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Item Analysis of the Patient-Physician Relationship, Race, and Pain Control and Physical Function Among Adults With Chronic Low Back Pain(American Medical Association, 2022-06-01) Licciardone, John C.; Ganta, Sweta; Goehring, Leah; Wallace, Kendall; Pu, RyanImportance: Racial and ethnic disparities in pain outcomes are widely reported in the United States. However, the impact of the patient-physician relationship on such outcomes remains unclear. Objective: To determine whether the patient-physician relationship mediates the association of race with pain outcomes. Design, Setting, and Participants: This cross-sectional study uses data from the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation, collected from April 2016 to December 2021. All registry enrollees who identified as Black or White with chronic low back pain who had a regular physician who provided pain care were included. Data were analyzed during December 2021. Exposures: Participant-reported aspects of their patient-physician relationship, including physician communication, physician empathy, and satisfaction with physician encounters. Main Outcomes and Measures: The primary outcomes included low back pain intensity, measured with a numerical rating scale and physical function, measured with the Roland-Morris Disability Questionnaire. Mediator variables were derived from the Communication Behavior Questionnaire, Consultation and Relational Empathy measure, and Patient Satisfaction Questionnaire. Results: Among 1177 participants, the mean (SD) age was 53.5 (13.1) years, and there were 876 (74.4%) women. A total of 217 participants (18.4%) were Black, and 960 participants (81.6%) were White. The only difference between Black and White participants in the patient-physician relationship involved effective and open physician communication, which favored Black participants (mean communication score, 72.1 [95% CI, 68.8-75.4] vs 67.9 [95% CI, 66.2-69.6]; P = .03). Black participants, compared with White participants reported worse outcomes for pain intensity (mean pain score, 7.1 [95% CI, 6.8-7.3] vs 5.8 [95% CI, 5.7-6.0]; P < .001) and back-related disability (mean disability score, 15.8 [95% CI, 15.1-16.6] vs 14.1 [95% CI, 13.8-14.5]; P < .001). In mediation analyses that controlled for potential confounders using disease risk scores, virtually none of the associations of race with each outcome was mediated by the individual or combined factors of physician communication, physician empathy, and patient satisfaction. Similarly, no mediation was observed in sensitivity analyses that included only participants with both chronic low back pain and the same treating physician for more than 5 years. Conclusions and Relevance: These findings suggest that factors other than the patient-physician relationship were important to pain disparities experienced by Black participants. Additional research on systemic factors, such as access to high-quality medical care, may be helpful in identifying more promising approaches to mitigating racial pain disparities.Item Ancestry Informativeness of Alu Markers in Four Populations Relevant for the United States(2015-05-01) D'Auben, Aislinn G.; Chakraborty, Ranajit; LaRue, Bobby L.; Barber, Robert C.Determination of ancestry using DNA markers is an important issue in DNA forensics. The ability to identify an individual’s ancestry could narrow down the pool of possible individuals involved in a crime. Several types of ancestry informative markers (AIMs) have been suggested in the literature. For this study, Alu markers were used for investigating their utility for Caucasian versus African and Caucasian versus Asian ancestry determinations. Three measures of AIMs were calculated for 42 Alu markers. Rank correlations of these three measures were used for investigating if a smaller number of top-ranked loci can improve ancestry determination. The Alu markers chosen for this study were less informative than anticipated but did show potential for ancestry estimation when all 42 markers were used together.Item Association of Magnesium Intake with Liver Fibrosis among Adults in the United States(MDPI, 2021-01-02) Tao, Meng-Hua; Fulda, Kimberly G.Liver fibrosis represents the consequences of chronic liver injury. Individuals with alcoholic or nonalcoholic liver diseases are at high risk of magnesium deficiency. This study aimed to evaluate the association between magnesium and calcium intakes and significant liver fibrosis, and whether the associations differ by alcohol drinking status. Based on the National Health and Nutrition Examination Survey (NHANES) 2017–2018, the study included 4166 participants aged >18 years who completed the transient elastography examination and had data available on magnesium intake. The median liver stiffness of 8.2 kPa was used to identify subjects with significant fibrosis (≥F2). The age-adjusted prevalence of significant fibrosis was 12.81%. Overall total magnesium intake was marginally associated with reduced odds of significant fibrosis (p trend = 0.14). The inverse association of total magnesium intake with significant fibrosis was primarily presented among those who had daily calcium intake <1200 mg. There were no clear associations for significant fibrosis with calcium intake. Findings suggest that high total magnesium alone may reduce risk of significant fibrosis. Further studies are needed to confirm these findings.Item At the intersection of precision medicine and population health: an implementation-effectiveness study of family health history based systematic risk assessment in primary care(BioMed Central Ltd., 2020-11-07) Orlando, Lori A.; Wu, R. Ryanne; Myers, Rachel A.; Neuner, Joan; McCarty, Catherine; Haller, Irina V.; Harry, Melissa; Fulda, Kimberly G.; Dimmock, David; Rakhra-Burris, Teji; Buchanan, Adam; Ginsburg, Geoffrey S.Background: Risk assessment is a precision medicine technique that can be used to enhance population health when applied to prevention. Several barriers limit the uptake of risk assessment in health care systems; and little is known about the potential impact that adoption of systematic risk assessment for screening and prevention in the primary care population might have. Here we present results of a first of its kind multi-institutional study of a precision medicine tool for systematic risk assessment. Methods: We undertook an implementation-effectiveness trial of systematic risk assessment of primary care patients in 19 primary care clinics at four geographically and culturally diverse healthcare systems. All adult English or Spanish speaking patients were invited to enter personal and family health history data into MeTree, a patient-facing family health history driven risk assessment program, for 27 medical conditions. Risk assessment recommendations followed evidence-based guidelines for identifying and managing those at increased disease risk. Results: One thousand eight hundred eighty-nine participants completed MeTree, entering information on N = 25,967 individuals. Mean relatives entered = 13.7 (SD 7.9), range 7-74. N = 1443 (76.4%) participants received increased risk recommendations: 597 (31.6%) for monogenic hereditary conditions, 508 (26.9%) for familial-level risk, and 1056 (56.1%) for risk of a common chronic disease. There were 6617 recommendations given across the 1443 participants. In multivariate analysis, only the total number of relatives entered was significantly associated with receiving a recommendation. Conclusions: A significant percentage of the general primary care population meet criteria for more intensive risk management. In particular 46% for monogenic hereditary and familial level disease risk. Adopting strategies to facilitate systematic risk assessment in primary care could have a significant impact on populations within the U.S. and even beyond.Item Comparison of Dietary Micronutrient Intakes by Body Weight Status among Mexican-American and Non-Hispanic Black Women Aged 19-39 Years: An Analysis of NHANES 2003-2014(MDPI, 2019-11-20) Liu, Jialiang; Zhu, Xiangzhu; Fulda, Kimberly G.; Chen, Shande; Tao, Meng-HuaThe objective of the current study was to examine micronutrient intake from foods in women of childbearing age and to better understand potential nutritional problems varied by body weight status in minority women. A sample of women aged 19-39 years from the National Health and Nutrition Examination Surveys (NHANES) 2003-2014 was analyzed. Dietary intakes of 13 micronutrients were estimated using the National Cancer Institute method. Mexican-American and non-Hispanic Black women were categorized into normal/under-weight, overweight, or obese groups according to their body mass index (BMI). Mexican-American and non-Hispanic Black women had lower dietary intakes for vitamins A, B2, B6, B12, and D, folate, calcium, and magnesium than non-Hispanic Whites. Among Mexican-Americans, obese women had the lowest dietary intake of vitamins A, B2, C and D. Obese non-Hispanic Black women had significantly lower dietary intakes of iron and zinc than their normal/under-weight counterparts. Comparable percentages (>30%) of Mexican-American and non-Hispanic Black women had dietary intake less than the Estimated Average Requirements (EARs) for several key nutrients including vitamin A, C and D, folate, calcium and magnesium, and the percentages varied by body weight status. These results indicate micronutrient inadequacies persist among and within racial/ethnic and body weight groups.Item Depression, inflammation, and memory loss among Mexican Americans: analysis of the HABLE cohort(Cambridge University Press, 2017-06-20) Johnson, Leigh A.; Edwards, Melissa; Gamboa, Adriana; Hall, James R.; Robinson, Michelle; O'Bryant, Sid E.Background: This study explored the combined impact of depression and inflammation on memory functioning among Mexican-American adults and elders. Methods: Data were analyzed from 381 participants of the Health and Aging Brain study among Latino Elders (HABLE). Fasting serum samples were collected and assayed in duplicate using electrochemiluminesce on the SECTOR Imager 2400A