Digital Commons Network^™

The Promise And The Reality Of Long-Term Care Insurance, Randy Desonia

National Health Policy Forum

The aging of the nation’s population will create a surge in the need for long-term care services, putting pressure on existing funding sources and fueling demand for more. This paper examines one financing option—private long-term care insurance—and summarizes its brief history and the several critical precedents that have influenced the products as currently sold. Other topics discussed include the challenges to encouraging sales growth as well as increasing the role of this type of insurance in paying for long-term care.

Non-Parametric Estimation Of Roc Curves In The Absence Of A Gold Standard, Xiao-Hua Zhou, Pete Castelluccio, Chuan Zhou

UW Biostatistics Working Paper Series

In evaluation of diagnostic accuracy of tests, a gold standard on the disease status is required. However, in many complex diseases, it is impossible or unethical to obtain such the gold standard. If an imperfect standard is used as if it were a gold standard, the estimated accuracy of the tests would be biased. This type of bias is called imperfect gold standard bias. In this paper we develop a maximum likelihood (ML) method for estimating ROC curves and their areas of ordinal-scale tests in the absence of a gold standard. Our simulation study shows the proposed estimates for the …

Health Care In Canada: Provinces Versus The Federal Government, Vivian Mcalister

Data and Test Instruments

Transcript: Listen to today's Commentary Introduction: Who speaks best for health care: Paul Martin or the provincial premiers? Vivian McAlister is a transplant surgeon and a professor of surgery in London, Ontario. On Commentary, he says move over Ottawa..the provinces should take the lead in improving medicare. Vivian McAlister: During last month's election campaign Paul Martin set himself up as the saviour of medicare. He was reinforcing an old theme: that Ottawa must keep a close eye on the provinces lest they experiment - looking for different ways to provide health care. The prime minister conveniently ignored the fact that …

Ozone And Mortality: A Meta-Analysis Of Time-Series Studies And Comparison To A Multi-City Study (The National Morbidity, Mortality, And Air Pollution Study), Michelle L. Bell, Jonathan M. Samet, Francesca Dominici

Johns Hopkins University, Dept. of Biostatistics Working Papers

While many time-series studies of ozone and daily mortality identified positive associations,others yielded null or inconclusive results. We performed a meta-analysis of 144 effect estimates from 39 time-series studies, and estimated pooled effects by lags, age groups,cause-specific mortality, and concentration metrics. We compared results to estimates from the National Morbidity, Mortality, and Air Pollution Study (NMMAPS), a time-series study of 95 large U.S. cities from 1987 to 2000. Both meta-analysis and NMMAPS results provided strong evidence of a short-term association between ozone and mortality, with larger effects for cardiovascular and respiratory mortality, the elderly, and current day ozone exposure as …

Social Support Protects Against The Negative Effects Of Partner Violence On Mental Health, Ann L. Coker, Paige H. Smith, Martie P. Thompson, Robert E. Mckeown, Lesa Bethea, Keith E. Davis

CRVAW Faculty Journal Articles

Objectives: Social support for abused women may reduce the impact of abuse on mental health, yet few studies have addressed this issue. We wish to determine associations between intimate partner violence (IPV) and mental health outcomes and to assess the protective role of abuse disclosure and support on mental health among abused women.

Methods: A cross-sectional survey was conducted of 1152 women, ages 18–65, recruited from family practice clinics from 1997 through 1999. They were screened for IPV during a brief in-clinic interview, and physical and mental health status was assessed in a follow-up interview.

Results: IPV, defined as sexual, …

Health Education’S New Frontier In Addressing Corporate Influences On Health: An Interview With Nicholas Freudenberg, Nicholas Freudenberg, Ellen Jones, Lori Dorfman

Publications and Research

Nick Freudenberg is Distinguished Professor of Public Health at Hunter College, City University of New York. For the past 25 years, he has worked with community organizations to develop, implement, and evaluate community interventions to improve the well-being of low-income urban communities. He has also worked for many years in the New York City jail, running programs to improve the transition from jail to the community, and advocating for policy changes related to jail conditions and postrelease drug treatment, health care, and housing. More recently, he has turned his attention to the role of corporate policies and practices on the …

Living Well And Medicaid: Better Health For Consumers -- Lower Costs For States, Craig Ravesloot Ph.D., University Of Montana Rural Institute

Health and Wellness

The United States has the world’s most expensive healthcare system. In 2002, health spending rose to nearly 15 percent of U.S. Gross Domestic Product. Healthcare policymakers charged with balancing cost containment with quality healthcare for consumers are desperate for solutions (Levit, Smith, Cowan, Sensenig, and Catlin, 2004).

