Clinical Epidemiology Commons^™

Safety Constraint Optimization Of Combination Drug Therapy In Hypertension Clinical Trials, Victor Chukwu

Electronic Theses and Dissertations

In Clinical Practice, combination drug therapy has become common in treating many disease conditions. The purpose of these combinations is often to ensure optimal efficacy and to reduce adverse effects that may arise from monotherapy. Clinical trials have also been conducted to ensure efficacy and safety of these combinations before they are introduced into the market. However, adverse effects still occur with combination therapies. The objective of this study is to (1) To determine a region of optimum doses of Drug A and Drug B in combination while focusing on efficacy alone (2) To determine a region of optimum doses …

Syndemics Of Severity And Frequency Of Elder Abuse: A Cross-Sectional Study In Mexican Older Females, Mireya Vilar-Compte, Pablo Gaitán-Rossi

Department of Public Health Scholarship and Creative Works

Background: Elder abuse is a common phenomenon with important effects on the health and well-being of older adults. There are important gaps in elder abuse measurement, as it is usually reported as the absence or presence of elder abuse, disregarding its severity and frequency.

Objectives: Identify different ways of measuring severity and frequency of elder abuse and assess whether different experiences of severity and frequency suggest syndemic relationships.

Methods: Through a sample of 534 non-institutionalized Mexican older women, we assessed how severity (i.e., number of abusive experiences and number of types of abuses) and frequency (i.e., if abusive experiences had …

Syndemics Of Severity And Frequency Of Elder Abuse: A Cross-Sectional Study In Mexican Older Females, Mireya Vilar-Compte, Pablo Gaitán-Rossi

Department of Public Health Scholarship and Creative Works

Background: Elder abuse is a common phenomenon with important effects on the health and well-being of older adults. There are important gaps in elder abuse measurement, as it is usually reported as the absence or presence of elder abuse, disregarding its severity and frequency.

Objectives: Identify different ways of measuring severity and frequency of elder abuse and assess whether different experiences of severity and frequency suggest syndemic relationships.

Methods: Through a sample of 534 non-institutionalized Mexican older women, we assessed how severity (i.e., number of abusive experiences and number of types of abuses) and frequency (i.e., if abusive experiences had …

Surveillance, Prevention And Surgical Treatments For Hepatocellular Carcinoma, Kerui Xu

Theses & Dissertations

Liver cancer is the second-leading cause of cancer death, representing roughly 9.1% of all cancer mortality. Of all primary cancers of the liver, hepatocellular carcinoma (HCC) accounts for roughly 85%. HCC has been increasing in the U.S. and other countries. In particular, HCC places a huge burden on the Chinese population, as China alone consists of approximately 50% of the total HCC cases and deaths. In China, chronic hepatitis B virus (HBV) infection is the leading cause for developing HCC. The two challenges in prevention and control of HCC experienced in China are low rates of HCC screening among the …

“Are You Accepting New Patients?” A Pilot Field Experiment On Telephone-Based Gatekeeping And Black Patients’ Access To Pediatric Care, Tamara Leech, Amy Irby-Shasanmi, Anne L. Mitchell

Department of Public Health Scholarship and Creative Works

Study Objectives

To determine whether the name and accent cues that the caller is Black shape physician offices’ responses to telephone‐based requests for well‐child visits.

Method and Data

In this pilot study, we employed a quasi‐experimental audit design and examined a stratified national sample of pediatric and family practice offices. Our final data include information from 205 audits (410 completed phone calls). Qualitative data were blind‐coded into binary variables. Our case‐control comparisons using McNemar's tests focused on acceptance of patients, withholding information, shaping conversations, and misattributions.

Findings

Compared to the control group, “Black” auditors were less likely to be told …

Characterization Of Cancer Incidence In Chronic Kidney Disease Patients: A Single Center Study, 2008 – 2018, Jagadeesh Puvvula

Capstone Experience

Background: Chronic kidney disease (CKD) is an established risk factor for cardiovascular disease, but the significance of lower Glomerular filtration rate on incidence and mortality from cancer is uncertain. There is evidence that cancer risk and cancer mortality may be increased in individuals with End Stage Renal Disease (ESRD) requiring dialysis or after renal transplantation but whether less severe kidney disease is associated with cancer remains poorly understood.