from Meso Scale Discovery. Positive DepE (depression endophenotype) was codified as any score >1 on a five-point scale based on the GDS-30. Inflammation was determined by TNFɑ levels and categorized by tertiles (1st, 2nd, 3rd). WMS-III LMI and LMII as well as CERAD were utilized as measures of memory. ANOVAs examined group differences between positive DepE and inflammation tertiles with neuropsychological scale scores as outcome variables. Logistic regressions were used to examine level of inflammation and DepE positive status on the risk for MCI. Results: Positive DepE as well as higher inflammation were both independently found to be associated with lower memory scores. Among DepE positive, those who were high in inflammation (3rd tertile) were found to perform significantly worse on WMS-III LM I (F = 4.75, p = 0.003), WMS-III LM II (F = 8.18, p < 0.001), and CERAD List Learning (F = 17.37, p < 0.001) when compared to those low on inflammation (1st tertile). The combination of DepE positive and highest tertile of inflammation was associated with increased risk for MCI diagnosis (OR = 6.06; 95% CI = 3.9-11.2, p < 0.001). Conclusion: Presence of elevated inflammation and positive DepE scores increased risk for worse memory among Mexican-American older adults. Additionally, the combination of DepE and high inflammation was associated with increased risk for MCI diagnosis. This work suggests that depression and inflammation are independently associated with worse memory among Mexican-American adults and elders; however, the combination of both increases risk for poorer memory beyond either alone.Item Do physical activity levels differ by number of children at home in women aged 25-44 in the general population?(Sage Publications, 2019-09-09) Abell, Laura P.; Tanase, Kelly A.; Gilmore, Madison L.; Winnicki, Anna E.; Holmes, Victor L.; Hartos, Jessica L.OBJECTIVES: While physical activity is important for health, many women do not meet recommended levels, particularly mothers. The purpose of this study was to assess whether physical activity levels differ by number of children at home in women aged 25-44 in the general US population. METHODS: This cross-sectional analysis used 2017 Behavioral Risk Factor Surveillance System data for females aged 25-44 (N = 6266) from California, Colorado, New York, Texas, and Utah. Ordered logistic regression analysis assessed the relationship between physical activity levels and number of children at home while controlling for state and demographic, socioeconomic, and health-related factors. RESULTS: About half of participants reported "inactive" or "insufficiently active" physical activity levels and about two-thirds reported having one or more children at home. The results of adjusted analysis indicated that physical activity level was significantly related to having one child (adjusted odds ratio = 0.75, 95% confidence interval = 0.63, 0.89), two children (adjusted odds ratio = 0.79; 95% confidence interval = 0.67, 0.93), and three or more children (adjusted odds ratio = 0.80, 95% confidence interval = 0.67, 0.94) at home. CONCLUSION: Overall, physical activity levels were significantly related to presence of children at home for women aged 25-44, but increasing number of children at home did not impact effect size. For women aged 25-44 in a primary care setting, a moderate prevalence of inactive or insufficiently active physical activity may be expected. Providers should address physical activity with all patients in this target population during well-visits, but particularly for women with children at home; educate patients about the health benefits of regular physical activity; and provide resources that will help them integrate physical activity into their daily lifestyles.Item Effects of temperature on bacterial microbiome composition in Ixodes scapularis ticks(John Wiley & Sons, Inc., 2018-09-21) Thapa, Santosh; Zhang, Yan; Allen, Michael S.Ixodes scapularis, the blacklegged deer tick, is the principal vector of Lyme disease in North America. Environmental factors are known to influence regional and seasonal incidence of Lyme disease and possibly the endemicity of the disease to the northeastern and upper mid-western regions of the United States. With a goal to understand the impact of environmental temperature on microbial communities within the tick, we investigated the bacterial microbiome of colony-reared I. scapularis ticks statically incubated at different temperatures (4, 20, 30, and 37°C) at a constant humidity in a controlled laboratory setting by comparison of sequenced amplicons of the bacterial 16S V4 rRNA gene to that of the untreated baseline controls. The microbiomes of colony-reared I. scapularis males were distinct than that of females, which were entirely dominated by Rickettsia. In silico removal of Rickettsia sequences from female data revealed the underlying bacterial community, which is consistent in complexity with those seen among male ticks. The bacterial community composition of these ticks changes upon incubation at 30°C for a week and 37°C for more than 