Medicine and Health Sciences Commons^™

A Likelihood Based Method For Real Time Estimation Of The Serial Interval And Reproductive Number Of An Epidemic, Laura Forsberg White, Marcello Pagano

Harvard University Biostatistics Working Paper Series

No abstract provided.

A Report From The Forum Session "Complexity, Coordination And Compromise: States And The Medicare Drug Benefit" (August 4, 2006), Lee Partridge

National Health Policy Forum

This National Health Policy Forum meeting report reviews a technical session that took place on August 4, 2006. The invitation-only meeting was designed to discuss implementation issues related to the new Medicare drug benefit, with special consideration of state activities, problems, and concerns. This meeting followed similar ones sponsored by the Forum in 2004 and 2005 in which the state perspective was the primary focus of conversation. Participants, including current and former state Medicaid directors, other state officials and experts, federal officials, Medicare drug plan representatives, and beneficiary advocates, described their experiences during the implementation process and addressed continuing challenges. …

Transfusion-Associated Transmission Of West Nile Virus, United States 2003 Through 2005, Susan P. Montgomery, Jennifer A. Brown, Matthew Kuehnert, Theresa L. Smith, Nicholas Crall, Robert S. Lanciotti, Alexandre Macedo De Oliveira, Thomas Boo, Anthony A. Marfin, 2003 West Nile Virus Transfusion-Associated Transmission Investigation Team

Public Health Resources

BACKGROUND: National blood donation screening for West Nile virus (WNV) started in June 2003, after the documentation of WNV transfusion-associated transmission (TAT) in 2002.
STUDY DESIGN AND METHODS: Blood donations were screened with investigational nucleic acid amplification assays in minipool formats. Blood collection agencies (BCAs) reported screening results to state and local public health authorities. Donor test results and demographic information were forwarded to CDC via ArboNET, the national electronic arbovirus surveillance system. State health departments and BCAs also reported suspect WNV TATs to CDC, which investigated these reports to confirm WNV infection in blood transfusion recipients in the absence …

The Qingdao Twin Registry: A Focus On Chronic Disease Research, C. Anderson Johnson, Zengchang Pang, Feng Ning, Jennifer B. Unger, Shaojie Wang, Qian Guo, Weihua Cao, Liming Lee

CGU Faculty Publications and Research

With the changing patterns of morbidity and mortality in China, noncommunicable chronic diseases have become the major threats to the health of the Chinese population. The causes of chronic diseases include genetic factors and behavioral risk factors such as the use of tobacco, alcohol, and other drugs, unhealthy dietary behaviors, and lack of physical activity. Twin studies offer a unique opportunity to disentangle the genetic and environmental risk and protective factors for chronic disease. The Qingdao Twin Registry (QTR) was initiated in 1998 as part of the National Chinese Twin Registry. Over 11,000 pairs of twins and multiples of all …

A Multilevel Analysis Of Socioeconomic Status And Prostate Cancer Risk, Maureen Sanderson, Ann L. Coker, Adriana Perez, Xianglin L. Du, Gerson Peltz, Mary K. Fadden

Health & Biomedical Sciences Faculty Publications and Presentations

PURPOSE

We investigated whether prostate cancer was associated with socioeconomic status (SES) at the individual level, area level, or a combination of both levels.

METHODS

This population-based case–control study of prostate cancer in men aged 65 to 79 years was conducted between 2000 and 2002 in South Carolina. Complete interviews were available for 407 incident prostate cancer cases and 393 controls (with respective response rates of 61% and 64%). We used educational level to measure individual-level SES and a composite variable capturing income and education from 2000 Census data to measure area-level SES.

RESULTS

After adjustment for race, age, geographic …

Objectively Measured Physical Activity In Sixth-Grade Girls, Russell R. Pate, June Stevens, Charlotte Pratt, James F. Sallis, Kathryn H. Schmitz, Larry S. Webber, Gregory J. Welk, Deborah Rohm Young

Faculty Publications

Objectives - To describe the objectively-measured physical activity (PA) characteristics of a diverse sample of 6^th grade girls to examine influences on PA, and to report compliance with PA guidelines.

