Analysis Of Postoperative Troponin T Screening In Patients Undergoing Noncardiac Surgery, Giovanna Al Lurati Buse

Open Access Dissertations and Theses

Introduction: Globally, more than 200 million patients undergo major non-cardiac surgery each year and more than 10 million patients will be exposed to postoperative myocardial ischemia, a condition strongly associated with 30-day mortality. The majority of these events go undetected without postoperative Troponin screening. Methods: We conducted a model-based cost-consequence analysis comparing a postoperative Troponin T screening vs. standard care in patients undergoing noncardiac surgery. In a first model, we evaluated the incremental number of detected perioperative myocardial infarctions and the incremental costs. A second model assessed the effect of the screening and consequent treatment on 1-year survival and the ...

Magnetic Resonance And Radiography In Rheumatoid Arthritis: Intermodality Comparisons Of Erosion Detection, Ruben V. Tavares

Open Access Dissertations and Theses

BACKGROUND. Classically, radiography (x-ray) has been used to visualize the destructive effects of uncontrolled rheumatoid arthritis (RA) on articular bones. Both x-ray and magnetic resonance imaging (MRI) may be used to visualize erosive disease. The multi-slice and multi-planar characteristics of MRI provide greater detail per anatomy imaged than x-ray.

OBJECTIVE. The objective of this dissertation was to compare the relative merits of x-ray and MRI erosion detection.

METHODS. In Chapters 1 through 3, RA, its clinical management, and the role of diagnostic imaging were introduced. In Chapter 4, the overall objective was first investigated by evaluating the current state of ...

Understanding The Link Between Religious Service Attendance, Coronary Heart Disease And Related Risk Factors In Canada: A Mixed Methods Study And Future Directions For Health Promotion., Ananya Tina Banerjee Ck Msc

Open Access Dissertations and Theses

Research examining the relationships between religious indicators and the cardiovascular health of individuals and populations has been relatively understudied in the Canadian context. This thesis contains three main studies, developed from a sequential explanatory mixed method research design.

The first study examined the association between the frequency of religious service attendance (RSA) and prevalence of coronary heart disease (CHD), diabetes and high blood pressure in Canada. The Saskatchewan sample of the Canadian Community Health Survey (CCHS-4.1) was used to build multivariable logistic regression models. The analysis revealed participants who attended religious services more than once a week had lower ...

Socioeconomic-Status And Mental Health In A Personality Disorder Sample: The Importance Of Neighborhood Factors, Zach Walsh, M. Tracie Shea, Shirley Yen, Emily B. Ansell, Carlos M. Grilo, Thomas H. Mcglashan, Robert L. Stout, Donna S. Bender, Andrew E. Skodol, Charles A. Sanislow, Leslie C. Morey, John G. Gunderson

Charles A. Sanislow

This cross-sectional study examined the associations between neighborhood-level socioeconomic-status (NSES), and psychosocial functioning and personality pathology among 335 adults drawn from the Collaborative Longitudinal Personality Disorders Study. Participants belonged to four personality disorder (PD) diagnostic groups: Avoidant, Borderline, Schizotypal, and Obsessive Compulsive. Global functioning, social adjustment, and PD symptoms were assessed following a minimum two-year period of residential stability. Residence in higher-risk neighborhoods was associated with more PD symptoms and lower levels of functioning and social adjustment. These relationships were consistent after controlling for individual-level socioeconomic-status and ethnicity; however, the positive association between neighborhood-level socio-economic risk and PD symptoms was ...

Individuals With Single Versus Multiple Suicide Attempts Over 10 Years Of Prospective Follow-Up, Christina L. Boisseaua, Shirley Yen, John C. Markowitz, Carlos M. Grilo, Charles A. Sanislow, M. Tracie Shea, Mary C. Zanarini, Andrew E. Skodol, John G. Gunderson, Leslie C. Morey, Thomas H. Mcglashan

Charles A. Sanislow

Background: The study attempted to identify characteristics that differentiate multiple suicide attempters from single attempters in individuals with personality disorders (PDs) and/or major depression.

Method: Participants were 431 participants enrolled in the Collaborative Longitudinal Study of Personality Disorders from July 1996 to June 2008. Suicide attempts were assessed with the Longitudinal Interval Follow-up Evaluation at 6 and 12months, then yearly through 10years. Logistic regression was used to compare single attempters to multiple attempters on Axis I and II psychiatric disorders and personality trait variables.

