Browsing by Subject "mortality"
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Item A Comparative Breast Cancer Study: Stage & Mortality in El Paso County's non-Hispanic white and Hispanic population(2003-05-01) Aravind, Raven; Russel HovermanAravind, Raven, A Comparative Breast Cancer Study: Stage & Mortality in El PasoCounty's non-Hispanic white and Hispanic population, 1990-2000. Master of Public Health (Epidemiology), May 2003, 17pp., 1 table, 3 figures, bibliography, 43 titles. This retrospective breast cancer study compares the stage of breast cancer diagnosis and mortality between Hispanic (HS) and non-Hispanic white women (NHW). The study includes 874 Hispanic women and 802 non-Hispanic white women diagnosed with breast cancer between January 1990 and December 2000 at the El Paso Cancer Treatment Center, El Paso Texas. The objectives of the study were: 1) to determine if this population of Hispanic women is being diagnosed at a later stage of breast cancer 2) to ascertain the relative survival of non-Hispanic white and Hispanic women 3) to verify if Hispanic women were being diagnosed at a younger age; and 4) to examine tumor size at diagnosis to determine if there is a need for more assertive screening measures in this population of women.Item A Six-Year Analysis of the Distribution of Time to Death Among Colorectal Cancer Patients in the State of Texas(2000-05-01) Williams, Vanessa P.; Antonio A. Rene; Thomas J. Fairchild; Sally BlakleyWilliams, Vanessa P., A Six-Year Analysis of the Distribution of Time to Death Among Colorectal Cancer Patients in the State of Texas. Master of Public Health (Epidemiology), May 2000, 55 pp., 11 tables, 9 figures, references, 52 titles. The cancer experience of Texans differs substantially by race/ethnicity. Among Caucasian, African American, and Hispanic men and women, colon cancer is either the second or third leading type of cancers among Texans. The distribution of time to death over a six-year period were assessed from a cohort of African American, Hispanic, and Caucasian men and women diagnosed with colon cancer in 1992. The purpose of this study is to determine if there is a difference in the overall death time distribution and tumor histology among African Americans, Hispanics, and Caucasian men and women who were diagnosed with colon cancer in 1992 in the state of Texas. Analysis results indicated that Hispanic females (65.59%) and Caucasian males (65.52%) had higher survival times among the race/ethnic groups. African American males (53.85%) and females (56.40%) experienced lower survival time for the cohort. For overall distribution of time to death among deceased subjects, African American males and Hispanic females experienced the lowest distribution times among the subjects. The overall distribution of time to death for all histology types were the same for each type.Item Barriers to Women's Cardiovascular Risk Knowledge: A Tarrant County Study(2004-05-01) Liewer, Linda J.; Kristine LykensLiewer, Linda J., Barriers to Women’s Cardiovascular Risk Knowledge: A Tarrant County Study. Master of Public Health (Health Management and Policy), May 2004, 71 pp., 19 tables, 6 illustrations, 36 references, 17 titles. Women’s death rate from cardiovascular disease is greater than the death rate from all cancers. Awareness and knowledge of a disease are key to dealing with it, yet many women are still unaware of their CVD risk. The purpose of this study is to identify the barriers to knowledge about cardiovascular disease risk in women in Tarrant County. Interviews with administrative personnel in 10 community organizations confirmed the lack of awareness of CVD. Barriers included: women in caregiver roles advocate effectively for their family members, but less effectively for themselves; physician communication with women regarding CVD is often suboptimal; women fear breast cancer far more than CVD; a program deficiency exists in Tarrant County; lack of a visible woman champion and heart disease is still seen as a man’s disease.Item Clinical Internship with the Pediatric Clinic's Clinical Research at the Patient Care Center of the University of North Texas Health Science Center/Texas College of Osteopathic Medicine: Literature Review of Meningococcal Meningitis(2002-07-01) Puckett, Fredric Clark; Harold Sheedlo; Robin Newman; John FlingEpidemic meningococcal meningitis and meningococcemia disease is caused by the bacterial pathogen Neisseria meningitidis. Once infected with meningococci, onset of the disease is rapid with a high rate or morbidity and mortality. Without medical intervention the mortality rate is over 50%. Medical treatment is over 50%. Medical treatment of an outbreak of the disease with antibiotics can reduce the death rate to 10-15%. However, 10-20% of