Digital Commons Network^™

The Effectiveness Of Treatment In An Inpatient And Outpatient Psychiatric Facility, Timothy Quan Tran

Loma Linda University Electronic Theses, Dissertations & Projects

The present study is aimed at examining treatment outcome in a large psychiatric facility that provides both inpatient and outpatient services to a broad range of patients. Not only will patient outcomes be assessed at a facility-wide level, but patient outcomes on the various units/programs in the facility will also be assessed and compared. It is expected that, facility wide, patients will show significant improvement on the outcome measure from admission to discharge, but that patient outcomes will differ across the various units/programs in the facility. In sum, the results of the paired-sample t-test and effect size obtained in this …

Is American Health Care Uniquely Inefficient?, Alan M. Garber, Jonathan Skinner

Dartmouth Scholarship

No abstract provided.

Breast Cancer Screening Disparities In Japanese-American Women, Theodora Stratis

Loma Linda University Electronic Theses, Dissertations & Projects

Cancer screening disparities in ethnic minority women have received much research attention in the last several years due to a marked increase in ethnic minority cancer incidence and poor survival rates (Miller, Kollnel, Bernstein, Young Swanson, West et ah, 1996). Breast cancer is the leading cause of death for Asian American women (Asian American Network for Cancer Awareness, Research & Training, 2002) and, although their incidence and mortality rates are lower than Caucasian women, these rates continue to increase every year. This increasing mortality rate is likely due to the underutilization of breast cancer screening by Asian American women. Asian …

Gender Differences In The Risk Of Hiv Infection Among Persons Reporting Abstinence, Monogamy, And Multiple Sexual Partners In Northern Tanzania, Keren Z. Landman, Jan Ostermann, John A. Crump, Anna Mgonja, Meghan K. Mayhood, Dafrosa K. Itemba, Alison C. Tribble, Evaline M. Ndosi, Helen Y. Chu, John F. Shao, John A. Bartlett, Nathan M. Thielman

Faculty Publications

Background: Monogamy, together with abstinence, partner reduction, and condom use, is widely advocated as a key behavioral strategy to prevent HIV infection in sub-Saharan Africa. We examined the association between the number of sexual partners and the risk of HIV seropositivity among men and women presenting for HIV voluntary counseling and testing (VCT) in northern Tanzania.

Methodology/ Principal Findings: Clients presenting for HIV VCT at a community-based AIDS service organization in Moshi, Tanzania were surveyed between November 2003 and December 2007. Data on sociodemographic characteristics, reasons for testing, sexual behaviors, and symptoms were collected. Men and women were categorized by …

Pengelolaan Sampah Berbasis Masyarakat Di Kampung Rawajati Jakarta Selatan, Catur Puspawati, Besral Besral

Kesmas

Kampung Rawajati di Jakarta yang menerapkan sistem pengelolaan sampah berbasis masyarakat merupakan alternatif upaya mengatasi sampah rumah tangga. Penelitian ini bertujuan mengetahui pengaruh sistem tersebut terhadap penurunan berat sampah rumah tangga. Dengan desain studi potong lintang, penelitian ini dilakukan pada sampel 175 ibu rumah tangga yang dipilih secara acak. Hasil penelitian ini menunjukan bahwa pengelolaan sampah berbasis masyarakat dapat menurunkan berat sampah sebesar 28,3%. Analisis regresi linier ganda memperlihatkan bahwa kegiatan pengelolaan yang berpengaruh terhadap penurunan berat sampah adalah kegiatan reuse, daur ulang, dan pembuatan kompos (nilai-p < 0,05). Pembuatan kompos merupakan variabel yang berkontribusi terhadap penurunan berat sampah 657,3 gram setelah dikontrol variabel perancu. Penurunan berat sampah ditemukan lebih besar pada rumah tangga yang mendapat pelatihan. Tidak ada perbedaan penurunan berat sampah menurut jumlah anggota keluarga, penghasilan rumah tangga, dan pengetahuan ibu. Disarankan agar Pemerintah DKI Jakarta dapat melakukan replikasi model pengelolaan sampah berbasis masyarakat kepada wilayah lainnya, dengan memberikan pelatihan pengelolaan sampah kepada masyarakat. Kampung Rawajati in Jakarta applies community-based solid waste management system as an alternative way to overcome household waste problem. The objective of the research is to assess the effect of community-based solid waste management on reduction of household waste weight. This study has crosssectional study design and was conducted on 175 housewife as respondent who were selected randomly. The data was collected by interview using structured questionnaire and weighing of household waste. The result shows that the community-based solid waste management can reduce 28.3% of household waste weight (weight before: 1.845 gram/house/day and after: 1.324 gram/house/day). Multiple linear regression analysis shows that variables affecting the reduction of solid waste including re-using activity, recycling, and composting (p-value <0.05). Composting represents the biggest effect to reduction (657.26 gram) after controlled by potential confounders. The reduction was higher among household with waste training and number of trained household member. It was found that number of family member, family income, and mother knowledge are not significant. It was recommended to the Government of DKI Jakarta to replicate this community-based waste management system to other regions by providing training facilities on solid waste management.

