Statistics and Probability Commons^™

Chagas Disease In Hiv-Infected Patients: It’S Time To Consider The Diagnosis, Melissa Nolan Ph.D., Mph, Natasha S. Hochberg

Faculty Publications

No abstract provided.

Effect Of An Antenatal Lifestyle Intervention On Dietary Inflammatory Index And Its Associations With Maternal And Fetal Outcomes: A Secondary Analysis Of The Pears Trial, Sarah Louise Killen, Catherine M. Phillips, Anna Delahunt, Cara A. Yelverton, Nitin Shivappa Mbbs, Mph, Ph.D., James Hébert Scd, Maria A. Kennelly, Martina Cronin, John Mehegan, Fionnuala M. Mcauliffe

Faculty Publications

We investigated the effect of an antenatal lifestyle intervention of a low-glycaemic index (GI) diet and physical activity on energy-adjusted dietary inflammatory index (E-DIITM) and explored its relationship with maternal and child health in women with overweight and obesity. This was a secondary analysis of 434 mother−child pairs from the Pregnancy Exercise and Nutrition Study (PEARS) trial in Dublin, Ireland. E-DII^TM scores were calculated for early (10–16 weeks) and late (28 weeks) pregnancy. Outcomes included lipids, inflammation markers, insulin resistance, mode of delivery, infant size, pre-eclampsia, and gestational diabetes. T-tests were used to assess changes in E-DII^TM. …

Associations Between Fasting Duration, Timing Of First And Last Meal, And Cardiometabolic Endpoints In The National Health And Nutrition Examination Survey, Michael David Wirth, Longgang Zhao, Gabrielle Turner-Mcgrievy, Andrew Ortaglia

Faculty Publications

Background: Research indicates potential cardiometabolic benefits of energy consumption earlier in the day. This study examined the association between fasting duration, timing of first and last meals, and cardiometabolic endpoints using data from the National Health and Nutrition Examination Survey (NHANES). Methods: Cross-sectional data from NHANES (2005–2016) were utilized. Diet was obtained from one to two 24-h dietary recalls to characterize nighttime fasting duration and timing of first and last meal. Blood samples were obtained for characterization of C-reactive protein (CRP); glycosylated hemoglobin (HbA1c %); insulin; glucose; and high-density lipoprotein (HDL), low-density lipoprotein (LDL), and total cholesterol. Survey design procedures …

Predictors Of Chronic Opioid Therapy In Medicaid Beneficiaries With Hiv Who Initiated Antiretroviral Therapy, Gyeon Oh, Emily S. Brouwer, Erin L. Abner, David W. Fardo, Patricia R. Freeman, Chris Delcher, Daniela C. Moga

Epidemiology and Environmental Health Faculty Publications

The factors associated with chronic opioid therapy (COT) in patients with HIV is understudied. Using Medicaid data (2002-2009), this retrospective cohort study examines COT in beneficiaries with HIV who initiated standard combination anti-retroviral therapy (cART). We used generalized estimating equations on logistic regression models with backward selection to identify significant predictors of COT initiation. COT was initiated among 1014 out of 9615 beneficiaries with HIV (male: 10.4%; female: 10.7%). Those with older age, any malignancy, Hepatitis C infection, back pain, arthritis, neuropathy pain, substance use disorder, polypharmacy, (use of) benzodiazepines, gabapentinoids, antidepressants, and prior opioid therapies were positively associated with …

Treatment Patterns And Outcomes In Elderly Patients With Newly Diagnosed Multiple Myeloma: Results From The Connect® Mm Registry, Hans C. Lee, Sikander Ailawadhi, Cristina J. Gasparetto, Sundar Jagannath, Robert M. Rifkin, Brian G.M. Durie, Mohit Narang, Howard R. Terebelo, Kathleen Toomey, James W. Hardin Ph.D., Lynne Wagner, James L. Omel, Mazaher Dhalla, Liang Liu, Prashant Joshi, Rafat Abonour

Faculty Publications

No abstract provided.