Design - Cross-sectional study.

Setting - Six locations across the United States.

Participants - 1578 6^th grade girls. Actigraph accelerometers were worn for 7 days, and data for 6 days were included in the analyses.

Main exposure - Race/ethnicity, free-or-reduced price lunch (FRPL), and geographic region.

Main outcome measure - Six operational definitions of adequate activity (60 min or 30 min of daily MVPA at or above 4.6, …

Women’S Health In Developing Countries, Javed Rizvi, Nadeem F. Zuberi

Department of Obstetrics & Gynaecology

Healthcare priorities are different in developing and developed countries. A more effective resource allocation, complemented by efforts to implement only those practices that are effective, should be a priority for improving reproductive health services in developing countries. A large burden of gynaecological disease exists in developing countries and it is difficult to envisage serious reforms and improvements without an increase in public-sector spending. However, communities themselves could assume some responsibility for women's health in ways that prioritize women's own perceptions and primary needs. In this chapter we have compiled existing evidence regarding various gynaecological problems faced by women in developing …

Personal Health Records: The People's Choice?, Lisa Sprague

National Health Policy Forum

Information technology (IT), especially in the form of an electronic health record (EHR), is touted by many as a key component of meaningful improvement in health care delivery and outcomes. A personal health record (PHR) may be an element of an EHR or a stand-alone record. Proponents of PHRs see them as tools that will improve consumers’ ability to manage their care and will also enlist consumers as advocates for widespread health IT adoption. This issue brief explores what a PHR is, the extent of demand for it, issues that need to be resolved before such records can be expected …

Value-Based Coverage Policy In The United States And The United Kingdom: Different Paths To A Common Goal, Wilhelmine Miller

National Health Policy Forum

This background paper traces the development within American health care of two interrelated trends and activities: an evidence-based approach to medical practice and the critical evaluation of new technologies with respect to their costs and effectiveness. Over the past 35 years each of these developments has increasingly shaped the coverage decisions of public and private health insurers, and their importance for coverage policy is certain to grow. The paper also contrasts the different approaches to such “evidence-” or “value-based” coverage policy in the mixed public and private U.S. health care enterprise with the approach taken in Great Britain’s single-payer National …

Spatio-Temporal Analysis Of Areal Data And Discovery Of Neighborhood Relationships In Conditionally Autoregressive Models, Subharup Guha, Louise Ryan

Harvard University Biostatistics Working Paper Series

No abstract provided.

Semiparametric Regression Of Multi-Dimensional Genetic Pathway Data: Least Squares Kernel Machines And Linear Mixed Models, Dawei Liu, Xihong Lin, Debashis Ghosh

Harvard University Biostatistics Working Paper Series

No abstract provided.

Medicare And Mental Health: The Fundamentals, Christopher Loftis, Eileen Salinsky

National Health Policy Forum

This background paper provides a review of mental health coverage in the Medicare program. It examines the prevalence of mental disorders among Medicare beneficiaries, treatment available through Medicare, and the cost of such treatment. A brief summary of relevant policy issues is provided, including Medicare’s outpatient mental health limitation and the potential effect of the prescription drug benefit on the provision of mental health services.

The Nevada Institute For Children’S Research And Policy: Final Report, The Nevada Institute For Children’S Research And Policy

Nevada Institute for Children's Research and Policy Reports

On November 16, 2005, the Legislative Commission unanimously voted to approve hiring the Nevada Institute for Children’s Research and Policy (NICRP), School of Public Health, UNLV to study and evaluate governmental entities and private facilities that have physical custody of children pursuant to a court order and other public entities that provide for the care and supervision of children in the State of Nevada. The study included three primary components. The first component involved an analysis of the guidelines, protocols, policies and procedures of these entities/facilities which affect the health, safety, welfare, treatment and civil or other rights of children …

Epsdt: Medicaid's Critical But Controversial Benefits Program For Children, Christie Provost Peters

