Epidemiology Commons^™

Upending The Social Ecological Model To Guide Health Promotion Efforts Toward Policy And Environmental Change, Lisa D. Lieberman, Shelley D. Golden, Kenneth R. Mcleroy, Lawrence W. Green, Jo Anne L. Earp

Department of Public Health Scholarship and Creative Works

Efforts to change policies and the environments in which people live, work, and play have gained increasing attention over the past several decades. Yet health promotion frameworks that illustrate the complex processes that produce health-enhancing structural changes are limited. Building on the experiences of health educators, community activists, and community-based researchers described in this supplement and elsewhere, as well as several political, social, and behavioral science theories, we propose a new framework to organize our thinking about producing policy, environmental, and other structural changes. We build on the social ecological model, a framework widely employed in public health research and …

Epidemiology News, Georgia Southern University

Epidemiology News (2012-2018)

• Acceptability and Feasibility of Physical Activity Assessment Methods

Thirty Day Hospital Re-Admissions In Patients With Non St-Segment Elevation Acute Myocardial Infarction, Mayra Tisminetzky, David Mcmanus, Nathaniel Erskine, Jane Saczynski, Jorge Yarzebski, Edgard Granillo, Joel Gore, Robert Goldberg

Jorge L. Yarzebski

BACKGROUND: Limited data exist about relatively recent trends in the magnitude and characteristics of patients who are rehospitalized shortly after admission for a non ST-segment elevation acute myocardial infarction (NSTEMI). This observational study describes decade-long trends (1999-2009) in the magnitude and characteristics of patients readmitted to the hospital within 30 days of hospitalization for an incident (initial) episode of NSTEMI.

METHODS: We reviewed the medical records of 2,249 residents of the Worcester (MA) metropolitan area who were hospitalized for an initial NSTEMI in 6 biennial periods between 1999 and 2009 at 3 central MA medical centers.

RESULTS: The average age …

Medical Advice And Diabetes Self-Management Reported By Mexican-American, Black- And White-Non-Hispanic Adults Across The United States, Joan A. Vaccaro, Daniel J. Feaster, Sandra L. Lobar, Marianna K. Baum, Marcia Magnus, Fatma G. Huffman

Joan A. Vaccaro

Background

Diabetes has reached epidemic proportions in the United States, particularly among minorities, and if improperly managed can lead to medical complications and death. Healthcare providers play vital roles in communicating standards of care, which include guidance on diabetes self-management. The background of the client may play a role in the patient-provider communication process. The aim of this study was to determine the association between medical advice and diabetes self care management behaviors for a nationally representative sample of adults with diabetes. Moreover, we sought to establish whether or not race/ethnicity was a modifier for reported medical advice received and …

The National Health Security Preparedness Index: Harnessing Evidence & Experience To Drive Improvement, Glen P. Mays

Health Management and Policy Presentations

This presentation profiles the National Health Security Preparedness Index as a mechanism for measuring preparedness and resiliency levels across the U.S. Forthcoming enhancements in measurement and analytic methodologies will allow the Index to play heightened roles in informing policies and practices that protect the U.S. population from a broad range of hazards.

The National Health Security Preparedness Index: Harnessing Evidence & Experience To Drive Improvement, Glen P. Mays

Glen Mays

This presentation profiles the National Health Security Preparedness Index as a mechanism for measuring preparedness and resiliency levels across the U.S. Forthcoming enhancements in measurement and analytic methodologies will allow the Index to play heightened roles in informing policies and practices that protect the U.S. population from a broad range of hazards.

Associations Between Physical Activity And Weight Status With Grade-School Performance, Taylor Panfil

Theses and Dissertations

Physical activity and weight control are predictive of childhood health, but more recent research suggests they may also be associated with academic success.

PURPOSE: To explore the relationships between physical activity, weight status, and academic performance in children.