Physical Activity Barriers And Assets In Rural Appalachian Kentucky: A Mixed-Methods Study, Natalie Jones, Deirdre Dlugonski, Rachel Gillespie, Emily M. Dewitt, Joann Lianekhammy, Stacey A. Slone, Kathryn M. Cardarelli

Sports Medicine Research Institute Faculty Publications

Obesity is an increasing public health concern in the U.S. and a contributor to chronic illness, with trends revealing a rise in adult obesity and chronic disease rates among the most vulnerable and disadvantaged populations, including those in rural communities. A mixed-methods approach was used to examine perspectives on perceived physical activity barriers, resources, and level of community support. Researchers utilized the socioecological model to examine the multiple domains that support physical activity in rural Appalachia. The present study focuses on baseline data, including a cohort survey to assess physical activity, health status, and barriers to physical activity, and five …

Pattern Of Use Of Electronic Health Record (Ehr) Among The Chronically Ill: A Health Information National Trend Survey (Hints) Analysis, Rose Calixte, Sumaiya Islam, Zainab Toteh Osakwe, Argelis Rivera, Marlene Camacho-Rivera

Publications and Research

Effective patient–provider communication is a cornerstone of patient-centered care. Patient portals provide an effective method for secure communication between patients or their proxies and their health care providers. With greater acceptability of patient portals in private practices, patients have a unique opportunity to manage their health care needs. However, studies have shown that less than 50% of patients reported accessing the electronic health record (EHR) in a 12-month period. We used HINTS 5 cycle 1 and cycle 2 to assess disparities among US residents 18 and older with any chronic condition regarding the use of EHR for secure direct messaging …

Cognitive Complaints In Age-Related Chronic Conditions: A Systematic Review, Nikki L. Hill, Sakshi Bhargava, Monique J. Brown, Hyejin Kim, Iris Bhang, Kaitlyn Mullin, Kathleen Phillips, Jacqueline Mogle

Faculty Publications

Introduction

Cognitive complaints in older adults may be indicative of progressive cognitive decline including Alzheimer’s disease (AD), but also occur in other age-related chronic conditions, complicating identification of early AD symptoms. To better understand cognitive complaints in aging, we systematically reviewed the evidence to determine their prevalence and characterization among older adults with the most common age-related chronic conditions.

Methods

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the review protocol was prospectively registered with PROSPERO (ID: CRD42020153147). Searches were conducted in PubMed, CINAHL, PsycINFO, Web of Science, and …

Association Of Chronic Pain With Participation In Motor Skill Activities In Children With Cerebral Palsy, Haresh Rochani, Christopher M. Modlesky, Barbara Weissman, Joshua Vova, Gavin T. Colquitt

Biostatistics, Epidemiology & Environmental Health Sciences: Faculty Publications

Many children with cerebral palsy (CP) experience the secondary condition of pain, which is problematic because children with CP face barriers to participation in motor skill activities.^1,2 Motor performance in activities of daily living among children with CP is markedly lower than that among their age-matched peers.³ Because of the potential effect of pain on children with CP, we sought to examine the association between pain and activities requiring motor skill performance (ie, difficulty dressing or bathing and participation in sport) among a nationally representative sample of US children with CP.

Identification Of Novel And Rare Variants Associated With Handgrip Strength Using Whole Genome Sequence Data From The Nhlbi Trans-Omics In Precision Medicine (Topmed) Program, Chloé Sarnowski, Han Chen, Mary L. Biggs, Sylvia Wassertheil-Smoller, Jan Bressler, Marguerite R. Irvin, Kathleen A. Ryan, David Karasik, Donna K. Arnett, L. Adrienne Cupples, David W. Fardo, Stephanie M. Gogarten, Benjamin D. Heavner, Deepti Jain, Hyun Min Kang, Charles Kooperberg, Arch G. Mainous, Braxton D. Mitchell, Alanna C. Morrison, Jeffrey R. O'Connell

Epidemiology and Environmental Health Faculty Publications

Handgrip strength is a widely used measure of muscle strength and a predictor of a range of morbidities including cardiovascular diseases and all-cause mortality. Previous genome-wide association studies of handgrip strength have focused on common variants primarily in persons of European descent. We aimed to identify rare and ancestry-specific genetic variants associated with handgrip strength by conducting whole-genome sequence association analyses using 13,552 participants from six studies representing diverse population groups from the Trans-Omics in Precision Medicine (TOPMed) Program. By leveraging multiple handgrip strength measures performed in study participants over time, we increased our effective sample size by 7-12%. Single-variant …

