Public Health Commons^™

Bayesian Hierarchical Distributed Lag Models For Summer Ozone Exposure And Cardio-Respiratory Mortality, Yi Huang, Francesca Dominici, Michelle L. Bell

Johns Hopkins University, Dept. of Biostatistics Working Papers

In this paper, we develop Bayesian hierarchical distributed lag models for estimating associations between daily variations in summer ozone levels and daily variations in cardiovascular and respiratory (CVDRESP) mortality counts for 19 U.S. large cities included in the National Morbidity Mortality Air Pollution Study (NMMAPS) for the period 1987 - 1994.

At the first stage, we define a semi-parametric distributed lag Poisson regression model to estimate city-specific relative rates of CVDRESP associated with short-term exposure to summer ozone. At the second stage, we specify a class of distributions for the true city-specific relative rates to estimate an overall effect by …

Dynamical Epidemic Suppression Using Stochastic Prediction And Control, Ira Schwartz, Lora Billings, Erik Bollt

Department of Mathematics Faculty Scholarship and Creative Works

We consider the effects of noise on a model of epidemic outbreaks, where the outbreaks appear randomly. Using a constructive transition approach that predicts large outbreaks prior to their occurrence, we derive an adaptive control scheme that prevents large outbreaks from occurring. The theory is applicable to a wide range of stochastic processes with underlying deterministic structure.

The Provider System For Children's Mental Health: Workforce Capacity And Effective Treatment, Jane Koppelman

National Health Policy Forum

This issue brief examines two issues that are key to meeting children’s unmet needs for mental health care: ensuring that the provider supply is adequate and that the care delivered is effective. It describes the shortage of qualified providers to address children’s mental disorders, as well its possible causes; it describes how managed care, to a certain extent, drives practice patterns; and it discusses the gray areas in deciding which providers are most qualified to deliver what care. In addition, this paper introduces what is known about evidence-based care in children’s mental health, the extent to which it is being …

Licensed Electrician Dies When Electrocuted By 480volts, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Other

On July 4, 2003, a 36-year-old male lead electrician died after being electrocuted with 480 volts of electricity. A crew of five licensed electricians were working at an automotive supply manufacturing facility running wires to connect service for two air conditioning units (3-phase; 480 volts; 30 amp and 35 amp) and service for a lighting panel (3-phase; 277/480 volts and 200 amps). The manufacturing facility had been shut down for the holiday, and besides a facilities office worker in the facilities main office, the five men were the only workers at the site and had complete control of the facility …

Data Adaptive Estimation Of The Treatment Specific Mean, Yue Wang, Oliver Bembom, Mark J. Van Der Laan

U.C. Berkeley Division of Biostatistics Working Paper Series

An important problem in epidemiology and medical research is the estimation of the causal effect of a treatment action at a single point in time on the mean of an outcome, possibly within strata of the target population defined by a subset of the baseline covariates. Current approaches to this problem are based on marginal structural models, i.e., parametric models for the marginal distribution of counterfactural outcomes as a function of treatment and effect modifiers. The various estimators developed in this context furthermore each depend on a high-dimensional nuisance parameter whose estimation currently also relies on parametric models. Since misspecification …

Semiparametric Methods For The Binormal Model With Multiple Biomarkers, Debashis Ghosh

The University of Michigan Department of Biostatistics Working Paper Series

Abstract: In diagnostic medicine, there is great interest in developing strategies for combining biomarkers in order to optimize classification accuracy. A popular model that has been used when one biomarker is available is the binormal model. Extension of the model to accommodate multiple biomarkers has not been considered in this literature. Here, we consider a multivariate binormal framework for combining biomarkers using copula functions that leads to a natural multivariate extension of the binormal model. Estimation in this model will be done using rank-based procedures. We also discuss adjustment for covariates in this class of models and provide a simple …

Mainecare Managed Care Performance Report 2003, Catherine Ormond, Stuart Bratesman

Disability & Aging

No abstract provided.

