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Estimating Effects By Combining Instrumental Variables With Case-Control Designs: The Role Of Principal Stratification, Russell T. Shinohara, Constantine E. Frangakis, Elizabeth Platz, Konstantinos Tsilidis

Johns Hopkins University, Dept. of Biostatistics Working Papers

The instrumental variable framework is commonly used in the estimation of causal effects from cohort samples. In the case of more efficient designs such as the case-control study, however, the combination of the instrumental variable and complex sampling designs requires new methodological consideration. As the prevalence of Mendelian randomization studies is increasing and the cost of genotyping and expression data can be high, the analysis of data gathered from more cost-effective sampling designs is of prime interest. We show that the standard instrumental variable analysis is not applicable to the case-control design and can lead to erroneous estimation and inference. …

Impact Of Ambient Air Pollution On Survival Of Renal Transplant Recipients, Rhonda Kristine Hwang

Loma Linda University Electronic Theses, Dissertations & Projects

There is increasing evidence that ambient air pollution is associated with coronary heart disease morbidity and mortality. This research has focused on the general public and less so on possible sensitive subgroups even though these may have even greater susceptibility to adverse effects of ambient air pollution. With highly prevalent traditional as well as nontraditional risk factors, renal transplant recipients may potentially be a sensitive subgroup. The purpose of this study was to evaluate the possible effect of between long-term exposure to air pollution on the risk of CHD mortality among renal transplant recipients. This cohort study includes 32,239 adult, …

Study Of The Four Factor Theory Of Women’S Sexual Function, Julie M. Merrell

Loma Linda University Electronic Theses, Dissertations & Projects

Tiefer, Hall, and Tavris (2002) described factors comprising four categories of female sexual function. They suggested that unique factors need to be examined to understand sexual function in women. Socio-cultural, political, or economic factors, partner and relationship factors, psychological factors, and medical factors were described as aspects of women’s lives that can be the source of sexual dysfunction. In a previous study, Merrell (2007) utilized Tiefer et al’s (2002) four factor model of sexual functioning to examine female sexual functioning looking specifically at body shame, relationship satisfaction, positive and negative affect, sexual self-schema, and overall health. Based on the results …

Synthesis, Characterisation And Anti-Candida Activity Of Inorganic And Organic Derivatives Of 1,10-Phenanthroline, Ruth Cogan

Masters

This thesis reports results in three areas: (i) the synthesis, characterisation and biological activity of simple metal salts incorporating 1,10-phenanthroline (phen) and 1,10 phenanthroline- 5,6-dione (phendione) ligands, (ii) the synthesis, characterisation and biological activity of three different organic derivatives of phendione, and (iii) the synthesis or attempted synthesis, characterisation and biological activity of phendione-amino acid conjugates.

Coverage And Payment For Prescription Drugs Under Medicare Part B: A Complex Patchwork, Amanda Cassidy

National Health Policy Forum

As part of the diverse discussions around health care reform, many have looked to refining Medicare payment systems as a way to give health care practitioners and providers greater incentives to deliver care more efficiently, and thus slow health care spending growth. Understanding how Medicare currently pays for Part B services, including drugs covered under Part B, is essential to understanding the potential impact of these types of reforms. Most items and services covered under Part B, including most Part B drugs, are paid individually, which means practitioners and providers generally receive more payments for providing more services. Some reform …

The Development And Evaluation Of Low-Load Resistance Exercise With Blood Flow Restriction As A Countermeasure To Muscular Unloading, Summer B. Cook

Dissertations - ALL

Future space exploration must overcome both scientific and non-scientific obstacles. In accordance with the mission statement of the National Aeronautics Space Administration (NASA) (described in Chapter I), there were four major aims of these experiments. The first was to develop an exercise countermeasure to prevent muscle atrophy and weakness during simulated microgravity. The second and third aims were to determine the physiological adaptations in the knee extensor muscles and plantar flexor muscles following prolonged unloading in human subjects and to assess the effectiveness of the exercise countermeasure at preventing disuse atrophy. The final aim was to assess the relationship between …

Modulations Of Cell Cycle Checkpoints During Hcv Associated Disease, Anwar Ali Siddiqui, Saira Sarfraz, Wasim Jafri, Saeed Hamid, Syed Ali

Department of Biological & Biomedical Sciences

Background

Impaired proliferation of hepatocytes has been reported in chronic Hepatitis C virus infection. Considering the fundamental role played by cell cycle proteins in controlling cell proliferation, altered regulation of these proteins could significantly contribute to HCV disease progression and subsequent hepatocellular carcinoma (HCC). This study aimed to identify the alterations in cell cycle genes expression with respect to early and advanced disease of chronic HCV infection.