Mental Health Services Provision In Primary Care And Emergency Department Settings: Analysis Of Blended Fee-For-Service And Blended Capitation Models In Ontario, Canada., Thyna Vu, Kelly K Anderson, Nibene H Somé, Amardeep Thind, Sisira Sarma

Epidemiology and Biostatistics Publications

Treating mental illnesses in primary care is increasingly emphasized to improve access to mental health services. Although family physicians (FPs) or general practitioners are in an ideal position to provide the bulk of mental health care, it is unclear how best to remunerate FPs for the adequate provision of mental health services. We examined the quantity of mental health services provided in Ontario's blended fee-for-service and blended capitation models. We evaluated the impact of FPs switching from blended fee-for-service to blended capitation on the provision of mental health services in primary care and emergency department using longitudinal health administrative data …

Evaluation Of Circulating Levels Of Interleukin-10 And Interleukin-16 And Dietary Inflammatory Index In Lebanese Knee Osteoarthritis Patients, Zeina El-Ali, Germine El-Kassas, Fouad M. Ziade, Nitin Shivappa Mbbs, Mph, Ph.D., James Hébert Scd, Nisrine Bissar

Faculty Publications

Objectives

To investigate plasma concentrations of Interleukin-16 (IL-16) and Interleukin-10 (IL-10) in Lebanese knee osteoarthritis (KOA) patients and to examine the association between the diet-associated inflammation and increased risk for KOA.

Methods

A total of 208 study participants were assigned to one of the 3 groups: Diagnosed Knee Osteoarthritis group (DKOA) (N = 78); Undiagnosed Knee Osteoarthritis group (UKOA) (N = 60) and controls matched on age, sex and sociodemographic characteristics (N = 70). UKOA represents KOA features before they are altered by therapeutic intervention and lifestyle modifications that follow the diagnosis. Energy-adjusted dietary inflammatory index (E-DII™) scores were calculated …

Comparing Dietary Score Associations With Lipoprotein Particle Subclass Profiles: A Cross-Sectional Analysis Of A Middle-To Older-Aged Population, Seán R. Millar, Pilar Navarro, Janas M. Harrington, Nitin Shivappa Mbbs, Mph, Ph.D., James Hébert Scd, Ivan J. Perry, Catherine M. Phillips

Faculty Publications

Background and objectives: Lipoprotein particle concentrations and size are associated with increased risk for atherosclerosis and premature cardiovascular disease. Studies also suggest that certain dietary behaviours may be cardioprotective. Limited comparative data regarding any dietary score/index-lipoprotein particle subclass associations exist. Thus, our objective was to assess relationships between the Dietary Approaches to Stop Hypertension (DASH), Health Eating Index-2015 (HEI-2015), Mediterranean Diet (MD) and Energy-adjusted Dietary Inflammatory Index (E-DII™) scores and plasma lipids and lipoprotein profiles to test the hypothesis that healthier diet (better quality and more anti-inflammatory) would be associated with a more favourable lipoprotein profile.

Materials and methods: This …

The Essence Of Telemedicine For Bridging The Gap In Health Services, Budi Wiweko, Sarah Chairani Zakirah, Atha Luthfi

Kesmas

This study aimed to review the essence of telemedicine in this modern era of technology and innovation, especially in developing countries. It also investigated the regulation aspect as the main component for healthcare services. There were five main categories of telemedicine: revenue stream and technology literacy, health facilities, human resources, data authorization and security, and health protocol. Furthermore, when combined with wearable devices, it enhanced healthcare delivery opportunities. There were two major components of global electronic health, namely telehealth and health informatics, based one-commerce and e-learning systems. The World Health Organization (WHO) has been able to describe the roles of …

The Determinants Of Stunting For Children Aged 24-59 Months In Kulon Progo District 2019, Chatrine Aprilia Hendraswari, Yuliasti Eka Purnamaningrum, Tri Maryani, Yani Widyastuti, Sakinah Harith

Kesmas

This study pertains to stunting in children in Indonesian with z-scores of less than -2 Standard Deviation (SD) and less than -3 SD. The preliminary study results showed the highest prevalence of stunting to be 22.6%, at the Temon II Primary Health Care in Kulon Progo District. The study aimed to assess the determinants of stunting children aged 24–59 months. This study was conducted from September 2018–May 2019. The design of this study was analytical observational with study design case-control. The sample was 60 children aged 24–59 months. The method utilized proportional sampling, whereas the data analysis applied chi-square and …