Defining Accelerometer Thresholds For Activity Intensities In Adolescent Girls, Margarita S. Treuth, Kathryn H. Schmitz, Diane J. Catellier, Robert G. Mcmurray, David M. Murray, Maria João C. A. Almeida, Scott Going, James E. Norman, Russell R. Pate

Faculty Publications

Purpose - To derive a regression equation that estimates metabolic equivalent (MET) from accelerometer counts, and to define thresholds of accelerometer counts that can be used to delineate sedentary, light, moderate, and vigorous activity.

Methods - Seventy-four healthy 8th grade girls, age 13-14 yr, were recruited from urban areas of Baltimore, MD, Minneapolis/St. Paul, MN, and Columbia, SC, to participate in the study. Accelerometer and oxygen consumption (VO₂) data for 10 activities that varied in intensity from sedentary (e.g., TV watching) to vigorous (e.g., running) were collected. While performing these activities, the girls wore two accelerometers, a heart …

Universal Coverage And The American Health Care System Crisis (Again), Rick Mayes

Political Science Faculty Publications

Ten years after President Clinton’s ambitious attempt at comprehensive health care reform died, several old and new issues with the health care system have emerged. First, the number of uninsured Americans rose to 43.6 million in 2002—and the numbers have since increased. Also, the costs for those who do not have insurance are rapidly increasing. In addition health care related problems are one of the leading causes of personal bankruptcy in the United States. Finally, the government’s two primary health insurance programs—Medicare and Medicaid—are experiencing considerable financial strain. Dr. Mayes examines these problems in depth before and revisits President Clinton’s …

Research In Home-Care Telemedicine: Challenges In Patient Recruitment, Usha Subramanian, Faith Hopp, Julie Lowery, Peter Woodbridge, David Smith

Social Work Faculty Publications

This study reports challenges in recruiting patients for a randomized controHed trial of home-care telemedicinae. Descriptive statistics on patient eligibility for home-care telemedidne services and patient refusals for participation are provided. Frequency counts of reasons for study exclusion and participant refusal and Chi-square tests to compare race and age-related differences are given. Of 302 home-care patients reviewed, 197 (65.2%) did not meet inclusion criteria. The most common reasons for study exclusion were patients either needing <2 visits per month (n = 59, 30%) or >3 skilled nurse visits per week (n = 46, 23.4%). Of the eligible patients (n = 105), 79 …

Jefferson Medical College Annual Report, 2004, Thomas J. Nasca

Jefferson Medical College Administrative Documents and Reports

No abstract provided.

Annual Report To The Nation On The Status Of Cancer, 1975–2001, With A Special Feature Regarding Survival, Ahmedin Jemal, Limin X. Clegg, Elizabeth Ward, Lynn A. G. Ries, Xiao-Cheng Wu, Patricia Jamison, Phyllis A. Wingo, Holly L. Howe, Robert N. Anderson, Brenda K. Edwards

United States Public Health Resources

BACKGROUND. The American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR) collaborate annually to provide updated information regarding cancer occurrence and trends in the U.S. This year’s report features a special section on cancer survival.

METHODS. Information concerning cancer cases was obtained from the NCI, CDC, and NAACCR and information concerning recorded cancer deaths was obtained from the CDC. The authors evaluated trends in age-adjusted cancer incidence and death rates by regression models and described and compared survival rates over …

Comparison Of Medical Subject Headings And Text-Word Searches In Medline To Retrieve Studies On Sleep In Healthy Individuals, Elizabeth Sergeevna Jenuwine, Judith A. Floyd

Nursing Faculty Research Publications

Objective: The objective was to investigate the performance of two search strategies in the retrieval of primary research papers containing descriptive information on the sleep of healthy people from MEDLINE.