National Health Policy Forum

The Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program under Medicaid provides the most comprehensive set of health benefits for children and adolescents in the public or private sector. A cornerstone of early childhood preventive and treatment services in the nation’s health care “safety net,” the EPSDT program serves nearly 30 million low-income children, including children with disabilities and special needs. Over the years, states have expressed frustration with the administrative burdens of EPSDT requirements. Rising Medicaid costs have put all Medicaid benefits, including the EPSDT program, in the budgetary crosshairs. This issue brief reviews the fundamental characteristics of …

Updating Medicare's Physician Fees: The Sustainable Growth Rate Methodology, Laura A. Dummit

National Health Policy Forum

Medicare’s method to annually update the fees it pays physicians has been under fire for some time—specifically, since the method determined that physician fees should be reduced rather than increased. The update method, called the sustainable growth rate (SGR), was implemented to control the growth in Medicare physician spending. Yet Congress, in response to physician concerns about beneficiary access to care, has acted to avert physician fee cuts since 2003. Although this signals dissatisfaction with the SGR methodology, there is yet to be a widely accepted physician fee update proposal that balances federal budgetary realities with the need to ensure …

The Nuts And Bolts Of Pdps, Mary Ellen Stahlman

National Health Policy Forum

This issue brief provides an overview of Medicare prescription drug plans (PDPs), with a focus on fundamentals such as enrollment, premiums, formularies, cost sharing, prices, payment, cost management, and appeals and grievance processes. It also highlights major changes to the PDP landscape between 2006 and 2007.

Updating The Wic Food Packages: It's About Time, Jessamyn Taylor

National Health Policy Forum

This issue brief reviews key revisions to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program proposed by the USDA, which are based substantially on recommendations by the Institute of Medicine. Should the changes become regulation, they will be the most significant revision of the WIC food packages in over 25 years. This brief describes the changes, the impetus for their consideration, and possible implementation issues from the perspectives of vendors, state and local WIC agencies, and participants.

A Primer On Eva For Healthcare Providers, James L. Grant

Financial Services Forum Publications

The concept of economic profit (EVA) has proved successful in the field of corporate finance since its adoption by several U.S. and International companies over the past 25 years. Unlike accounting earnings, EVA is a measure of a company’s true earnings because it fully “accounts” for the costs of all forms of financing, including debt and equity. In the EVA view, a company is not truly profitable unless it earns a return on capital that bests the opportunity cost of capital. That being said, the question that we address here is how to measure the economic profit of providers in …

Preventive Medicine: A "Cure" For The Healthcare Crisis, Janice L. Clarke, Deborah Meiris

College of Population Health Faculty Papers

Introductory Editorial: Few would dispute the premise that prevention, early detection, and early intervention form the first line of defense on the disease management (DM) continuum. That being the case, our national statistics on preventive health should be raising concerns throughout the industry. The US healthcare delivery system continues to fall woefully short of its prevention targets. On the international scene, the United States lags behind countries with less wealth and less technological savvy. Commentaries abound on the problems, but recently I became aware of an organization with an exciting goal and a novel solution for bringing preventive medicine …

Community Mobility And Dementia: A Review Of The Literature, Nina M. Silverstein, Megan Vanderbur

Gerontology Institute Publications

By the year 2030, 70 million Americans will be 65 or older. Approximately 80 percent of this population will likely be driving themselves. And without appropriate and timely interventions, many are likely to be driving with Alzheimer’s disease (AD). Current estimates suggest that 2 percent of the population 65 to 74, 19 percent of the population 75 to 84, and 47 percent of the population 85 and older are likely to suffer from Alzheimer’s disease or a related disorder. By the year 2050, the number of Americans with Alzheimer’s disease could range from 11.3 million to 16 million. This significant …

Phylogenetic Analysis Of Buggy Creek Virus: Evidence For Multiple Clades In The Western Great Plains, United States Of America, Martin Pfeffer, Jerome E. Foster, Eric A. Edwards, Mary Bomberger Brown, Nicholas Komar, Charles R. Brown

