Medicine and Health Sciences Commons^™

The Impact Of Medicare Prescription Drug Coverage On The Use Of Antidementia Drugs, Nicole R. Fowler, Yi-Fan Chen, Christiana A. Thurton, Aiju Men, Eric G. Rodriguez, Julie M. Donohue

Publications and Research

Background Cholinesterase inhibitors and memantine are prescribed to slow the progression dementia. Although the efficacy of these drugs has been demonstrated, their effectiveness, from the perspective of patients and caregivers, has been questioned. Little is known about whether the demand for cholinesterase inhibitors and memantine are sensitive to out-of-pocket cost. Using the 2006 implementation of Medicare Part D as a natural experiment, this study examines the impact of changes in drug coverage on use of cholinesterase inhibitors and memantine by comparing use before and after Medicare Part D implementation among older adults who did and did not experience a change …

Testosterone, Cardiovascular, Men, Trial, Lin Xu, Guy Freeman, Benjamin J. Cowling, Mary Schooling

Publications and Research

Background
Testosterone therapy is increasingly promoted. No randomized placebo-controlled trial has been implemented to assess the effect of testosterone therapy on cardiovascular events, although very high levels of androgens are thought to promote cardiovascular disease.

Methods
A systematic review and meta-analysis was conducted of placebo-controlled randomized trials of testosterone therapy among men lasting 12+ weeks reporting cardiovascular-related events. We searched PubMed through the end of 2012 using “(“testosterone” or “androgen”) and trial and (“random*”)” with the selection limited to studies of men in English, supplemented by a bibliographic search of the World Health Organization trial registry. Two reviewers independently searched, …

Age-Period-Cohort Projections Of Ischaemic Heart Disease Mortality By Socio-Economic Position In A Rapidly Transitioning Chinese Population, Irene O.L. Won, Benjamin J. Cowling, Gabriel M. Leung, Mary Schooling

Publications and Research

Background
With economic development and population aging, ischaemic heart disease (IHD) is becoming a leading cause of mortality with widening inequalities in China. To forewarn the trends in China we projected IHD trends in the most economically developed part of China, i.e., Hong Kong.

Methods
Based on sex-specific IHD mortality rates from 1976 to 2005, we projected mortality rates by neighborhood-level socio-economic position (i.e., low- or high-income groups) to 2020 in Hong Kong using Poisson age-period-cohort models with autoregressive priors.

Results
In the low-income group, age-standardized IHD mortality rates among women declined from 33.3 deaths in 1976–1980 to 19.7 per …

Network Firewall Dynamics And The Subsaturation Stabilization Of Hiv, Bilal Khan, Kirk Dombrowski, Mohamed Saad, Katherine Mclean, Samuel Friedman

Publications and Research

In 2001, Friedman et al. conjectured the existence of a “firewall effect” in which individuals who are infected with HIV, but remain in a state of low infectiousness, serve to prevent the virus from spreading. To evaluate this historical conjecture, we develop a new graph-theoreticmeasure that quantifies the extent towhich Friedman’s firewall hypothesis (FH) holds in a risk network.We compute this new measure across simulated trajectories of a stochastic discrete dynamical system that models a social network of 25,000 individuals engaging in risk acts over a period of 15 years. The model’s parameters are based on analyses of data collected …

Infective Endocarditis In The U.S., 1998–2009: A Nationwide Study, David H. Bor, Steffie Woolhandler, Rachel Nardin, David Brusch, David U. Himmelstein

Publications and Research

Background
Previous studies based on local case series estimated the annual incidence of endocarditis in the U.S. at about 4 per 100,000 population. Small-scale studies elsewhere have reported similar incidence rates. However, no nationally-representative population-based studies have verified these estimates.