survivors will suffer from neurological damage that may include loss of hearing, paralysis or mental retardation. Recent concerns have been noted regarding the emergence of Neisseria meningitidis strains resistant to antibiotics. Vaccines have been developed in an effort to reduce epidemic outbreaks of meningococcal meningitis and meningococcemia. The first generation polysaccharide vaccines have shown to be safe and possess some degree of effectiveness but have shortcomings of limited length of immune protection and evidence of hyporesponsiveness to subsequent vaccinations. The second generation conjugated polysaccharide vaccines have been able to overcome these problems and show great promise in reducing the sale of epidemic meningococcal outbreaks with implementation of effective mass vaccination campaigns. In addition, reducing the number of infections will limit the exposure of Neisseria meningitidis to antibiotics and, in theory, slow the development of resistance to antibiotics.Item COVID-19 in India: Are Biological and Environmental Factors Helping to Stem the Incidence and Severity?(JKL International, 2020-05-09) Chakrabarti, Sankha Shubhra; Kaur, Upinder; Banerjee, Anindita; Ganguly, Upsana; Banerjee, Tuhina; Saha, Sarama; Parashar, Gaurav; Prasad, Suvarna; Chakrabarti, Suddhachitta; Mittal, Amit; Agrawal, Bimal Kumar; Rawal, Ravindra Kumar; Zhao, Robert Chunhua; Gambhir, Indrajeet Singh; Khanna, Rahul; Shetty, Ashok K.; Jin, Kunlin; Chakrabarti, SasankaThe ongoing Corona virus (COVID-19) pandemic has witnessed global political responses of unimaginable proportions. Many nations have implemented lockdowns that involve mandating citizens not to leave their residences for non-essential work. The Indian government has taken appropriate and commendable steps to curtail the community spread of COVID-19. While this may be extremely beneficial, this perspective discusses the other reasons why COVID-19 may have a lesser impact on India. We analyze the current pattern of SARS-CoV-2 transmission, testing, and mortality in India with an emphasis on the importance of mortality as a marker of the clinical relevance of COVID-19 disease. We also analyze the environmental and biological factors which may lessen the impact of COVID-19 in India. The importance of cross-immunity, innate immune responses, ACE polymorphism, and viral genetic mutations are discussed.Item DESCRIPTIVE ANALYSIS OF MORTALITY DATA IN TEXAS STATE CORRECTIONAL FACILITIES(2013-04-12) Hall, LaurenPurpose: Inadequate prisoner healthcare in Texas is a significant problem. The Federal Constitution requires Texas to provide basic medical care for prisoners' serious medical conditions. Federal courts have had to monitor Texas for failing to meet the basic requirements of prisoner medical care. This study analyzed data on prison deaths in the state of Texas in order to determine trends in causes of death and identify points of advocacy to improve prisoner healthcare. Methods: This study used data on Texas prisoner deaths found in custodial death reports and made publicly accessible in a dataset via request to the Texas Attorney General's office. The dataset contained information for deaths reported between February 7, 2006 and October 12, 2011. Descriptive analyses were performed on demographics, death types, and medical conditions which were further stratified by gender. Overall mortality rates were calculated per year, and further stratified by prison type. Results: Texas female and male prisoners primarily died due to natural causes/illness (48%), followed by suicide (20%). The main medical cause of death due to natural causes was cardiovascular disease (24%), followed by infection in males (11.2%) and respiratory disease in females (16.9%). Overall, mortality rates in Texas prisons have decreased each year from 81.3 per 100,000 in 2006 to 67.7 per 100,000 in 2011. Higher mortality rates were observed in the smaller, low capacity Texas Department of Criminal Justice prison units. Conclusions: Mortality rates appear to be decreasing across prison facilities (both penitentiaries and county jails) in the state of Texas from 2006 to 2011. A more comprehensive and uniform database would be beneficial to future analyses on Texas prisoner deaths and healthcare. Further data is needed for a more robust interpretation of the data analyzed.Item Disability-Adjusted Life Years Lost Due to Adult Pulmonary Tuberculosis in Tarrant County, 2005-2006: An Analysis of the Role of Post Tuberculosis Impairment(2008-05-01) Pasipanodya, Jotam Garaimunashe; Sejong Bae; Kristine Lykens; Peter HilsenrathPasipanodya, Jotam G. Disability-Adjusted Life Years lost due to adult pulmonary tuberculosis in Tarrant County, 2005-2006: An analysis of the role of post tuberculosis impairment. Doctor of Public Health (Health Management and Policy), May 2008. 