Digital Commons Network^™

Remote Physiological Monitoring: Clinical, Financial, And Behavioral Outcomes In A Heart Failure Population, Laurel R. Hudson Msn, Rn, G. Brent Hamar Dds, Mph, Patty Orr Rn, Edd, Jeffrey H. Johnson Bs, Amy Neftzger Ma, Richard S. Chung Md, Myra L. Williams Mph, William M. Gandy Edd, Albert Crawford Phd, Mba, Msis, Janice L. Clarke Rn, Bba, Neil I. Goldfarb

College of Population Health Faculty Papers

This article reports on the outcomes associated with remote physiological monitoring (RPM) conducted as part of a heart failure disease management program. Claims data, medical records, data transmission records, and survey results for 91 individuals ages 50–92 (mean 74 years) successfully completing a heart failure RPM program were analyzed for time periods before, during, and after the monitoring intervention. The program was associated with significant reductions in per member per month costs and emergency room and hospital utilization. More detailed analyses were performed for specific gender and age subgroups. Participant surveys indicated high levels of satisfaction, and improvements in self-perceived …

Are Specific Language Impairment And Dyslexia Distinct Disorders?, Hugh W. Catts, Suzanne M. Adlof, Tiffany Hogan, Susan Ellis Weismer

Faculty Publications

Purpose - The purpose of this study was to determine whether specific language impairment (SLI) and dyslexia are distinct developmental disorders.

Method - Study 1 investigated the overlap between SLI identified in kindergarten and dyslexia identified in 2nd, 4th, or 8th grades in a representative sample of 527 children. Study 2 examined phonological processing in a subsample of participants, including 21 children with dyslexia only, and 43 children with SLI only, 18 children with SLI and dyslexia, and 165 children with typical language/reading development. Measures of phonological awareness and nonword repetition were considered.

Results - Study 1 showed limited but …

Intimate Partner Violence And Disabilities Among Women Attending Family Practice Clinics, Ann L. Coker, Paige H. Smith, Mary Kay Fadden

CRVAW Faculty Journal Articles

Purpose: To estimate the frequency and type of disabilities preventing work among those experiencing intimate partner violence (IPV) compared with those never experiencing IPV.

Methods: We used a large cross-sectional survey of women, ages 18–65, attending family practice clinics from 1997 through 1998. Participation included a 5–10-minute in-clinic survey assessing IPV experience and a longer telephone survey assessing health status and chronic disabilities that prevented work outside the home or housework.

Results: Of 1,152 eligible women surveyed, 54% experienced some type of IPV, and 24% were currently in a violent relationship. Women who had ever experienced IPV …

Pratiques Cliniques Des Physiothérapeutes Dans Le Traitement De Travailleurs Souffrant De Maux De Dos Aigus Et Subaigus, Régis Blais, Stéphane Poitras, Bonnie Swaine, Michel Rossignol

Rapports de recherche scientifique

Les maux de dos représentent une part importante des lésions indemnisées par la Commission de la Santé et Sécurité du Travail du Québec (CSST). Les physiothérapeutes sont couramment engagés dans la prise en charge de ce problème, mais on ne peut évaluer l'efficacité de leur approche thérapeutique puisqu'on en connaît mal la constitution.

Ce projet visait principalement à 1) décrire prospectivement les interventions pratiquées par les physiothérapeutes auprès de travailleurs indemnisés par la CSST suite à un mal de dos aigu ou subaigu et 2) identifier les facteurs associés à ces choix d'interventions.

Une enquête prospective a été réalisée auprès …

Population Intervention Models In Causal Inference, Alan E. Hubbard, Mark J. Van Der Laan

U.C. Berkeley Division of Biostatistics Working Paper Series

Marginal structural models (MSM) provide a powerful tool for estimating the causal effect of a] treatment variable or risk variable on the distribution of a disease in a population. These models, as originally introduced by Robins (e.g., Robins (2000a), Robins (2000b), van der Laan and Robins (2002)), model the marginal distributions of treatment-specific counterfactual outcomes, possibly conditional on a subset of the baseline covariates, and its dependence on treatment. Marginal structural models are particularly useful in the context of longitudinal data structures, in which each subject's treatment and covariate history are measured over time, and an outcome is recorded at …