Evaluating Uranium Depth Versus Socio-Economic Statistics For Residential Radon Vulnerability In Warren County, Kentucky, Anthony Iovanna

Masters Theses & Specialist Projects

Residences in Warren County, Kentucky, are characterized by high levels of residential radon, which is one of the radioactive daughter products of uranium. According to the United States Environmental Protection Agency (US EPA), radon exposure causes approximately 22,000 lung cancer deaths in the United States per year. The City of Bowling Green, in Warren County, is underlain by karst, an easily soluble limestone subsurface, which allows radon gas to travel easily through cracks and fissures. Carbonate rocks under Bowling Green are underlain by the Devonian Chattanooga Shale, a low-grade uranium ore and a potential source of radon gas. A digital …

Ua61/6 Newsletter Issue 4, Wku Institute For Rural Health Development & Research

WKU Administration Documents

Newsletter created by and about the Institute for Rural Health Development & Research. This issue contains:

• Simpson, Staci. Letter from the Director
• Institute for Rural Health Development & Research Impact Statement
• Mobile Health Unit Conference Attended
• WKU Mobile Health & Wellness Unit
• Kentucky State Fair Project
• Health House of Horrors
• Wilson, Richard. Faculty Presents at American Public Health Association Conference
• New Interdisciplinary Program: WellWorks
• Health Fair Event for Migrant Workers Held
• Local Interventions to Encourage the Enhancement of the Health of the Rural Elderly
• Jones, Susan. Predicting the Use of Personal Respiratory Protection Among Workers in Swine Confinement Buildings
• The …

Workers Crushed By Vehicles, Kentucky Injury Prevention And Research Center

Kentucky Haz Alerts--Motor Vehicle

To prevent motor vehicle repair injuries:

• Ensure that vehicles are positively restrained from moving with chocks.
• Do not place jack stands under potential moving vehicle parts.
• The space under a jack-suspended vehicle should not be entered unless suitable vehicle support stands are utilized.

Trabajadores Aplastados Por Vehículos, Kentucky Injury Prevention And Research Center

Kentucky Haz Alerts--Motor Vehicle

Para prevenir lesiones relacionadas con la reparación de automotores:

1. Asegúrese de que los vehículos estén firmemente inmovilizados con tacos.
2. No coloque los soportes bajo partes del vehículo que se puedan mover.
3. No se debe ocupar el espacio entre un vehículo suspendido con gato y el suelo a menos que se haga uso de bases de soporte adecuadas para el mismo.

Lisa Schechtman On Reproductive Health And Human Rights: Integrating Medicine, Ethics, And Law By Rebecca J. Cook, Bernard M. Dickens, And Mahmoud F. Fathalla. Oxford: Oxford University Press, 2003. 554 Pp., Lisa Schechtman

Human Rights & Human Welfare

A review of:

Reproductive Health and Human Rights: Integrating Medicine, Ethics, and Law by Rebecca J. Cook, Bernard M. Dickens, and Mahmoud F. Fathalla. Oxford: Oxford University Press, 2003. 554 pp.

Mental Healthcare In A Rural Community, Thuy Nguyen

Independent Study Project (ISP) Collection

This study intends to observe and document the picture of mental health in a rural setting specifically, the Keiskamahoek area. Also, the project aims to evaluate the changes, if any exist, that resulted from recent attempts to integrate mental healthcare into the primary healthcare setting and bring psychiatric patients back to the community environment for treatment.

Assessment Of A Body Composition-Focused Approach To Obesity Treatment, Beverly D. Hall

Loma Linda University Electronic Theses, Dissertations & Projects

Obesity is a significant United States’ public health concern. However, high relapse rates continue to be a problem for obesity treatment programs while the focus remains on weight loss, not body composition change. This study examined whether a clinic-based obesity treatment program, focused on body composition change through resistance training, lead to improved body composition, exercise behaviors, and attitude change from focus on weight loss to body composition change. Improvements in self efficacy, outcome expectations and stages of change were also examined. Forty-eight physician-referred overweight or obese adult women (mean body fat 41%, SD = 6.65%), completed assessments and questionnaires …

Answering The Earthquake, Thomas G. Plante

Psychology

During the past several years, the American Catholic Church has suffered an enormous earthquake due to the child sexual abuse crisis that was initially reported on January 6, 2002 by the Boston Globe Spotlight Team. Although the sexual abuse of children by priests had been in the news many times before, the recent case in Boston 14 Conversations resulted in perhaps the largest earthquake ever in the American Catholic Church. While the epicenter of the quake was centered in Boston, there were many significant aftershocks felt across the land. Sadly, Jesuits and Jesuit universities were not immune from the recent …

Lower Extremity Muscle Strength And Risk Of Self-Reported Hip Or Knee Osteoarthritis, Jennifer M. Hootman, Shannon J. Fitzgerald, Carol A. Macera, Steven N. Blair

Faculty Publications

Purpose: The purpose of this study was to investigate the gender-specific longitudinal association between quadriceps strength and self-reported, physician-diagnosed hip or knee osteoarthritis (OA).

