Digital Commons Network^™

Empirical Efficiency Maximization, Daniel B. Rubin, Mark J. Van Der Laan

U.C. Berkeley Division of Biostatistics Working Paper Series

It has long been recognized that covariate adjustment can increase precision, even when it is not strictly necessary. The phenomenon is particularly emphasized in clinical trials, whether using continuous, categorical, or censored time-to-event outcomes. Adjustment is often straightforward when a discrete covariate partitions the sample into a handful of strata, but becomes more involved when modern studies collect copious amounts of baseline information on each subject.

The dilemma helped motivate locally efficient estimation for coarsened data structures, as surveyed in the books of van der Laan and Robins (2003) and Tsiatis (2006). Here one fits a relatively small working model …

Neighborhood Context And Ethnicity Differences In Body Mass Index: A Multilevel Analysis Using The Nhanes Iii (1988-1994), D. Phuong Do, Tamara Dubowitz, Chloe E. Bird, Nicole Lurie, José J. Escarce, Brian K. Finch

Faculty Publications

A growing body of literature has documented a link between neighborhood context and health outcomes. However, little is known about the relationship between neighborhood context and body mass index (BMI) or whether the association between neighborhood context and BMI differs by ethnicity. This paper investigates several neighborhood characteristics as potential explanatory factors for the variation of BMI across the United States; further, this paper explores to what extent segregation and the concentration of disadvantage across neighborhoods help explain ethnic disparities in BMI. Using data geo-coded at the census tract-level and linked with individual-level data from the Third National Health and …

Session 1 - Rationalizing The Home Front: The Cold War, The Nevada Test Site, And Radiation Exposure, Leisl A. Carr

International Symposium on Technology and Society

Beginning in 1953, radiation exposure and its effects became a hotly contested issue between the government, members of communities surrounding the Nevada Test Site (NTS), and researchers within the national scientific community. The Atomic Energy Commission (AEC), concerned about maintaining a continental testing facility and aware that atomic testing would impact communities surrounding the NTS, sent representatives to areas potentially affected by fallout to instruct and reassure the affected public. How government officials perceived neighboring communities and how these communities perceived these representatives of the government often determined public responses to the atomic testing program. The story of radiation monitors …

Exclusive Breastfeeding Practices In Rural Haitian Women, Susan B. Roman

UCHC Graduate School Masters Theses 2003 - 2010

No abstract provided.

An Evaluation Of Personal Protective Equipment Used With Local Public Health Employees, Aimee E. Eberly

UCHC Graduate School Masters Theses 2003 - 2010

No abstract provided.

Emotional Stroop Effects: Eating Disorders And Obesity, Kristy Anne Kuehfuss

Loma Linda University Electronic Theses, Dissertations & Projects

This study addresses the effects of emotional valence on selective processing of body-shape related words in young women who suffer from anorexia, bulimia, or obesity, and non-clinical controls. Research in the area of emotional Stroop interference has indicated that persons with eating disorders, particularly anorectics, show elevated latencies in naming colors of words related to food or body-shape, in contrast to either neutral words, or to non-clinical control groups. One intriguing issue regarding the emotional Stroop interference among various clinical populations relates to the question of whether the interference is due to the emotionality of the relevant words or to …

Should Massachusetts Regionalize Public Health?, Eric W. Hayden

Financial Services Forum Publications

Amidst rising global concerns about bioterrorism and pandemic flu preparedness, the delivery capacity and effectiveness of public health service assumes increased importance and relevance. In the United States, the lack of a centralized, national public health system has meant that “public health” is the primary responsibility of state and local governments. Many states have established various types of intrastate regional structures to deliver the range of on-going, occasional, and/or episodic services that characterize the world of public health. However, Massachusetts is not among them. Despite its global reputation as a pre-eminent medical center, the state of Massachusetts has a highly …

Shape-It: The Stroke , Hypertension, And Prostate Education Intervention Team, Michael P. Rosenthal

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Adjusting For Covariates In Studies Of Diagnostic, Screening, Or Prognostic Markers: An Old Concept In A New Setting, Holly Janes, Margaret Pepe

UW Biostatistics Working Paper Series

The concept of covariate adjustment is well established in therapeutic and etiologic studies. However, it has received little attention in the growing area of medical research devoted to the development of markers for disease diagnosis, screening, or prognosis, where classification accuracy, rather than association, is of primary interest. In this paper, we demonstrate the need for covariate adjustment in studies of classification accuracy, discuss methods for adjusting for covariates, and distinguish covariate adjustment from several other related but fundamentally different uses for covariates. We draw analogies and contrasts throughout with studies of association.

