Medicine and Health Sciences Commons^™

Issue Of Data Imbalance On Low Birthweight Baby Outcomes Prediction And Associated Risk Factors Identification: Establishment Of Benchmarking Key Machine Learning Models With Data Rebalancing Strategies, Yang Ren, Dezhi Wu, Yan Tong, Ana Lopez-De Fede

Publications

Background: Low birthweight (LBW) is a leading cause of neonatal mortality in the United States and a major causative factor of adverse health effects in newborns. Identifying high-risk patients early in prenatal care is crucial to preventing adverse outcomes. Previous studies have proposed various machine learning (ML) models for LBW prediction task, but they were limited by small and imbalanced data sets. Some authors attempted to address this through different data rebalancing methods. However, most of their reported performances did not reflect the models’ actual performance in real-life scenarios. To date, few studies have successfully benchmarked the performance of ML …

Association Of Hospital Incentive Care Management Partnerships For Uninsured Patients With Emergency Department Utilization, Sarah Gareau, Ana Lopez-De Fede, Zhimin Chen, Nathaniel Bell

Publications

IMPORTANCE The South Carolina (SC) Healthy Outcomes Plan (HOP) program aimed to expand access to health care to individuals without insurance; it remains unknown whether there is an association between the SC HOP program and emergency department (ED) use among patients with high health care costs and needs. OBJECTIVES To determine whether participation in the SC HOP was associated with reduced ED utilization among uninsured participants. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included 11 684 HOP participants (ages 18-64 years) with at least 18 months of continuous enrollment. Generalized estimating equations and segmented regression of interrupted time-series analyses …

The Problem Of The Color Line: Spatial Access To Hospital Services For Minoritized Racial And Ethnic Groups, Jan M. Eberth, Pelvin Hung, Gabriel A. Benavidez, Janice Probst, Whitney E. Zahnd, Mary-Katherine Mcnatt, Ebony Toussaint, Melinda A. Merrell, Elizabeth L. Crouch

Faculty Publications

Examining how spatial access to health care varies across geography is key to documenting structural inequalities in the United States. In this article and the accompanying StoryMap, our team identified ZIP Code Tabulation Areas (ZCTAs) with the largest share of minoritized racial and ethnic populations and measured distances to the nearest hospital offering emergency services, trauma care, obstetrics, outpatient surgery, intensive care, and cardiac care. In rural areas, ZCTAs with high Black or American Indian/Alaska Native representation were significantly farther from services than ZCTAs with high White representation. The opposite was true for urban ZCTAs, with high White ZCTAs being …

Geographic Proximity To Primary Care Providers As A Risk-Assessment Criterion For Quality Performance Measures, Nathaniel Bell, Ana Lopez-De Fede, Bo Cai, John Brooks

Publications

Importance Previous studies have found a mixed association between Patient-Centered Medical Home (PCMH) designation and improvements in primary care quality indicators, including avoidable pediatric emergency department (ED) encounters. Whether these associations persist after accounting for the geographic locations of providers relative to where patients reside is unknown. Objective To examine the association between geographic proximity to primary care providers versus hospitals and risk of avoidable and potentially avoidable ED visits among children with pre-existing diagnosis of attention-deficit/hyperactivity disorder or asthma. Methods Retrospective cohort study of a panel of pediatric Medicaid claims data from the South Carolina from 2016–2018 for 2,959 …

The Individual Water Insecurity Experiences (Iwise) Scale: Reliability, Equivalence And Validity Of An Individual-Level Measure Of Water Security, Sera L. Young, Hilary J. Bethancourt, Zacchary R. Ritter, Edward A. Frongillo Jr.

Faculty Publications

Objective: The lack of a validated and cross-culturally equivalent scale for measuring individual-level water insecurity has prevented identification of those most vulnerable to it. Therefore, we developed the 12-item Individual Water InSecurity Experiences (IWISE) Scale to comparably measure individual experiences with access, use, and stability (reliability) of water. Here, we examine the reliability, cross-country equivalence, and cross-country and within-country validity of the scale in a cross-sectional sample.

