Medicine and Health Sciences Commons^™

Migrant Worker Dies In Tractor Rollover, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Tractors/Logging

On September 13, 2002, a 26 year-old male Hispanic migrant worker (decedent) died when the tractor he was driving on a country roadway overturned. The decedent had experience driving the tractor in a field, but did not have experience driving it on a public roadway. On the afternoon of the incident, the decedent drove the tractor, pulling a wagonload of tobacco, from the farm where it had been harvested to the tobacco barn one mile away. The road was hilly and had a sharp curve to the right at the bottom of the hill. As the decedent drove the tractor …

Screening At Worksite Applying The Framingham Heart Study Score., Paulo A. Lotufo

Paulo A Lotufo

The first evaluation of class of occupation and cardiovascular risk factors in a Brazilian sample of civil servants. 1) context: Cardiovascular diseases are the main causes of death in Brazil. The high-risk approach to cardiovascular risk factors by screening test at worksite is one possible strategy of prevention. 2) objective: to verify the impact of a risk factors screening according to occupational levels. 3) type of study: cross-sectional 4) setting: occupational division of University of Sao Paulo 5) participants: 6,587 employees aged 20 to 69 years-old classified according three occupational grades (non-skilled, both manual and non-manual jobs; technical; faculty). 6) …

The Effectiveness Of Heart Failure Disease Management: Initial Findings From A Comprehensive Program, Janice L. Clarke, David B. Nash

College of Population Health Faculty Papers

A prevalent, chronic condition among members of the mushrooming elderly population in the United States, heart failure (HF) is a logical focus for population-based disease management. Evidence supporting the premise that multidisciplinary interventions can significantly improve clinical outcomes while decreasing the cost of medical care for people with HF is steadily mounting. A growing number of controlled and observational studies focus on the effects of HF disease management on re-admission rates, length of stay, and improvement in appropriate diagnostic testing and prescribing. This paper describes a large-scale, comprehensive HF program and reports on clinical quality, utilization, and financial outcomes observed …

Predicting High Utilization Of Emergency Department Services Among Patients With A Diagnosis Of Psychosis In A Medicaid Managed Care Organization, Tammy K. Girts, Albert G. Crawford, Neil I. Goldfarb, Mark Bachleda, Amy Grogg

College of Population Health Faculty Papers

Studies have demonstrated increased utilization of medical services for patients with behavioral health diagnoses. Medicaid managed care organizations (MMCOs) that operate under behavioral health carve-outs face the challenge of effectively targeting disease management initiatives in the absence of information on behavioral diagnoses. This study sought to develop a predictive model of emergency department (ED) utilization for patients where a diagnosis of psychosis could be identified from a claim associated with a medical service provider visit. A retrospective cohort analysis was performed using medical and pharmacy claims from an MMCO in Philadelphia, Pennsylvania, to identify patients known to have a diagnosis …

Urinary Excretion Of Dithiocarbamates And Selfreported Cruciferous Vegetable Intake: Application Of The ‘Method Of Triads’ To A Foodspecific Biomarker, Jay H. Fowke, James R. Hébert, Jed W. Fahey

Faculty Publications

Objective: Greater intake of Cruciferous vegetables (e.g. broccoli) may prevent cancer at several sites. Urinary excretion of isothiocyanate conjugates (dithiocarbamates, DTC) provides a specific biomarker of Cruciferous vegetable consumption suitable for epidemiological investigations. However, no gold-standard referent is available for evaluating urinary DTC levels as an estimator of Cruciferous vegetable consumption. We compared urinary DTC levels to intake as measured by two selfreported dietary assessment techniques. Design: Cruciferous vegetable consumption was measured before and after a behavioural dietary intervention using multiple 24-hour recalls (24HR), a foodcounting questionnaire (VFQ) and urinary DTC excretion levels. Analysis included a structural equation approach (Method …