Methods

Using freshly frozen liver biopsies, mRNA levels of 84 cell cycle genes in pooled RNA samples from patients with early or advanced fibrosis of chronic HCV infection were studied. To associate mRNA …

Birth Weight As A Risk Factor For Breast Cancer: A Meta-Analysis Of 18 Epidemiologic Studies, Xiaohui Xu, Amy B. Dailey, Mary Peoples-Sheps, Evelyn O. Talbott, Ning Li, Jeffrey Roth

Health Sciences Faculty Publications

Background: Birth weight has been identified as a birth-related factor associated with the risk of breast cancer. However, the evidence is inconsistent.

Methods: To investigate the association between birth weight and breast cancer, we conducted a meta-analysis of published studies between 1996 and 2008. Eighteen studies encompassing 16,424 breast cancer cases were included in the meta-analysis. Data were combined using a fixed-effect or random-effect model depending on the heterogeneity across studies.

Results: Women with their own birth weight >4000 g or 8.5 lb had a higher risk for developing breast cancer than those with birth weight(OR¼1.20, 95% CI 1.08, 1.34). …

Sedentary Behavior And Obesity In A Large Cohort Of Children, Jonathan A. Mitchell, Calum Mattocks, Andy R. Ness, Sam D. Leary, Russell R. Pate, Marsha Dowda, Steven N. Blair, Chris Riddoch

Faculty Publications

The purpose of this study was to examine the association between sedentary behavior and obesity among 12-year-old children, while adjusting for moderate-to-vigorous physical activity (MVPA) and other potential confounding variables.

Cross-sectional analyses were carried out with data from 5434 children who participated in the Avon Longitudinal Study of Parents and Children (ALSPAC). Fat mass was derived using dual x-ray emission absorptiometry (DXA), and height and weight measurements were used to calculate body mass index (BMI; kg/m²). The children wore an accelerometer for seven days. The cut points for sedentary behavior and MVPA were ≤199 cpm and ≥3600 cpm, …

Solar Water Disinfection In Household Settings:Hype Or Hope?, Zulfiqar Ahmed Bhutta

Woman and Child Health

No abstract provided.

Pandemic Flu Planning In Africa: Thoughts From A Nigerian Case Study, Cheryl Loeb, Lynn Mcgrath, Sudhir Devalia

Defense and Technology Papers

This paper discusses the Avian Influenza/Pandemic Influenza Policy Planning workshop held in Nigeria in June 2007, the objective of which was assisting selected Nigerian officials in evaluating their nation’s pandemic response plan.

The Effects Of Physical Activity And Nutrient Intake On The Risk Of Hip Fracture : Results From The Adventist Health Study-2, Wen-Ling Liao

Loma Linda University Electronic Theses, Dissertations & Projects

This is a two year of follow up study of Adventist Health Study-2 (AHS-2). We assessed the association between physical activity, nutrient intake and risk of hip fracture among peri- and post menopausal Caucasian women using unconditional logistic regression models. All subjects completed a lifestyle questionnaire which including information of physical activity and frequency and portion size of food intake at enrollment into the study (2002-2007). The “Bi-Annual Hospitalization History” questionnaire which included a question about hip fractures due to minor trauma/falls was sent to subjects approximately two years after enrollment, with a response rat of 82.84%. In this cohort, …

Effect Of California Mission Fig Consumption On Levels Of C-Reactive Protein And Antioxidant Levels, Rasha Abdrabou