Methods and Findings
Using the 1998–2009 Nationwide Inpatient Sample, which provides diagnoses from about 8 million U.S. hospitalizations annually, we examined endocarditis hospitalizations, bacteriology, co-morbidities, outcomes and costs. Hospital admissions for endocarditis rose from 25,511 in 1998 to 38, 976 in 2009 (12.7 per 100,000 population in 2009). The age-adjusted endocarditis admission rate increased 2.4% annually. The proportion of patients …

The Effect Of Statins On Testosterone In Men And Women, A Systematic Review And Meta-Analysis Of Randomized Controlled Trials, Mary Schooling, Shiu Lun Au Yeung, Guy Freeman, Benjamin J. Cowling

Publications and Research

Background
Statins are extensively used for cardiovascular disease prevention. Statins reduce mortality rates morethan other lipid-modulating drugs, although evidence from randomized controlled trials also suggests that statinsunexpectedly increase the risk of diabetes and improve immune function. Physiologically, statins would beexpected to lower androgens because statins inhibit production of the substrate for the local synthesis of androgens and statins’ pleiotropic effects are somewhat similar to the physiological effects of lowering testosterone, so we hypothesized that statins lower testosterone.

Methods
A meta-analysis of placebo-controlled randomized trials of statins to test the a priori hypothesis that statins lower testosterone. We searched the PubMed, …

Curatedovariandata: Clinically Annotated Data For The Ovarian Cancer Transcriptome, Benjamin Frederick Ganzfried, Markus Riester, Benjamin Haibe-Kains, Thomas Risch, Svitlana Tyekucheva, Ina Jazic, Xin Victoria Wang, Mahnaz Ahmadifar, Michael J. Birrer, Giovanni Parmigiani, Curtis Huttenhower, Levi Waldron

Publications and Research

This article introduces a manually curated data collection for gene expression meta-analysis of patients with ovarian cancer and software for reproducible preparation of similar databases. This resource provides uniformly prepared microarray data for 2970 patients from 23 studies with curated and documented clinical metadata. It allows users to efficiently identify studies and patient subgroups of interest for analysis and to perform meta-analysis immediately without the challenges posed by harmonizing heterogeneous microarray technologies, study designs, expression data processing methods and clinical data formats. We confirm that the recently proposed biomarker CXCL12 is associated with patient survival, independently of stage and optimal …

Sexual Orientation And Functional Pain In U.S. Young Adults: The Mediating Role Of Childhood Abuse, Andrea L. Roberts, Margaret Rosario, Heather L. Corliss, David Wypij, Jennifer R. Lightdale, S. Bryn Austin

Publications and Research

Objective: Pain without known pathology, termed ‘‘functional pain,’’ causes much school absenteeism, medication usage, and medical visits. Yet which adolescents are at risk is not well understood. Functional pain has been linked to childhood abuse, and sexual orientation minority youth (gay, lesbian, bisexual, ‘‘mostly heterosexual,’’ and heterosexual with same-sex sexual contact) are more likely to be victims of childhood abuse than heterosexuals, thus may be at greater risk of functional pain.

Methods: We examined sexual orientation differences in past-year prevalence of functional headache, pelvic, and abdominal pain and multiple sites of pain in 9,864 young adults (mean age = …

A Naturally-Occurring Histone Acetyltransferase Inhibitor Derived From Garcinia Indica Impairs Newly Acquired And Reactivated Fear Memories, Stephanie A. Maddox, Casey S. Watts, Valerie Doyere, Glenn E. Schafe

Publications and Research

The study of the cellular and molecular mechanisms underlying the consolidation and reconsolidation of traumatic fear memories has progressed rapidly in recent years, yet few compounds have emerged that are readily useful in a clinical setting for the treatment of anxiety disorders such as post-traumatic stress disorder (PTSD). Here, we use a combination of biochemical, behavioral, and neurophysiological methods to systematically investigate the ability of garcinol, a naturallyoccurring histone acetyltransferase (HAT) inhibitor derived from the rind of the fruit of the Kokum tree (Garcina indica), to disrupt the consolidation and reconsolidation of Pavlovian fear conditioning, a widely studied rodent model …

Motivational Interviewing Targeting Risk Behaviors For Youth Living With Hiv In Thailand, Chokechai Rongkavilit, Sylvie Naar-King, Bo Wang, Apirudee Panthong, Torsak Bunupuradah, Jeffrey T. Parsons, Supalak Phonphithak, Juline A. Koken, Pichai Saengcharnchai, Praphan Phanuphak