Subsets More Likely To Benefit From Surgery Or Prophylactic Cranial Irradiation After Chemoradiation For Localized Non-Small-Cell Lung Cancer, Bruce Keith, Mark Vincent, Larry Stitt, Anna Tomiak, Richard Malthaner, Edward Yu, Pauline Truong, Richard Inculet, Michael Lefcoe, A. Dar, Walter Kocha, Ian Craig

Edward Yu

After chemoradiation for localized non-small-cell lung cancer, surgery and prophylactic cranial irradiation (PCI) have been used as additional therapies. Less than a third of patients develop brain recurrences, or have local recurrence as their sole initial site of recurrence; these are groups that would benefit from PCI or surgery, respectively. Pretreatment identification of patients more likely to benefit from surgery or PCI would be useful. A retrospective analysis of 80 patients was performed to determine prognostic factors for such patterns of failure. Twenty-nine patients were subsequently selected for surgery in a nonrandomized manner. Seventeen patients had isolated local initial recurrence …

Analysis Of Longitudinal Marginal Structural Models , Jennifer F. Bryan, Zhuo Yu, Mark J. Van Der Laan

U.C. Berkeley Division of Biostatistics Working Paper Series

In this article we construct and study estimators of the causal effect of a time-dependent treatment on survival in longitudinal studies. We employ a particular marginal structural model (MSM), and follow a general methodology for constructing estimating functions in censored data models. The inverse probability of treatment weighted (IPTW) estimator is used as an initial estimator and the corresponding treatment-orthogonalized, one-step estimator is consistent and asymptotically linear when the treatment mechanism is consistently estimated. We extend these methods to handle informative censoring. A simulation study demonstrates that the the treatment-orthogonalized, one-step estimator is superior to the IPTW estimator in terms …

Depression: A Decade Of Progress, More To Do, Veronica V. Goff

National Health Policy Forum

This issue brief discusses the most recent findings on depression prevalence and cost; examines trends in outpatient treatment, including the dramatic growth in antidepressant use; discusses efforts to improve treatment in primary care; and explores possible public policy avenues for improving treatment access and quality.

Ua3/9/5 Special Announcement - Kelly Autism Project, Wku President's Office

WKU Archives Records

Speech delivered by WKU president Gary Ransdell announcing the beginning of the Kelly Autism Project at Western Kentucky University.

U.S. Childhood Vaccine Availability: Legal, Regulatory, And Economic Complexities, Robin J. Strongin

National Health Policy Forum

Despite the vital role they play in public health, childhood vaccines travel a complicated road from laboratory to provider and patient. From the fall of 2000 until well into 2002, a combination of factors, including market dynamics, legal challenges, and regulatory hurdles, led to a shortage of some childhood vaccines. This paper examines each of these factors, focusing on the important roles of both the public and the private sectors.

Prescription Drugs In Nursing Homes: Managing Costs And Quality In A Complex Environment, Dan Mendelson, Rajeev Ramchand, Richard Abramson, Anne Tumlinson

National Health Policy Forum

This issue brief provides a description of prescription drug use in nursing homes and a summary of policy issues in this area. It first profiles the nursing home pharmaceutical market, outlining the major trends in demographics and drug utilization, the supply chain by which drugs go from manufacturers to pharmacies to nursing home residents, and the alternative arrangements by which prescription drugs in nursing homes are financed. The paper then provides a synopsis of current policy issues, focusing in turn on cost containment and quality improvement initiatives.

The Medicare And Medicaid Intersection: Caring For Arizona's Seniors, Nora Super, Lisa Sprague, Judith D. Moore

National Health Policy Forum

This site visit to Phoenix examined the interplay between Medicare and Medicaid and how payment streams and regulatory requirements affect the delivery of health and long-term care services. The visit explored trends related to Medicare+Choice plan participation, physician acceptance of Medicare patients, and care management for individuals with chronic illnesses, such as Alzheimer’s disease. It also considered Arizona’s capitated Medicaid long-term care program, which recently implemented competitive bidding among plans in Maricopa County.