Public Health Resources

We present the first detailed phylogenetic analysis of Buggy Creek virus (BCRV), a poorly known alphavirus with transmission cycles involving a cimicid swallow bug (Oeciacus vicarius) vector and cliff swallows (Petrochelidon pyrrhonota) and house sparrows (Passer domesticus) as the principal avian hosts. Nucleotide sequences of a 2,075-bp viral envelope glycoprotein-coding region, covering the entire PE2 gene, were determined for 33 BCRV isolates taken from swallow bugs at cliff swallow colonies in Nebraska and Colorado in the summer of 2001 and were compared with the corresponding region of BCRV isolates collected from Oklahoma in the …

Knowledge And Attitudes About Health Research Amongst A Group Of Pakistani Medical Students, Hassan Khan, Muhammad Rizwanulhaq Khawaja, Abdul Waheed, Muhammad Ameen Rauf, Zafar Fatmi

Community Health Sciences

Background

Health research training is an important part of medical education. This study was conducted to assess the level of knowledge and attitudes regarding health research in a group of Pakistani medical students at Aga Khan University, Karachi.

Methods

It was a cross-sectional pilot study conducted among a group of Pakistani medical students. Through stratified random sampling, a pre-tested, structured and validated questionnaire was administered to 220 medical students. Knowledge and attitudes were recorded on a scale (graduated in percentages).

Results

Mean scores of students were 49.0% on knowledge scale and 53.7% on attitude scale. Both knowledge and attitudes improved …

Statistical Analysis Of Air Pollution Panel Studies: An Illustration, Holly Janes, Lianne Sheppard, Kristen Shepherd

UW Biostatistics Working Paper Series

The panel study design is commonly used to evaluate the short-term health effects of air pollution. Standard statistical methods for analyzing longitudinal data are available, but the literature reveals that the techniques are not well understood by practitioners. We illustrate these methods using data from the 1999 to 2002 Seattle panel study. Marginal, conditional, and transitional approaches for modeling longitudinal data are reviewed and contrasted with respect to their parameter interpretation and methods for accounting for correlation and dealing with missing data. We also discuss and illustrate techniques for controlling for time-dependent and time-independent confounding, and for exploring and summarizing …

Medicare Physician Payments And Spending, Laura A. Dummit

National Health Policy Forum

The Medicare program’s physician payment method is intended to control spending while ensuring beneficiary access to physician services, but there are signs that it may not be working. The physician’s role in the health care delivery system as the primary source of information and treatment options, together with growing demand for services and the imperfect state of knowledge about appropriate service use, challenge Medicare’s ability to achieve these two goals. This issue brief describes the history of physician spending and the contribution of escalating service use and intensity of services to the rise in Medicare outlays, setting the stage for …

Environmental Equity Is Child's Play: Mapping Public Provision Of Recreation Opportunities In Urban Neighbourhoods, Jason Gilliland, Martin Holmes, Jennifer D. Irwin, Patricia Tucker

Geography & Environment Publications

This paper examines the spatial distribution of recreational opportunities for children and youth in a mid-sized Canadian city (London, Ontario), in relation to the socioeconomic status of neighbourhoods and estimated local need for publicly provided recreation spaces. Public recreation facilities (N = 537) throughout the city were identified, mapped and analysed in a geographic information system. To explore potential socio-environmental inequities, neighbourhoods (N = 22) were characterized by socioeconomic and environmental variables, an index of neighbourhood social distress, a neighbourhood play space needs index, and measures of the prevalence and density of recreational opportunities. The results of the …

Stress, Coping, Social Support, And Prostate Cancer Risk Among Older African American And Caucasian Men, Ann L. Coker, Maureen Sanderson, Gary L. Ellison, Mary Kay Fadden

CRVAW Faculty Journal Articles

Objectives: While psychosocial stress and high effort coping have been associated with reduced immune function, no epidemiologic study has addressed psychological stress and risk of prostate cancer. The purpose of this analysis was to investigate the association between stress, coping, social support, and risk of prostate cancer among older men (age 65–79 years). Design: Population-based case-control study in South Carolina.