145 pages, 18 tables, 11 illustrations, 135 references. Pulmonary impairment after tuberculosis treatment (PIAT) is not yet incorporated in assessing burden of tuberculosis. Previous global and national TB burden estimates therefore did not fully reflect the consequences of surviving tuberculosis disease. This study was conducted to assess burden of TB in Tarrant County, Texas, using Disability-Adjusted Life Years (DALY). DALY is a composite measure of premature mortality and disability that equates years of healthy life lost. DALY, stratified by gender and race were calculated for 118 adult TB subjects seen between July 2005 and October 2006. Years of Life Lost (YLL) were calculated from the difference between standard life expectancy and age at death from TB, summed across county population. Years Lived with Disability (YLD) were derived from age and gender-specific disease incidence weight-adjusted for impairment levels; using disability weights obtained from literature. Three percent discount rate per year was used. One hundred and eighteen subjects lost 444.25 DALY during the study period. Years of life lost to premature mortality (YLL) contributed 159.62 (36%) and years of life lived with disability (YLD) contributed majority of total DALY. Pulmonary impairment after tuberculosis (YLD PIAT) contributed 234.6 (53%), while YLD Acute contributed only 50.03 (11 %) of total DALYS. Contrary to previous estimates; disability contributes more than mortality to TB burden in areas with low TB adult and child mortality. PIA T contributes significantly to TB burden, but was previously unrecognized. These findings suggest that the greatest health savings will be achieved through strategies to prevent tuberculosis from developing rather than strategies to shorten treatment once it has developed.Item Documentation of Preventive Medicine Practices in a University-Based Primary Care Clinic System: A Pilot Study(2001-05-01) Benavides, John Paul; Benavides, John Paul; Rene, Antonio A.; Marshall, Muriel A.Benavides, John P., Rene, Antonio A., Marshall Muriel A., Singh, Karan P. Documentation of Preventive Medicine Practices in a University-Based Primary Care Clinic System: A Pilot Study. The Significance of tracking preventive services is important when one considers the changing mortality patterns over the past century. Preventable sources of morbidity and mortality, highlighted by smoking and unhealthy nutritional and physical activity patterns, has resulted in over 700,000 deaths a year and provide examples for the need to optimize the delivery of primary prevention. The purpose of this study was to determine the delivery of preventive services in an osteopathic medicine-based university primary care system. Five family practice clinics affiliated with a university-based health science center participated. These clinics serve as ambulatory practice sites for faculty osteopathic physicians, physician assistants, and medical students. There were over 30,000 outpatient visits last year to the five family practice clinics. Differences in Preventive Flow Sheet documentation rates among the different clinics was noted. Female preventive flow sheet documentation was the most commonly performed, but cardiovascular risk assessment was the least documented. Females were also observed to have more preventive service documentation concerning alcohol use, abuse, and addiction.Item Duration of unemployment and self-perceived health in Europe(2016-03-01) Brenner, M. HarveyThis study investigates the potential impact of employment loss on self-perceived health according to the duration of national levels of unemployment in EU member states during 2004-2012. The principal findings were that the total unemployment rate, long-term unemployment (LTU) rate and very long-term unemployment (VLTU) rate were all strongly related to increased reports of bad and very bad self-perceived health. In fact, the impact of unemployment (i.e., effects based on the coefficients) increased in a ‘dose-response’ manner with the total unemployment rate showing the smallest coefficient, the LTU rate showing a greater coefficient, and the VLTU rate showing the strongest impact in terms of increasingly bad and very bad self-reported health. The findings complement existing evidence that identified unemployment as an important risk factor for heart disease mortality at the start of the 2008/2009 recession.Item Lung Cancer Risk Among Workers in Poultry Slaughtering and Processing Plants: A Pilot Study(2008-05-01) Preacely, Nykiconia D.; Ramphal-Naley, Lilly; Cardarelli, Kathryn; Qualls-Hampton, RaquelPreacely, Nykiconia D., Lung Cancer Risk Among Workers in Poultry Slaughtering and Processing Plants: A Pilot Study. Doctor