Results: Twenty-one percent of participants attempted suicide during the 10years of observation, with 39 (9 ...

Do Patients Managed Within A Trial Experience Different Outcomes Than Their Counterparts Managed Outside The Trial? A Systematic Review And Meta-Analysis Of Randomized And Observational Studies., Natasha A. Fernandes

Open Access Dissertations and Theses

Context: It is unclear whether the construct of a randomized controlled trial (RCT) itself could confer benefit or harm to trial participants beyond any effect of the experimental treatment under study (trial effect).

Objective: To determine whether there is a trial effect appreciated by RCT participants (insiders) compared to similar patients who do not participate (outsiders). Although we are most interested in the pragmatic comparison of insiders to outsiders, we will also conduct the explanatory comparison of insiders to outsiders when the intervention is the same.

Data Sources: We searched electronic health research databases, including CENTRAL (1960-2010), MEDLINE (1966-2010), EMBASE ...

Aspects Of Human Rhinovirus Infection In Hospitalized And Non-Hospitalized Individuals, Andrea C. Granados

Open Access Dissertations and Theses

Human rhinovirus (HRV) is a single-stranded RNA virus responsible for causing the common cold and exacerbating chronic respiratory diseases. HRV is the most common cause of acute respiratory illness. Unfortunately, difficult culturing conditions and perceived mild symptoms have limited our understanding of HRV. This thesis characterizes fundamental aspects of HRV such as viral load in different patient populations, prevalence and diversity of HRV, and severity and duration of infection.

We developed an HRV qPCR assay to quantitate HRV in clinical isolates. We used this assay to measure viral loads in hospitalized and community members. We found that HRV viral loads ...

Evaluating The Montreal Cognitive Assessment (Moca) And The Mini Mental State Exam (Mmse) For Cognitive Impairment Post Stroke: A Validation Study Against The Cognistat, Lauren Friedman

Electronic Thesis and Dissertation Repository

Objective. To identify the better of two commonly used screening tools for detecting probable cognitive impairment in stroke patients in a large regional rehabilitation hospital (ParkwoodHospital,London,Ontario). This was a validation study of the Mini-Mental State Exam (MMSE) and the Montreal Cognitive Assessment (MoCA), using the Cognistat, as the criterion or ‘gold standard’. It was hypothesized that the MoCA is a superior screening instrument to the MMSE for the detection of cognitive impairment in stroke patients.

Methods. The MMSE and the MoCA were administered by occupational therapists and the Cognistat was administered by the student investigator. A second Cognistat ...

The Art In Medicine - Treatment Decision-Making And Personalizing Care: A Grounded Theory Of Physicians' Treatment-Decision Making Process With Their (Stage Ii, Stage Iiia And Stage Iiib) Non-Small Cell Lung Cancer Patients In Ontario, Saira Akram

Open Access Dissertations and Theses

Introduction: In Ontario alone, an estimated 6,700 people (3,000 women; 3,700 men) will die of lung cancer in 2011 (Canadian Cancer Society, 2011). A diagnosis of cancer is associated with complex decisions; the array of choices of cancer treatments brings about hope, but also anxiety over which treatment is best suited for the individual patient (Blank, Graves, Sepucha et al., 2006). The overall cancer experience depends on the quality of this decision (Blank et al., 2006). Clinical practice guidelines are knowledge translation tools to facilitate treatment decision-making. In Ontario, guidelines have been developed and disseminated with the ...

Shift Work And Cardiovascular Events: Systematic Review And Meta-Analysis, Manav V. Vyas

Electronic Thesis and Dissertation Repository

The prevalence of shift work is increasing in the general population. There is conflicting epidemiologic evidence on the association between shift work and cardiovascular disease. We performed a systematic review and meta-analysis of observational studies that measured shift work-cardiovascular disease associations. We screened 12,350 articles and identified 35 eligible studies. The pooled risk ratios (RR) for myocardial infarction, all coronary events and ischemic stroke were 1.23 (95% confidence interval [CI] 1.15 to 1.31, I² = 0), 1.24 (95% CI 1.10 to 1.39, I² = 85%) and 1.05 (95% CI 1.01 to ...