Post Traumatic Stress Symptoms And Critical Incident Stress Debriefing (Cisd) In Emergency Medical Services (Ems) Personnel., Ginger Lee Woods

Electronic Theses and Dissertations

EMS personnel were examined for Post Traumatic Stress symptoms and the usefulness of Critical Incident Stress Debriefing (CISD) using the Los Angeles Symptom Checklist (LASC) and a demographics questionnaire. This study revealed that women in this group show higher PTSD symptoms than male coworkers. Level of Training (LOT) of the EMS provider did not demonstrate a significant difference in whether a provider developed PTSD. EMS personnel receiving debriefing actually suffered greater levels of PTSD than those that did not receive debriefing. And 16% of EMS providers in this study suffered from PTSD, while approximately 20% suffered from partial PTSD or …

Low-Income Minority Mothers’ Reports Of Infant Health Care Utilisation Compared With Medical Records, Kennan D. Murray, Ayman El-Mohandes, M. Nabil El-Khorazaty, Michele Kiely

Publications and Research

This study aimed to investigate mothers’ reporting of the nature, location, frequency and content of health care visits for their infants, as compared with data abstracted from the infants’ medical records. It was part of a community-based parenting intervention designed to improve preventive health care utilisation among minority mothers in Washington, DC. Mothers 18 years old with newborn infants and with poor or no prenatal care were enrolled in the study. A total of 160 mother–infant dyads completed the 12-month study. Mothers were interviewed when the infants were 4, 8 and 12 months old, and were asked to recall infant …

Haplotype Association Between Haptoglobin (Hp2) And Hp Promoter Snp (A-61c) May Explain Previous Controversy Of Haptoglobin And Malaria Protection, Sharon E. Cox, Conor Doherty, Sarah H. Atkinson, Chidi V. Nweneka, Anthony J.C. Fulford, Hala Ghattas Ph.D., Kirk A. Rockett, Dominic P. Kwiatkowski, Andrew M. Prentice

Faculty Publications

Background.

Malaria is one of the strongest recent selective pressures on the human genome, as evidenced by the high levels of varying haemoglobinopathies in human populations-despite the increased risk of mortality in the homozygous states. Previously, functional polymorphisms of Hp, coded by the co-dominant alleles Hp1 and Hp2, have been variously associated with several infectious diseases, including malaria susceptibility.

Methodology/Principal Findings.

Risk of a clinical malarial episode over the course of a malarial transmission season was assessed using active surveillance in a cohort of Gambian children aged 10-72 months. We report for the first time that the major haplotype for …

Haplotype Association Between Haptoglobin (Hp2) And Hp Promoter Snp (A-61c) May Explain Previous Controversy Of Haptoglobin And Malaria Protection, Sharon E. Cox, Conor Doherty, Sarah H. Atkinson, Chidi V. Nweneka, Anthony J.C. Fulford, Hala Ghattas Ph.D., Kirk A. Rockett, Dominic P. Kwiatkowski, Andrew M. Prentice

Faculty Publications

Background

Malaria is one of the strongest recent selective pressures on the human genome, as evidenced by the high levels of varying haemoglobinopathies in human populations–despite the increased risk of mortality in the homozygous states. Previously, functional polymorphisms of Hp, coded by the co-dominant alleles Hp1 and Hp2, have been variously associated with several infectious diseases, including malaria susceptibility.