of Public Health (Epidemiology), May 2008, 104 pp., 21 tables, 4 figures, bibliography, 50 titles. Poultry workers are at a great risk of exposure to potentially harmful transmissible agents which can cause cancer in poultry; yet there are few epidemiological studies that examine the association of occupation and illnesses experienced by these workers. Workers in poultry slaughtering and processing plants are well suited to investigate the effects of exposure to poultry oncogenic agents because they have one of the highest human exposure to carcinogenic chemicals formed during the packaging and preparation of poultry. The preparations of poultry via smoking, and frying are additional exposures that release carcinogens which may be involved in lung cancer risk among poultry workers. Union records from several unions belonging to the United Food & Commercial Workers International Union for the years 1949-1989 were used to identify a cohort of workers once employed in poultry slaughtering and processing plants. The current research investigated whether certain occupational exposures were associated with lung cancer mortality among these workers. The research employed a case cohort design that provided individual level occupational and lifestyle data for workers who died with lung cancer between 1990 and 2003 compared to a sub-cohort of individuals randomly sampled from the entire cohort. It is anticipated that by identifying potentially harmful exposures in this industry, future research may focus on developing methods to alleviate them among poultry workers. The results of this study will provide public health professionals and the poultry industry with new information on the occupational exposures not previously explored in relation to lung cancer mortality among poultry slaughtering/processing plant workers.Item Predictors of In-Hospital Mortality Among Acute Myocardial Infarction Patients in a Large Health Care System(2001-07-01) Zhang, Huiling; Karan Singh; Antonio Rene; Sally BlakleyZhang, Huiling. Predictors of In-hospital Mortality Among Acute Myocardial Infarction Patients in a Large Health Care System. Master of Public Health, July 2000, 29 pp., 4 tables, 29 references. Background---There is increasing interest in the identification of risk predictors for in-hospital mortality due to acute myocardial infarction (AMI). To date, there has been no AMI in-hospital mortality prediction models developed using clinical database. Methods and Results---The study population consists of 4,167 AMI cases admitted to 36 hospitals in 3 states. Thirty variables were selected as candidate predictors, and 19 showed significant bivariate association with AMI in-hospital mortality. By applying multiple logistic regression and stepwise selection, 10 variables were selected for inclusion in the final prediction model: age, arrive from cardiac rehabilitation center, CPR on arrival, Killip class, AMI with comorbidities, AMI with complications, PCTA performed, beta-blockers given, ACE inhibitors given, Plavix given. Conclusion---A ten-variable in-hospital mortality prediction model for AMI patients, which includes both risk factors and beneficial treatment procedures, was developed. Chi-square goodness of fit test suggested a very good fit for the model.Item Preterm Birth: A Cause of Concern for High Infant Mortality Rates(2009-12-01) Oak, Amruta; Dr. Patricia GwirtzItem Repeated measurements of serum urate and mortality: a prospective cohort study of 152,358 individuals over 8 years of follow-up(BioMed Central Ltd., 2020-04-15) Li, Shanshan; Cui, Liufu; Cheng, Jin; Shu, Rong; Chen, Shuohua; Nguyen, Uyen-Sa D. T.; Misra, Devyani; Wu, Shouling; Gao, XiangBACKGROUND: Longitudinal evidence on change of serum urate level with mortality risk is limited as prior studies have a measurement of serum urate at a single time point. Further, the combined effect of serum urate and systemic inflammation on mortality is unknown. METHODS: We conducted a prospective cohort study of 152,358 participants (122,045 men and 30,313 women) with repeated measurements of serum urate in 2006, 2008, 2010, and 2012 (107,751 participants had all four measurements of serum urate). We used the Cox proportional hazard model to examine the association between cumulative average and changes in serum urate with mortality. The combined effect of serum urate and systemic inflammation was determined by testing the interaction of serum urate and high-sensitive C-reactive protein (hs-CRP) in relation to mortality risk. RESULTS: During a median follow-up of 8.7 (interquartile range 6.3-9.2) years, we identified 7564 all-cause deaths, 1763 CVD deaths, 1706 cancer deaths, and 1572 other deaths. We observed U-shaped relationships of cumulative average serum urate with all-cause