Assessing Workplace Tobacco Policies: A Community-Academic Partnership, Ellen J. Hahn, Mary Kay Rayens, Chizimuzo T.C. Okoli

Nursing Presentations

Purpose

• Describe the number and type of tobacco policies in manufacturing facilities

• Assess the resources for tobacco education and cessation

• Identify factors related to tobacco policies and practices within manufacturing facilities

Diet, Obesity And Reflux In The Etiology Of Adenocarcinomas Of The Esophagus And Gastric Cardia In Humans, Susan Mayne, Stephanie A. Navarro Silvera

Department of Public Health Scholarship and Creative Works

Incidence rates for esophageal adenocarcinoma have increased >350% since the mid-1970s. Rates for gastric cardia adenocarcinoma have also increased, although less steeply. This led to the initiation of large population-based case-control studies, particularly in the United States and Sweden, aimed at identifying risk factors for these cancers. Results have been emerging from these studies, with the consistent finding that obesity and gastroesophageal reflux disease are important risk factors for these cancers. Analyses of dietary factors are also available and indicate that diets high in total fat, saturated fat and cholesterol are associated with an increased risk of these cancers, whereas …

A Survey Of Health Services And Identification Of Needs For Asian American Elderly Women In The Greater Boston Area, Connie S. Chan, Lin Zhan

Institute for Asian American Studies Publications

Over one hundred Asian American and mainstream health care providers in the greater Boston area were surveyed for this study. The authors have identified critical gaps in services for elderly Asian American women.

Associations Between Cardiorespiratory Fitness And C-Reactive Protein In Men, Timothy S. Church, Carolyn E. Barlow, Conrad P. Earnest, James B. Kampert, Elisa L. Priest, Steven N. Blair

Faculty Publications

Objective - This study examined the association between cardiorespiratory fitness and C-reactive protein (CRP), with adjustment for weight and within weight categories.

Methods and Results - We calculated median and adjusted geometric mean CRP levels, percentages of individuals with an elevated CRP (≥2.00 mg/L), and odds ratios of elevated CRP across 5 levels of cardiorespiratory fitness for 722 men. CRP values were adjusted for age, body mass index, vitamin use, statin medication use, aspirin use, the presence of inflammatory disease, cardiovascular disease, and diabetes, and smoking habit. We found an inverse association of CRP across fitness levels (P for …

Activity Patterns And Correlates Among Youth: Differences By Weight Status, Wendell C. Taylor, James F. Sallis, Marsha Dowda, Patty S. Freedson, Karen Eason, Russell R. Pate

Faculty Publications

The purposes of the study were to assess differences in physical activity levels and correlates of physical activity among overweight (‡ 85th percentile of body mass index for their sex and age) and non-overweight (< 85th percentile) youth. The sample included 509 seventh through twelfth graders. Activity was measured by a 7-day, 46-item activity checklist. Overweight girls were more sedentary than non-overweight girls (p<.03), and non-overweight girls engaged in more vigorous physical activity than overweight girls (p<.03). For boys, there were no significant differences in activity. The regression analyses for vigorous activity yielded the largest total R²'s (R²=.049 for overweight and R²=.27 for non-overweight.) The significant factor for overweight youth was greater athletic coordination (p<.01). For non-overweight youth, the significant factors were greater family support (p<.05), greater peer support (p<.001), fewer barriers (p<.03), and greater athletic coordination (p<.01). Correlates of physical activity vary by weight status of young people.

What Is Cochrane All About?, Chris Del Mar, Jenny Doust

Jenny Doust

Recently the Australian Minister for Health, the Hon Kay Patterson, announced that Australia is purchasing the Cochrane Library for all Australians. Australians will now have access to the library free of charge through the web.