Methods: IWISE items were implemented by the Gallup World Poll among nationally representative samples of 43 970 adults (15 y) in 31 low-income and middle-income countries (LMICs). Internal consistency was assessed …

Association Of Expanded Prenatal Care Coverage For Immigrant Women With Postpartum Contraception And Short Interpregnancy Interval Births, Maria I. Rodriguez, Menolly Kaufman, Stephan Lindner, Aaron B. Caughey, Ana Lopez-De Fede

Publications

Importance Access to prenatal and postpartum care is restricted among women with low income who are recent or undocumented immigrants enrolled in Emergency Medicaid. Objective To examine the association of extending prenatal care coverage to Emergency Medicaid enrollees with postpartum contraception and short interpregnancy interval births. Design, Setting, and Participants This cohort study used a difference-in-differences design to compare the staggered rollout of prenatal care in Oregon with South Carolina, a state that does not cover prenatal or postpartum care. Linked Medicaid claims and birth certificate data from 2010 to 2016 were examined for an association between prenatal care coverage …

Analysis Of Contraceptive Use Among Immigrant Women Following Expansion Of Medicaid Coverage For Postpartum Care, Maria I. Rodriguez, Megan Skye, Stephan Lindner, Aaron B. Caughey, Ana Lopez-Defede

Publications

Importance: Access to postpartum care is restricted for low-income women who are recent or undocumented immigrants enrolled in Emergency Medicaid. Objective: To examine the association of a policy extending postpartum coverage to Emergency Medicaid recipients with attendance at postpartum visits and use of postpartum contraception. Design, setting, and participants: This cohort study linked Medicaid claims and birth certificate data from 2010 to 2019 to examine changes in postpartum care coverage on postpartum care and contraception use. A difference-in-difference design was used to compare the rollout of postpartum coverage in Oregon with a comparison state, South Carolina, which did not cover …

Disparities In Postpartum Contraceptive Use Among Immigrant Women With Restricted Medicaid Benefits, Maria I. Rodriguez, K. John Mcconnell, Megan Skye, Menolly Kaufman, Aaron B. Caughey, Ana Lopez-De Fede

Publications

BACKGROUND: The Emergency Medicaid program offers restricted Medicaid benefits for people who meet the same financial eligibility criteria as Traditional Medicaid recipients but do not meet the citizenship requirements for enrollment in Traditional Medicaid. By federal law, Emergency Medicaid covers care for life-threatening emergencies or a hospital admission for childbirth. No prenatal or postpartum care is covered. Most of the women enrolled in Emergency Medicaid are Latina. OBJECTIVE: We assessed postpartum visits and receipt of postpartum contraception and compared the outcomes for Emergency (restricted benefit) Medicaid recipients with those of Traditional (full-benefit) Medicaid recipients in Oregon and South Carolina, 2 …

Association Of Patient-Centered Medical Home Designation And Quality Indicators Within Hrsa-Funded Community Health Center Delivery Sites, Nathaniel Bell, Rebecca Wilkerson, Kathy Mayfield-Smith, Ana Lopez-De Fede

Publications

Background: Patient-Centered Medical Home (PCMH) adoption is an important strategy to help improve primary care quality within Health Resources and Service Administration (HRSA) community health centers (CHC), but evidence of its effect thus far remains mixed. A limitation of previous evaluations has been the inability to account for the proportion of CHC delivery sites that are designated medical homes. Methods: Retrospective cross-sectional study using HRSA Uniform Data System (UDS) and certification files from the National Committee for Quality Assurance (NCQA) and the Joint Commission (JC). Datasets were linked through geocoding and an approximate string-matching algorithm. Predicted probability scores were regressed …

Community Social Determinants And Health Outcomes Drive Availability Of Patient-Centered Medical Homes, Nathaniel Bell, Rebecca Wilkerson, Kathy Mayfield-Smith, Ana Lopez-De Fede