Additive Hazards Models With Latent Treatment Effectiveness Lag Time, Ying Qing Chen, Charles A. Rohde, Mei-Cheng Wang

Johns Hopkins University, Dept. of Biostatistics Working Papers

In many clinical trials to evaluate treatment efficacy, it is believed that there may exist latent treatment effectiveness lag times after which medical procedure or chemical compound would be in full effect. In this article, semiparametric regression models are proposed and studied to estimate the treatment effect accounting for such latent lag times. The new models take advantage of the invariance property of the additive hazards model in marginalizing over random effects, so parameters in the models are easy to be estimated and interpreted, while the flexibility without specifying baseline hazard function is kept. Monte Carlo simulation studies demonstrate the …

Prescription Drug Recalls On Florida’S Medicaid Preferred Drug List

Florida Public Health Review

No abstract provided.

Is The Number Of Sick Persons In A Cohort Constant Over Time?, Paula Diehr, Ann Derleth, Anne Newman, Liming Cai

UW Biostatistics Working Paper Series

Objectives: To estimate the number of persons in a cohort who are sick, over time.

Methods: We calculated the number of sick persons in the Cardiovascular Health Study (CHS), a cohort study of older adults followed up to 14 years, using eight definitions of “healthy” and “sick”. We projected the number in each health state over time for a birth cohort.

Results: The number of sick persons in CHS was approximately constant for 14 years, for all definitions of “sick”. The estimated number of sick persons in the birth cohort was approximately constant from ages 55-75, after which it decreased. …

The Silence Around Them: Aids Ngos, Scaling Up And Aids Fatigue In University Students, Carolyn Holmes

Independent Study Project (ISP) Collection

HIV/AIDS is undoubtedly one of the most talked about aspects of the political scene in South Africa. This epidemic is expected to ravage the South African population, wholly changing the country’s demographic landscape. The most infected and affected generation is also the first generation to come of age in the democracy for which their parents fought. In this study, the author examines the attitudes and opinions of students within the aforementioned generation; current students at the Howard College Campus of the University of KwaZulu Natal in Durban. Largely, the students were found to be apathetic and overexposed to NGO’s campaigns …

Evaluation Of African-American And White Racial Classification In A Surveillance, Epidemiology, And End Results Cancer Registry, Diva A. Patel, Alicia Knowles, Ann G. Schwartz, Kendra Schwartz

FMPHS Faculty Publications

Objectives: This study evaluated the validity of registry-reported race for individuals who participated in research studies conducted since 1980 through the Metropolitan Detroit Cancer Surveillance System (MDCSS), a Surveillance, Epidemiology, and End Results (SEER) Program registry.

Methods: 5329 individuals who self-identified as African American or White and were classified in the MDCSS registry as African American or White were included. Self-identified and registry-reported race were compared, and associations between demographics and racial misclassification were examined.

Results: Most self-identified African Americans and Whites were correctly classified (sensitivity= 98.5%, specificity=99.7%). Males were two times more likely to be misclassified than females [odds …

Abortion: The Reality For Women Of Praia Grande, Anna Tawse

Independent Study Project (ISP) Collection

Under Brazilian law, abortions are prohibited in all cases except for pregnancies resulting from rape or sexual violence and pregnancies which present possible death or harm to the mother. Upon a closer look, however, it is obvious that regardless of the illegality, Brazilian women are getting abortions. In light of this, I conducted a research project to uncover more about the reality that Brazilian women, specifically located in Praia Grande (a small community on Ilha de Mare off the coast of Salvador), face given the simultaneous existence of the two situations listed above (which I refer to as the “abortion …

Recruitment And Retention Of Emergency Medical Technicians: A Qualitative Study, P. Daniel Patterson, Janice C. Probst, Katherine H. Leith, Sara J. Corwin, M. Paige Powell

Faculty Publications

Emergency medical technicians (EMTs) are critical to out-of-hospital care, but maintaining staff can be difficult. The study objective was to identify factors that contribute to recruitment and retention of EMTs and paramedics. Information was drawn from three focus groups of EMT-Basic, EMT-Intermediate, and EMT-Paramedic personnel recruited from participants at an annual conference. Thoughts and feelings of EMTs and paramedics were investigated using eight questions designed to explore entry into emergency medical services, what it is like to be an EMT or paramedic, and the EMT educational process. Data were analyzed at the group level for common themes using NVivo. For …