5 days. Moreover, the male ticks incubated at 30 and 37°C exhibited significantly different bacterial diversity compared to the initial baseline microbiome, and the change in bacterial diversity was dependent upon duration of exposure. Rickettsia-free data revealed a significantly different bacterial diversity in female ticks incubated at 37°C compared to that of 4 and 20°C treatments. These results provide experimental evidence that environmental temperature can impact the tick bacterial microbiome in a laboratory setting.Item Evaluation of Neighborhood-Level Disadvantage and Cognition in Mexican American and Non-Hispanic White Adults 50 Years and Older in the US(American Medical Association, 2023-08-30) Wong, Christina G.; Miller, Justin B.; Zhang, Fan; Rissman, Robert A.; Raman, Rema; Hall, James R.; Petersen, Melissa E.; Yaffe, Kristine; Kind, Amy J.; O'Bryant, Sid E.; Team, HABS-HD StudyIMPORTANCE: Understanding how socioeconomic factors are associated with cognitive aging is important for addressing health disparities in Alzheimer disease. OBJECTIVE: To examine the association of neighborhood disadvantage with cognition among a multiethnic cohort of older adults. DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, data were collected between September 1, 2017, and May 31, 2022. Participants were from the Health and Aging Brain Study-Health Disparities, which is a community-based single-center study in the Dallas/Fort Worth area of Texas. A total of 1614 Mexican American and non-Hispanic White adults 50 years and older were included. EXPOSURE: Neighborhood disadvantage for participants' current residence was measured by the validated Area Deprivation Index (ADI); ADI Texas state deciles were converted to quintiles, with quintile 1 representing the least disadvantaged area and quintile 5 the most disadvantaged area. Covariates included age, sex, and educational level. MAIN OUTCOMES AND MEASURES: Performance on cognitive tests assessing memory, language, attention, processing speed, and executive functioning; measures included the Spanish-English Verbal Learning Test (SEVLT) Learning and Delayed Recall subscales; Wechsler Memory Scale, third edition (WMS-III) Digit Span Forward, Digit Span Backward, and Logical Memory 1 and 2 subscales; Trail Making Test (TMT) parts A and B; Digit Symbol Substitution Test (DSST); Letter Fluency; and Animal Naming. Raw scores were used for analyses. Associations between neighborhood disadvantage and neuropsychological performance were examined via demographically adjusted linear regression models stratified by ethnic group. RESULTS: Among 1614 older adults (mean [SD] age, 66.3 [8.7] years; 980 women [60.7%]), 853 were Mexican American (mean [SD] age, 63.9 [7.9] years; 566 women [66.4%]), and 761 were non-Hispanic White (mean [SD] age, 69.1 [8.7] years; 414 women [54.4%]). Older Mexican American adults were more likely to reside in the most disadvantaged areas (ADI quintiles 3-5), with 280 individuals (32.8%) living in ADI quintile 5, whereas a large proportion of older non-Hispanic White adults resided in ADI quintile 1 (296 individuals [38.9%]). Mexican American individuals living in more disadvantaged areas had worse performance than those living in ADI quintile 1 on 7 of 11 cognitive tests, including SEVLT Learning (ADI quintile 5: beta = -2.50; 95% CI, -4.46 to -0.54), SEVLT Delayed Recall (eg, ADI quintile 3: beta = -1.11; 95% CI, -1.97 to -0.24), WMS-III Digit Span Forward (eg, ADI quintile 4: beta = -1.14; 95% CI, -1.60 to -0.67), TMT part A (ADI quintile 5: beta = 7.85; 95% CI, 1.28-14.42), TMT part B (eg, ADI quintile 5: beta = 31.5; 95% CI, 12.16-51.35), Letter Fluency (ADI quintile 4: beta = -2.91; 95% CI, -5.39 to -0.43), and DSST (eg, ADI quintile 5: beta = -4.45; 95% CI, -6.77 to -2.14). In contrast, only non-Hispanic White individuals living in ADI quintile 4 had worse performance than those living in ADI quintile 1 on 4 of 11 cognitive tests, including SEVLT Learning (beta = -2.35; 95% CI, -4.40 to -0.30), SEVLT Delayed Recall (beta = -0.95; 95% CI, -1.73 to -0.17), TMT part B (beta = 15.95; 95% CI, 2.47-29.44), and DSST (beta = -3.96; 95% CI, -6.49 to -1.43). CONCLUSIONS AND RELEVANCE: In this cross-sectional study, aging in a disadvantaged area was associated with worse cognitive functioning, particularly for older Mexican American adults. Future studies examining the implications of exposure to neighborhood disadvantage across the life span will be important for improving cognitive outcomes in diverse populations.Item Food Choice Priorities Change Over Time and Predict Dietary Intake at the End of the First Year of College Among Students in the U.S(MDPI, 2018-09-13) Vilaro, Melissa J.; Colby, Sarah E.; Riggsbee, Kristen; Zhou, Wenjun; Byrd-Bredbenner, Carol; Olfert, Melissa D.; Barnett, Tracey E.; Horacek, Tanya; Sowers, Morgan; Mathews, Anne E.This study assessed food choice priorities (FCP) and associations with consumption of fruits and vegetables (FV), fiber, added sugars from non-beverage sources, and sugar-sweetened beverages (SSB) among college