Publications

The collaborative design of America’s patient-centered medical homes places these practices at the forefront of emerging efforts to address longstanding inequities in the quality of primary care experienced among socially and economically marginalized populations. We assessed the geographic distribution of the country’s medical homes and assessed whether they are appearing within communities that face greater burdens of disease and social vulnerability. We assessed overlapping spatial clusters of mental and physical health surveys; health behaviors, including alcohol-impaired driving deaths and drug overdose deaths; as well as premature mortality with clusters of medical home saturation and community socioeconomic characteristics. Overlapping spatial clusters …

Explainable Ai Using Knowledge Graphs, Manas Gaur, Ankit Desai, Keyur Faldu, Amit Sheth

Publications

During the last decade, traditional data-driven deep learning (DL) has shown remarkable success in essential natural language processing tasks, such as relation extraction. Yet, challenges remain in developing artificial intelligence (AI) methods in real-world cases that require explainability through human interpretable and traceable outcomes. The scarcity of labeled data for downstream supervised tasks and entangled embeddings produced as an outcome of self-supervised pre-training objectives also hinders interpretability and explainability. Additionally, data labeling in multiple unstructured domains, particularly healthcare and education, is computationally expensive as it requires a pool of human expertise. Consider Education Technology, where AI systems fall along a …

Activist Framing Of Abortion And Use For Policy Change In Peru, Cynthia Beavin, Deborah L. Billings, Susana Chávez

Faculty Publications

Identifying how activists frame the topic of abortion is key to unpacking their understanding of “abortion” in Peru. It is important to explore how and why certain frames are privileged in attempts to shift policy and social norms. In 2016, the authors conducted qualitative interviews with 10 activists in Lima, Peru to develop a deep understanding of these issues. Activists worked through different approaches and lenses, including law, medicine, sociology, psychiatry, journalism, non-governmental organisational management, LGBTQ rights, and indigenous rights. Four common frames emerged through the analysis and those frames shifted based on whether activists were speaking to the general …

Diagnosed Diabetes Prevalence And Risk Factor Rankings, By State, 2014-2016: A Ring Map Visualization, Ana Lopez-De Fede, John E. Stewart

Publications

Background In the United States, diabetes is a leading cause of adult-onset blindness, kidney failure, and death (1). Efforts to prevent and control diabetes must consider geographic variation in disease prevalence and risk factors such as obesity, sedentary lifestyle, and low educational attainment (2). Maps are essential to our understanding of geographic differences in population health and disease vulnerability. Comparing geographic patterns of disease and population risk across multiple maps, however, can be cumbersome. Ring mapping is an innovative geovisualization method that permits the display of multiple spatially referenced variables on a single map (3). We used a ring map …

Precision Of Provider Licensure Data For Mapping Member Accessibility To Medicaid Managed Care Provider Networks., Nathaniel Bell, Ana Lopez-De Fede, Rebecca C. Wilkerson, Kathy Mayfield-Smith

Publications

Background: In July 2018, the Centers for Medicare and Medicaid Services (CMS) updated its Medicaid Managed Care (MMC) regulations that govern network and access standards for enrollees. There have been few published studies of whether there is accurate geographic information on primary care providers to monitor network adequacy. Methods: We analyzed a sample of nurse practitioner (NP) and physician address data registered in the state labor, licensing, and regulation (LLR) boards and the National Provider Index (NPI) using employment location data contained in the patient-centered medical home (PCMH) data file. Our main outcome measures were address discordance (%) at the …

Small-Area Variation In Hypertension Prevalence Among Black And White Medicaid Enrollees, Kellee White, John E. Stewart, Ana Lopez-De Fede, Rebecca C. Wilkerson

Publications

Objectives: To examine within-state geographic heterogeneity in hypertension prevalence and evaluate associations between hypertension prevalence and small-area contextual characteristics for Black and White South Carolina Medicaid enrollees in urban vs rural areas.

Design: Ecological.

Setting: South Carolina, United States.

Main outcome measures: Hypertension prevalence.