mortality, cardiovascular mortality, and other mortalities. Compared with participants with stable serum urate, those with greater increases in serum urate had a 1.7-fold elevated mortality (hazard ratio (HR) = 1.66, 95% confidence interval (CI) = 1.49-1.84), and those with decreased serum urate had a 2-fold elevated mortality risk (HR = 2.14, 95% CI 1.93-2.37). Participants with both hyperuricemia and hs-CRP had 1.6 times higher mortality, compared with those with low serum urate and hs-CRP levels (HR = 1.56, 95% CI 1.37-1.76). CONCLUSIONS: We observed a U-shaped relationship of long-term cumulative average serum urate with all-cause mortality, cardiovascular mortality, and other mortalities. Compared with participants with relatively stable serum urate levels, a greater increase or decrease in serum urate was associated with elevated mortality. Participants with both hyperuricemia and high systemic inflammation had the greatest mortality risk compared with those with low serum urate and low hs-CRP levels.Item The Association Between Medical Insurance Coverage, In-Hospital Case Fatality Rate, and Length of Hospital Stay Following Admission for Acute Myocardial Infarction in Texas Hospitals(2002-07-01) Boppana, Dinesh; Antonio A. Rene; Sally Blakley; Doug A. MainsDinesh Boppana, The Association Between Medical Insurance Coverage, In-hospital Case Fatality Rate and Length of Hospital Stay Following Admission for Acute Myocardial Infarction in Texas Hospitals. Master of Public Health, July 2002, 53pp., 22 tables, bibliography, 63 titles. This study reports the possible association between type of medical insurance coverage, in-hospital case fatality rates and length of hospital stay following admission for acute myocardial infarction (AMI) in Texas hospitals for the year of 1999. Methods. The data sources was the Texas Health Care Information Council public use data file. Crude and multivariable-adjusted analyses were used to examine the relation between type of medical insurance coverage, length of hospital stay and in-hospital case-fatality rates following AMI. Results. Relative to the referent group of private or commercial insurance patients (odds ratio, 1.0) the multi-variable adjusted odds for dying during acute hospitalization were 1.98 (95% CI, 1.53-2.52) for Medicaid, 1.45 (95% CI, 1.27-1.64) for Medicare. The mean length of hospital stay in days after excluding patients with a prolonged hospitalization was 8.53 (95% CI, 7.93-9.14) for Medicaid, 6.75 (95% CI, 6.52-6.95) for Medicare, and 5.58 (95% CI, 5.37-5.79) for commercial insurance. Conclusions. The findings suggest that patient enrolled in Medicaid and Medicare insurance program had increased in-hospital mortality, and higher length of hospital stay following admission with AMI when compared to the patients enrolled in commercial insurance.Item The Avian Influenza Pandemic and Physicians' Perception of Preparedness(2008-05-01) Oberdorfer, Joseph R.; Cardarelli, Roberto; Felini, Martha; Licciardone, John C.Oberdorfer, Joseph R., The avian influenza pandemic and physicians’ perception of preparedness. Master of Science (Biomedical Sciences) May, 2008, 77 pp., 5 tables, 3 figures, bibliography 84 titles. Prepared physicians may reduce the mortality and morbidity in patients affected during an avian influenza pandemic. However, repeated surveys of preparedness is physicians indicate that physicians are not confident in the preparedness plans. A survey of 86 physicians was performed to test the perception of preparedness. Multivariable regression analysis indicated that predictors of male gender, OR=29.5, 95%CI=1.172-740.541, ability to access the internet, OR=0.4, 95%CI=1.172-740.541, ability to access the internet, OR=0.4, 95%CI=0.250-0.779, patient education efforts, OR=2.9, 95%CI=1.403-6.163, utilization of electronic records, OR=1.1, 95%CI=1.123-3.514, practicing physical manipulation, OR=1.6, 95%CI=1.022-2.432, and knowledge of government plans, OR=0.5, 95%CI=0.250-0.974, predict better physician preparedness, which was defined as an aggregate score of knowledge and capacity to avian influenza pandemic planning. These results suggest an understanding of the relationship of knowledge and capacity is important in developing a better understanding of physician perception of preparedness.Item THE EFFECT OF PREOPERATIVE TRANSTHORACIC ECHOCARDIOGRAM ON MORTALITY AND SURGICAL TIMING IN ELDERLY HIP FRACTURE PATIENTS(2014-03) Luttrell, Kevin; Nana, ArvindEchocardiograms are a noninvasive way to assess heart function in elderly patients prior to surgical treatment of hip fractures. Unfortunately testing delays surgical treatment, and intervention for heart disease is rarely performed based on echocardiogram findings. Our patient review demonstrated no benefit to