Screening for hypercholesterolemia in family practice

The purpose of this study was twofold: (1) To see if there was any difference in screening for hypercholesterolemia in a Family Practice setting after two national recommendations of 1985 and 1988. (2) To see if presence of coronary heart disease (CHD) risk factors e.g. smoking, hypertension, family history of heart disease, diabetes mellitus, and obesity influenced screening for hypercholesterolemia.^ A retrospective chart auditing was done at the Baylor College of Medicine, Family Practice Center, Houston for the years of 1985, 1986 and 1989. Statistically significant improvement in screening was observed in 1989 (after the second NCEP recommendations of 1988) compared to 1986 data (after the first national recommendations of 1985). But the proportion of target population screened (about 35%) was still far below the NCEP recommendations. Probably due to the small number of patients with CHD risk factors, no significant statistical differences were found in screening for hypercholesterolemia in 1985, 1986 and 1989 in patients with any CHD risk factor. ^

The use of invasive myocardial revascularization procedures following myocardial infarction and the effectiveness of these procedures in the biethnic community of Nueces County, Texas, 1988--1991

High levels of poverty and unemployment, and low levels of health insurance coverage may pose barriers to obtaining cardiac care by Mexican Americans. We undertook this study to investigate differences in the use of invasive myocardial revascularization procedures received within the 4-month period following hospitalization for a myocardial infarction (MI) between Mexican Americans and non-Hispanic whites in the Corpus Christi Heart Project (CCHP). The CCHP is a population-based surveillance program for hospitalized MI, percutaneous transluminal coronary angioplasty (PTCA), and aortocoronary bypass surgery (ACBS). Medical record data were available for 1706 patients identified over a three-year period. Mexican Americans had significantly lower rates of receiving a PTCA following MI than non-Hispanic Whites (RR: 0.56, 95% CI: 0.44-0.70). No meaningful ethnic difference was seen in the rates of ACBS use. History of PTCA use appeared to interact with ethnicity. Among patients without a history of PTCA use, Mexican Americans were less likely to receive a PTCA than non-Hispanic whites (RR: 0.59; 95% CI: 0.46-0.76). Among patients with a history of PTCA use, however, Mexican Americans were more likely to receive a PTCA than non-Hispanic whites (RR: 1.47; 95% CI: 0.75-2.87).^ Differences in the effectiveness of a first-time PTCA and first-time ACBS between Mexican Americans and non-Hispanic whites in the CCHP were also investigated. Mexican Americans were more likely to receive a 2nd PTCA (RR: 1.56, 95% CI: 1.11-2.17) and suffer a subsequent MI (RR: 1.42, 95% CI: 1.03-1.96) following a first-time PTCA than non-Hispanic whites. No meaningful ethnic differences were found in the rates of death and rates of ACBS following a first-time PTCA. Also, no significant ethnic differences were found in the rates of any of the events following a first-time ACBS. After adjusting for potential demographic, socioeconomic, clinical and angiographic confounders using Cox regression analysis, Mexican Americans were still more likely to receive a 2nd PTCA (HR: 1.38; 95% CI: 0.99-1.93) following a first-time PTCA than non-Hispanic whites. A significant difference in the rates of a subsequent MI following a first-time PTCA persisted (HR: 1.39, 95% CI: 1.01-1.93). (Abstract shortened by UMI.) ^

THE INCIDENCE OF PELVIC ENDOMETRIOSIS IN ROCHESTER, MINNESOTA, 1970-1979

The primary objectives of the study were to measure the incidence of pelvic endometriosis among white females of reproductive age (15-49 years) in Rochester, Minnesota, during the period 1970-1979 and to determine the risk of endometriosis by age, marital status, nun status, and educational attainment in this population. An historical prospective design was used. Incident (newly diagnosed) cases were identified from community medical records, and person-years of risk in the study population were estimated from census data.^ Almost two-thirds of the incident cases had surgically verified endometriosis, while the remainder were diagnosed by clinical findings alone. Incidence rates were prepared first with histologically confirmed cases only and then with the successive inclusion of less certain cases: surgically visualized, clinically probable, and clinically possible. On this basis, overall incidence rates were 108.8 to 246.9 newly diagnosed cases per 100,000 person-years. The incidence of pelvic endometriosis was lowest for women 15-19 years of age, increased markedly through age 44, and then declined for women 45-49 years of age. A significantly greater risk of pelvic endometriosis in never married women was detected only when the numerator was limited to histologically confirmed cases. Among never married women 20-49 years of age, no significant difference in the risk of pelvic endometriosis by nun status was detected, but a trend toward a lower incidence in nuns was observed. Women with education beyond high school had a significantly higher incidence of endometriosis than women with less education.^ Cases in the four diagnostic groups differed greatly by age and marital status but were similar with respect to virtually all other characteristics, once age differences were considered. Reproductive history characteristics described included: age of menarche; history of menopause; total pregnancies; ages of first pregnancy, marriage, and sexual intercourse; years from menarche to first intercourse; years of ovulatory cycling; difficulty becoming pregnant; and delay of the first pregnancy by choice. How these characteristics of incident cases differ from those of women free of endometriosis needs to be studied in future research. ^