Methodology/Principal Findings

Risk of a clinical malarial episode over the course of a malarial transmission season was assessed using active surveillance in a cohort of Gambian children aged 10–72 months. We report for the first time that the major haplotype for …

Preps Surveillance: Summary Of Cognitive Interviews And Recommendations For Preps Surveillance Measures, Lois Biener, Karen Bogen

Center for Survey Research Publications

A review of existing research on population awareness of potentially reduced exposure tobacco products (PREPs) as well as results of cognitive interviews suggest that awareness of PREPs is quite low at this time, except in active test-markets. In order to monitor changes in awareness and perceptions of, and receptivity to these products over time, we have proposed using a set of questions as well as coding conventions that appear to result in reasonably accurate estimates of awareness of a particular group of products. The recommended items, which performed will in cognitive interviews, are presented in Appendix D of this report. …

Biomass Combustion And Ari In Kiwengwa, Unguja, Eric Fournier, Nicole Poepping

Independent Study Project (ISP) Collection

A study was undertaken investigating the relationship between biomass cook stove usage practices in Kiwengwa, Unguja and the incidence of acute respiratory infections (ARI) amongst individuals participating in household cooking activities. In each household, the incidence of ARI was determined via semi-structured interviews conducted with the primary cooker. Additionally, measurements and observations of: biomass cook stove efficiency, stove usage behaviors, and the physical cooking environment were obtained. Statistical analysis was then performed to assess the nature and significance of relationships between variables in the three cook stove usage categories and the stated incidence of ARI within the sample households. Data …

A Case Study Of Pediatric Diarrhea At Murchison District Hospital In Port Shepstone, Kwazulu-Natal, South Africa, T. Smith

Independent Study Project (ISP) Collection

This study investigates pediatric diarrhea in children under 5 years old at Murchison District Hospital in Port Shepstone, South Africa. Hospital Child Pip data was used to determine the number of admissions to the hospital for pediatric diarrhea and its mortality rate. Characteristics of deceased patients including age, malnutrition, and HIV status, were then synthesized with information on patients’ access to clean water and improved sanitation obtained through 20 interviews of mothers of patients as well as caregivers’ infant feeding practices and hygiene practices, such as handwashing with soap. Treatment and prevention of diarrhea was also explored. Murchison’s management of …

Clinicians’ Perception Of Inmates’ Satisfaction With Mental Health Services, Jerry B. Daniel, Wynne S. Korr

Journal of the Georgia Public Health Association

A growing body of literature addresses the mental health needs of prison inmates; however, very little research has examined mental health services among this population. Based on the Behavioral Model of Health Services Use (Andersen Model), the current study examined clinicians’ perception of inmates’ satisfaction with mental health services. The study’s main objective was to identify the effect of three major groups of predictor variables (predisposing, enabling, and need) on clinicians’ perception with inmates’ satisfaction with mental health services. The study utilized an exploratory, survey methodology. Although only a few variables were found to be statistically significant in the multivariate …

Multi-Level Evaluation Of A Perinatal Health Program In Rural Southeast Georgia, Swati Raychowdhury, Stuart H. Tedders, Greta O'Steen, Sarah Jones

Journal of the Georgia Public Health Association

Problem: Infant mortality has declined steadily in the past decade, however, significant disparities associate with lack of adequate perinatal health services and barriers to access disproportionately impact women residing in rural areas. In Georgia, data suggest significant challenges with respect to birth outcomes, and this problem seems to be exacerbated in rural regions of state. The objective of this presentation is to report on the impact of a regional perinatal health care collaborative implemented in rural southeast Georgia.

Method: Analysis of pre-intervention and post-intervention birth outcomes (gestational age, birth weight and infant mortality) served as the focal point programmatic evaluation. …

Trends In Particulate Matter And Mortality: An Approach To The Assessment Of Unmeasured Confounding, Holly Janes, Francesca Dominici, Scott Zeger

Johns Hopkins University, Dept. of Biostatistics Working Papers

We propose a method for diagnosing confounding bias under a model which links a spatially and temporally varying exposure and health outcome. We decompose the association into orthogonal components, corresponding to distinct spatial and temporal scales of variation. If the model fully controls for confounding, the exposure effect estimates should be equal at the different temporal and spatial scales. We show that the overall exposure effect estimate is a weighted average of the scale-specific exposure effect estimates.