Publications and Research

Healthy Choices, a four-session motivational interviewing-based intervention, reduces risk behaviors among US youth living with HIV (YLWH). We randomized 110 Thai YLWH (16–25 years) to receive either Healthy Choices or time-matched health education (Control) over 12 weeks. Risk behaviors were assessed at baseline, 1, and 6 months post-session. The pilot study was not powered for between-group differences; there were no statistical differences in sexual risks, alcohol use, and antiretroviral adherence between the two groups at any visit. In within-group analyses, Healthy Choices group demonstrated decreases in the proportion of HIV-negative partners (20 vs 8.2 %, P = 0.03) and HIV …

A Guide To Enterotypes Across The Human Body: Meta- Analysis Of Microbial Community Structures In Human Microbiome Datasets, Omry Koren, Dan Knights, Antonio Gonzalez, Levi Waldron, Nicola Segata, Rob Knight, Curtis Huttenhower, Ruth E. Ley

Publications and Research

Recent analyses of human-associated bacterial diversity have categorized individuals into ‘enterotypes’ or clusters based on the abundances of key bacterial genera in the gut microbiota. There is a lack of consensus, however, on the analytical basis for enterotypes and on the interpretation of these results. We tested how the following factors influenced the detection of enterotypes: clustering methodology, distance metrics, OTU-picking approaches, sequencing depth, data type (whole genome shotgun (WGS) vs.16S rRNA gene sequence data), and 16S rRNA region. We included 16S rRNA gene sequences from the Human Microbiome Project (HMP) and from 16 additional studies and WGS sequences from …

Changes In Natural Killer Cell Activation And Function During Primary Hiv-1 Infection, Vivek Naranbhai, Marcus Altfeld, Salim S. Abdool Karim, Thumbi Ndung’U, Quarraisha Abdool Karim, William H. Carr

Publications and Research

Background: Recent reports suggest that Natural Killer (NK) cells may modulate pathogenesis of primary HIV-1 infection. However, HIV dysregulates NK-cell responses. We dissected this bi-directional relationship to understand how HIV impacts NK-cell responses during primary HIV-1 infection.

Methodology/Principal Findings: Paired samples from 41 high-risk, initially HIV-uninfected CAPRISA004 participants were analysed prior to HIV acquisition, and during viraemic primary HIV-1 infection. At the time of sampling post-infection five women were seronegative, 11 women were serodiscordant, and 25 women were seropositive by HIV-1 rapid immunoassay. Flow cytometry was used to measure NK and T-cell activation, NK-cell receptor expression, cytotoxic and cytokine-secretory functions, …

Estimation Of Total Body Skeletal Muscle Mass In Chinese Adults: Prediction Model By Dual-Energy X-Ray Absorptiometry, Xinyu Zhao, Zimian Wang, Junyi Zhang, Jianming Hua, Wei He, Shankuan Zhu

Publications and Research

Background: There are few reports on total body skeletal muscle mass (SM) in Chinese. The objective of this study is to establish a prediction model of SM for Chinese adults.

Methodology: Appendicular lean soft tissue (ALST) was measured by dual energy X-ray absorptiometry (DXA) and SM by magnetic resonance image (MRI) in 66 Chinese adults (52 men and 14 women). Images of MRI were segmented into compartments including intermuscular adipose tissue (IMAT) and IMAT-free SM. Regression was used to fit the prediction model SM~czk|ALST. Age and gender were adjusted in the fitted model. The piece-wise linear function was performed to …

Corticospinal Reorganization After Locomotor Training In A Person With Motor Incomplete Paraplegia, Nupur Hajela, Chaithanya K. Mummidisetty, Andrew C. Smith, Maria Knikou

Publications and Research

Activity-dependent plasticity as a result of reorganization of neural circuits is a fundamental characteristic of the central nervous system that occurs simultaneously in multiple sites. In this study, we established the effects of subthreshold transcranial magnetic stimulation (TMS) over the primary motor cortex region on the tibialis anterior (TA) long-latency flexion reflex. Neurophysiological tests were conducted before and after robotic gait training in one person with a motor incomplete spinal cord injury (SCI) while at rest and during robotic-assisted stepping. The TA flexion reflex was evoked following nonnociceptive sural nerve stimulation and was conditioned by TMS at 0.9 TA motor …

Anxiety In Disabling Osteoarthritis: Implications For Research And Practice, Ray Marks

Publications and Research

No abstract provided.