students. Freshmen from eight U.S. universities (N = 1149) completed the Food Choice Priorities Survey, designed for college students to provide a way to determine the factors of greatest importance regarding food choices, and the NCI Dietary Screener Questionnaire. Changes in FCP and dietary intake from fall 2015 to spring 2016 were assessed. Multiple regression models examined associations between FCP and log-transformed dietary intake, controlling for sex, age, race, and BMI. Participant characteristics and FCP associations were also assessed. FCP importance changed across the freshmen year and significantly predicted dietary intake. The most important FCP were price, busy daily life and preferences, and healthy aesthetic. Students who endorsed healthy aesthetic factors (health, effect on physical appearance, freshness/quality/in season) as important for food choice, consumed more FV and fiber and less added sugar and SSB. Busy daily life and preferences (taste, convenience, routine, ability to feel full) predicted lower FV, higher added sugar, and higher SSB consumption. Price predicted lower FV, higher SSB, and more added sugar while the advertising environment was positively associated with SSB intake. FCP and demographic factors explained between 2%(-)17% of the variance in dietary intake across models. The strongest relationship was between healthy aesthetic factors and SSB (B = -0.37, p < 0.01). Self-rated importance of factors influencing food choice are related to dietary intake among students. Interventions that shift identified FCP may positively impact students' diet quality especially considering that some FCP increase in importance across the first year of college.Item Generating a Future Vision of Patient Safety: A Pilot Program to Test the Integration of Certified Professional in Patient Safety Curriculum into Undergraduate Medical Education(Sage Publications, 2021-07-28) Gelinas, Lillee S.; Reynolds, Conner D.; Lindsley, Joshua; Lieto, JanetPreventable healthcare-associated harm results in significant morbidity and mortality in the United States, costing nearly 400 000 patient lives annually. The Institute for Healthcare Improvement provides high-quality educational resources tailored for working healthcare professionals. One such resource is the Certified Professional in Patient Safety (CPPS) review course, which equips professionals with advanced proficiency in 5 core patient safety domains. The CPPS certification is the only interprofessional, patient safety science credential recognized worldwide. In 2010, the Lucian Leape Institute at the National Patient Safety Foundation described the critical need for medical students to participate in patient safety solutions as well. However, equivalent patient safety credentialing remains challenging for students in the preclinical and clinical stages of training to obtain. To address this growing dilemma, the Texas College of Osteopathic Medicine (TCOM) piloted the first-of-its-kind CPPS course with 10 medical students to test a novel, academic-level approach to patient safety curriculum. Medical students showed large gains in performance on the post-test (83.18% +/- 26.12%) compared to the pre-test (46.46% +/- 27.18%) (P < .001, eta(2) p = .368), representing increased knowledge across all learning domains. On the national certification examination, students had a 90% first-time pass rate, exceeding the current national average of 70% for first-time examinees. In satisfaction surveys, students expressed the value of pilot curriculum for their medical training, the importance of similar Patient Safety Education and CPPS certification for all medical students, their confidence as future healthcare change agents. Content analysis of open response questions revealed 3 key areas of strength and opportunity for guiding future iterations of the course. This pilot generates a future vision of patient safety, equipping students with critical knowledge to systematically improve healthcare quality.Item Genetically engineered probiotic for the treatment of phenylketonuria (PKU); assessment of a novel treatment in vitro and in the PAHenu2 mouse model of PKU(PLOS, 2017-05-17) Durrer, Katherine E.; Allen, Michael S.; Hunt von Herbing, IonePhenylketonuria (PKU) is a genetic disease characterized by the inability to convert dietary phenylalanine to tyrosine by phenylalanine hydroxylase. Given the importance of gut microbes in digestion, a genetically engineered microbe could potentially degrade some ingested phenylalanine from the diet prior to absorption. To test this, a phenylalanine lyase gene from Anabaena variabilis (AvPAL) was codon-optimized and cloned into a shuttle vector for expression in Lactobacillus reuteri 100-23C (pHENOMMenal). Functional expression of AvPAL was determined in vitro, and subsequently tested in vivo in homozygous PAHenu2 (PKU model) mice. Initial trials of two PAHenu2 homozygous (PKU) mice defined conditions for freeze-drying and delivery of bacteria. Animals showed reduced blood phe within three to four days of treatment with pHENOMMenal