A Path Analysis Model For Explaining The Factors Influencing Wearing A Mask Among Commuting Workers Using Commuter Line Bogor-Jakarta, David Kusmawan, Shofi Andari, Ira Gustina, Indri Hapsari Susilowati, Mufti Wirawan

Kesmas

Jakarta is one of the most air-polluted cities in the world, which can increase the health risk of commuting workers exposed to pollutants. This study aimed to determine the factors that directly and indirectly affect healthy behavior (wearing a mask) for commuters using the Bogor-Jakarta Commuter Line. Furthermore, a total of 155 respondents participated and the data collected were analyzed using descriptive and path analysis. The commuters aware of the hazard potential related to air pollution during commuting were 137 people (88.4%). While 104 people (67.1%) were aware of the good perception of pollution and 125 uses masks during commuting …

Empowering Health Cadres To Support Drug-Resistant Tuberculosis (Dr-Tb) Patient To Enroll In Treatment, Esty Febriani, Adik Wibowo, Neeraj Kak, Hala Jassim Al Mossawi

Kesmas

Tuberculosis (TB) remains a big challenge globally, while the involvement of health cadres’ constitutes one of the key strategies for the TB program in Indonesia. These roles were further expanded to providing support to DR-TB patients. This study was a qualitative study, conducted in 2015 to explore the various factors which influence the performance of health cadres’ in supporting DR-TB patients to enroll in treatment. A total of 39 informants consisting of 24 health cadres, three nurses, four DR-TB patients, and three family members, two peer support, a head of primary health care, and two TB staffs from the District …

National Health Insurance Scheme: Internal And External Barriers In The Use Of Reproductive Health Services Among Women, Evi Martha, Herna Lestari, Resvi Siti Zulfa, Yoslien Sopamena

Kesmas

Lack of familiarity among the community, medical workers, and administrative staff regarding reproductive health services covered by Badan Penyelenggara Jaminan Sosial (BPJS) or the National Health Insurance (NHI) in Indonesia remained a problem. Therefore, this resulted in sub-optimal use of the medical services, as shown by surveys from the Women's Health Foundation for three consecutive years (2015-2017). This qualitative study was conducted with a Rapid Assessment Procedure design in three cities within Indonesia: Padang Pariaman, Manado, and Kupang. Data were collected through IDIs (n = 47informants) and 6 FGDs (7 persons/group). Participants also consisted of NHI RHS users (mothers and …

Prevalence And Determinants Of Pre-Lacteal Feeding: Insights From The 2017 Indonesia Demographic And Health Survey, Siti Nurokhmah, Siti Masitoh, Kusuma Estu Werdani

Kesmas

Pre-lacteal feeding is widely known as a distraction to exclusive breastfeeding, and the malpractice continues to be prevalent in Indonesia. Therefore, this study aimed to explore the potential determinants of pre-lacteal feeding among mothers of infants below 24 months. A sample of 6,455 mother-infant pairs from the 2017 Indonesia Demographic and Health Survey (IDHS) was used. Also, multivariate logistic regression was employed to identify factors associated with pre-lacteal feeding practice. In Indonesia, 44% of infants were introduced to solid/liquid feeds in their first three days of life. Infant formula was the most common pre-lacteal feed given, followed by any other …

Inter-Related Factors Influencing Sexual Quality Of Life Among Women Living With Hiv In Banten Province, Indonesia: A Mixed Methods Study, Dyah Juliastuti, Judith Dean, Yati Afiyanti, Lisa Fitzgerald

Kesmas

Socio-cultural concerns often restrict women's sexual rights and well-being living with HIV (WLHIV) in developing countries. These convergent parallel mixed methods study combined quantitative and qualitative approaches to explore factors influencing WLHIV sexual quality of life in Banten Province, Indonesia. A 2017 cross-sectional survey of 207 reproductive-aged WLHIV was analyzed using univariate and multivariate logistic regression statistics. Furthermore, in-depth interviews with a sub-sample of survey participants (n = 30) were thematically analyzed. Most of the women (60%) involved reported loss of sexual pleasure and depressed sexual life. Meanwhile, 48% affirmed low sexual quality of life which was associated with unemployment …