Methods: Data representing adult South Carolina Medicaid recipients enrolled in fiscal year 2013 (N=409,907) and ZIP Code Tabulation Area (ZCTA)-level contextual measures (racial segregation, rurality, poverty, educational attainment, unemployment and primary care physician adequacy) were linked in a spatially referenced database. Optimized Getis-Ord hotspot mapping was used to visualize geographic clustering of hypertension prevalence. Spatial regression …

Comparison Of Small-Area Deprivation Measures As Predictors Of Chronic Disease Burden In A Low-Income Population, Ana Lopez-De Fede, John E. Stewart, James W. Hardin, Kathy Mayfield-Smith

Publications

Background: Measures of small-area deprivation may be valuable in geographically targeting limited resources to prevent, diagnose, and effectively manage chronic conditions in vulnerable populations. We developed a census-based small-area socioeconomic deprivation index specifically to predict chronic disease burden among publically insured Medicaid recipients in South Carolina, a relatively poor state in the southern United States. We compared the predictive ability of the new index with that of four other small-area deprivation indicators. Methods: To derive the ZIP Code Tabulation Area-Level Palmetto Small-Area Deprivation Index (Palmetto SADI), we evaluated ten census variables across five socioeconomic deprivation domains, identifying the combination of …

Antipsychotic Prescriptions For Children Aged 5 Or Younger: Do We Need Policy Oversight Standards?, Ana Lopez-De Fede, Medha Vyavaharkar, Jessica D. Bellinger

Publications

The use of antipsychotics in very young children is of concern given the lack of empirical evidence in their efficacy and long-term impact on children’s health. This study examined the prescription of antipsychotics among children aged ≤5 years enrolled in a state Medicaid program. Secondary data analysis was conducted using the Medicaid administrative data of a southeastern state. Using SAS 9.3, descriptive statistics were performed to examine socio-demographic characteristics, psychiatric diagnoses, off-label use, receipt of medications from multiple psychotropic drug classes, and receipt of non-pharmacologic psychiatric services among children aged ≤5 years who received antipsychotic prescriptions in calendar year (CY) …

The Children And Parents In Focus Project: A Population-Based Cluster-Randomised Controlled Trial To Prevent Behavioural And Emotional Problems In Children, R. Salari, H. Fabian, Ron Prinz, S. Lucas, I. Feldman, Amanda Fairchild, A. Sarkadi

Faculty Publications

Background: There is large body of knowledge to support the importance of early interventions to improve child health and development. Nonetheless, it is important to identify cost-effective blends of preventive interventions with adequate coverage and feasible delivery modes. The aim of the Children and Parents in Focus trial is to compare two levels of parenting programme intensity and rate of exposure, with a control condition to address impact and cost-effectiveness of a universally offered evidence-based parenting programme in the Swedish context. Methods/Design: The trial has a cluster randomised controlled design comprising three arms: Universal arm (with access to participation in …

Family-Focused Physical Activity, Diet, And Obesity Interventions In African-American Girls: A Systematic Review, Daheia J. Barr-Anderson, Alexis W. Adams-Wynn, Katherine I. Disantis, Shiriki Kumanyika

Faculty Publications

Obesity interventions that involve family members may be effective with racial/ethnic minority youth. This review assessed the nature and effectiveness of family involvement in obesity interventions among African-American girls aged 5-18 years, a population group with high rates of obesity. Twenty-six databases were searched between January 2011 and March 2012, yielding 27 obesity pilot or full-length prevention or treatment studies with some degree of family involvement and data specific to African-American girls. Interventions varied in type and level of family involvement, cultural adaptation, delivery format, and behavior change intervention strategies; most targeted parent-child dyads. Some similarities in approach based on …

Elite Athletes' Survival Advantage: Could Be Shared By All Through Physical Activity, Adrian E. Bauman, Steven N. Blair

Faculty Publications

No abstract provided.

The Effect Of Exercise Training Modality On Serum Brain Derived Neurotrophic Factor Levels In Individuals With Type 2 Diabetes, Damon L. Swift, Neil M. Johannsen, Valerie H. Myers, Conrad P. Earnest, Jasper A. J. Smits, Steven N. Blair, Timothy S. Church

Faculty Publications

Introduction: Brain derived neurotrophic factor (BDNF) has been implicated in memory, learning, and neurodegenerative disease. However, the relationship of BDNF with cardiometabolic risk factors is unclear, and the effect of exercise training on BDNF has not been previously explored in individuals with type 2 diabetes.

