Public Health Commons^™

Semiparametric Estimation Of Time-Dependent: Roc Curves For Longitudinal Marker Data, Yingye Zheng, Patrick Heagerty

UW Biostatistics Working Paper Series

One approach to evaluating the strength of association between a longitudinal marker process and a key clinical event time is through predictive regression methods such as a time-dependent covariate hazard model. For example, a time-varying covariate Cox model specifies the instantaneous risk of the event as a function of the time-varying marker and additional covariates. In this manuscript we explore a second complementary approach which characterizes the distribution of the marker as a function of both the measurement time and the ultimate event time. Our goal is to flexibly extend the standard diagnostic accuracy concepts of sensitivity and specificity to …

Optimization Of Breast Cancer Screening Modalities, Yu Shen, Giovanni Parmigiani

Johns Hopkins University, Dept. of Biostatistics Working Papers

Mathematical models and decision analyses based on microsimulations have been shown to be useful in evaluating relative merits of various screening strategies in terms of cost and mortality reduction. Most investigations regarding the balance between mortality reduction and costs have focused on a single modality, mammography. A systematic evaluation of the relative expenses and projected benefit of combining clinical breast examination and mammography is not at present available. The purpose of this report is to provide methodologic details including assumptions and data used in the process of modeling for complex decision analyses, when searching for optimal breast cancer screening strategies …

Maine Employer Experience And Perceptions Related To Providing Health Insurance: 2003 Summary Report, Gino Nalli, Elizabeth Kilbreth

Disability & Aging

No abstract provided.

The Relationship Of Health Beliefs And Health Value In Cardiovascular Outcomes, Kimberley Schaub

All-Inclusive List of Electronic Theses and Dissertations

Despite extensive theoretical information regarding Schwarzer's Health Action Process Approach the utility of the model pas yet to be explored within a chronic illness population. Using Schwarzer's Health Action Process Approach (Schwarzer, 1992), the purpose of this study was to investigate cardiovascular outcomes based on health beliefs and health value. Participants were eighty-one adults ages 42-87 with cardiovascular disease recruited from a cardiac rehabilitation program in Central Indiana. Participants completed instruments that assessed (a) health beliefs, (b) health value and, (c), quality of life. Measurements of physiological outcome (resting heart rate, distance walked, and metabolic equivalent) were also obtained. A …

Sensory Evaluation Of Gluten-Free Brownies Prepared Using Green Banana Flour, Banana-Potato Blend And Rice-Potato-Tapioca Blend, Sonia F. Murgueytio

All-Inclusive List of Electronic Theses and Dissertations

Increasing numbers of people worldwide are being diagnosed with Celiac Disease, an intestinal disorder caused by ingestion of foods containing gluten. Traditional baked goods are prepared using wheat flour that contains gluten. Literature suggests that the absorptive surface of the small intestine is damaged in people susceptible to gluten. Alternative gluten-free products are needed to improve the health of people with this disease. The purpose of this study was to assess the overall acceptability and palatability of chocolate brownies made with 100% banana flour or a blend of banana flour and potato starch. Appearance, color, texture, flavor and overall acceptability …

Bacteriolytic Activity Of Selected Vertebrate Sera For Borrelia Burgdorferi Sensu Stricto And Borrelia Bissettii, Amy J. Ullmann, Robert S. Lane, Klaus Kurtenbach, Michael Miller, Martin E. Schriefer, Nordin Zeidner, Joseph Piesman

United States Public Health Resources

An in vitro assay to evaluate the bacteriolytic activity of the complement pathway was applied to 2 strains of Borrelia bissettii, CO501 and DN127, and compared with that of B. burgdorferi sensu stricto B31. Sera from mule deer ( Odocoileus hemionus) and the Western Fence lizard ( Sceloporus occidentalis) were completely borreliacidal for B. burgdorferi and for both strains of B. bissettii. Serum from Bobwhite quail ( Colinus virginianus) was nonlytic for B. burgdorferi and partially lytic for B. bissettii strains, CO-501 and DN127. Serum from a New Zealand White rabbit ( Oryctolagus cuniculus) …

Heavy Equipment Owner/Operators Dying On The Job, Kentucky Injury Prevention And Research Center

Kentucky Haz Alerts--Other

To prevent heavy equipment injuries:

• Owner/operators should become familiar with and adhere to Kentucky Occupational Safety and Health guidelines.
• Manufacturers’ procedures for operation and maintenance of heavy equipment should be followed.
• Avoid potentially hazardous situations. Operators should perform a thorough hazard assessment before work is initiated.