Attitudes Concerning Sexual Behavior Towards Risky Sexual Behavior Of Sexual Transmitted Infections Among Male Adolescents In Indonesia, Helda Helda, Nurul Muchlisa

Kesmas

There has been an increase of sexually transmitted infections (STIs) such as HIV/AIDS worldwide, especially in Indonesia. Several studies on adolescent behavior, especially the male as the main predictor, reported increased in STIs’ cases due to risky sexual behavior. This study aimed to show the relationship between attitudes, sexual behavior, and the risks of STIs among male adolescents in Indonesia based on the Indonesia Demographic and Health Survey (IDHS) data in 2017. This cross-sectional study involved 10,547 male adolescents using the total sampling method according to the inclusion and exclusion criteria. Data were analyzed using a complex sample logistic regression …

The Effect Of Smoking On Carbon Monoxide Respiration Among Active Smokers In Palembang City, Indonesia, Rico Januar Sitorus, Imelda Gernauli Purba, Merry Natalia, Kraichat Tantrakarnapa

Kesmas

Smoking leads to disease and disability as well as harm nearly every organ of the body. Furthermore, smoking of tobacco is known to cause pulmonary dysfunction and lead to complications, pain, or even death. This study aimed to measure the risk factors for the respiration of carbon monoxide among smokers. A cross-sectional design was implemented by involving 156 smokers in Karyajaya Subdistrict, Palembang City. The dependent variable was carbon monoxide levels (ppm), while the independent variables were smoking frequency, duration, and the last period of smoking. The carbon monoxide levels (ppm) measured with a PiCO + Smokerlyzer® device from Bedfont …

The Significance Of Super Depo Sutorejo: Waste Management Project In Surabaya Municipality, Indonesia, Yohanes Kambaru Windi, Dyah Wijayanti, Eko Rustamaji Wiyatno, Loetfia Dwi Rahariyani

Kesmas

The Super Depo Sutorejo Surabaya (SDSS) Project was created to separate household waste into fractions, but its separation effect is unknown. This study assessed the significance of the project in sorting general waste into biodegradable, non-biodegradable, and assorted. The t-test compared the means of general and biodegradable waste (normally distributed). The non-biodegradable and assorted waste were not significantly distributed; therefore, the Wilcoxon Signed Ranks Test was used to compare their medians against general waste. The multivariate analysis compared the significance level of each waste fraction. Each statistical analysis showed that the SDSS significantly sorts the general waste. The p-values were …

Spatially Refined Time-Varying Reproduction Numbers Of Covid-19 By Health District In Georgia, Usa, March–December 2020, Chigozie A. Ogwara, Arshpreet Kaur Mallhi, Xinyi Hua, Kamalich Muniz-Rodriguez, Jessica S. Schwind, Xiaolu Zhou, Jeffery A. Jones, Joanne Chopak-Foss, Gerardo Chowell, Isaac Chun-Hai Fung

Biostatistics, Epidemiology & Environmental Health Sciences: Faculty Publications

This study quantifies the transmission potential of SARS-CoV-2 across public health districts in Georgia, USA, and tests if per capita cumulative case count varies across counties. To estimate the time-varying reproduction number, Rt of SARS-CoV-2 in Georgia and its 18 public health districts, we apply the R package ‘EpiEstim’ to the time series of historical daily incidence of confirmed cases, 2 March–15 December 2020. The epidemic curve is shifted backward by nine days to account for the incubation period and delay to testing. Linear regression is performed between log10-transformed per capita cumulative case count and log10-transformed population size. We observe …

Reporting Of Eating Disorder Deaths, Katherine Mobley, Amy Hord

Symposium of Student Scholars

Those affected by eating disorders experience disturbances in eating behaviors which are often related to underlying psychiatric disorders such as anxiety, depression, or obsessive-compulsive disorder (Parekh, 2017, Drieberg et al., 1998 p.53). The duplicitous nature of the disorder makes it difficult to diagnose, and the tole it takes on an individual’s physical health makes its mortality rate the second highest among psychiatric disorders (Guinhut et al., 2021 p.130). Even if the correct education and resources are accessible to certain individuals, negative stigmatization about the disorder can make sufferers unlikely to seek help (Becker et al., 2010). Findings from analysis of …