METHODS: 614 third-to-fifth grade children (53.9% female, age 9.6 ± 0.9 years) from two Midwestern communities participated. Physical activity was assessed using a Digiwalker 200-SW pedometer worn for seven consecutive days. Teachers provided an estimate of general academic performance, and children were categorized into three performance groups (high, moderate, low). School behavior (attentiveness, staying on task, interruptive behavior) was assessed by the …

Cost-Effectiveness Of Coronary Artery Calcium Testing For Coronary Heart And Cardiovascular Disease Risk Prediction To Guide Statin Allocation: The Multi-Ethnic Study Of Atherosclerosis (Mesa), Khurram Nasir

All Publications

BACKGROUND: The Multi-Ethnic Study of Atherosclerosis (MESA) showed that the addition of coronary artery calcium (CAC) to traditional risk factors improves risk classification, particularly in intermediate risk asymptomatic patients with LDL cholesterol levels /dL. However, the cost-effectiveness of incorporating CAC into treatment decision rules has yet to be clearly delineated.OBJECTIVE: To model the cost-effectiveness of CAC for cardiovascular risk stratification in asymptomatic, intermediate risk patients not taking a statin. Treatment based on CAC was compared to (1) treatment of all intermediate-risk patients, and (2) treatment on the basis of United States guidelines.METHODS: We developed a Markov model of first coronary …

The Effects Of Menopausal Vasomotor Symptoms And Changes In Anthropometry On Breast Cancer Etiology, Victoria Hart

Doctoral Dissertations

One of the strongest predictors of breast cancer risk is mammographic density; however, incomplete understanding of the mechanisms relating density to risk has limited its use as a marker for breast cancer susceptibility. Hormone fluctuations during the menopausal transition may influence declines in mammographic density and may also trigger the onset of menopausal vasomotor symptoms (VMS), which have been associated with lower breast cancer risk. The effects of hormone changes on density, VMS, and breast cancer risk are complicated by external factors such as changing body mass and hormone therapy use during the menopausal transition. We evaluated the association between …

Epidemiology News, Georgia Southern University

Epidemiology News (2012-2018)

• Evaluation of Diverse Community Asthma Interventions

Obesity And Metabolic Phenotypes (Metabolically Healthy And Unhealthy Variants) Are Significantly Associated With Prevalence Of Elevated C-Reactive Protein And Hepatic Steatosis In A Large Healthy Brazilian Population, Sameer Shaharyar, Lara Roberson, Omar Jamal, Adnan Younus, Shozab Ali, Arthur Agatston, Khurram Nasir Baptist Health Medical Group

All Publications

BACKGROUND:Among the obese, the so-called metabolically healthy obese (MHO) phenotype is thought to confer a lower CVD risk as compared to obesity with typical associated metabolic changes. The present study aims to determine the relationship of different subtypes of obesity with inflammatory-cardiometabolic abnormalities.METHODS:We evaluated 5,519 healthy, Brazilian subjects (43 ± 10 years, 78% males), free of known cardiovascular disease. Those with (MRF) were considered metabolically healthy, and those with BMI ≥ 25 kg/m(2) and/or waist circumference meeting NCEP criteria for metabolic syndrome as overweight/obese (OW). High sensitivity C reactive protein (hsCRP) was measured to assess underlying inflammation and hepatic steatosis …

Epidemiology News, Georgia Southern University

Epidemiology News (2012-2018)

• Converting Big Data into Public Health
• Evaluation of Diverse Community Asthma Interventions

Hospital-Based Surveillance Of Invasive Pneumococcal Disease And Pneumonia In South Bangalore, India., R Nisarga, R Premalatha, Shivananda, Kl Ravikumar, U Shivappa, A Gopi, Sb Chikkadasarahalli, R Batuwanthudawe, Paul E. Kilgore, Sa Kim, I Balter, S Jouve, J Ye, M Moscariello