Propietarios/Operadores De Equipo Pesado Mueren En Su Trabajo, Kentucky Injury Prevention And Research Center

Kentucky Haz Alerts--Motor Vehicle

Para prevenir lesiones al trabajar con equipo pesado:

1. Propietarios/operadores deberán familiarizarse y aplicar las normas de Seguridad y Salud Ocupacional de Kentucky.
2. Deberán ser seguidos los procedimientos indicados por el fabricante para la operación y mantenimiento de equipo pesado.
3. Evite situaciones que impliquen un riesgo potencial. Los operadores deberán llevar a cabo una valoración cuidadosa de los riesgos potenciales antes de iniciar el trabajo.

Barriers To Lesbian Health Care, Paula Bowles

Masters Theses & Specialist Projects

The primary purpose of this research was to examine a sample of sixteen lesbian women regarding the barriers to lesbian health-care. From this information several interpretive findings regarding lesbian health-care are made. Data were gathered via indepth interviews with each individual lesbian. The data suggest that most lesbian women do not reveal their sexual orientation to their primary-care physician for fear of reprisal. Most of the women interviewed do feel they receive adequate health-care from their physician. The women who participated in this project did so confidentially and were assigned pseudonyms. They were asked questions on a variety of topics, …

A Smoking Cessation Project For African American Women: Implications For Relational Research, Suzanne M. Hanna, Patricia W. Walker, Jerome F. Walker, Jacalyn A. Claes, Cheryl K. Stewart, Ann M. Swank, L. Jane Goldsmith

SHU Faculty Publications

Smoking cessation among African Americans is a primary health objective for the nation. African American women are more likely than their counterparts to have a high dependency upon nicotine. Studies with African American women report lower quit rates than those for whites. A culturally sensitive pilot project was designed for African American women to investigate smoking, perception of family environment (FES-R, Life Events Scale, family survey), feasibility of family-focused followup sessions, and an exercise program. Baseline cigarettes were negatively correlated with the FES-R subscales for cohesion, active-recreational orientation, and moral/ religious emphasis; they were positively correlated with negativity in an …

Data Analysis In The Antes System, Yavuz Tor

Theses and Dissertations - UTB/UTPA

Acanthosis nigricans is a skin condition that can be used as an indicator for the risk of developing type 2 diabetes in the future. Border Health Office, in University of Texas - Pan American, organizes screenings in schools for acanthosis nigricans. Screening results are, then, collected and evaluated in the Border Health Office. The ANTES System is a computer system that stores and manages the data collected in those screenings.

This study is on the analysis of those collected data to track the progress of data entry, to evaluate the progress on obesity and related problems, and to discover the …

Antes: A Web-Based Acanthosis Nigricans And Other Obesity Related Information System, Chunyue Wang

Theses and Dissertations - UTB/UTPA

Acanthosis nigricans is a cutaneous marker associated with systemic disorders and may serve as an indicator for risk of Type 2 diabetes. Acanthosis nigricans screening can help identify children who have high insulin levels and who may be at-risk for developing Type 2 diabetes. The ANTES system is a computerization attempt for acanthosis nigricans control of the student population from elementary schools and secondary schools in Texas. A general description of the system and the medical and history background of the ANTES program is given. The technology applied to the system is demonstrated. An overview of the system operation status …