Faktor Penentu Kontaminasi Bakteriologik Pada Makanan Jajanan Di Sekolah Dasar, Anton Wibawa

Kesmas

Makanan jajanan merupakan produk pengolahan makanan yang banyak dijumpai di sekitar sekolah dan dikonsumsi secara rutin oleh banyak anak usia sekolah. Selain bermanfaat makanan jajanan juga berisiko menimbulkan masalah kesehatan. Tujuan penelitian ini adalah mengetahui kontaminasi bakteriologi pada makanan jajanan serta faktor yang mempengaruhinya. Penelitian ini menggunakan disain potong lintang (Cross Sectional), dengan sumber data sekunder kegiatan pengawasan makanan dan minuman oleh Dinas Kesehatan Kabupaten Tangerang tahun 2006. Sampel diambil dari 159 Sekolah Dasar di kabupaten Tangerang. Variabel yang diamati adalah : pengetahuan, perilaku, peralatan sarana air bersih, sarana pembuangan limbah, tempat pembuangan sampah dan lokasi usaha, sedangkan variabel terikat …

Analisis Praktek Bidan Pada Pelayanan Ibu Bersalin Dan Bayi Baru Lahir, Alhafiza Putra

Kesmas

Sekitar tigapuluh persen kematian bayi terjadi pada periode neonatal yang 80 % di antaranya terjadi pada minggu pertama. Hal tersebut mengindikasikan status kesehatan ibu dan bayi baru lahir yang rendah serta akses dan kualitas pelayanan persalinan masih rendah. Tahun 2006, kematian neonatal di Kabupaten Solo adalah 47 dari 8.250 kelahiran hidup dan di Kecamatan Lembah Gumanti adalah 23 kematian neonatal dari 1,091 kelahiran hidup. Tujuan penelitian ini untuk mengetahui pengaruh praktek bidan di wilayah kerja Puskesmas Alahan Panjang terhadap pelayanan ibu bersalin dan bayi baru lahir pasca persalinan. Penelitian dilakukan dengan metode kualitatif diskusi kelompok terarah, wawancara mendalam dan observasi. …

Pre-Eklampsia Berat Di Rsud Bayu Asih Purwakarta, Lia Yulianti, Sandra Fikawati

Kesmas

Pada periode 2004 - 2005, kejadian pre-eklampsia berat pada ibu hamil di RSUD Bayu Asih Purwakarta meningkat dari 15,2% menjadi 23,6%. Peningkatan kejadian PEB ini diperkirakan dipengaruhi faktor pendidikan, pekerjaan, umur ibu, paritas, umur kehamilan, riwayat penyakit, dan pemeriksaan antenatal. Penelitian ini bertujuan melakukan analisis berbagai faktor determinan pre-eklampsia berat pada Ibu hamil di RSUD Bayu Asih Purwakarta. Penelitian dengan disain studi case control ini dilakukan pada 133 kasus ibu dengan pre-eklampsia berat dan 133 kontrol ibu dengan non pre-eklampsia berat di RSUD Bayu Asih Purwakarta tahun 2004-2005. Metoda analisis yang digunakan adalah metoda analisis regresi logistik ganda. Penelitian ini …