probiotic, and blood phe concentrations remained significantly reduced (P < 0.0005) compared to untreated controls during the course of experiments. Although pHENOMMenal probiotic could be cultured from fecal samples at four months post treatment, it could no longer be cultivated from feces at eight months post treatment, indicating eventual loss of the microbe from the gut. Preliminary screens during experimentation found no immune response to AvPAL. Collectively these studies provide data for the use of a genetically engineered probiotic as a potential treatment for PKU.Item Getting Lost in Translation: The Dangers in Literal Translation(2008-04-18) Pena, Itzel; Gwirtz, Patricia A.; Gladue, Brian; Espinoza, AnnaCurrently 16 million Hispanics in the U.S. do not speak any English making the need for Spanish translation apparent. Within the clinical research realm, accurate translation is important for complete comprehension of the informed consent process, as it is the application of the ethical principle of respect for persons (autonomy). This study found that literal translations might not always be the best form of translation. Instead, non-literal translations may offer better comprehension of the consent process. However, the effect of being bilingual and attaining high education levels are significant factors influencing the comprehension of the informed consent document. Additionally these factors may actually facilitate the understanding of the consent form more than the literal and non-literal translation. Lastly, the perception and meaning behind different translations can affect comprehension of consent concepts. Subjects preferred to be called participants showing that the two different translations can hold different meanings.Item Leading Predictors of COVID-19-Related Poor Mental Health in Adult Asian Indians: An Application of Extreme Gradient Boosting and Shapley Additive Explanations(MDPI, 2023-01-09) Ikram, Mohammad; Shaikh, Nazneen F.; Vishwanatha, Jamboor K.; Sambamoorthi, UshaDuring the COVID-19 pandemic, an increase in poor mental health among Asian Indians was observed in the United States. However, the leading predictors of poor mental health during the COVID-19 pandemic in Asian Indians remained unknown. A cross-sectional online survey was administered to self-identified Asian Indians aged 18 and older (N = 289). Survey collected information on demographic and socio-economic characteristics and the COVID-19 burden. Two novel machine learning techniques-eXtreme Gradient Boosting and Shapley Additive exPlanations (SHAP) were used to identify the leading predictors and explain their associations with poor mental health. A majority of the study participants were female (65.1%), below 50 years of age (73.3%), and had income >/= $75,000 (81.0%). The six leading predictors of poor mental health among Asian Indians were sleep disturbance, age, general health, income, wearing a mask, and self-reported discrimination. SHAP plots indicated that higher age, wearing a mask, and maintaining social distancing all the time were negatively associated with poor mental health while having sleep disturbance and imputed income levels were positively associated with poor mental health. The model performance metrics indicated high accuracy (0.77), precision (0.78), F1 score (0.77), recall (0.77), and AUROC (0.87). Nearly one in two adults reported poor mental health, and one in five reported sleep disturbance. Findings from our study suggest a paradoxical relationship between income and poor mental health; further studies are needed to confirm our study findings. Sleep disturbance and perceived discrimination can be targeted through tailored intervention to reduce the risk of poor mental health in Asian Indians.Item Pre-diabetes Screening Tools for Adults Living in the United States(2014-05-01) Evans, Eva L.; Sterling, David; Fischbach, Lori; Felini, Martha J.Almost 37% of persons living in the US aged [greater than] 18 years have pre-diabetes, Persons with pre-diabetes are at high risk of developing type-2 diabetes (advanced hyperglycemia) and also have a higher risk of cardiovascular disease than those with normal blood glucose levels. Furthermore, results from cross-sectional studies indicate that microvascular complications arising from hyperglycemia may begin at the pre-diabetic stage. There is evidence that progression of pre-diabetes may be halted or even reversed with lifestyle and pharmaceutical interventions. However, less than 10% of US adults with pre-diabetes are aware of their condition, which indicates that current pre-diabetes screening methods are inadequate. US physicians need a comprehensive pre-diabetes screening tool. To this end, non-invasive screening score sets were created to screen for IFG, IGT and elevated HbA1c. Because preliminary analyses indicated that the screening accuracy of the pre-diabetes screening score sets would be enhanced by not restricting the score sets to only the pre-diabetic ranges of hyperglycemia, the pre-diabetes screening tool was designed to screen for hyperglycemia