Methodology: Two search strategies - one based on the use of only Medical Subject Headings (MeSH), the second based on text-word searching - were evaluated as to their specificity and sensitivity in retrieving a set of relevant research papers published in the journal Sleep from 1996 to 2001 that were preselected by a hand search.

Results: The subject search provided higher specificity than the text- word search …

Cancer Esophagus Karachi 1995-2002:Epidemiology, Risk Factors And Trends, Y. Bhurgri, N. Faridi, L. A.G. Kazi, S. K. Ali, H. Bhurgri, A. Usman, J. Malik, A. Bhurgri, R. Ahmed, S. Muzaffar, N. Kayani, Shahid Pervez, S. H. Hasan

Department of Pathology and Laboratory Medicine

Objective: To study the trends of cancer esophagus in Karachi South during 1995-2002 and identify risk factors.

Methods: Incident esophageal cancer cases recorded at the Karachi Cancer Registry for Karachi South, during 1st January 1995 to 31st December 2003 were reviewed. For maximum completion of data, incident cases registered from 1st January 1995 to 31st December 2002 were included for final analyses.

Results: The Age Standardized Incidence Rates (ASIRs) of cancer esophagus in Karachi South for males were 6.5/100,000 (1995-1997) and 6.4/100,000 (1998-2002). In females the observed rates were 7.0/100,000 (1995-1997) and 8.6/100,000 (1998-2002).

Conclusion: In the moderately high incidence, …

Accuracy Of Msi Testing In Predicting Germline Mutations Of Msh2 And Mlh1: A Case Study In Bayesian Meta-Analysis Of Diagnostic Tests Without A Gold Standard, Sining Chen, Patrice Watson, Giovanni Parmigiani

Johns Hopkins University, Dept. of Biostatistics Working Papers

Microsatellite instability (MSI) testing is a common screening procedure used to identify families that may harbor mutations of a mismatch repair gene and therefore may be at high risk for hereditary colorectal cancer. A reliable estimate of sensitivity and specificity of MSI for detecting germline mutations of mismatch repair genes is critical in genetic counseling and colorectal cancer prevention. Several studies published results of both MSI and mutation analysis on the same subjects. In this article we perform a meta-analysis of these studies and obtain estimates that can be directly used in counseling and screening. In particular we estimate the …

Racial Discrepancies In The Association Between Paternal Vs. Maternal Educational Level And Risk Of Low Birthweight In Washington State, Christina Nicolaidis, Cynthia W. Ko, Somnath Saha, Thomas D. Koepsell

School of Social Work Faculty Publications and Presentations

Background: The role of paternal factors in determining the risk of adverse pregnancy outcomes has received less attention than maternal factors. Similarly, the interaction between the effects of race and socioeconomic status (SES) on pregnancy outcomes is not well known. Our objective was to assess the relative importance of paternal vs. maternal education in relation to risk of low birth weight (LBW) across different racial groups.

Methods: We conducted a retrospective population-based cohort study using Washington state birth certificate data from 1992 to 1996 (n = 264,789). We assessed the associations between maternal or paternal education and LBW, adjusting for …

Anemia And Blood Transfusion In The Critically Ill Patient: Role Of Erythropoietin, Howard L. Corwin

Dartmouth Scholarship

Critically ill patients receive an extraordinarily large number of blood transfusions. Between 40% and 50% of all patients admitted to intensive care units receive at least 1 red blood cell (RBC) unit during their stay, and the average is close to 5 RBC units. RBC transfusion is not risk free. There is little evidence that 'routine' transfusion of stored allogeneic RBCs is beneficial to critically ill patients. The efficacy of perioperative recombinant human erythropoietin (rHuEPO) has been n demonstrated in a variety of elective surgical settings. Similarly, in critically ill patients with multiple organ failure, rHuEPO therapy will also stimulate …

Multiple Testing Methods For Chip-Chip High Density Oligonucleotide Array Data, Sunduz Keles, Mark J. Van Der Laan, Sandrine Dudoit, Simon E. Cawley