Paul E. Kilgore

OBJECTIVE: To estimate the incidence of invasive pneumococcal disease and pneumonia, distribution of pneumococcal serotypes, and antibiotic susceptibility in children aged 28 days to <60 months. DESIGN: Hospital-based surveillance. SETTING: South Bangalore, India. PARTICIPANTS: 9950 children aged 28 days to <60 months with clinical suspicion of invasive pneumococcal disease or pneumonia. RESULTS: The estimated at-risk population included 224,966 children <5 years of age. Forty cases of invasive pneumococcal disease were identified. Estimated invasive pneumococcal disease incidence was 17.8/100,000 with incidence being highest among children aged 6 months to <12 months (49.9/100,000). Clinical pneumonia syndrome was the most frequent diagnosis (12.5/100,000). Pneumococcal serotypes included: 6A (n=6, 16.7%); 14 (n=5, 13.9%); 5 (n=4, 11.1%); 6B (n=4, 11.1%); 1, 18C, and 19A (n=3 each, 8.3%); 9V (n=2, 5.6%); and 3, 4, 10C, 18A, 18F, and 19F (n=1 each, 2.8%). Serotypes 6A, 14, 6B, 1, 18C, 19A, 9V, 4, 10C, and 18A showed antibiotic resistance. Clinical pneumonia incidence was 2109/100,000, with incidence being highest among children aged 28 days to <6 months (5033/100,000). Chest radiograph-confirmed pneumonia incidence was 1114/100,000, with incidence being highest among children aged 28 days to <6 months (2413/100,000). CONCLUSIONS: Invasive pneumococcal disease and pneumonia were found to be common causes of morbidity in young children living in South Bangalore, India.

Fighting Microbial Drug Resistance: A Primer On The Role Of Evolutionary Biology In Public Health, Gabriel Perron, R. Inglis, Pleuni Pennings, Sarah Cobey

Biology Department Faculty Works

Although microbes have been evolving resistance to antimicrobials for millennia, the spread of resistance in pathogen populations calls for the development of new drugs and treatment strategies. We propose that successful, long-term resistance management requires a better understanding of how resistance evolves in the first place. This is an opportunity for evolutionary biologists to engage in public health, a collaboration that has substantial precedent. Resistance evolution has been an important tool for developing and testing evolutionary theory, especially theory related to the genetic basis of new traits and constraints on adaptation. The present era is no exception. The articles in …

Multiplicative Disadvantage Of Being An Unmarried And Inadequately Insured Woman Living In Poverty With Colon Cancer: Historical Cohort Exploration In California, Naomi R. Levitz, Sundus Haji-Jama, Tonya Munro, Kevin M. Gorey

Social Work Publications

Background: Many Americans diagnosed with colon cancer do not receive indicated chemotherapy. Certain unmarried women may be particularly disadvantaged. A 3-way interaction of the multiplicative disadvantages of being an unmarried and inadequately insured woman living in poverty was explored. Methods: California registry data were analyzed for 2,319 women diagnosed with stage II to IV colon cancer between 1996 and 2000 and followed until 2014. Socioeconomic data from the 2000 census classified neighborhoods as high poverty (≥30% of households poor), middle (5–29%) or low poverty (<5% poor). Primary health insurance was private, Medicare, Medicaid or none. Comparisons of chemotherapy rates used standardized rate ratios (RR). We respectively used logistic and Cox regression models to assess chemotherapy and survival. Results: A statistically significant 3-way marital status by health insurance by poverty interaction effect on chemotherapy receipt was observed. Chemotherapy rates did not differ between unmarried (39.0%) and married (39.7%) women who lived in lower poverty neighborhoods and were privately insured. But unmarried women (27.3%) were 26% less likely to receive chemotherapy than were married women (37.1%, RR = 0.74, 95% CI 0.58, 0.95) who lived in high poverty neighborhoods and were publicly insured or uninsured. When this interaction and the main effects of health insurance, poverty and chemotherapy were accounted for, survival did not differ by marital status. Conclusions: The multiplicative barrier to colon cancer care that results from being inadequately insured and living in poverty is worse for unmarried than married women. Poverty is more prevalent among unmarried women and they have fewer assets so they are probably less able to absorb the indirect and direct, but uncovered, costs of colon cancer care. There seem to be structural inequities related to the institutions of marriage, work and health care that particularly disadvantage unmarried women that policy makers ought to be cognizant of as future reforms of the American health care system are considered.