mortality in patients tested with echocardiogram prior to surgical treatment of hip fractures with significant delay in surgical timing and subsequent increased length of hospital stay. Purpose (a): Heart disease is the most common cause of postoperative mortality in elderly hip fracture patients, and transthoracic echocardiogram (TTE) is often used to assess cardiac function prior to surgery. The purpose of our study was to evaluate the effect of preoperative TTE on mortality, postoperative complications, surgical timing, and length of stay in surgically treated hip fracture patients. Methods (b): A retrospective chart review was performed on 694 consecutive hip fracture patients >60 years of age treated surgically at two local hospitals. Patients were identified by billing codes over a 30 month time period from July 1st 2009 to December 31st 2011. Hospital records were reviewed for age, sex, timing of admission, medical clearance, operation and discharge, admitting service, fracture and treatment type, medical comorbidities, American Society of Anesthesiologists (ASA) score, preoperative testing ordered (TTE), preoperative cardiac intervention, complications, and mortality. The social security death index was used for thirty day and one year mortality data when not available in the hospital records. Our primary outcome measure was in-hospital, thirty day, and one year mortality following hip fracture surgery in patients that receive preoperative TTE. Secondary outcome measures included complications (particularly cardiovascular) and time required for medical clearance and operative treatment. Results (c): Preoperative echocardiogram was performed on 131 patients (18.9%). Patients admitted by the medicine service were 1.76 times more likely to receive preoperative TTE (p < .01). Patients were 2.28 times more likely to receive TTE if they had a history of coronary artery disease (p < .001), and 2.12 times more likely if they had a history of arrhythmia (p < .001). Five patients in the TTE group and one patient in the control group underwent cardiac catheterization prior to surgery, but none of these patients required angioplasty or stent placement. There was no difference in mortality between the TTE group and the control group in hospital (3.8% versus 1.8%, p = .176), at 30 days (6.9% versus 6.6%, p = .90), or at one year (20.6% versus 20.1%, p = .89) respectively. There was no significant difference in major cardiac complications between groups. Average time from admission to operative treatment was 66.5 hours in the TTE group and 34.8 hours in the control group (p < .001). Average time from admission to medical clearance was 43.2 hours in the TTE group and 12.4 hours in the control group (p < .001). There was no difference in the time between medical clearance and operative treatment between the two groups (23.3 hours versus 22.4 hours, p = .639). The TTE group also had a significantly longer length of stay at 8.68 days compared to 6.44 days in the control group (p < .001). Conclusions (d): Preoperative TTE does not help reduce mortality rates in elderly hip fracture patients in either short or long term postoperative periods. In addition TTE delayed surgical treatment, resulted in no cardiac intervention, and increased length of stay. The American Heart Association (AHA) and the American College of Cardiology (ACC) have developed guidelines for perioperative assessment of patients in case of non-cardiac surgery. TTE should not be used as a screening tool in hip fracture patients, but instead used to further evaluate active cardiac conditions.Item The impact of unemployment on heart disease and stroke mortality in European Union Countries(2016-05-01) Brenner, M. HarveyThis paper examines the relation between unemployment and CVD mortality in European Union countries during the first decade of the 21st century. Two separate studies are summarized, focusing on increased heart disease and stroke mortality rates as potential outcomes of the greatly extended unemployment rate during 2000 – 2010 and especially the Great Recession of 2007 – 2009. Unemployment rates and mortality from two cardiovascular illnesses are viewed in pooled cross-sectional analyses over the range of EU countries. In addition to the unemployment rate, other economic variables, expressing the Recession, are studied in relation to cardiovascular mortality over multiple years in a pooled cross-sectional time-series analysis with random effects. The principal finding is that increases in the unemployment rate are related to increased heart disease and stroke mortality. Controlling for other labour market variables, such as labour force participation, as well as gross domestic product (GDP) per capita—the principal indicator of recession and economic growth.