Loma Linda University Electronic Theses, Dissertations & Projects

Polyphenols exert anti-inflammatory and antioxidant effects. We investigated the effect of consumption of polyphenol-rich figs on high sensitivity C-reactive protein (CRP) and antioxidant levels in hyperlipidemic subjects. The purpose of this study was to examine the effect of fig consumption on C-reactive protein and antioxidant levels. Analyses were carried out on collected data from September to December of 2008. Using a crossover design, one hundred and two participants were recruited and randomized into an intervention phase (eating figs) and a control phase (not eating figs) for 5 weeks. Blood samples were drawn from each group at the 4th and 5th …

Hp Newsletter June 2009 Download Full Pdf

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Follow-On Biologics, Patient Safety And Policy Focus Of Jsph Program In Dc

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Complexity, Cofactors, And The Failure Of Aids Policy In Africa, Eileen Stillwaggon

Economics Faculty Publications

Global AIDS policy still treats HIV as an exceptional case, abstracting from the context in which infection occurs. Policy is based on a simplistic theory of HIV causation, and evaluated using outdated tools of health economics. Recent calls for a health systems strategy – preventing and treating HIV within a programme of comprehensive health care – have not yet influenced the silo approach of AIDS policy.

Evidence continues to accumulate, showing that multiple factors, such as malnutrition, malaria and helminthes, increase the risk of sexual and vertical transmission of HIV. Moreover, complementary interventions that reduce viral load, improve immune response, …

Carbohydrate Intake And Overweight And Obesity Among Healthy Adults, Anwar T. Merchant, Hassanali Vatanparast, Shahzaib Barlas, Mahshid Dehghan, Syed Mahboob Ali Shah, Lawrence De Koning, Susan E. Steck

Faculty Publications

Background - Little is known about the dietary habits of people with optimal body weight in communities with high overweight and obesity prevalence.

Objective - To evaluate carbohydrate intake in relation to overweight and obesity in healthy, free-living adults

Design - We used a cross-sectional analysis

Subjects/setting - The Canadian Community Health Survey Cycle 2.2 is a cross-sectional survey of Canadians conducted in 2004-2005. There were 4,451 participants aged 18 years and older with anthropometric and dietary data and no comorbid conditions in this analysis.

Main outcome measures - Outcome variables were body mass index (BMI; calculated as kg/m^{2 …}

Impact Of Allhat Publication On Antihypertensive Prescribing Patterns In Regione Emilia-Romagna, Italy, Vittorio Maio, Pharmd, Ms, Msph, Joshua J. Gagne, Pharmd, Ms

College of Population Health Faculty Papers

Background and objective: Studies from the US and Canada observed changes in antihypertensive prescribing patterns in accordance with Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) study findings immediately after the study's publication, but little is known about the impact of ALLHAT in Italy. The objective of this study was to examine antihypertensive prescribing patterns in Regione Emilia-Romagna (RER), Italy, following the publication of the ALLHAT main results.

Methods: We conducted a time series analysis using automated pharmacy data of approximately 4 million RER residents between 1 January 2000 and 31 December 2003. We computed monthly relative percentages …

Chronic Illness And Smoking Cessation, Kushal Patel, David Schlundt, Celia Larson, Hong Wang, Anne Brown, Margaret Hargreaves

Public Health, Health Administration, and Health Sciences Faculty Research

Introduction

Smoking is among the leading causes of premature mortality and preventable death in the United States. Although smoking contributes to the probability of developing chronic illness, little is known about the relationship between quitting smoking and the presence of chronic illness. The present study investigated the association between diagnoses of one or more chronic diseases (diabetes, hypertension, or high cholesterol) and smoking status (former or current smoker). Methods

The data analyzed were a subset of questions from a 155-item telephone-administered community survey that assessed smoking status, demographic characteristics, and presence of chronic disease. The study sample consisted of 3,802 …

Ethnicity Matters: The Socioeconomic Gradient In Health Among Asian Americans, Emily S. Ihara