We use this approach to estimate the association between monthly averages of fine particles (PM2.5) over the preceding 12 months and monthly mortality …

Food Facilities, Food Service Workers And The Flow Of Food: Food-Borne Illnesses In Taiwan's Preschools, Shu-Chen Lin

Graduate Student Dissertations, Theses, Capstones, and Portfolios

This study examined food-borne illnesses in Taiwan's preschools which are a major cause of personal distress and preventable death. They are of particular concern in preschools as very young children are highly susceptible to food-borne illnesses. Previous studies that comprehensively investigated the factors impacting food-borne illnesses in Taiwan were not found in the literature. The development of a universal food safety model is necessary as a means to measure relevant constructs. Application of the model should be able to prevent the occurrence of food-borne illnesses in organizations. This explanatory (correlational) study examined the relationships among food facilities, food service workers, …

Effects Of Residence And Race On Burden Of Travel For Care: Cross Sectional Analysis Of The 2001 Us National Household Travel Survey, Janice C. Probst, Sarah B. Laditka, Jong-Yi Wang, Andrew O. Johnson

Faculty Publications

Background: Travel burden is a key element in conceptualizing geographic access to health care. Prior research has shown that both rural and minority populations bear disproportionate travel burdens. However, many studies are limited to specific types of patient or specific locales. The purpose of our study was to quantify geographic and race-based differences in distance traveled and time spent in travel for medical/dental care using representative national data.

Methods: Data were drawn from 2001 National Household Travel Survey (NHTS), a nationally representative, cross-sectional household survey conducted by the US Department of Transportation. Participants recorded all travel on a designated day; …

Condition Reporting And Resolution, J. M. Pesek, S. A. Wade

Publications (YM)

This procedure facilitates a safety conscious work environment by providing a mechanism for employees to make management aware of existing and potential conditions. This procedure establishes the responsibilities and process to be used to ensure that conditions related to, but not limited to, the environment, safety, health, waste isolation, operations, security, or quality of items and services associated with Office of Civilian Radioactive Waste Management (OCRWM) work activities are promptly identified, controlled, evaluated, and corrected as soon as practical. This procedure describes the process flow, controls, interfaces, and requirements for condition identification and resolution. This includes adverse conditions as well …

Medical Malpractice Reform: A Societal Crisis Or Fear Marketing?, Phil Rutsohn, Andrew Sikula Sr.

Management Faculty Research

This paper explores the primary issues surrounding the malpractice crisis currently facing the healthcare system and asks the question ‘is it truly a crisis or is it an effective marketing campaign waged by interested parties?’ The authors discuss the primary issues presented by both the supporters of tort reform and the opposition to tort reform. As is true for many issues in healthcare, final analysis suggests that tort reform is needed or not needed depends on the analysts' role in the system. The authors argue that the evidence suggests malpractice reform will produce desired results if the goal is to …

Fatal Aerial Lift Injuries, Kentucky Injury Prevention And Research Center

Kentucky Haz Alerts--Motor Vehicle

To prevent injuries while working in aerial lifts:

• A “pre-job safety plan” should be developed for each job site and reviewed prior to each day on the job site.
• Mechanical checks should be performed on all equipment at each job site prior to each use.
• There should be communication between the worker in the elevated lift and ground control crew.
• Ensure that appropriate fall protection equipment is available and correctly used when working from elevations.
• Employees should work within job qualifications and job limits.