Methods: Subjects were 3081 community-dwelling adults who were free of OA, joint symptoms and injuries, completed a maximum treadmill exercise test, had isokinetic knee extension and flexion and isotonic leg press strength measurements taken at baseline and returned at least one written follow-up survey. Multivariate logistic regression was used to estimate odds ratios and 95% confidence intervals.

Results: Women with moderate or high isokinetic quadriceps strength had a significantly reduced risk (55% to 64%) of hip …

Indigenous Healing Practices And Their Effect On Tb And Hiv/Tb Patients’ Utilization And Compliance With Anti-Tb Medication, Josephine Thinwa

Independent Study Project (ISP) Collection

A sample of 27 Tuberculosis patients attending New Brighton Clinic in small urban community for treatment were surveyed and interviewed on their use of alternative treatments and interpretation of TB. This study specifically focused on TB patients’ use of traditional medicine in treating TB and whether this use had an effect on the patients’ willingness to utilize and adherence to anti-TB treatment from the clinic. Investigations were also done to characterize if an HIV positive status influenced TB patients’ inclination to utilize traditional medicine. Through a focus group discussion with three traditional healers, information was provided on traditional medicine and …

Cervical Cancer Screening In Rural South Africa: An Analysis Of The Awareness, Attitudes, And Practices Of Women Served By The Masincedane Clinic, Jordan Schneider

Independent Study Project (ISP) Collection

The aim of this study was to conduct a brief investigation into the awareness, attitudes and practices regarding cervical cancer among women living in Keiskammahoek, a rural area in the Eastern Cape of South Africa. The objectives of this study were to:

• Determine if screening is available within a localized rural community and the methods that are being used.

• Determine if women are coming in for screening, the demographics of these women, and the circumstances that bring them into PHC clinics.

• Investigate the level of knowledge and education about cervical cancer and prevention among women within the …

Descriptive And Comparative Study Of The Nutritional Knowledge And Behavior Of Mothers Of Young Children Who Have Received Targeted Nutritional Education And Those Who Have Not As A Method To Ascertain The Effectiveness Of The Little Tree Nutritional And Educational Centre In Combating Malnutrition In The Pienaarsig Township Of Nieu Bethesda, Eastern Cape Province, South Africa, Amelia Peterson

Independent Study Project (ISP) Collection

No abstract provided.

Estimating The Retransformed Mean In A Heteroscedastic Two-Part Model, Alan H. Welsh, Xiao-Hua Zhou

UW Biostatistics Working Paper Series

Two distribution free estimators are proposed to estimate the mean of a dependent variable after fitting a semiparametric two-part heteroscedastic regression model to a transformation of the dependent variable. We show that the proposed estimators are consistent and have asymptotic normal distributions. We also compare their finite-sample performance in a simulation study. Finally, we illustrate the proposed methods in a real-world example of predicting in-patient health care costs.

Electronic Health Records: How Close? How Far To Go?, Lisa Sprague

National Health Policy Forum

This paper looks at the central role of the electronic health record (EHR) in health information technology. It considers the extent to which EHRs are in use and initiatives designed to increase their prevalence, as well as barriers to the widespread adoption of EHRs and efforts to surmount them. Particular attention is given to such obstacles as cost, the professional culture of physicians, standardization, and legal questions.

History-Adjusted Marginal Structural Models And Statically-Optimal Dynamic Treatment Regimes, Mark J. Van Der Laan, Maya L. Petersen

U.C. Berkeley Division of Biostatistics Working Paper Series

Marginal structural models (MSM) provide a powerful tool for estimating the causal effect of a treatment. These models, introduced by Robins, model the marginal distributions of treatment-specific counterfactual outcomes, possibly conditional on a subset of the baseline covariates. Marginal structural models are particularly useful in the context of longitudinal data structures, in which each subject's treatment and covariate history are measured over time, and an outcome is recorded at a final time point. However, the utility of these models for some applications has been limited by their inability to incorporate modification of the causal effect of treatment by time-varying covariates. …

A Marginal Model Approach For Analysis Of Multi-Reader Multi-Test Receiver Operating Characteristic (Roc) Data, Xiao Song, Xiao-Hua Zhou

UW Biostatistics Working Paper Series

The receiver operating characteristic (ROC) curve is a popular tool to characterize the capabilities of diagnostic tests with continuous or ordinal responses. One common design for assessing the accuracy of diagnostic tests is to have each patient examined by multiple readers with multiple tests; this design is most commonly used in a radiology setting, where the results of diagnostic tests depend on a radiologist's subjective interpretation. The most widely used approach for analyzing data from such a study is the Dorfman-Berbaum-Metz (DBM) method (Dorfman, Berbaum and Metz, 1992) which utilizes a standard analysis of variance (ANOVA) model for the jackknife …