Asphalt Compactor Operator Dies When Machine Slides And Falls 17 Feet, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Motor Vehicle

A 32-year-old woman (the decedent) was killed when the asphalt compactor she was operating slid over an embankment and dropped 17 feet to a roadway below. At the time she was pressing an asphalt joint joining a roadway and a shoulder/emergency lane. She was two miles behind the asphalt truck and 1000 feet in front of a flat bed truck. The location of the incident had been identified as a possible hazardous location and her supervisors had instructed her to use extra caution in that area. The decedent was trained and had several years of experience operating an asphalt compactor. …

An Empirical Study Of Marginal Structural Models For Time-Independent Treatment, Tanya A. Henneman, Mark J. Van Der Laan

U.C. Berkeley Division of Biostatistics Working Paper Series

In non-randomized treatment studies a significant problem for statisticians is determining how best to adjust for confounders. Marginal structural models (MSMs) and inverse probability of treatment weighted (IPTW) estimators are useful in analyzing the causal effect of treatment in observational studies. Given an IPTW estimator a doubly robust augmented IPTW (AIPTW) estimator orthogonalizes it resulting in a more e±cient estimator than the IPTW estimator. One purpose of this paper is to make a practical comparison between the IPTW estimator and the doubly robust AIPTW estimator via a series of Monte- Carlo simulations. We also consider the selection of the optimal …

Trends. Fantasies, Death, And Violence, Ibpp Editor

International Bulletin of Political Psychology

This Trends article examines violence and death in the context of the goals of international health organizations.

Natural Experiment Examining Impact Of Aggressive Screening And Treatment On Prostate Cancer Mortality In Two Fixed Cohorts From Seattle Area And Connecticut, Grace Lu-Yao, Peter C. Albertsen, Janet L. Stanford, Therese A. Stukel

Dartmouth Scholarship

To determine whether the more intensive screening and treatment for prostate cancer in the Seattle≠Puget Sound area in 1987≠90 led to lower mortality from prostate cancer than in Connecticut.

Laboratory Response To Anthrax Bioterrorism, New York City, 2001, Michael B. Heller, Michel L. Bunning, Martin E.B. France, Debra M. Niemeyer, Leonard Peruski, Tim Naimi, Phillip M. Talboy, Patrick H. Murray, Harald W. Pietz, John Kornblum, William Oleszko, Sara T. Beatrice, Joint Microbiological Rapid Response Team, New York City Anthrax Investigation Working Group, Denis Nash

Publications and Research

In October 2001, the greater New York City Metropolitan Area was the scene of a bioterrorism attack. The scale of the public response to this attack was not foreseen and threatened to overwhelm the Bioterrorism Response Laboratory’s (BTRL) ability to process and test environmental samples. In a joint effort with the Centers for Disease Control and Prevention and the cooperation of the Department of Defense, a massive effort was launched to maintain and sustain the laboratory response and return test results in a timely fashion. This effort was largely successful. The development and expansion of the facility are described, as …

Chronic Obstructive Pulmonary Disease Surveillance --- United States, 1971--2000, David M. Mannino, David M. Homa, Lara J. Akinbami, Earl S. Ford, Stephen C. Redd

David M. Mannino

PROBLEM/CONDITION:

Chronic obstructive pulmonary disease (COPD) includes chronic bronchitis and emphysema but has been defined recently as the physiologic finding of nonreversible pulmonary function impairment. This surveillance summary reports trends in different measures of COPD during 1971-2000.

REPORTING PERIOD COVERED:

This report presents national data regarding objectively determined COPD (1971-1994); COPD-associated activity and functional limitations (1980-1996); self-reported COPD prevalence, COPD physician office and hospital outpatient department visits, COPD hospitalizations, and COPD deaths (1980-2000); and COPD emergency department visits (1992-2000).