‘What’S In The Niddk Cdr?’—Public Query Tools For The Niddk Central Data Repository, Huaqin Pan, Mary-Anne Ardini, Vesselina Bakalov, Michael Delatte, Paul Eggers, Laxminarayana Ganapathi, Craig R. Hollingsworth, Joshua Levy, Sheping Li, Joseph Pratt, Norma Pugh, Ying Qin, Rebekah Rasooly, Helen Ray, Jean E. Richardson, Amanda Flynn Riley, Susan M. Rogers, Sylvia Tan, Charles F. Turner, Stacie White, Philip C. Cooley

Publications and Research

The National Institute of Diabetes and Digestive Disease (NIDDK) Central Data Repository (CDR) is a web-enabled resource available to researchers and the general public. The CDR warehouses clinical data and study documentation from NIDDK funded research, including such landmark studies as The Diabetes Control and Complications Trial (DCCT, 1983–93) and the Epidemiology of Diabetes Interventions and Complications (EDIC, 1994–present) follow-up study which has been ongoing for more than 20 years. The CDR also houses data from over 7 million biospecimens representing 2 million subjects. To help users explore the vast amount of data stored in the NIDDK CDR, we developed …

Bridging The Gap Between Health And Justice, Lior Gideon

Publications and Research

No abstract provided.

Infant Mortality In American Indians And Alaska Natives 1995–1999 And 2000–2004, Patrik Johansson, Weston Williams, Ayman El-Mohandes

Publications and Research

Objectives. (1) To determine the infant mortality rate (IMR) in American Indians/ Alaska Natives (AI/AN) and Whites between 1995–1999 and 2000–2004. (2) To compare the leading causes of infant mortality in AI/AN and Whites. (3) To examine differences in neonatal vs. postneonatal causes of death in Whites and AI/AN.

Methods. Using the 1995–99 and 2000–04 Centers for Disease Control and Prevention’s National Center for Health Statistics national linked birth/infant death data, we examined neonatal and postneonatal IMR among AI/AN and Whites.

Results. AI/AN experienced significantly greater overall IMR in 1995–1999 and 2000–2004 than Whites. While the reduction in …

Strengths And Limitations Of Qualitative Approaches To Research In Occupational Health Psychology, Irvin Sam Schonfeld, Joseph J. Mazzola

Publications and Research

Like all research methods, qualitative methods have strengths and limitations. This chapter describes seven strengths and five limitations. With an understanding of their strengths and limitations and how to minimize and/or balance them, occupational health psychology (OHP) researchers can benefit from qualitative methods. It is important to understand that qualitative findings do not establish generalizable cause-effect relations. However, qualitative methods can help an OHP researcher develop a theory of causality and derive hypotheses related to the theory and, thus, motivate quantitatively organized research designed to test the hypotheses. The challenge for the OHP researcher is to be mindful of what …

Circularized Synthetic Oligodeoxynucleotides Serve As Promoterless Rna Polymerase Iii Templates For Small Rna Generation In Human Cells, Christine I. Seidl, Lodoe Lama, Kevin Ryan

Publications and Research

Synthetic RNA formulations and viral vectors are the two main approaches for delivering small therapeutic RNA to human cells. Here we report findings supporting an alternative strategy in which an endogenous human RNA polymerase (RNAP) is harnessed to make RNA hairpin-containing small RNA from synthetic single-stranded DNA oligonucleotides. We report that circularizing a DNA template strand encoding a pre-microRNA hairpin mimic can trigger its circumtranscription by human RNAP III in vitro and in human cells. Sequence and secondary structure preferences that appear to promote productive transcription are described. The circular topology of the template is required for productive transcription, at …

The Role Of Dairy Products And Milk In Adolescent Obesity: Evidence From Hong Kong’S ‘‘Children Of 1997’’ Birth Cohort, Shi Lin Lin, Marie Tarrant, Lai Ling Hui, Man Ki Kwok, Tai Hing Lam, Gabriel M. Leung, Mary Schooling

Publications and Research

Background
Observational studies, mainly from Western populations, suggest dairy consumption is inversely associated with adiposity. However, in these populations the intake range is limited and both diet and obesity may share social patterning. Evidence from non-Western developed settings with different social patterning, is valuable in distinguishing whether observed associations are biologically mediated or socially confounded.