U.C. Berkeley Division of Biostatistics Working Paper Series

Cawley et al. (2004) have recently mapped the locations of binding sites for three transcription factors along human chromosomes 21 and 22 using ChIP-Chip experiments. ChIP-Chip experiments are a new approach to the genome-wide identification of transcription factor binding sites and consist of chromatin (Ch) immunoprecipitation (IP) of transcription factor-bound genomic DNA followed by high density oligonucleotide hybridization (Chip) of the IP-enriched DNA. We investigate the ChIP-Chip data structure and propose methods for inferring the location of transcription factor binding sites from these data. The proposed methods involve testing for each probe whether it is part of a bound sequence …

Combining Predictors For Classification Using The Area Under The Roc Curve, Margaret S. Pepe, Tianxi Cai, Zheng Zhang

UW Biostatistics Working Paper Series

We compare simple logistic regression with an alternative robust procedure for constructing linear predictors to be used for the two state classification task. Theoritical advantages of the robust procedure over logistic regression are: (i) although it assumes a generalized linear model for the dichotomous outcome variable, it does not require specification of the link function; (ii) it accommodates case-control designs even when the model is not logistic; and (iii) it yields sensible results even when the generalized linear model assumption fails to hold. Surprisingly, we find that the linear predictor derived from the logistic regression likelihood is very robust in …

Medicaid Prescription Drug Spending And Use, Brian Bruen, Arunabh Ghosh

Health Policy and Management Issue Briefs

No abstract provided.

Effects Of A Tailored Follow-Up Intervention On Health Behaviors, Beliefs, And Attitudes, Alissa D. Jacobs, Alice S. Ammerman, Susan T. Ennett, Marci K. Campbell, Katherine W. Tawney, Semra Aytur, Stephen W. Marshall, Julie C. Will, Wayne D. Rosamond

Health Management & Policy

Background: The high rates of relapse that tend to occur after short-term behavioral interventions indicate the need for maintenance programs that promote long-term adherence to new behavior patterns. Computer-tailored health messages that are mailed to participants or given in brief telephone calls offer an innovative and time-efficient alternative to ongoing face-to-face contact with healthcare providers.

Methods: Following a 1-year behavior change program, 22 North Carolina health departments were randomly assigned to a follow-up intervention or control condition. Data were collected from 1999 to 2001 by telephone-administered surveys at preintervention and postintervention for 511 low-income, midlife adult women enrolled …

Commencement Program 2004, Loma Linda University

Commencement Programs

CONTENTS

2 | 2004 Events of Commencement

3 | The Academic Procession

4 | Significance of Academic Regalia

5 | The Speakers

12 | The University Honorees

19 | The School Honorees

27 | The Program

• School of Medicine, 28
• School of Dentistry, 35
• Graduate School, 44
• School of Nursing, 54
• School of Allied Health Professions - Physical Therapy, 59
• School of Allied Health Professions, 65
• School of Public Health, 73

The Association Of Blood Type On The Five Factors Of Personality In Chinese Adolescents, Kunher Wu

Loma Linda University Electronic Theses, Dissertations & Projects

The purpose of this study was to identify the number of personality factors in Chinese adolescents using the Chinese Revised NEO Personality Inventory (NEO-PI-R) and to determine whether blood type is associated with personality. It is widely accepted by psychologists that the five-factor model can provide an adequate representation of adult personality dimensions, but there is less agreement on the number of factors observable in adolescence. A total of 3,396 11^th graders from the city of Kaohsiung, Taiwan completed the Chinese NEO-PI-R. Principle component analysis with varimax rotation showed five factors of personality in these Taiwanese adolescents, which clearly …

The Anti-Proliferation Effects Of Lycopene On Breast Cancer Cells, Tixieanna Dissmore

Loma Linda University Electronic Theses, Dissertations & Projects

Background: The incidence and deaths from breast cancer represent the most cause of all cancer deaths among women. Lycopene, the carotenoid in tomatoes has been associated with decreasing risk of prostate, breast, and digestive tract cancers. Various mechanisms of lycopene action have been proposed, including antioxidant activity and pro-differentiation activities. Identifying changes in the expression of proteins modified by lycopene can provide information to study the modulating effects of lycopene carcinogenesis and tumorigenesis development.