Some studies indicate that these associations do appear to be organ specific. It has been reported that reduced renal function is associated with an increased risk of cancers of the kidney and …

Evaluation Of The Hiv Infant Tracking System (Hitsystem) To Optimise Quality And Efficiency Of Early Infant Diagnosis: A Cluster-Randomised Trial In Kenya., Sarah Finocchario-Kessler, Brad Gautney, Anlin Cheng, Catherine Wexler, May Maloba, Niaman Nazir, Samoel Khamadi, Raphael Lwembe, Melinda Brown, Thomas A. Odeny, Jacinda K. Dariotis, Matthew Sandbulte, Natabhona Mabachi, Kathy Goggin

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: The HIV Infant Tracking System (HITSystem) is a web-based intervention linking providers of early infant diagnosis, laboratory technicians, and mothers and infants to improve outcomes for HIV-exposed infants. We aimed to evaluate the efficacy of the HITSystem on key outcomes of early infant diagnosis.

METHODS: We did a cluster-randomised trial at six hospitals in Kenya, which were matched on geographic region, resource level, and volume of patients (high, medium, and low). We randomly allocated hospitals within a matched pair to either the HITSystem (intervention; n=3) or standard of care (control; n=3). A random number generator was used to assign …

Decipher Mechanisms By Which Nuclear Respiratory Factor One (Nrf1) Coordinates Changes In The Transcriptional And Chromatin Landscape Affecting Development And Progression Of Invasive Breast Cancer, Jairo Ramos

FIU Electronic Theses and Dissertations

Despite tremendous progress in the understanding of breast cancer (BC), gaps remain in our knowledge of the molecular basis underlying the aggressiveness of BC and BC disparities. Nuclear respiratory factor 1 (NRF1) is a transcription factor (TF) known to control breast cancer cell cycle progression. DNA response elements bound by NRF1 positively correlate with the progression of malignant breast cancer. Mechanistic aspects by which NRF1 contributes to susceptibility to different breast tumor subtypes are still not fully understood. Therefore, the primary objective of this dissertation was to decipher mechanisms by which NRF1 coordinates changes in the transcriptional and chromatin landscape …

Patterns Of Regularity Noncompliance Identified By The U.S. Food And Drug Administration And Their Effects On Meta-Analyses, Craig A. Garmendia

FIU Electronic Theses and Dissertations

The objective of this study was to determine the patterns of regulatory noncompliance, as identified by the U.S. Food and Drug Administration (FDA), and their effects on meta-analyses. In order to achieve these objective, three studies were undertaken: analysis of citations issued by FDA Investigators at the conclusion of an inspection; analysis of regulatory actions taken by the FDA towards clinical researchers based on the observations cited by FDA Investigators; and sensitivity analysis of meta-analyses based on the Agency’s determination of research misconduct, primarily the falsification of data. FDA Investigator citations were analyzed using Chi-Square analysis based on geographic location …

Maternal Experiences Of Intimate Partner Violence And C-Reactive Protein Levels In Young Children In Tanzania, Natalie Slopen, Jing Zhang, Samuel S. Urlacher, Gretchen De Silva, Mona Mittal

Publications and Research

Intimate partner violence (IPV) is a critical public health issue that impacts women and children across the globe.Prior studies have documented that maternal experiences of IPV are associated with adverse psychological and physical health outcomes in children; however, research on the underlying physiological pathways linking IPV to these conditions is limited. Drawing on data from the 2010 Tanzania Demographic and Health Survey, we examined the relationship between maternal report of IPV in the past 12 months and inflammation among children ages 6 months to 5 years. Our study included 503 children who were randomly selected to provide a blood sample …

The Legalization Of Medical/Recreational Marijuana: Implications For School Health Drug Education Programs, Joseph Donnelly, Michael Young

Department of Public Health Scholarship and Creative Works

BACKGROUND

More than half of US states have legalized medical marijuana. Several states have also legalized it for recreational use. In spite of states' actions, marijuana remains illegal under federal law. It remains to be seen, however, if the Trump administration will enforce federal law in states that have legalized marijuana. For now, it appears the move toward state legalization of marijuana will increase. Because of its legal status, research concerning the medical benefits of marijuana has been limited.