in the pre-diabetic and diabetic ranges. These hyperglycemia screening score sets have been based on a scoring system of non-invasive factors associated with hyperglycemia that are already routinely measured or assessed during a visit to the doctor. These factors were age, gender, smoking status, diabetes family history, history of cardiovascular disease, history of hypertension, height, body mass index, physical activity level (by surrogate measure of fasting heart rate), level of alcohol consumption, history of early menarche (women only), and history of gestational diabetes (parous women only). To boost performance for the non-invasive fasting hyperglycemia score set and the non-invasive elevated HbA1c screening score set, both for use in parous women, the fasting screening score set and the HbA1c screening score set included the factor, ethnicity. The pre-diabetes tools were externally and internally validated and were also compared to other non-invasive methods that might be used to screen for hyperglycemia.Item Predicting for Disciplinary Action by the Texas State Board of Medical Examiners, 1989-1998(2001-01-01) Cardarelli, Roberto; Licciardone, John C.; Ramirez, Gilbert; Marshall, MurielContext The rate of physician disciplinary action in the United States has been increasing over the lack decade. While studies have analyzed various facets of malpractice and types of physician offenses, few have attempted to investigate factors that may place physicians at risk for disciplinary action. Objective To determine predictors for physician disciplinary action. Design Case-control study using publicly available data matching 174 disciplined physicians with non-disciplined physicians on age and years in practice. Subjects Disciplined physicians reported by the Texas State Board of Medical Examiners from January 1989 to December 1998. Main Outcome Measures Characteristics of disciplined physicians and multivariate predictors of disciplinary action. Results Of the 1382 physicians disciplined during the study period, 174 cases were eligible for inclusion. Sixty six percent of the study period, 174 cases were eligible for inclusion. Sixty six percent of the study population was 40 years or less of age, while 69.5% were men. Whites composed 65.4% of the study population and internal medicine was the predominate specialty. In the multivariate analysis female physicians were less likely to receive disciplinary action (odds ratio [OR]=0.27, 95% confidence interval [CI]=0.17-0.44. Additionally, internists (OR=0.35, 95% CI=0.22-0.56), surgeons (OR=0.30, 95% CI=0.17-0.54), and pediatricians (OR=0.28, 95% CI=0.13-0.61) were less likely to be disciplined compared to family medicine physicians, while general practitioners (OR=2.48, 95% CI=1.24-4.95) were most likely to be disciplined. Conclusions Although only a small fraction practicing physicians is disciplined each year, an economic and public health issue persists. This study identified several predictors for disciplinary action, however, further studies are needed to better understand those at risk so effective interventions can be developed.Item Prevalence and Risk Indicators for Root Caries in Non-Institutionalized Older Adults U.S. Population, 1988-1994(2000-05-01) Rivera Torres, AngelRivera Torres, Angel D.D.S., M.P.H., M.S.P.H., Prevalence and Risk Indicators for Root Caries in Non-Institutionalized Older Adults U.S. Population, 1988-1994. Doctor of Philosophy (Biomedical Sciences), May 2000, 139 pp., 17 tables, 1 illustration, bibliography, 132 titles. Background. Dental caries and periodontal disease are prevalent in the elderly population; the progressive consequences of these have physical, economic, social, and psychological implications for long term care. This study reports on associated risk indicators for root caries in a population-based sample of non-institutionalized older adults of diverse race/ethnic groups and age cohorts. Methods. Data were analyzed from 3.313 non-institutionalized U.S. adults 65 years of age and over, who had been surveyed in the National Health and Nutrition Examination Survey, III 1988-94 (NHANES III) and who had completed the dental examination. Descriptive and multivariate statistics were used to compare older adults with and without root caries. Logistic regression analyses was utilized in this study to identify predictors for root caries. Results. The mean number of teeth in this population was 21, with an average prevalence of root decayed, filled surfaces (RDFs) of 2.17. The prevalence as measured by the root caries index (RCI) was 39.07 and the ratio RDs/RDFs was 70%. Multivariate logistic regression analysis indicated that African-American males (O.R.1.55;C.I.1.30-1.84) or Mexican-American males (O.R.3.18;C.I.2.56-3.94) with a level of education less than 8 years (O.R.1.50;C.I.1.25-1.81) living below poverty level (O.R.1.60;C.I.1.33-1.93) were most likely to have root caries. Smoking (O.R.1.70;C.I.1.41-2.04), previous root caries experience (O.R.1.61;C.I.1.15-1.68), wearing a partial denture (O.R.1.78;C.I.1.38-2.29), having 14 