Differences In ​The Proportion Of Children Meeting Behavior Guidelines ​Between Summer ​And School By Socioeconomic Status And Race, Ethan T. Hunt, Lauren Von Klinggraeff, Alexis Jones, Sarah Burkart, Roddrick Dugger, Bridget Armstrong Ph.D., Michael Beets Ph.D., Gabrielle Turner-Mcgrievy Ph.D., Rd, Marco Geraci, Robert Glenn Weaver Med, Phd

Faculty Publications

Objective

Children who fail to meet activity, sleep, and screen-time guidelines are at increased risk for obesity. Further, children who are Black are more likely to have obesity when compared to children who are White, and children from low-income households are at increased risk for obesity when compared to children from higher-income households. The objective of this study was to evaluate the proportion of days meeting obesogenic behavior guidelines during the school year compared to summer vacation by race and free/reduced priced lunch (FRPL) eligibility.

Methods

Mixed-effects linear and logistic regressions estimated the proportion of days participants met activity, sleep, …

Differences In Effectiveness And Use Of Laparoscopic Surgery In Locally Advanced Colon Cancer Patients, M. Schootman, Matthew Mutch, T. Loux, Jan M. Eberth Ph.D., N. O. Davidson

Faculty Publications

Patients with locally advanced colon cancer have worse outcomes. Guidelines of various organizations are conflicting about the use of laparoscopic colectomy (LC) in locally advanced colon cancer. We determined whether patient outcomes of LC and open colectomy (OC) for locally advanced (T4) colon cancer are comparable in all colon cancer patients, T4a versus T4b patients, obese versus non-obese patients, and tumors located in the ascending, descending, and transverse colon. We used data from the 2013–2015 American College of Surgeons’ National Surgical Quality Improvement Program. Patients were diagnosed with nonmetastatic pT4 colon cancer, with or without obstruction, and underwent LC (n …

Time Series Forecasting Of Covid-19 Deaths In Massachusetts, Andrew Disher

Honors Program Theses and Projects

The aim of this study was to use data provided by the Department of Public Health in the state of Massachusetts on its online dashboard to produce a time series model to accurately forecast the number of new confirmed deaths that have resulted from the spread of CoViD-19. Multiple different time series models were created, which can be classified as either an Auto-Regressive Integrated Moving Average (ARIMA) model or a Regression Model with ARIMA Errors. Two ARIMA models were created to provide a baseline forecasting performance for comparison with the Regression Model with ARIMA Errors, which used the number of …

Randomised Trials At The Level Of The Individual, Jay J H. Park, Nathan Ford, Denis Xavier, Per Ashorn, Rebecca F. Grais, Zulfiqar Ahmed Bhutta, Herman Goossens, Kristian Thorlund, Maria Eugenia Socias, Edward J. Mills

Centre of Excellence in Women and Child Health

In global health research, short-term, small-scale clinical trials with fixed, two-arm trial designs that generally do not allow for major changes throughout the trial are the most common study design. Building on the introductory paper of this Series, this paper discusses data-driven approaches to clinical trial research across several adaptive trial designs, as well as the master protocol framework that can help to harmonise clinical trial research efforts in global health research. We provide a general framework for more efficient trial research, and we discuss the importance of considering different study designs in the planning stage with statistical simulations. We …

Association Between Dietary Inflammatory Index, Dietary Patterns, Plant-Based Dietary Index And The Risk Of Obesity, Yoko B. Wang, Nitin Shivappa, James R. Hébert Scd, Amanda J. Page, Yohannes Adama Melaku

Faculty Publications

Evidence on the association between various dietary constructs and obesity risk is limited. This study aims to investigate the longitudinal relationship between different diet indices and dietary patterns with the risk of obesity. Non-obese participants (n = 787) in the North West Adelaide Health Study were followed from 2010 to 2015. The dietary inflammatory index (DII®), plant-based dietary index (PDI) and factor-derived dietary pattern scores were computed based on food frequency questionnaire data. We found the incidence of obesity was 7.62% at the 5-year follow up. In the adjusted model, results from multivariable log-binomial logistic regression showed that a prudent …