Development Of Dose Conversion Coefficients For Radionuclides Produced In Spallation Neutron Sources: Quarterly Progress Report 8/20/03 – 12/01/03, Phillip W. Patton, Mark Rudin

Transmutation Sciences Physics (TRP)

A research consortium comprised of representatives from several universities and national laboratories has been established as part of this project to generate internal and external dose conversion coefficients for radionuclides produced in spallation neutron sources. Information obtained from this multi-year study will be used to support the siting and licensing of future accelerator-driven nuclear initiatives within the U.S. Department of Energy complex, including the Spallation Neutron Source (SNS) and Accelerator Production of Tritium (APT) Projects. Determination of these coefficients will also fill data gaps for several hundred radionuclides that exist in Federal Guide Report No. 11 and in Publications 68 …

Inadequate Physician Knowledge Of The Effects Of Diet On Blood Lipids And Lipoproteins., Mary M. Flynn, Chris N. Sciamanna, Kevin C. Vigilante

College of Population Health Faculty Papers

BACKGROUND:To assess the nutrition knowledge of physicians on the basic effects of diet on blood lipids and lipoproteins.

METHODS:Anonymous mailed dietary knowledge surveys to 6000 randomly selected physicians in the United States licensed in either Internal Medicine or Cardiology.RESULTS:Response rate: 16% (n = 639). Half of the physicians did not know that canola oil and 26% did not know olive oil were good sources of monounsaturated fat. Ninety-three percent (84% of cardiologists vs. 96% of internists; p < 0.001) did not know that a low-fat diet, in general, would increase blood triglycerides. Approximately three-quarters (70% of cardiologists vs. 77% of internists; p < 0.01) did not know a low-fat diet would decrease HDL-c and almost half (45%) thought that a low-fat diet would not change HDL-c.

CONCLUSIONS:If physicians are to implement dietary and cholesterol management guidelines, they will likely need to become more knowledgeable about nutrition.

Hiv Risk Behaviors In Adults With Serious Mental Illness: Testing The Imb Theory Of Hiv Risk Reduction, Leslie D. Bjork

All-Inclusive List of Electronic Theses and Dissertations

The Human Immunodeficiency Virus (HIV) has proliferated substantially since its initial identification in 1981. Studies ofHIV seroprevalence indicate a recent statistical surge in rural AIDS cases relative to urban locales (McKinney, 1998; Stephenson, 2000). Data also suggest adults with severe and persistent mental illness (SPMI) evidence higher behavioral risk for HIV infection than individuals in the general population (Carey, Carey, & Kalichman, 1997; McKinnon, Carey & Cournos, 1997). This study examined HIV risk behaviors in rural adults with SPMI, including analyses of sexual behaviors, psychiatric severity, and substance problems. In addition, Fisher and Fisher's (1992) Information-Motivation-Behavior (1MB) theory ofHIV risk …

Time-Series Studies Of Particulate Matter, Michelle L. Bell, Jonathan M. Samet, Francesca Dominici

Johns Hopkins University, Dept. of Biostatistics Working Papers

Studies of air pollution and human health have evolved from descriptive studies of the early phenomena of large increases in adverse health effects following extreme air pollution episodes, to time-series analyses and the development of sophisticated regression models. In fact, advanced statistical methods are necessary to address the many challenges inherent in the detection of a small pollution risk in the presence of many confounders. This paper reviews the history, methods, and findings of the time-series studies estimating health risks associated with short-term exposure to particulate matter, though much of the discussion is applicable to epidemiological studies of air pollution …

Smooth Quantile Ratio Estimation With Regression: Estimating Medical Expenditures For Smoking Attributable Diseases, Francesca Dominici, Scott L. Zeger

Johns Hopkins University, Dept. of Biostatistics Working Papers

In this paper we introduce a semi-parametric regression model for estimating the difference in the expected value of two positive and highly skewed random variables as a function of covariates. Our method extends Smooth Quantile Ratio Estimation (SQUARE), a novel estimator of the mean difference of two positive random variables, to a regression model.