Comparative Effectiveness Of Total Population Versus Disease-Specific Neural Network Models In Predicting Medical Costs, Albert G. Crawford, Joseph P. Fuhr Jr., Janice Clarke, Brandon Hubbs

College of Population Health Faculty Papers

The objective of this research was to compare the accuracy of two types of neural networks in identifying individuals at risk for high medical costs for three chronic conditions. Two neural network models—a population model and three disease-specific models—were compared regarding effectiveness predicting high costs. Subjects included 33,908 health plan members with diabetes, 19,264 with asthma, and 2,605 with cardiac conditions. For model development/testing, only members with 24 months of continuous enrollment were included. Models were developed to predict probability of high costs in 2000 (top 15% of distribution) based on 1999 claims factors. After validation, models were applied to …

Development Of A Scale To Measure Nutritional Literacy, James J. Diamond

Population Health Matters (Formerly Health Policy Newsletter)

Note: The Nutritional Literacy Scale can be found here:

http://jdc.jefferson.edu/nls/1/

Interclerkship Day 2005: Improving Patient Safety

Population Health Matters (Formerly Health Policy Newsletter)

No abstract available.

Letters To The Editor

Population Health Matters (Formerly Health Policy Newsletter)

No abstract available.

Computerized Physician Order Entery (Cpoe) At Thomas Jefferson University Hospital, Jonathan E. Gottlieb

Population Health Matters (Formerly Health Policy Newsletter)

No abstract available.

Jefferson Launches Effort To Eliminate Use Of Dangerous Medication Abbreviations And Dose Designations, Craig Senholzi

Population Health Matters (Formerly Health Policy Newsletter)

No abstract available.

Estimation Of Direct Causal Effects, Maya L. Petersen, Mark J. Van Der Laan

U.C. Berkeley Division of Biostatistics Working Paper Series

Many common problems in epidemiologic and clinical research involve estimating the effect of an exposure on an outcome while blocking the exposure's effect on an intermediate variable. Effects of this kind are termed direct effects. Estimation of direct effects arises frequently in research aimed at understanding mechanistic pathways by which an exposure acts to cause or prevent disease, as well as in many other settings. Although multivariable regression is commonly used to estimate direct effects, this approach requires assumptions beyond those required for the estimation of total causal effects. In addition, multivariable regression estimates a particular type of direct effect, …

From The Editor: The Acopm Of The Jcaho, David B. Nash

Population Health Matters (Formerly Health Policy Newsletter)

No abstract available.

From The Editor: An Atm For Healthcare?, David B. Nash

Population Health Matters (Formerly Health Policy Newsletter)

No abstract available.

Health Policy: An Introduction To The Health Care System -- A Required First-Year Course, Daniel Z. Louis, Gang Xu, Jon J. Veloski, David B. Nash, James R. Boex

Population Health Matters (Formerly Health Policy Newsletter)

No abstract available.

A Nonstationary Negative Binomial Time Series With Time-Dependent Covariates: Enterococcus Counts In Boston Harbor, E. Andres Houseman, Brent Coull, James P. Shine

Harvard University Biostatistics Working Paper Series

Boston Harbor has had a history of poor water quality, including contamination by enteric pathogens. We conduct a statistical analysis of data collected by the Massachusetts Water Resources Authority (MWRA) between 1996 and 2002 to evaluate the effects of court-mandated improvements in sewage treatment. Motivated by the ineffectiveness of standard Poisson mixture models and their zero-inflated counterparts, we propose a new negative binomial model for time series of Enterococcus counts in Boston Harbor, where nonstationarity and autocorrelation are modeled using a nonparametric smooth function of time in the predictor. Without further restrictions, this function is not identifiable in the presence …

Revised Adult Treatment Panel Iii Guidelines And Cardiovascular Disease Mortality In Men Attending A Preventive Medical Clinic, Chris I. Ardern, Peter T. Katzmarzyk, Ian Janssen, Timothy S. Church, Steven N. Blair

Faculty Publications

Background - National Cholesterol Education Program Adult Treatment Panel III guidelines recommended therapeutic lifestyle changes (TLC) and drug therapy to reduce cardiovascular disease (CVD) risk. These guidelines have been revised recently (ATP III-R); however, the risk of CVD mortality within each intervention window and the effects of cardiorespiratory fitness (CRF) and metabolic syndrome on CVD mortality within the framework of the guidelines are unknown.