Participants: Cases were 400 incident, histologically confirmed prostate cancer cases identified through the South Carolina Central Cancer Registry between 1999 and 2001 (70.6% response rate). Controls were 385 men identified through the 1999 Health Care Financing Administration Medicare beneficiary file …

Annual Report To The Nation On The Status Of Cancer, 1975–2003, Featuring Cancer Among U.S. Hispanic/ Latino Populations, Holly L. Howe, Xiao-Cheng Wu, Lynn A. G. Ries, Vilma Cokkinides, Faruque Ahmed, Ahmedin Jemal, Barry A. Miller, Melanie Williams, Elizabeth Ward, Phyllis A. Wingo, Amelie Ramirez, Brenda K. Edwards

Public Health Resources

BACKGROUND. The American Cancer Society, Centers for Disease Control and Prevention, National Cancer Institute, and North American Association of Central Cancer Registries collaborate annually to provide U.S. cancer information, this year featuring the first comprehensive compilation of cancer information for U.S. Latinos.

METHODS. Cancer incidence was obtained from 90% of the Hispanic/Latino and 82% of the U.S. populations. Cancer deaths were obtained for the entire U.S. population. Cancer screening, risk factor, incidence, and mortality data were compiled for Latino and non-Latino adults and children (incidence only). Long-term (1975– 2003) and fixed-interval (1995–2003) trends and comparative analyses by disease …

Health And Needs Assessment Of Geriatric Patients: Results Of A Survey At A Teaching Hospital In Karachi, Syed Nabeel Zafar, Hammad Ashraf Ganatra, Sarah Tehseen, Waris Qidwai

Department of Family Medicine

Objective: To study the health and needs of geriatric patients

Methods: A questionnaire based survey of patients visiting the out-patient department of Aga Khan University was carried out. Ethical requirements were met and included administration of informed consent and provision of confidentiality to patients. Convenience sampling was used without any randomization for interviews. Epi-info and SPSS software were used for data management.

Results: Four hundred and two (402) subjects above the age of 65 were surveyed. Most of the subjects were retired (40.5%) married (76.4%) men (69.7%). Ages ranged from 65 to 90 years, the mean being 70.57 years and …

Individual Responsibility Concerning Hiv Transmission Among Msm: A Comparative Study Of The Effectiveness Of Ngo Intervention Policies And Their Practical Applications Within The United Kingdom, Australia, And The Netherlands, Martha Kienbaum

Independent Study Project (ISP) Collection

This study investigates the complexities involved in utilizing the terms of individual responsibility for the construction of HIV prevention campaigns that target men who have sex with men. Four health workers in the Netherlands were interviewed about their personal opinions regarding HIV intervention, and these interviews were analyzed qualitatively for their points of comparison and contrast. Then, campaign materials from organizations in the United Kingdom and Australia were analyzed for their use of the language of responsibility, their portrayal of MSM, their balance between promoting disclosure and communication, their focus on individual groups within the MSM community, and their overall …

Frequency And Characteristics Of Breast Lymphomas Presenting To A Tertiary Care Hospital, Pakistan, Nausheen Yaqoob, Shahid Pervez, Naila Kayani, Rashida Ahmed, Zubair Ahmed, Sheema Hasan

Department of Pathology and Laboratory Medicine

Objective: To assess the relative frequency of (primary and secondary) mammary lymphomas presenting to a tertiary care hospital, Pakistan and its categorization according to WHO classification of lymphoid neoplasms.

Methods: All NHLs (nodal and extra nodal) diagnosed in the section of histopathology during 1992-2004 were retrieved and reviewed. All patients (n=30) diagnosed with lymphomatous involvement of the breast were selected. Distinction between primary and secondary breast lymphomas was not made owing to lack of availability of clinical information.

Results: A total of 5637 breast malignancies were diagnosed in our department during the study period of 10 years and the total …