The methodological development of this paper is motivated by a common problem in econometrics where we are interested in estimating the difference in the average expenditures between two populations, say with and without a disease, taking covariates into account. Let Y1 and Y2 be two positive …

Bridging Silos, Part Ii: Di, Ssi, Medicare, And Medicaid Issues And Initiatives, Karen Matherlee

National Health Policy Forum

The second of two papers on the general topic of public disability and health benefits, this background paper lays out some key issues confronting the Social Security Disability Insurance, Supplemental Security Income, Medicare, and Medicaid programs. It also discusses major initiatives to address those issues, in light of growing administrative, fiscal, and other problems.

Bridging Silos, Part I: Linkages Among The Di, Ssi, Medicare, And Medicaid Programs, Karen Matherlee

National Health Policy Forum

This paper, the first of two on the general topic of public disability and health benefits, centers on the fundamentals of the Disability Insurance and Supplemental Security Income programs and their relationships with Medicare and Medicaid. In addition to looking at the programs’ definitions, distinctions, and overlaps, it reviews the effects on them of the Ticket to Work and Work Incentives Improvement Act of 1999 and, to a lesser extent, the Personal Responsibility and Work Opportunity Reconciliation Act of 1996.

Sailing Schip Through Troubled Waters, Jennifer Ryan

National Health Policy Forum

As the State Children’s Health Insurance Program (SCHIP) enters its sixth year of operation, states have continued their commitment to children’s coverage and to reaching out to the uninsured. This issue brief explores the current status of SCHIP in light of fiscal pressures that have been created by the state budget crisis. It highlights some of the key successes in the program thus far and notes several examples of state initiatives to serve particularly vulnerable populations and collect outcomes data and information about access to care.

A Corrected Pseudo-Score Approach For Additive Hazards Model With Longitudinal Covariates Measured With Error, Xiao Song, Yijian Huang

UW Biostatistics Working Paper Series

In medical studies, it is often of interest to characterize the relationship between a time-to-event and covariates, not only time-independent but also time-dependent. Time-dependent covariates are generally measured intermittently and with error. Recent interests focus on the proportional hazards framework, with longitudinal data jointly modeled through a mixed effects model. However, approaches under this framework depend on the normality assumption of the error, and might encounter intractable numerical difficulties in practice. This motivates us to consider an alternative framework, that is, the additive hazards model, under which little has been done when time-dependent covariates are measured with error. We propose …

Rural Health Care In The Electronic Age (Danville, Pa), Lisa Sprague, Nora Super

National Health Policy Forum

This site visit to the Geisinger Health System in central Pennsylvania explored the use of technology in providing health care to an aging, rural population with a high index of chronic-care needs. The agenda included an in-depth examination of Geisinger’s electronic medical record and its use in various domains of care, including outpatient clinics, disease management, and non-Geisinger medical practices and community hospitals. The program also highlighted specific care management initiatives in the areas of radiology, stroke, and obesity. Geisinger’s advantages as an integrated system dominant in its market, with the resources to invest in technology were weighed in considering …

Muriéndose Por Conducir - Colisiones Ocupacionales De Automotores En Kentucky, Kentucky Injury Prevention And Research Center

Kentucky Haz Alerts--Motor Vehicle

Para prevenir lesiones al trabajar con vehículos motorizados:

Los empleadores deben proporcionar programas de entrenamiento sobre seguridad al conducir, obligatorios y adaptados a sus empleados, que incluyan Reconocimiento de Síntomas de Distracción / Déficit de Atención del Conductor y Fatiga del Conductor.

Los empleados deben evitar distracciones y llevar siempre puesto el cinturón de seguridad.

Evite exponerse usted mismo a una situación potencialmente riesgosa. Los conductores deben siempre permanecer alerta y practicar Técnicas Defensivas de Conducción.