METHODS

We reviewed the literature pertaining to medical use and legalization of marijuana.

RESULTS

Available research shows that marijuana can benefit …

Knowledge And Risk Factors For Stroke Among Undergraduates In Southwestern Nigeria, Wasiu Olalekan Adebimpe

Marshall Journal of Medicine

The burden of non-communicable diseases due to stroke is increasing. Despite this, community based studies that could stimulate stroke primordial prevention among the population at risk are sparse. This study assessed community knowledge and risk factors to stroke among University undergraduates in Osogbo, southwestern Nigeria. A descriptive cross sectional study was conducted among 420 male undergraduates selected through multi-stage sampling method. Research instruments were self-administered semi structured questionnaire. Data was analyzed using the SPSS software version 17.0. Four hundred and seven (96.9%) have heard about stroke. Good mean knowledge score of causes, symptoms, warning signs and risk factors of stroke …

Racial Disparity Among Women Diagnosed With Invasive Breast Cancer In A Large Integrated Health System, Maharaj Singh, Santhi D. Konduri, George C. Bobustuc, Amin B. Kassam, Richard A. Rovin

Journal of Patient-Centered Research and Reviews

Purpose: Reasons for the well-described disparity in outcomes between African American (AA) and non-Hispanic white (NHW) women with invasive breast cancer are unclear, making it difficult to identify solutions. This study examined the effects of demographics, biomarkers, tumor characteristics, cancer stage, morphology, and treatment variables on overall and cancer-free survival in these patient populations.

Methods: We retrospectively reviewed data for 6231 patients diagnosed with invasive breast cancer throughout an integrated health system from January 2006 through March 2015. Included for analysis were 5023 NHW and 413 AA women. All category and continuous variables in the study were described in the …

Improving Health And Well-Being: Connecting Research And Practice. The 24th Annual Conference Of The Health Care Systems Research Network, Karen L. Margolis, Nico Pronk, Jane E. Duncan, Sarah M. Greene

Journal of Patient-Centered Research and Reviews

The 24th annual conference of the Health Care Systems Research Network (HCSRN, formerly the HMO Research Network), held April 11–13, 2018, in Minneapolis, Minnesota, attracted 357 attendees. The HCSRN is a consortium of 18 community-based research organizations embedded in or affiliated with large health care delivery systems. Its annual research conference, held since 1994, is a unique venue that brings diverse stakeholders (eg, research teams, clinicians, patients, funders) together to explore a range of health research topics and scientific findings, with a unifying goal of connecting applied research to real-world care delivery for the betterment of individual and community health. …

Automated Real-Time Collection Of Pathogen-Specific Diagnostic Data: Syndromic Infectious Disease Epidemiology, Lindsay Meyers, Christine C. Ginocchio, Aimie N. Faucett, Frederick S. Nolte, Per H. Gesteland, Amy Leber, Diane Janowiak, Virginia Donovan, Jennifer Dien Bard, Silvia Spitzer, Kathleen A. Stellrecht, Hossein Salimnia, Rangaraj Selvarangan, Stefan Juretschko, Judy A. Daly, Jeremy C. Wallentine, Kristy Lindsey, Franklin Moore, Sharon L. Reed, Maria Aguero-Rosenfeld, Paul D. Fey, Gregory A. Storch, Steve J. Melnick, Christine C. Robinson, Jennifer F. Meredith, Camille V. Cook, Robert K. Nelson, Jay D. Jones, Samuel V. Scarpino, Benjamin M. Althouse, Kirk M. Ririe, Bradley A. Malin, Mark A. Poritz

Manuscripts, Articles, Book Chapters and Other Papers

© Lindsay Meyers, Christine C Ginocchio, Aimie N Faucett, Frederick S Nolte, Per H Gesteland, Amy Leber, Diane Janowiak,.