Objective: The objective was to study the anti-proliferative effects of lycopene on MCF- 7 human breast cancer cells and to identify changes in protein expression patterns. …

Osha Laboratory Safety Standard 29 Cfr 1910.1450 And Achieving Compliance In The Microelectronic Laboratory, Danielle M. Digironimo

Theses

This thesis is a practical application of occupational exposures to hazardous substances in a microelectronics laboratory. The Occupational Safety and Health Administration (OSHA) standard for the safety in laboratories is (29 CFR 1910.1450). The application is a demonstration of the implementation of the standard in a university setting. Hazards that exist in laboratory settings are very complex and the task of providing a safe workplace can become increasingly complicated. A laboratory can and does impose different health and safety concerns that a standard industrial workplace setting might not have. The need for a laboratory safety standard program to be implemented …

An Ergonomic Assessment Of The Airline Baggage Handler, Stephen P. Salomon

Theses

A material or baggage handler is responsible for loading and unloading baggage and materials from inbound/outbound aircraft flights and transferring the materials to and from the baggage holding and sorting areas and back to the passengers or output source. Baggage handlers work in all types of inclement weather, all over the airport, and in-and-around the aircraft. The baggage handler's job entails repeated lifting pulling, pushing, squatting, twisting, kneeling, and stretching of the arms and back, which makes the baggage handler's job one of the more challenging material handling jobs to ergonomically assess and make corrections for. The aim of the …

Master Plumber Dies When Trench Collapses, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Other

On July 29, 2003, a 35-year-old, male master plumber died when an unshorn trench collapsed. Two employees from the contracting company were speaking with him at the time from the side of the trench. He had searched and diagnosed a water line leak when the walls of the trench collapsed. The plumber was employed by a plumbing company contracted by a commercial establishment to locate and repair a water leak. He died at the scene from asphyxia due to chest compression.

To prevent future occurrences of similar incidents, the following recommendations have been made:

Recommendation No. 1: Employers should train …

Seasonal Analyses Of Air Pollution And Mortality In 100 U.S. Cities, Roger D. Peng, Francesca Dominici, Roberto Pastor-Barriuso, Scott L. Zeger, Jonathan M. Samet

Johns Hopkins University, Dept. of Biostatistics Working Papers

Time series models relating short-term changes in air pollution levels to daily mortality counts typically assume that the effects of air pollution on the log relative rate of mortality do not vary with time. However, these short-term effects might plausibly vary by season. Changes in the sources of air pollution and meteorology can result in changes in characteristics of the air pollution mixture across seasons. The authors develop Bayesian semi-parametric hierarchical models for estimating time-varying effects of pollution on mortality in multi-site time series studies. The methods are applied to the updated National Morbidity and Mortality Air Pollution Study database …

Roofing Laborer Dies After 60-Foot Fall, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Falls

At 8:00 AM on the morning of October 7, 2003, a 33-year-old laborer, working for a roofing contractor, was removing debris from a commercial building roof when he slipped and fell 60 feet to the sidewalk below. There were 2 other laborers and the contractor at the work site that morning. It was the second work day at this particular job site and the three workers were to finish discarding bags of debris from the roof. The decedent and one of the laborers accessed the roof through the building interior, up a flight of stairs to a five-step ladder which …

Predicting The Use Of Personal Respiratory Protection Among Workers In Swine Confinement Buildings, M. Susan Jones

Nursing Faculty Publications

The purpose of this study was to identify the variables that influence the frequency of personal respiratory protection (PRP) use by workers in swine confinement buildings (SCBs). The study was designed to answer four research questions: 1). What is the validity and reliability of the Personal Respiratory Protection Survey (PRPS)? 2). How frequently do workers in SCBs wear PRP? 3). How do demographics, occupational histories, and self-reported respiratory health histories influence the use of PRP in SCBs? and 4). What are the relationships of the constructs (benefits, barriers, susceptibility, severity, norms) to the use of PRP by workers in SCBs? …