Risk Of Gastrointestinal Bleeding Associated With Oral Anticoagulants: Population Based Retrospective Cohort Study, Hsien-Yen Chang, Meijia Zhou, Wenze Tang, G. Caleb Alexander, Sonal Singh

Epidemiology Faculty Publications

Objectives To determine the real world safety of dabigatran or rivaroxaban compared with warfarin in terms of gastrointestinal bleeding.

Design Retrospective cohort study.

Setting Large administrative database of commercially insured people in United States from 1 October 2010 through 31 March 2012.

Participants Enrollees with a prescription of warfarin, dabigatran, or rivaroxaban between 1 October 2010 and 31 March 2012, who were aged 18 years or older, had continuous enrollment and no oral anticoagulant use during the six months before the entry date, with known age and sex, and with no gastrointestinal bleeding for at least six months before the …

Risk Factors And Costs Influencing Hospitalizations Due To Heat-Related Illnesses: Patterns Of Hospitalization, Michael T. Schmeltz

Dissertations, Theses, and Capstone Projects

The objective of this dissertation was to identify individual and environmental risk factors, investigate outcomes and hospital resource use, including costs, and document the pattern of heat-related illness hospitalizations in the United States. The main data source for the study population was the 2001-2010 Nationwide Inpatient Sample (NIS). The study population for heat-related illnesses (HRIs) consists of patients in the NIS with at least one diagnosis of a heat-related illness (ICD-9 codes 992.0 - 992.9) from 2001 to 2010. Outcome analysis included a study population of patients who had primary or secondary diagnoses of diabetes, cardiovascular diseases, respiratory illnesses, nephritic …

Validating Estimates Of Prevalence Of Non-Communicable Diseases Based On Household Surveys: The Symptomatic Diagnosis Study, Spencer L. James, Minerva Romero, Dolores Ramírez-Villalobos, Sara Gómez

Dartmouth Scholarship

Easy-to-collect epidemiological information is critical for the more accurate estimation of the prevalence and burden of different non-communicable diseases around the world. Current measurement is restricted by limitations in existing measurement systems in the developing world and the lack of biometry tests for non-communicable diseases. Diagnosis based on self-reported signs and symptoms (“Symptomatic Diagnosis,” or SD) analyzed with computer-based algorithms may be a promising method for collecting timely and reliable information on non-communicable disease prevalence. The objective of this study was to develop and assess the performance of a symptom-based questionnaire to estimate prevalence of non-communicable diseases in low-resource areas.

Health Disparities Among Racial And Ethnic Minority Firefighters, Walker Sc Poston, Christopher K. Haddock, Sara A. Jahnke, Nattinee Jitnarin, Rena Sue Day, I David Daniels

Journal of Health Disparities Research and Practice

ABSTRACT

Background: Racial/ethnic minorities are substantially underrepresented in the fire service and this situation is unique when compared to similarly mentally and physically demanding and hazardous occupations such as the military and law enforcement. There is little systematic research to provide greater clarity about this significant disparity. The purpose of this study is to examine physical and behavioral health issues of racial/ethnic minority firefighters when compared to their white, non-Hispanic counterparts and potentially identify areas for future research that might assist in improving their substantial underrepresentation.

Materials and Methods: We report the results of a secondary analysis of data combining …

Cohort Of Birth Modifies The Association Between Fto Genotype And Bmi, James Niels Rosenquist, Steven F. Lehrer, A. James O'Malley, Alan M. Zaslavsky, Jordan W. Smoller, Nicholas A. Christakis

Dartmouth Scholarship

A substantial body of research has explored the relative roles of genetic and environmental factors on phenotype expression in humans. Recent research has also sought to identify gene-environment (or g-by-e) interactions, with mixed success. One potential reason for these mixed results may relate to the fact that genetic effects might be modified by changes in the environment over time. For example, the noted rise of obesity in the United States in the latter part of the 20th century might reflect an interaction between genetic variation and changing environmental conditions that together affect the penetrance of genetic influences. To evaluate this …