DESCRIPTION OF SYSTEMS:

The Centers for Disease Control's National Center for Health Statistics conducts the National Health Interview Survey annually, which …

The Analysis Of Placement Values For Evaluating Discriminatory Measures, Margaret S. Pepe, Tianxi Cai

UW Biostatistics Working Paper Series

The idea of using measurements such as biomarkers, clinical data, or molecular biology assays for classification and prediction is popular in modern medicine. The scientific evaluation of such measures includes assessing the accuracy with which they predict the outcome of interest. Receiver operating characteristic curves are commonly used for evaluating the accuracy of diagnostic tests. They can be applied more broadly, indeed to any problem involving classification to two states or populations (D = 0 or D = 1). We show that the ROC curve can be interpreted as a cumulative distribution function for the discriminatory measure Y in the …

Relationship Between Low Quality-Of-Care Scores And Hmos' Subsequent Public Disclosure Of Quality-Of-Care Scores, Danny Mccormick, David U. Himmelstein, Steffie Woolhandler, Sidney M. Wolfe, David H. Bor

Publications and Research

Context Public disclosure of quality data on health maintenance organizations (HMOs) might improve public accountability, inform consumer decision making, and promote quality improvement. But, because disclosure is voluntary, some HMOs could subvert these objectives by refusing to release unfavorable data.

Objective To determine the association between HMO quality of care and withdrawal from public disclosure of quality-of-care data the subsequent year.

Design and Setting Retrospective cohort study of administrative and quality-of-care data on HMOs from the National Committee for Quality Assurance (NCQA) annual Quality Compass databases for 1997, 1998, and 1999, including Health Plan Employer Data and Information Set (HEDIS) …

Running On Empty: The State Budget Crisis Worsens, Randy Desonia

National Health Policy Forum

This issue brief reviews the status of state budget shortfalls and their growing impact on the Medicaid program. It describes the magnitude of the shortfalls, the forces behind them, and how states have responded with spending cuts and tax increases. It also discusses how long the budget crisis is expected to continue and what budget balancing options remain for fiscal year 2003.

Case-Control Current Status Data, Nicholas P. Jewell, Mark J. Van Der Laan

U.C. Berkeley Division of Biostatistics Working Paper Series

Current status observation on survival times has recently been widely studied. An extreme form of interval censoring, this data structure refers to situations where the only available information on a survival random variable, T, is whether or not T exceeds a random independent monitoring time C, a binary random variable, Y. To date, nonparametric analyses of current status data have assumed the availability of i.i.d. random samples of the random variable (Y, C), or a similar random sample at each of a set of fixed monitoring times. In many situations, it is useful to consider a case-control sampling scheme. Here, …

Assault-Related Admissions To Hospital In Central Australia, Ged F. Williams, Wendy P. Chaboyer, Philip J. Schluter

Aboriginal Policy Research Consortium International (APRCi)

Objective: To determine the number of assault-related admissions to hospital in the Central Australia region of the Northern Territory over a six-year period. Design and setting: Retrospective analysis of all patients admitted to Alice Springs Hospital (ASH) and Tennant Creek Hospital (TCH) from July 1995 to June 2001, where the primary cause of injury was “assault”. Main outcome measures: Frequency of assault-related admission to hospital; demographic characteristics of the victims. Results: In the six years, there were 2449 assault-related admissions to ASH and 545 to TCH. Adults aged 25–34 years were most frequently hospitalised for assault, in a proportion greater …

Patient Attitudes Toward Using Computers To Improve Health Services Delivery, Chris N. Sciamanna, Joseph A. Diaz, Puja Myne

College of Population Health Faculty Papers

BACKGROUND:The aim of this study was to examine the acceptability of point of care computerized prompts to improve health services delivery among a sample of primary care patients.

METHODS:Primary data collection. Cross-sectional survey. Patients were surveyed after their visit with a primary care provider. Data were obtained from patients of ten community-based primary care practices in the spring of 2001.

RESULTS:Almost all patients reported that they would support using a computer before each visit to prompt their doctor to: "do health screening tests" (92%), "counsel about health behaviors (like diet and exercise)" (92%) and "change treatments for health conditions" (86%). …