Cancer Incidence Among Pesticide Applicators Exposed To Atrazine In The Agricultural Health Study, Jennifer A. Rusiecki, Anneclaire De Roos, Won Jin Lee, Mustafa Dosemeci, Jay H. Lubin, Jane A. Hoppin, Aaron Blair, Michael C. R. Alavanja

United States Public Health Resources

Background: Atrazine is the most heavily applied agricultural pesticide for crop production in the United States. Both animal and human studies have suggested that atrazine is possibly carcinogenic, but results have been mixed. We evaluated cancer incidence in atrazine-exposed pesticide applicators among 53 943 participants in the Agricultural Health Study, a prospective cohort study of licensed pesticide applicators in Iowa and North Carolina.
Methods: We obtained detailed pesticide exposure information using a self-administered questionnaire completed at the time of enrollment (1993–1997). Cancer incidence was followed through December 31, 2001. We used adjusted Poisson regression to calculate rate ratios (RRs) and …

Nonparametric Confidence Intervals For The One- And Two-Sample Problems, Xiao-Hua Zhou, Phillip Dinh

UW Biostatistics Working Paper Series

Confidence intervals for the mean of one sample and the difference in means of two independent samples based on the ordinary-t statistic suffer deficiencies when samples come from skewed distributions. In this article, we evaluate several existing techniques and propose new methods to improve coverage accuracy. The methods examined include the ordinary-t, the bootstrap-t, the biased-corrected acceleration (BCa) bootstrap, and three new intervals based on transformation of the t-statistic. Our study shows that our new transformation intervals and the bootstrap-t intervals give best coverage accuracy for a variety of skewed distributions; and that our new transformation intervals have shorter interval …

Medicaid's Disproportionate Share Hospital Program: Complex Structure, Critical Payments, Robert E. Mechanic

National Health Policy Forum

This background paper describes the history and political evolution of Medicaid’s disproportionate share hospital (DSH) program and examines DSH as it exists today. It highlights the importance of DSH payments for the viability of safety net hospitals and considers the consequences of states’ creative financing strategies for maximizing federal Medicaid matching funds. Finally, this paper reviews several options for improving the structure and effectiveness of the DSH program.

Occupational Exposure To Hot Environments: Florida Workers Need Help

Florida Public Health Review

No abstract provided.

Estimation Of Treatment Effects In Randomized Trials With Noncompliance And A Dichotomous Outcome , Mark J. Van Der Laan, Alan E. Hubbard, Nicholas P. Jewell

U.C. Berkeley Division of Biostatistics Working Paper Series

We propose a class of estimators of the treatment effect on a dichotomous outcome among the treated subjects within covariate and treatment arm strata in randomized trials with non-compliance. Recent articles by Vansteelandt and Goethebeur (2003) and Robins and Rotnitzky (2004) have presented consistent and asymptotically linear estimators of a causal odds ratio, which rely, beyond correct specification of a model for the causal odds ratio, on a correctly specified model for a potentially high dimensional nuisance parameter. In this article we propose consistent, asymptotically linear and locally efficient estimators of a causal relative risk and a new parameter -- …

Re-Engineering Systems For The Treatment Of Depression In Primary Care: Cluster Randomised Controlled Trial, A. J. Dietrich, Thomas E. Oxman, John W. Williams Jr., Herbert C. Schulberg, Martha L. Bruce, Pamela W. Lee, Sheila Barry

Dartmouth Scholarship

Objective: To test the effectiveness of an evidence based model for management of depression in primary care with support from quality improvement resources.

Laboratory Reporting Of Tuberculosis Test Results And Patient Treatment Initiation In California, Lisa Pascopella, Steffi Kellam, John Ridderhof, Daniel P. Chin, Arthur Reingold, Edward Desmond, Jennifer Flood, Sarah Royce

Public and Community Health Sciences Faculty Publications

Prompt laboratory reporting of tuberculosis (TB) test results is necessary for TB control. To understand the extent of and factors contributing to laboratory reporting delays and the impact of reporting delays on initiation of treatment of TB patients, we analyzed data from 300 consecutive culture-positive TB cases reported in four California counties in 1998. Laboratory reporting to the specimen submitter was delayed for 26.9% of smear-positive patients and 46.8% of smear-negative patients. Delays were associated with the type of laboratory that performed the testing and with delayed transport of specimens. Referral laboratories (public health and commercial) had longer median reporting …