Objective
To examine the associations of milk or other dairy product consumption with adolescent obesity.

Methods
We used multivariable linear regression models to examine the associations of milk or other dairy product consumption, obtained from a food frequency questionnaire, at 11 years with body mass …

The Effect Of Weight Loss On Changes In Health-Related Quality Of Life Among Overweight And Obese Women With Urinary Incontinence, Angela Marinilli Pinto, Leslee L. Subak, Sanae Nakagawa, Eric Vittinghoff, Rena R. Wing, John W. Kusek, William H. Herman, Delia Smith West, Miriam Kuppermann

Publications and Research

OBJECTIVE: To estimate the effect of change in weight and change in urinary incontinence (UI) frequency on changes in preference-based measures of health-related quality of life (HRQL) among overweight and obese women with UI participating in a weight loss trial.

METHODS: We conducted a longitudinal cohort analysis of 338 overweight and obese women with UI enrolled in a randomized clinical trial comparing a behavioral weight loss intervention to an educational control condition. At baseline, 6, and 18 months, health utilities were estimated using the Health Utilities Index Mark 3 (HUI3), a transformation of the SF-36 to the preference-based SF-6D, and …

Ambiguity, Ambivalence, And Apprehensions Of Taking Hiv-1 Pre-Exposure Prophylaxis Among Male Couples In San Francisco: A Mixed Methods Study, Parya Saberi, Kristine Elizabeth Gamarel, Torsten B. Neilands, Megan Comfort, Nicolas Sheon, Lynae A. Darbes, Mallory O. Johnson

Publications and Research

Objective: We conducted a mixed-methods study to examine serodiscordant and seroconcordant (HIV-positive/HIVpositive) male couples’ PrEP awareness, concerns regarding health care providers offering PrEP to the community, and correlates of PrEP uptake by the HIV-negative member of the couple.

Design: Qualitative sub-study included one-on-one interviews to gain a deeper understanding of participants’ awareness of and experiences with PrEP and concerns regarding health care providers offering PrEP to men who have sex with men (MSM). Quantitative analyses consisted of a cross-sectional study in which participants were asked about the likelihood of PrEP uptake by the HIV-negative member of the couple and level …

Inter-Individual Variation During Transcranial Direct Current Stimulation And Normalization Of Dose Using Mri-Derived Computational Models, Abhishek Datta, Dennis Quangvinh Truong, Preet Minhas, Lucas C. Parra, Marom Bikson

Publications and Research

Background: Transcranial Direct Current Stimulation (tDCS) is a non-invasive, versatile, and safe neuromodulation technology under investigation for the treatment of neuropsychiatric disorders, adjunct to rehabilitation, and cognitive enhancement in healthy adults. Despite promising results, there is variability in responsiveness. One potential source of variability is the intensity of current delivered to the brain which is a function of both the operator controlled tDCS dose (electrode montage and total applied current) and subject specific anatomy. We are interested in both the scale of this variability across anatomical typical adults and methods to normalize inter-individual variation by customizing tDCS dose. Computational FEM …

Two-Factor Theory – At The Intersection Of Health Care Management And Patient Satisfaction, Josef Bohm

Publications and Research

Using data obtained from the 2004 Joint Canadian/United States Survey of Health, an analytic model using principles derived from Herzberg’s motivational hygiene theory was developed for evaluating patient satisfaction with health care. The analysis sought to determine whether survey variables associated with consumer satisfaction act as Hertzberg factors and contribute to survey participants’ self-reported levels of health care satisfaction. To validate the technique, data from the survey were analyzed using logistic regression methods and then compared with results obtained from the two-factor model. The findings indicate a high degree of correlation between the two methods. The two-factor analytical methodology offers …

The Role Of Dental Hygienists In Conducting Rapid Hiv Testing, Anthony J. Santella, Susan H. Davide, Marilyn Cortell, Winnie Furnari, Janet Tuthill

Publications and Research

Expanding rapid HIV testing in the dental setting may increase the number of individuals who are aware of their HIV status and can begin medical care and social support services if seropositive and appropriate.