Malaria Vivax Di Kabupaten Nias Selatan, Lambok Siahaan

Kesmas

Diperkirakan sekitar 2,5 milyar manusia hidup di wilayah endemis malaria dengan ± 300 juta kasus dan ± 1 juta kematian yang sebagian besar adalah anak-anak. Di Indonesia, malaria tak pernah tereradikasi dan mengalami pasang surut dari tahun ke tahun. Di Jawa-Bali, API pada tahun 2001 (0,62%) dan 2004 (0,15‰) dan di luar Jawa-Bali, AMI pada tahun 2001 (26,20‰) dan 2004 (21,20‰) terlihat menurun. Kabupaten Nias Selatan merupakan daerah endemis malaria dengan angka Monthly Malaria Incidence (MoMI) pada 2005 (124,24 ‰). Gempa bumi tektonik dan tsunami dan gempa bumi susulan yang terjadi berpengaruh meningkatkan angka insiden. Lingkungan menjadi lebih kondusif bagi …

Food Group Intake And Risk Of Subtypes Of Esophageal And Gastric Cancer, Stephanie A. Navarro Silvera, Susan T. Mayne, Harvey Risch, Marilee D. Gammon, Thomas L. Vaughan, Wong-Ho Chow, Robert Dubrow, Janet B. Schoenberg, Janet L. Stanford, Brian West, Heidrun Rotterdam, William J. Blot, Joseph F. Fraumeni Jr.

Department of Public Health Scholarship and Creative Works

Incidence rates for adenocarcinomas of the esophagus and gastric cardia have been increasing rapidly, while rates for non‐cardia gastric adenocarcinoma and esophageal squamous cell carcinoma have declined. We examined food group intake as a risk factor for subtypes of esophageal and gastric cancers in a multicenter, population‐based case–control study in Connecticut, New Jersey and western Washington state. Associations between food groups and risk were estimated using adjusted odds ratios (OR), based on increasing intake of one serving per day. Total vegetable intake was associated with decreased risk of esophageal adenocarcinoma (OR = 0.85, 95% CI = 0.75, 0.96). Conversely, total …

Uninsured And Medicaid Patients' Access To Preventive Care: Comparison Of Health Centers And Other Primary Care Providers, Avi Dor, Yuriy Pylypchuck, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This issue of Research Briefs examines health centers' role in reducing disparities in preventive health care access by medically vulnerable and high risk populations. The analysis uses information from several national data sources to examine differences in the provision of preventive health care to Medicaid and uninsured patients between health centers and other primary care providers.

Key Findings:

• Compared to those treated by other primary care providers, Medicaid and uninsured patients treated by health centers are significantly poorer, in significantly worse health, and in the case of uninsured patients, more likely to be members of racial and ethnic minority groups. …

Development And Pilot Testing Of A Low Literacy Handout For Hispanic/Latino Caregivers To Promote Breastfeeding And Introduce Age Appropriate Foods For Infants, Judith C. Rodriguez, Nancy Correa-Matos

Florida Public Health Review

Based on input from four focus groups the authors developed a culturally and linguistically appropriate material (CLAM) that used a pictorial format to promote breast feeding and age-appropriate introduction of solids for Hispanics/Latinos that attended a public health clinic in the northeast region of Florida. The handout focused on five key, but simple educational messages. Clients were randomly assigned to receive 1) the physician's usual oral instruction or 2) instruction that incorporated the use, and provision of, the handout. Among the group (n=12) that received the handout the mean month for introduction of solids was 5 months compared to 4.07 …

A Metastasis Or A Second Independent Cancer? Evaluating The Clonal Origin Of Tumors Using Array-Cgh Data, Irina Ostrovnaya, Adam Olshen, Venkatraman E. Seshan, Irene Orlow, D G. Albertson, Colin B. Begg

Memorial Sloan-Kettering Cancer Center, Dept. of Epidemiology & Biostatistics Working Paper Series

When a cancer patient develops a new tumor it is necessary to determine if this is a recurrence (metastasis) of the original cancer, or an entirely new occurrence of the disease. This is accomplished by assessing the histo-pathology of the lesions, and it is frequently relatively straightforward. However, there are many clinical scenarios in which this pathological diagnosis is difficult. Since each tumor is characterized by a genetic fingerprint of somatic mutations, a more definitive diagnosis is possible in principle in these difficult clinical scenarios by comparing the fingerprints. In this article we develop and evaluate a statistical strategy for …