Methods and Results - Risk factor and CRF data from 19,125 men (aged 20 to 79 years) who attended a preventive medical clinic between 1979 and 1995 were used. Mortality follow-up was completed until December 31, …

Direct Effect Models, Mark J. Van Der Laan, Maya L. Petersen

U.C. Berkeley Division of Biostatistics Working Paper Series

The causal effect of a treatment on an outcome is generally mediated by several intermediate variables. Estimation of the component of the causal effect of a treatment that is mediated by a given intermediate variable (the indirect effect of the treatment), and the component that is not mediated by that intermediate variable (the direct effect of the treatment) is often relevant to mechanistic understanding and to the design of clinical and public health interventions. Under the assumption of no-unmeasured confounders for treatment and the intermediate variable, Robins & Greenland (1992) define an individual direct effect as the counterfactual effect of …

Clinical Preventive Services: When Is The Juice Worth The Squeeze?, Eileen Salinsky

National Health Policy Forum

This paper provides an overview of clinical preventive services, including a definition of such services and the role of the U.S. Preventive Services Task Force in recommending which services should be routinely offered to patients. It also describes efforts to analyze the cost effectiveness of clinical preventive services and reviews the insurance coverage policies of private and public payers. Barriers to increased uptake of appropriate services are discussed and policy relevant issues are summarized.

Caring For "Ryan White": The Fundamentals Of Hiv/Aids Treatment Policy, Jessamyn Taylor

National Health Policy Forum

This background paper provides an overview of the HIV/ AIDS epidemic in the United States and discusses how treatment of the disease and the populations most affected by it have changed over time. The federal government’s domestic and global efforts in prevention, research, and treatment of the disease are highlighted. The paper outlines the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, a set of programs that fund treatment services for uninsured and underinsured individuals living with HIV/AIDS, and places it in the context of other federal programs that fund treatment for HIV/AIDS. Policy issues for Ryan White’s potential congressional …

Exposure To Volatile Organic Compounds And Effect On Neurobehavioral Function., Abhijeet Jagannath Bhanegaonkar

Electronic Theses and Dissertations

Data of 1338 respondents from the Priority Toxicant Reference Range Study were analyzed to examine exposure to volatile organic compounds (VOCs). Self-reported contact to chemical products and blood concentrations of specific chemicals were analyzed. Neurobehavioral function was assessed by simple reaction time test (SRTT), symbol digit substitution test (SDST), and serial digit learning test (SDLT). Prevalence of exposure to VOC products was, for instance, air freshener/room deodorant - 34.7%, gasoline - 29.2%, finger nail polish - 16.2%, and diesel fuel/ kerosene - 10.6%. The 95th percentiles of blood VOCs (μg/L) were calculated for 41 chemicals including Benzene - 0.476, 1,1,1-Trichloroethane …

Effects Of Resistance Training Volume And Variety On Dietary Intake And Mood State In Untrained Subject, Suzette K. Smith

Loma Linda University Electronic Theses, Dissertations & Projects

Background: While there is research on the effects of aerobic training on various aspects of mood state and nutrient intake, little is known of the effect of resistance training on these variables.

Purpose: To examine the effects of resistance training (RT) volume and variety on total energy (kcal) and macronutrient intake, and mood states in a healthy, untrained population.

Method:The investigation was part of a prospective experimental study examining the effects of three RT protocols on body composition and strength. An initial 102, healthy, untrained male and female participants, ages 20-40, were recruited, and randomized into one of three …

Mental Health And Juvenile Justice: Moving Toward More Effective Systems Of Care, Jane Koppelman

National Health Policy Forum

This issue brief discusses the mental health needs of youth who are involved with the juvenile justice system, how they come into contact with the system, and the evidence of the availability and quality of mental health services for such youth. The paper also explores public policy options for avoiding dependence on the juvenile justice system as a last resort for treating youth with mental disorders.