Methods: Men and women (N=150) with type 2 diabetes were randomized to an aerobic exercise (aerobic), resistance exercise (resistance), or a combination of both (combination) for 9 months. Serum BDNF levels were evaluated at baseline and follow-up from archived blood samples.

Results: Baseline serum BDNF was not associated with fitness, body composition, anthropometry, glucose control, …

Body Mass Index Trajectories From Adolescence To Midlife: Differential Effects Of Parental And Respondent Education By Race/Ethnicity And Gender, Katrina M. Walsemann, Jennifer A. Ailshire, Bethany A. Bell, Edward A. Frongillo

Faculty Publications

Objectives: Race/ethnicity and education are among the strongest social determinants of body mass index (BMI) throughout the life course, yet we know relatively little about how these social factors both independently and interactively contribute to the rate at which BMI changes from adolescence to midlife. The purpose of this study is to 1) examine variation in trajectories of BMI from adolescence to midlife by mothers' and respondents' education, and 2) determine if the effects of mothers' and respondents' education on BMI trajectories differ by race/ethnicity and gender.

Design: We used nationally representative data from the National Longitudinal Survey of Youth …

Dose-Response Effects Of Exercise Training On The Subjective Sleep Quality Of Postmenopausal Women: Exploratory Analyses Of A Randomised Controlled Trial, Christopher E. Kline, Xuemei Sui, Martica H. Hall, Shawn D. Youngstedt, Steven N. Blair, Conrad P. Earnest, Timothy S. Church

Faculty Publications

Objective: To investigate whether a dose-response relationship existed between exercise and subjective sleep quality in postmenopausal women. This objective represents a post hoc assessment that was not previously considered.

Design: Parallel-group randomised controlled trial.

Setting: Clinical exercise physiology laboratory in Dallas, Texas.

Participants: 437 sedentary or overweight/obese postmenopausal women.

Intervention: Participants were randomised to one of four treatments, each of 6 months of duration: a non-exercise control treatment (n=92) or one of three dosages of moderate-intensity exercise (50% of VO_2peak), designed to meet 50% (n=151), 100% (n=99) or 150% (n=95) of the National Institutes of Health Consensus Development …

Cardiorespiratory Fitness Reduces The Risk Of Incident Hypertension Associated With A Parental History Of Hypertension, Robin P. Shook, Duck-Chul Lee, Xuemei Sui, Vivek Prasad, Steven P. Hooker, Timothy S. Church, Steven N. Blair

Faculty Publications

Family history of hypertension increases the risk of an individual to develop hypertension, whereas moderate-to-high cardiorespiratory fitness has the opposite effect. However, the joint association of each on the development of hypertension is not well understood. We studied fitness and incident hypertension in 6278 participants who were given a preventative medical examination. Thirty-three percent reported a parent with hypertension, and there were 1545 cases of incident hypertension after a mean of 4.7 years. The presence of parental hypertension was associated with a 28% higher risk of developing hypertension after adjustments for age, sex, and examination year. After further adjustments for …

Adverse Metabolic Response To Regular Exercise: Is It A Rare Or Common Occurrence?, Claude Bouchard, Steven N. Blair, Timothy S. Church, Conrad P. Earnest, James M. Hagberg, Keijo Häkkinen, Nathan T. Jenkins, Laura Karavirta, William E. Kraus, Dabeeru C. Rao, Mark A. Sarzynski, James S. Skinner, Cris A. Slentz, Tuomo Rankinen

Faculty Publications

Background: Individuals differ in the response to regular exercise. Whether there are people who experience adverse changes in cardiovascular and diabetes risk factors has never been addressed.