Comorbidities Of Patients With Hypertension Admitted To Emergency Departments In Florida Hospitals

Florida Public Health Review

Although essential hypertension (EHT) tends to coexist with other conditions, few studies have focused on comorbidities and symptoms among patients admitted to emergency departments (ED). The objective was to compare the characteristics, comorbidities and symptoms among patients with three types (unspecified, benign, or malignant) of EHT in Florida. A public use data set of ED patients from the Florida Agency for Health Care Administration (AHCA) from 2005 was used. Records included those with primary diagnosis of three types of EHT based on the International Classification of Diseases, 9th edition (ICD-9) code. Group comparisons were made using Chi square tests and …

Community-Based Long-Term Care In Milwaukee: Wisconsin Still Ahead, Judith D. Moore, Carol O'Shaughnessy, Lisa Sprague

National Health Policy Forum

The National Health Policy Forum has made two site visits to Wisconsin in two years. The first, in August 2007, focused on an overview of Family Care, the state's managed long-term care program, and looking at service delivery in a rural setting. The August 2008 site visit focused on the operations of MCOs and Family Care service providers in the urban environment of Milwaukee. Issues examined included the link between housing and social services, care management, capitation and rate-setting, measuring quality, and integrating people with disabilities into a program that initially targeted the elderly.

Strong As The Weakest Link: Medical Response To A Catastrophic Event, Eileen Salinsky

National Health Policy Forum

Natural disasters and acts of terrorism have placed a spotlight on the ability of health care providers to surge in response to catastrophic conditions. This paper reviews the status of efforts to develop the capacity and capabilities of the health care system to respond to disasters and other mass casualty events. Strategies for adapting routine medical practices and protocols to the demands posed by extraordinary circumstances and scarce resources are summarized. Existing federal roles, responsibilities, and assets relative to the contributions of state and local government and the private sector are described, including specific programmatic activities such as the Strategic …

Tell A Church - Lessons Learned From A Church-Based Tuberculosis Health Education Program

Florida Public Health Review

Historically, the church has been the center of the African American community – contributing to the spiritual and physical well-being of its congregations. Community health education outreach utilizing African American churches could prove effective but is often neutralized by historical feelings of distrust in research and outreach by secular organizations. During the summer of 2007, the “Think TB” project, a tuberculosis education program, attempted to utilize the church as a health education venue and overcome the historical hurdles that usually hamper church- based health education promotion. This paper discusses the “Think TB” program’s challenges and successes.

Properties Of Monotonic Effects On Directed Acyclic Graphs, Tyler J. Vanderweele, James M. Robins

COBRA Preprint Series

Various relationships are shown hold between monotonic effects and weak monotonic effects and the monotonicity of certain conditional expectations. Counterexamples are provided to show that the results do not hold under less restrictive conditions. Monotonic effects are furthermore used to relate signed edges on a causal directed acyclic graph to qualitative effect modification. The theory is applied to an example concerning the direct effect of smoking on cardiovascular disease controlling for hypercholesterolemia. Monotonicity assumptions are used to construct a test for whether there is a variable that confounds the relationship between the mediator, hypercholesterolemia, and the outcome, cardiovascular disease.

Characteristics Of Patients Admitted To Florida Hospitals For Cardiovascular Diseases

Florida Public Health Review

The present study evaluated the variations in demographic and clinical characteristics of patients hospitalized for cardiovascular diseases (CVD) in Florida hospitals in 2005. Using the 2005 data from the Florida Agency for Health Care Administration, patients admitted for any CVD were extracted by using the International Classification of Diseases, 9th edition (ICD-9) codes. Of all patients (N=2,534,641) hospitalized in 2005, about 17.7% (n=450,559) were admitted for CVD. There were nine distinct diagnosis groups for CVD and about 33.2% and 31.8% of patients were admitted for other forms of heart disease (OHD) and ischemic heart disease (IHD), respectively. Cerebrovascular disease or …