Background: Health care and public health professionals rely on accurate, real-time monitoring of infectious diseases for outbreak preparedness and response. Early detection of outbreaks is improved by systems that are comprehensive and specific with respect to the pathogen but are rapid in reporting the data. It has proven difficult to implement these requirements on a large scale while maintaining patient privacy.

Objective: The aim of this study was to demonstrate the automated export, aggregation, and analysis of infectious disease diagnostic test …

Using A Model To Design Activity-Based Educational Experiences To Improve Cultural Competency Among Graduate Students, Kathleen D. Bauer, Yeon Bai

Department of Nutrition and Food Studies Scholarship and Creative Works

To improve the cultural competency of 34 students participating in graduate nutrition counseling classes, the Campinha-Bacote Model of Cultural Competence in the Delivery of Health Care Services was used to design, implement, and evaluate counseling classes. Each assignment and activity addressed one or more of the five constructs of the model, i.e., knowledge, skill, desire, encounters, and awareness. A repeated measure ANOVA evaluated pre- and post-test cultural competence scores (Inventory for Assessing the Process of Cultural Competence among Healthcare Professionals). The overall cultural competence score significantly improved (p < 0.001) from “culturally aware” (68.7 at pre-test) to “culturally competent” (78.7 at post-test). Students significantly improved (p < 0.001) in four constructs of the model including awareness, knowledge, skill, and encounter. Factor analysis indicated that course activities accounted for 83.2% and course assignments accounted for 74.6% of the total variance of cultural competence. An activity-based counseling course encouraging self-evaluation and reflection and addressing Model constructs significantly improved the cultural competence of students. As class activities and assignments aligned well with the Campinha-Bacote Model constructs, the findings of this study can help guide health educators to design effective cultural competence training and education programs.

Matters Of Trust: Examination Of The Patient-Provider Relationship In Cancer Care, Krista A. Brown

Capstone Experience

Background: The intangible concept of trust is critical in the patient-provider relationship. Cancer patients may experience positive and negative impacts of trust in this relationship to a higher degree due to the inherently serious nature of their disease and the level of dependence upon treatment providers.

Objective: The goal of this study was to compare colorectal cancer patients’ levels of trust in their primary care physician and oncologist, along with examining trust differences associated with demographics and other characteristics.

Methods: Colorectal cancer patients (n=158) treated at Nebraska Medicine and consented into the Integrated Cancer Repository for Cancer Research IRB …

Aggressive Diuresis And Severity-Adjusted Length Of Hospital Stay In Acute Congestive Heart Failure Patients., Muhammad U. Butt M.D.

Muhammad Umer Butt M.D., MSCRD

Lagged Influence Of Fine Particulate Matter And Geographic Disparities On Clinic Visits For Children’S Asthma In Taiwan, Lung-Chang Chien, Yu-An Chen, Hwa-Lung Yu

Public Health Faculty Publications

Recent studies have revealed the influence of fine particulate matter (PM2.5) on increased medication use, hospital admission, and emergency room visits for asthma attack in children, but the lagged influence of PM2.5 on children’s asthma and geographic disparities of children’s asthma have rarely been discussed simultaneously. This study investigated the documented diagnosis of children’s asthma in clinic visits for children aged less than 15 years old that were associated with PM2.5 in two counties located in west-central Taiwan during 2005–2010. The result shows that PM2.5 had a significant lagged effect on children’s asthma for up to 6 days. A significantly …

The Predictors Of Juvenile Recidivism: Testimonies Of Adult Students 18 Years And Older Exiting From Alternative Education, La Toshia Palmer

Dissertations

Purpose: The purpose of this descriptive, qualitative study was to identify and describe the importance of the predictors of juvenile recidivism and the effectiveness of efforts to prevent/avoid juvenile recidivism as perceived by previously detained, arrested, convicted, and/or incarcerated adult students 18 years of age and older exiting from alternative education in Northern California. A second purpose was to explore the types of support provided by alternative schools and the perceived importance of the support to avoid recidivism according to adult students 18 years of age and older exiting from alternative education.

Methodology: This qualitative, descriptive research design identified …