Dying To Drive – Occupational Motor Vehicle Collisions In Kentucky, Kentucky Injury Prevention And Research Center

Kentucky Haz Alerts--Motor Vehicle

To prevent motor vehicle injuries while working:

• Employers should provide mandatory comprehensive employee driver safety training programs including recognition of symptoms of driver distraction/inattention and driver fatigue.
• Employees should avoid distractions and wear seat belts at all times.
• Don’t place yourself in a potentially hazardous situation. Drivers should always stay alert and practice defensive driving techniques.

Content And Criterion Validity Evaluation Of National Public Health Performance Standards Measurement Instruments., Joyce Beaulieu, F. Douglas Scutchfield, Ann V. Kelly

Preventive Medicine and Environmental Health Faculty Publications

OBJECTIVE: The Centers for Disease Control and Prevention's National Public Health Performance Standards Program (NPHPSP) has developed instruments to measure the performance of local and state public health departments on the 10 "Essential Services of Public Health," which have been tested in several states. This article is a report of the evaluation of the content and criterion validity of the local public health performance assessment instrument, and the content validity of the state public health performance assessment instrument.

METHODS: Health department performance is measured using a set of indicators developed for the 10 Essential Services of Public Health and a …

Decreasing Barriers For Teens: Evaluation Of A New Teenage Pregnancy Prevention Strategy In School-Based Clinics, Abbey C. Sidebottom, Amanda Birnbaum, Sarah S. Nafstad

Department of Public Health Scholarship and Creative Works

Sidebottom et al seek to evaluate the effects of the change in distribution systems on students' receipt of requested contraceptives and demand for contraceptive school-based clinics (SBC). The result of the study reveals that the average number of requests per student was higher under the voucher system, possibly as a consequence of expires vouchers resulting in repeated requests. The findings also suggest that SBCs could go a step further in reducing adolescents' barriers to accessing contraceptives by adopting an on-site direct delivery system..

Overview, David B. Nash

College of Population Health Faculty Papers

No abstract available.

2001 Michigan Hospital Cqi/Tqm Study, Colleen L. Croxall

Wayne State University Dissertations

In recent years, there has been significant interest in the application of total quality management/continuous quality improvement (TQM/CQI) within health care organizations. The health care industry, in its quest to improve outcomes with fewer resources, began to look at CQI/TQM as a possible solution. To date, the most comprehensive and enthusiastic response to efforts to improve quality while containing or lowering costs is reflected in hospitals' commitment to continuous quality improvement/total quality management (CQI/TQM). The health care industry, particularly hospitals, has embraced the concepts of CQI/TQM with the belief that adoption will lead to an improvement in both the quality …

Socio-Economic And Demographic Factors Associated With Injecting Drug Use Among Drug Users In Karachi, Pakistan, A. Agha, S. Parviz, M. Younus, Zafar Fatmi

Community Health Sciences

Objective: To identify the socio-economic and demographic factors associated with injecting drug users (IDUs) in Karachi.

Methods: We recruited 242 IDUs (taking drugs through sub-dermal routes) and 231 non-IDUs (taking drugs other than sub-dermal routes) from February through June 1996. IDUs were interviewed regarding sociodemographic factors, economic condition, and social network (marital status, living with spouse). In addition, information regarding location of drug users within the city (districts of Karachi) and current history of sexually transmitted diseases (STDs) were gathered. Moreover, blood samples were also obtained for HIV testing

.Results: Multivariate analysis showed that the income generation via illegal …

Smooth Quantile Ratio Estimation, Francesca Dominici, Leslie Cope, Daniel Q. Naiman, Scott L. Zeger

Johns Hopkins University, Dept. of Biostatistics Working Papers

In a study of health care expenditures attributable to smoking, we seek to compare the distribution of medical costs for persons with lung cancer or chronic obstructive pulmonary disease (cases) to those without (controls) using a national survey which includes hundreds of cases and thousands of controls. The distribution of costs is highly skewed toward larger values, making estimates of the mean from the smaller sample dependent on a small fraction of the biggest values. One approach to deal with the smaller sample is to rely on a simple parametric model such as the log-normal, but this makes the undesirable …