Social And Environmental Risk Factors For Hypertension In African Americans

Florida Public Health Review

This study tests the hypothesis that disparities of hypertension risk in African Americans is related to lead exposure, perceptions of racism, and stress, among urban (Roxbury, MA) and rural (Gadsden, FL) communities. Analysis of preliminary data from Phase I reveal 60% in Gadsden and 39% in Roxbury respondents self-reported having hypertension. In Gadsden 80% people did not know if their residence contained lead paint, compared to 45% in Roxbury. In Gadsden County, 58% of respondents reported experiencing racial discrimination in different settings compared with 72% in Roxbury. In regression analyses high cholesterol emerged as a significant predictors of hypertension in …

Positioning Hospice Care Within The Black And Hispanic Communities, Carol Armstrong

Graduate Theses

Nationally, hospice care and the signing of advance directives are underutilized by minority populations. Research on this phenomenon includes cultural differences, access to medical care and language barriers. A retrospective study of 1,817 closed patient charts from a local hospice was conducted to determine significant differences among the White, Black and Hispanic patient populations. The number of White patients admitted to both hospice homecare and to the hospice inpatient was significantly greater than the number of admissions of either the Black or Hispanic patients. There were no significant findings in the total number of services provided to each of the …

Effect Of The California Tobacco Control Program On Personal Health Care Expenditures, James M. Lightwood, Alexis Dinno, Stanton A. Glantz

Community Health Faculty Publications and Presentations

Background: Large state tobacco control programs have been shown to reduce smoking and would be expected to affect health care costs. We investigate the effect of California's large-scale tobacco control program on aggregate personal health care expenditures in the state. Methods and Findings: Cointegrating regressions were used to predict (1) the difference in per capita cigarette consumption between California and 38 control states as a function of the difference in cumulative expenditures of the California and control state tobacco control programs, and (2) the relationship between the difference in cigarette consumption and the difference in per capita personal health expenditures …

Relationship Of Lactobacillus Casei To Prevention Of Antibiotic Associated Diarrhea Due To Clostridium Difficile, Kayal K. Chandramohan

All-Inclusive List of Electronic Theses and Dissertations

The purpose of this research was to study the effectiveness of Lactobacillus casei in preventing the occurrence of antibiotic associated diarrhea related to Clostridium difficile. Twenty-six patients, above the age of sixty years, who were prescribed antibiotic therapy and admitted to the Rehabilitation or Orthopedics Units at Union Hospital and who met the eligibility criteria were recruited for the study. Equal numbers of patients (13 in each group) were assigned to the Control and the Experimental group based on their admission date to the hospital and their willingness to consume a probiotic yogurt type drink. The patients in the experimental …

An All-Terrain Vehicle Safety Educational Program: Is It Effective In Improving Attitudes, Safety Knowledge, And Behaviors In Adolescents Ages 12 To 18?, Kim Elaine Young Vickous

Masters Theses & Specialist Projects

All terrain vehicles (ATVs) are a popular source of recreation. For some rural adolescents, ATVs are frequently used for agricultural work. Whether for work or recreation, many adolescents operate ATVs improperly either from a lack of knowledge, poor judgment or they engage in risky behaviors resulting in injuries and fatalities.

The Kentucky Department of Agriculture (KDA) has devoted resources to provide ATV safety programs to educate adolescents statewide. However, there are no known studies evaluating the effectiveness of this KDA intervention. Therefore, a pilot study was proposed to determine the effectiveness of The KDA ATV safety program in improving ATV …

Effects Of Hypoxic-Ischemic Encephalopathy And Whole-Body Hypothermia On Neonatal Auditory Function: A Pilot Study, Ulrike Mietzsch, Nehal A Parikh, Amber L Williams, Seetha Shankaran, Robert E Lasky

Faculty, Staff and Student Publications

We assessed the effects of hypoxic-ischemic encephalopathy (HIE) and whole-body hypothermia therapy on auditory brain stem evoked responses (ABRs) and distortion product otoacoustic emissions (DPOAEs). We performed serial assessments of ABRs and DPOAEs in newborns with moderate or severe HIE, randomized to hypothermia ( N = 4) or usual care ( N = 5). Participants were five boys and four girls with mean gestational age (standard deviation) of 38.9 (1.8) weeks. During the first week of life, peripheral auditory function, as measured by the DPOAEs, was disrupted in all nine subjects. ABRs were delayed but central transmission was intact, suggesting …