Methodology/Principle Findings: An adverse response is defined as an exercise-induced change that worsens a risk factor beyond measurement error and expected day-to-day variation. Sixty subjects were measured three times over a period of three weeks, and variation in resting systolic blood pressure (SBP) and in fasting plasma HDL-cholesterol (HDL-C), triglycerides (TG), in insulin (FI) was quantified. The technical error (TE) defined as the within-subject standard deviation derived from these measurements was computed. An …

A School-Based, Peer Leadership Physical Activity Intervention For 6th Graders: Feasibility And Results Of A Pilot Study, Daheia J. Barr-Anderson, Melissa N. Laska, Sara Veblen-Mortenson, Kian Farbakhsh, Bonnie Dudovitz, Mary Story

Faculty Publications

Background: The aim of this study was to promote physical activity in 6th graders by developing and testing the feasibility of an enhanced Presidential Active Lifestyle Award (PALA) program comprised of a peer leadership component and innovative exercise resource toolkit including DVDs. Methods: A racially/ethnically diverse sample of students received the standard PALA program (2 control schools, n = 61) or enhanced PALA+Peers program (2 intervention schools, n = 87) during 2006-2007 academic year. Results: Compared with the control condition, the intervention was successful in increasing moderate physical activity in all students (P = .02) and …

Longitudinal Changes In Body Composition Associated With Healthy Ageing: Men, Aged 20-96 Years, Andrew S. Jackson, Ian Janssen, Xuemei Sui, Timothy S. Church, Steven N. Blair

Faculty Publications

Obesity and sarcopenia are health problems associated with ageing. The present study modelled the longitudinal changes in body composition of healthy men, aged from 20 to 96 years, and evaluated the fidelity of BMI to identify age-dependent changes in fat mass and fat-free mass. The data from 7265 men with multiple body composition determinations (total observations 38,328) were used to model the age-related changes in body mass, fat mass, fat-free mass, BMI and percentage of body fat. Changes in fat mass and fat-free mass were used to evaluate the fidelity of BMI and to detect body composition changes with ageing. …

Heart Rate Variability And Exercise In Aging Women, Conrad P. Earnest, Steven N. Blair, Timothy S. Church

Faculty Publications

Background: Our group has shown a positive dose-response in maximal cardiorespiratory exercise capacity (VO_2max) and heart rate variability (HRV) to 6 months of exercise training but no improvement in VO_2max for women ≥60 years. Here, we examine the HRV response to exercise training in postmenopausal women younger and older than 60 years.

Methods: We examined 365 sedentary, overweight, hypertensive, postmenopausal women randomly assigned to sedentary control or exercise groups exercising at 50% (4 kcal/kg/week, [KKW]), 100% (8 KKW) and 150% (12 KKW) of the National Institute of Health (NIH) Consensus Development Panel physical activity guidelines. Primary outcomes …

School Racial Composition And Race/Ethnic Differences In Early Adulthood Health, Bridget J. Goosby, Katrina M. Walsemann

Faculty Publications

We investigate whether school racial composition is associated with racial and ethnic differences in early adult health. We then examine whether perceived discrimination, social connectedness, and parent support attenuates this relationship. Using U.S. data from Wave I and IV of the National Longitudinal Survey of Adolescent Health, we found that black adolescents attending predominantly white schools reported poorer adult health while Asians reported better health. Further research is warranted to understand whether there are qualitative differences in the treatment of racial and ethnic minorities within certain school contexts and how that differential treatment is related to adult health outcomes.

Comparing The Validity Of 2 Physical Activity Questionnaire Formats In African-American And Hispanic Women, Louise C. Mâsse, Janet E. Fulton, Kathleen B. Watson, Susan Tortolero, Harold W. Kohl Iii, Michael C. Meyers, Steven N. Blair, William W. Wong

Faculty Publications

Background: The purpose of this study was to compare the validity of 2 physical activity questionnaire formats - one that lists activities (Checklist questionnaire) and one that assesses overall activities (Global questionnaire) by domain.

Methods: Two questionnaire formats were validated among 260 African-American and Hispanic women (age 40-70) using 3 validation standards: 1) accelerometers to validate activities of ambulation; 2) diaries to validate physical activity domains (occupation, household, exercise, yard, family, volunteer/church work, and transportation); and 3) doubly-labeled water to validate physical activity energy expenditure (DLW-PAEE).

Results: The proportion of total variance explained by the Checklist questionnaire was 38.4% with …