teeth of less (O.R.1.42;C.I.1.15-1.76) and consuming starchy (O.R.1.52;C.I.1.26-1.83) and liquid sugar snacks (O.R.1.75;C.I. 1.44-2.11) were also indicators of an increased risk for root caries. Conclusions. These findings suggest that Caucasians had less risk of root caries than African-American and Mexican-Americans and that poor periodontal status (O.R.3.29; C.I. 2.39-4.52) increased the risk of root caries. Additionally, older adults in the U.S. population have a great need for dental treatment. Additional epidemiologic studies are needed and should focus on those social and behavioral factors that put individuals at risk for developing root caries.Item Public Opinion of the Uninsured: Who Are They? Can They Get Care? Should Insurance be Publically Provided(2001-07-01) Miller, Rachel; Lykens, Kristine; Mains, Doug A.; Singh, KaranThe United States is at the pinnacle of medical expertise and exploration. Many people from around the world come here to receive that outstanding care. Unfortunately, many of our own citizens are unable to enjoy that same privilege. With mounting technological and research costs, Health Maintenance Organizations, State-funded health insurance, and federally funded programs, such as Medicaid, are struggling to meet the expanding numbers of uninsured. The public is the driving force behind the policy debate in this country, and the debate over the uninsured may be lacking some very important information. It was the aim of this study to evaluate the public’s view of the uninsured. Meta-analysis was used to evaluate three questions regarding the public’s opinions of the status of the uninsured in the country to better understand the true perception held.Item Risk Factors Associated with Low Bone Mineral Density and Hip Fracture Among United States 20-90 Years of Age (NHANES III Study)(1999-06-01) Nandi, Shubhra; Rene, Antonio; Licciardone, John C.; Fong, Nelson C.Nandi, Shubhra. Risk Factors Associated with Low Bone Mineral Diversity and Hip Fracture Among United States Females 20-29 Years of Age. (NHANES III Study). Master of Public Health, June 1999, 45p.p. Osteoporosis has become a great public health problem because of the growing segment of the elderly population. The manifestation of osteoporosis results in morbidity with disability and a diminished quality of life due to hip fracture and spine fracture. This is also the major cause of hospital expenditure. Thus, understanding the development of low bone mineral density at various skeletal sites and the prevention of the causes related to the diminished bone mineral density is of great importance. This is a descriptive study of risk factors associated with low bone mineral density and hip fracture among United States females 20-90 years of age. Data was collected by the National Center for Health Statistics from 1988-1994 in two phases. Several risk factors have been associated with low bone mineral density. They are age, race, body mass index, fat-free mass, smoking, alcohol intake, caffeine intake, calcium supplement intake, dairy intake, and the level of physical activity. The primary objective of this study was to elucidate the relationship of low bone mineral density in a specific race-ethnic population with the perceived risk factors. This cross-sectional study provides information to confirm that Non-Hispanic Whites have low bone mineral density at the end of their decade of life compared to Non-Hispanic Blacks and Hispanic Americans. A significant association between low bone mineral density and age, race ethnicity, body mass index, and milk intake was detected (P [less than] 0.05). Other factors did not display any statistically significant correlation.Item Risk Factors for Childhood Asthma in the United States: A Cross-Sectional Study Based on NHANES 1999-2000 Data(2005-05-01) Alvarez-Garriga, Carolina; Sandhu, Raghbir; Cipher, Daisha; Rene, AntonioAlvarez-Garriga, Carolina, Risk Factors for Childhood Asthma in the United States: A Cross-Sectional Study Based on NHANES 1999-2000 Data. Doctor of Public Health (Epidemiology), May 2005, 114 pp., 18 tables, 4 figures, bibliography, 93 titles. The purpose of this study was to identify and assess risk factors for childhood asthma. A total of 158 asthmatics were compared to 1,104 non-asthmatics regarding selected factors by using the multiple logistic regression adjusted odds ratio as a measure of association. A 2.3 times higher prevalence (13.8 per 100) was found for the U.S. than that reported in the previous national surveys (NHANES III) during 1994 (5.9 per 100). Males and all race/ethnic minorities showed higher probability to have asthma. Income was inversely related to having asthma, and, among other results, renting a house, low birthweight, hay fever, chickenpox, learning disabilities, ear infections, trouble seeing even with glasses, and not covered by private insurance had higher chance of having asthma. Childhood asthma is still alarmingly increasing, and results from this study about high-risk groups and modifiable factors can be used for public health interventions.