Truck Drivers In Fatal Crashes After Substance Use, Kentucky Injury Prevention And Research Center

Kentucky Haz Alerts--Motor Vehicle

To prevent truck crashes due to substance use:

• Employers should implement and enforce a policy that prohibits commercial drivers who are ill or taking over-the-counter medications with potential side effects for impaired driving from operating a commercial vehicle.
• Employers should implement and enforce a “reasonable suspicion” drug testing policy if a driver is suspected to be under the influence of drugs.
• Companies should conduct comprehensive new-hire prescreening and after-hire random drug testing for substance abuse.
• A nationwide data- base containing a record of all commercial driver positive drug tests in the last two years should be developed.

Bilateral Claudication Results In Alterations In The Gait Biomechanics At The Hip And Ankle Joints, Shing-Jye Chen, Iraklis Pipinos, Jason Johanning, Matija Radovic, Jessie M. Huisinga, Sara A. Myers, Nikolaos Stergiou

Health and Kinesiology Faculty Publications

Claudication is the most common symptomatic manifestation of peripheral arterial disease (PAD), producing significant ambulatory compromise. The purpose of this study was to use advanced biomechanical gait analysis to determine the gait alterations occurring in claudicating patients both before and after onset of claudication pain in their legs. Hip, knee, and ankle joint moments were measured in claudicating patients (age: 64.46±8.47 years; body mass: 80.70±12.64 kg; body height: 1.72±0.08 m) and were compared to gender–age–body mass–height-matched healthy controls (age 66.27±9.22 years; body mass: 77.89±10.65 kg; body height: 1.74±0.08 m). The claudicating patients were evaluated both before (pain-free (PF) condition) and …

The Relationship Between Perceived Personal Risk Of Getting Prostate Cancer And Prostate-Specific Antigen (Psa) Screening, Yeatoe G. Mcintosh

Theses and Dissertations

Abstract Title: The Relationship between Perceived Personal Risk of getting Prostate cancer and Prostate-Specific Antigen (PSA) Screening Yeatoe G. McIntosh, MPH Candidate Advisor: Emmanuel Anum, MBChB, MPH, PHD Preceptor: Emmanuel Anum, MBChB, MPH, PHD Background: Prostate cancer is one of the most common cancer diagnoses in the United States. The American Cancer Society estimates that in 2008 28,660 deaths would be attributed to prostate cancer, projecting it to be the leading cause of cancer deaths in U.S. men. Despite the potential threat this cancer presents to men and the potential for improved disease outcomes from early detection, guidelines for screening …

Perceptions Of Quality Of Life Of Latinos With Diabetes Living In The U.S.: Variations By Geographic Region Of Origin, Janice M. Long

Dissertations

The Latino population, the largest ethnic minority in the United States, is a diverse group originating from numerous geographic regions of Latin America. Latinos vary in the risk for type 2 diabetes, a condition that exacts a costly burden on those who suffer with it. With the Latino population diversity, diverse strategies are needed. One strategy is to improve outcomes of life quality by improving knowledge of those who deliver health services to Latinos with type 2 diabetes. Through measurement of quality of life (QOL), the more precious aspects of living, how one feels about living with diabetes, can be …

The Association Of Maternal Intention To Breastfeed, Early Skin-To-Skin Mother/Infant Contact, And Exclusive Breastfeeding During The Maternity Hospital Stay, Leslie Mary Bramson

Loma Linda University Electronic Theses, Dissertations & Projects

Breastfeeding is the optimal method to nourish and nurture an infant. Exclusive breastfeeding rates in the United States have reached the goal of Healthy People 2010 that 75% of mother's breastfeed in the immediate postpartum period. Yet, less than 35% of San Bernardino county mothers and 47.7% of Riverside county mothers are exclusively breastfeeding during their maternity hospital stays, with as many as 50% of the infants being weaned from the breast in the first 14 days of life.

This prospective study examined archived data collected by Perinatal Services Network (PSN) of Loma Linda University Medical Center/Children's Hospital for the …