The Journal of Sociology & Social Welfare

This study examines the relationship between socioeconomic indicators and health status among Asian Americans using data from the 2001 California Health Interview Survey (CHIS), a population-based random-digit-dial survey with race-ethnic supplemental samples. Multivariate logistic regression analyses show that the inverse relationship between socioeconomic position and health status is similar for Asian Americans when measured as an aggregate group compared to Whites. However, when specific Asian American ethnic groups are examined, the relationship varies greatly. For example, among Chinese Americans and Vietnamese Americans, education is a significant predictor of poor health status, but household income is more significant among Korean Americans. …

Underwriting In The Non-Group Health Insurance Market: The Fundamentals, Kathryn Linehan

National Health Policy Forum

Non-group health insurance is coverage that individuals purchase on their own rather than as part of a group. Most states currently permit non-group insurers to underwrite, a process whereby an insurer assesses the health and other characteristics of individuals to determine their likely utilization of health services or risk; insurers then use this assessment to determine whether they will offer coverage and the premium they will charge. Policymakers have identified underwriting and related practices in non-group markets as a target for reform to enable broader access for the currently uninsured. This publication reviews the characteristics of non-group markets and insurers' …

Commencement Program 2009, Loma Linda University

Commencement Programs

CONTENTS

2 | 2009 Events of Commencement

3 | The Academic Procession

4 | Significance of the Academic Regalia

5 | The Good Samaritan

6 | The Speakers

13 | The University Honorees

19 | The School Honorees

30 | The Program

• School of Medicine, 31
• School of Pharmacy, 46
• School of Dentistry, 51
• School of Science and Technology and School of Religion, 63
• School of Nursing, 71
• School of Allied Health Professions - Physical Therapy, 78
• School of Allied Health Professions, 86
• School of Public Health, 95

Modeling And Analysis Of The Spread Of Japanese Encephalitis With Environmental Effects, Ram Naresh, Surabhi Pandey

Applications and Applied Mathematics: An International Journal (AAM)

A nonlinear mathematical model for the spread of Japanese Encephalitis, caused by infected mosquito feeding on susceptible human population incorporating demographic and environmental factors is proposed and analyzed. In the modeling process, it is assumed that the growth rates of reservoir animal population and vector mosquito population are enhanced due to environmental discharges caused by human population related factors. The model is analyzed by stability theory of differential equations and computer simulation. Both the disease-free and the endemic equilibria are found and their stability is investigated. It is found that whenever the disease-free equilibrium is locally asymptotically stable, the endemic …

Anthropometric Parameters Of Under-Five Years Old Children With Different Dietary Habits In Ukambani Region : A Study In Eastern Rural Kenya, Hellen M. Ndiku

Loma Linda University Electronic Theses, Dissertations & Projects

The objective of this descriptive cross sectional study was to assess dietary intake and nutritional status of children under-five years in two rural sites of Eastern Kenya where the staple cereals may differ. A modified rapid, knowledge, practice and coverage (KPC) questionnaire and a 24-hr dietary recall form were used to collect the data. A total of 403 households were surveyed from four randomly selected divisions. This yielded 629 surrogate 24-hr dietary recalls of children < 5 years with 314 from Mwingi district and 315 from Makueni district (49 % boys and 51 % girls).

Statistical analysis was done using SPSS and SAS. Comparison of means was done using t- test and chi square was used for proportions. The 24-hr …

Detecting, Preventing, And Treating Sexually Transmitted Diseases Among Adolescent Arrestees: An Unmet Public Health Need, Steven Belenko, Richard Dembo, Matthew Rollie, Kristina Childs, Christopher Salvatore

Department of Justice Studies Faculty Scholarship and Creative Works

Studies of detained and incarcerated adolescent offenders in the United States indicate that these juveniles have an elevated risk of sexually transmitted diseases (STDs). However, many more arrestees enter the “front end” of the juvenile justice system that is detained or incarcerated, and research into the STD risk profiles and service needs of this larger group is lacking. An expansion of STD testing (including of asymptomatic youths), prevention, and treatment is needed, as is improved knowledge about gender- and race-specific services. A pilot program in Florida has shown that juvenile justice and public health systems can collaborate to implement STD …