The Association Between Lifestyle Factors And Inflammatory Markers, Kerry Ann Stonebrook

Loma Linda University Electronic Theses, Dissertations & Projects

Background: Cardiovascular disease (CVD) is the leading cause of death for both men and women in the United States. While smoking, high blood pressure, and elevated cholesterol levels are established risk factors for CVD, inflammation is being evaluated as a potential independent risk factor. A key cytokine regulator of the inflammatory response, interleukin-1 (IL-1), has emerged as playing a particularly important role at the genetic level in determining the degree to which the inflammation pathway is turned on. How an individual’s genetic make-up affects inflammation, CVD risk, and response to lifestyle intervention is an area of research that is in …

Objectively Measured Physical Activity And Fat Mass In A Large Cohort Of Children, Andy R. Ness, Sam D. Leary, Calum Mattocks, Steven N. Blair, John J. Reilly, Jonathan Wells, Sue Ingle, Kate Tilling, George Davey Smith, Chris J. Riddoch

Faculty Publications

Background: Previous studies have been unable to characterise the association between physical activity and obesity, possibly because most relied on inaccurate measures of physical activity and obesity.

Methods and Findings: We carried out a cross sectional analysis on 5,500 12-year-old children enrolled in the Avon Longitudinal Study of Parents and Children. Total physical activity and minutes of moderate and vigorous physical activity (MVPA) were measured using the Actigraph accelerometer. Fat mass and obesity (defined as the top decile of fat mass) were measured using the Lunar Prodigy dual x-ray emission absorptiometry scanner. We found strong negative associations between MVPA and …

Assessing The Unreliability Of The Medical Literature: A Response To "Why Most Published Research Findings Are False", Steven Goodman, Sander Greenland

Johns Hopkins University, Dept. of Biostatistics Working Papers

A recent article in this journal (Ioannidis JP (2005) Why most published research findings are false. PLoS Med 2: e124) argued that more than half of published research findings in the medical literature are false. In this commentary, we examine the structure of that argument, and show that it has three basic components:

1)An assumption that the prior probability of most hypotheses explored in medical research is below 50%.

2)Dichotomization of P-values at the 0.05 level and introduction of a “bias” factor (produced by significance-seeking), the combination of which severely weakens the evidence provided by every design.

3)Use of Bayes …

Power Boosting In Genome-Wide Studies Via Methods For Multivariate Outcomes, Mary J. Emond

UW Biostatistics Working Paper Series

Whole-genome studies are becoming a mainstay of biomedical research. Examples include expression array experiments, comparative genomic hybridization analyses and large case-control studies for detecting polymorphism/disease associations. The tactic of applying a regression model to every locus to obtain test statistics is useful in such studies. However, this approach ignores potential correlation structure in the data that could be used to gain power, particularly when a Bonferroni correction is applied to adjust for multiple testing. In this article, we propose using regression techniques for misspecified multivariate outcomes to increase statistical power over independence-based modeling at each locus. Even when the outcome …

The Causal Effect Of Recent Leisure-Time Physical Activity On All-Cause Mortality Among The Elderly, Oliver Bembom, Mark J. Van Der Laan, Ira B. Tager

U.C. Berkeley Division of Biostatistics Working Paper Series

We analyze data collected as part of a prospective cohort study of elderly people living in and around Sonoma, CA, in order to estimate, for each round of interviews, the causal effect of leisure-time physical activity (LTPA) over the past year on the risk of mortality in the following two years. For each round of interviews, this effect is estimated separately for subpopulations defined based on past exercise habits, age, and whether subjects have had cardiac events in the past. This decomposition of the original longitudinal data structure into a series of point-treatment data structures corresponds to an application of …

Family Support For Physical Activity In Girls From 8th To 12th Grade In South Carolina, Marsha Dowda, Rod K. Dishman, Karin A. Pfeiffer, Russell R. Pate

Faculty Publications

Objective - To examine the relationship between perceived family support and other selected correlates of physical activity (PA) with changes in PA over time.

Methods - A total of 421 girls in South Carolina completed questionnaires at 8th, 9th and 12th grades (1998-2003). Family support for PA, PA self-efficacy, perceived behavioral control, attitudes, availability of equipment, and PA were measured.

Results - Growth curve analysis showed that family support, perceived behavioral control, and self-efficacy were independently related to age-related changes in PA as reflected by a total METs. Girls who reported lower family support at the 8th grade measure had …