Risk Factor Detection As A Metric Of Starhs Performance For Hiv Incidence Surveillance Among Female Sex Workers In Kigali, Rwanda, Sarah L. Braunstein, Janneke H. Van De Wijgert, Joseph Vyankandondera, Evelyn Kestelyn, Justin Ntirushwa, Denis Nash

Publications and Research

Background:
The epidemiologic utility of STARHS hinges not only on producing accurate estimates of HIV incidence, but also on identifying risk factors for recent HIV infection.

Methods:
As part of an HIV seroincidence study, 800 Rwandan female sex workers (FSW) were HIV tested, with those testing positive further tested by BED-CEIA (BED) and AxSYM Avidity Index (Ax-AI) assays. A sample of HIV-negative (N=397) FSW were followed prospectively for HIV seroconversion. We compared estimates of risk factors for: 1) prevalent HIV infection; 2) recently acquired HIV infection (RI) based on three different STARHS classifications (BED alone, Ax-AI alone, BED/Ax-AI combined); and …

Psychosocial Vulnerabilities To Depression After Acute Coronary Syndrome: The Pivotal Role Of Rumination In Predicting And Maintaining Depression, Ellen-Ge Denton, Nina Rieckmann, Karina W. Davidson, William F. Chaplin

Publications and Research

Psychosocial vulnerabilities may predispose individuals to develop depression after a significant life stressor, such as an acute coronary syndrome (ACS).The aims are (1) to examine the interrelations among vulnerabilities, and their relation with changes in depressive symptoms 3 months after ACS, (2) to prospectively assess whether rumination interacts with other vulnerabilities as a predictor of later depressive symptoms, and (3) to examine how these relations differ between post-ACS patients who meet diagnostic criteria for depression at baseline versus patients who do not. Within 1week after hospitalization for ACS, and again after 3 months, 387 patients (41% female, 79.6% white, mean …

Weaponizing Tear Gas: Bahrain’S Unprecedented Use Of Toxic Chemical Agents Against Civilians., Richard Sollom, Holly G. Atkinson

Publications and Research

The Bahraini government’s response to the early 2011 pro-democracy protests was brutal, systematic, and violent. In addition to birdshot and rubber bullets, government law enforcement attacked unarmed protestors with toxic chemical agents including tear gas. The government’s crackdown on the medical profession was especially harmful, as security forces arrested and detained doctors, raided health facilities, and obstructed patients from receiving necessary care. This report’s findings are based on field research that the authors conducted in Bahrain (April 2012) to investigate excessive use of force by law enforcement officials since June 2011—the end of Bahrain’s state of emergency. The medico-legal team …

Composition Of The Adult Digestive Tract Bacterial Microbiome Based On Seven Mouth Surfaces, Tonsils, Throat And Stool Samples, Nicola Segata, Susan Kinder Haake, Peter Mannon, Katherine P. Lemon, Levi Waldron, Dirk Gevers, Curtis Huttenhower, Jacques Izard

Publications and Research

Background: To understand the relationship between our bacterial microbiome and health, it is essential to define the microbiome in the absence of disease. The digestive tract includes diverse habitats and hosts the human body’s greatest bacterial density. We describe the bacterial community composition of ten digestive tract sites from more than 200 normal adults enrolled in the Human Microbiome Project, and metagenomically determined metabolic potentials of four representative sites.

Results: The microbiota of these diverse habitats formed four groups based on similar community compositions: buccal mucosa, keratinized gingiva, hard palate; saliva, tongue, tonsils, throat; sub- and supra-gingival plaques; and stool. …