Association Between Plasma 25-Hydroxyvitamin D And Breast Cancer Risk, Katherine D. Crew, Marilie D. Gammon, Susan E. Steck, Dawn L. Hershman, Serge Cremers, Elzbieta Dworakowski, Elizabeth Shane, Mary Beth Terry, Manisha Desai, Susan L. Teitelbaum, Alfred I. Neugut, Regina M. Santella

Faculty Publications

Vitamin D has been associated with decreased risk of several cancers. In experimental studies, vitamin D has been shown to inhibit cell proliferation and induce differentiation and apoptosis in normal and malignant breast cells. Using a population-based case-control study on Long Island, New York, we examined the association of breast cancer with plasma 25-hydroxyvitamin D (25-OHD) levels, a measure of vitamin D body stores. In-person interviews and blood specimens were obtained from 1,026 incident breast cancer cases diagnosed in 1996 to 1997 and 1,075 population-based controls. Plasma 25-OHD was measured in batched, archived specimens by Diasorin RIA. The mean (SD) …

Mapping Cancer Mortality-To-Incidence Ratios To Illustrate Racial And Sex Disparities In A High-Risk Population, James R. Hébert, Virginie Daguise, Deborah M. Hurley, Rebecca C. Wilkerson, Catishia M. Mosley, Swann Arp Adams, Robin C. Puett, James B. Burch, Susan E. Steck, Susan Bolick-Aldrich

Faculty Publications

Background - Comparisons of incidence and mortality rates are the metrics used most commonly to define cancer-related racial disparities. In the US, and particularly in South Carolina, these largely disfavor African Americans (AAs). Computed from readily available data sources, the mortality-to-incidence rate ratio (MIR) provides a population-based indicator of survival.

Methods - South Carolina Central Cancer Registry incidence data and Vital Registry death data were used to construct MIRs. ArcGIS 9.2 mapping software was used to map cancer MIRs by sex and race for 8 Health Regions within South Carolina for all cancers combined and for breast, cervical, colorectal, lung, …

Can We Apply The Mendelian Randomization Methodology Without Considering Epigenetic Effects?, Ikechkwu U. Ogbuanu, Hongmei Zhang, Wilfried J. Karmaus

Faculty Publications

Introduction: Instrumental variable (IV) methods have been used in econometrics for several decades now, but have only recently been introduced into the epidemiologic research frameworks. Similarly, Mendelian randomization studies, which use the IV methodology for analysis and inference in epidemiology, were introduced into the epidemiologist's toolbox only in the last decade.

Analysis: Mendelian randomization studies using instrumental variables (IVs) have the potential to avoid some of the limitations of observational epidemiology (confounding, reverse causality, regression dilution bias) for making causal inferences. Certain limitations of randomized controlled trials, such as problems with generalizability, feasibility and ethics for some exposures, and high …

Is Volunteering During Adolescence Associated With A Delay In Pregnancy Until Adulthood?, Diane Bishop

Theses and Dissertations

Purpose: The objective of this study was to determine if regular volunteering during adolescence was associated with a delay in first pregnancy until adulthood. Method: Data for this analysis were drawn from Wave III of the National Longitudinal Study of Adolescent Health (Add Health). Logistic regression was used, controlling for demographic characteristics and pregnancy intention, to estimate the independent contribution of volunteering during adolescence to a delay in first pregnancy until after age 18. Results: One-third of respondents reported regularly volunteering during adolescence. Volunteering significantly differed among those who had a teen pregnancy compared to those who delayed pregnancy until …

Reducing Stillbirths: Behavioural And Nutritional Interventions Before And During Pregnancy., Mohammad Yawar Yakoob, Esme V Menezes, Tanya Soomro, Rachel A Haws, Gary L Darmstadt, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background:The vast majority of global stillbirths occur in low- and middle-income countries, and in many settings, the majority of stillbirths occur antenatally, prior to the onset of labour. Poor nutritional status, lack of antenatal care and a number of behaviours increase women's risk of stillbirth in many resource-poor settings. Interventions to reduce these risks could reduce the resulting burden of stillbirths, but the evidence for the impact of such interventions has not yet been comprehensively evaluated.

Methods:

This second paper of a systematic review of interventions that could plausibly impact stillbirth rates covers 12 different interventions relating to behavioural …