THE POTENTIAL EFFECTS OF A COMMUNITY DEVELOPMENT PROGRAM ON DEMOGRAPHIC VARIABLES IN HIMALAYAN INDIAN VILLAGES

A community development program operating in the mountains of North India was studied to assess its potential effects on mortality, fertility and migration patterns in the community which it served. The development program operated in Jaunpur Block, Tehri-Garhwal District, Uttar Pradesh State. Two comparable villages in the district were studied. The development program had been working in one for two years, and the other was completely untouched by the program.^ Since not enough time had elapsed since the beginning of the development program's work for any effects on demographic patterns to be visable in Jaunpur Block, this study looked to attitudes of village residents as indicators of future demographic trends. Existing demographic patterns and their interrelationship with socio-religious customs were examined in the test village. A questionnaire was then administered to ascertain attitudinal differences between the residents of the test village and the control village.^ The primary work of the community development program was to train women as village health workers. The results of the attitudinal comparison of the residents of the two villages showed a marked difference in attitudes relating to the position of women in society. The data showed a higher esteem for women in the test village than in the control village, and it is argued that this difference may be attributable to the work of the development program.^ Predicting future demographic trends in Jaunpur Block on the basis of the observed difference in villagers' attitudes toward the status of women is speculatory. Jaunpur Block appears to be in the demographic stage of pre-transition, maintaining relatively high rates of both mortality and fertility. Based on demographic transition theory the next significant change in demographic patterns in Jaunpur is predicted to be a decline in mortality, and an increase in the status of women is unrelated to this prediction.^ The community development program which was studied terminated unexpectedly during the time of this study. A case study of the program's final months is presented, and speculation on the future course of demographic trends in Jaunpur Block is related to the possible alternatives for future development in the area. ^

The role and impact of transitional care utilization in colorectal cancer

BACKGROUND Although one out of every five gastrointestinal cancer patients needs transitional care (home-based skilled care or placement in skilled nursing or rehabilitation facilities) following treatment, few studies have examined outcomes in this population compared to patients who return home without assistance. This study has two primary goals: 1. To evaluate long-term cancer-specific outcomes in colorectal cancer patients utilizing transitional care compared to those that return home without assistance following therapy 2. To compare results using standard regression techniques and propensity scores. ^ METHODS Patients undergoing curative surgery for colorectal adenocarcinoma will be identified using data from a tertiary care Veterans Administration hospital. Survival and recurrence will then be determined from VA records and the Social Security Death Index. ^ The association between transitional care utilization and overall and disease-free survival will be evaluated using Cox proportional hazards regression to adjust for confounding factors. Predictors of transitional care utilization will be assessed using multiple logistic regression to generate a propensity score which will also be used to assess differences in survival based on transitional care use. ^ POTENTIAL SIGNIFICANCE If transitional care utilization is associated with worse survival and recurrence following therapy then it will be important to subsequently assess the mechanism in order to target interventions to improve outcomes. If there is no difference in cancer-specific outcomes, then this project can potentially highlight benefits of supportive therapy following colorectal cancer resection.^

The role of youth sports in public health

Study 1: Schools provide a range of opportunities for youth to be active, however, over the past decade, these opportunities have been declining. Sports teams are a promising venue to promote physical activity yet limited research has examined the gender an ethnic differences in sport participation. The purpose of this study is to examine trends in sport participation from 1991-2009 among US high school students. Secondly, we examined the association between gender and ethnicity with sports over time. This serial cross-sectional study used surveillance data from the Youth Risk Behavior Survey, a probability based sample weighted to represent gender and race/ethnic subpopulations of US high school students. The findings of this paper reveal persistent gender and ethnic disparities for sports participation among US youth. Since sports teams may provide a substantial source of physical activity, greater efforts should be undertaken to increase the participation of girls, especially minorities, in sports teams. ^ Study 2: Sports team participation is congruent with teaching and supporting healthy eating, yet limited research has examined the association between sports participation and dietary behaviors. This study aims to determine the association between youth sports participation and dietary behaviors among elementary-aged children. Significant dose-response associations were observed between number of sports teams and consumption of most fruits and vegetables. The likelihood of eating fruit for boys increased with the number of sports teams (1 team: OR=1.89; 3 teams: OR=3.44, p<0.001) and the likelihood of consuming green vegetables for girls was higher with the number of sports teams (1 team: OR=1.50; 3 teams: OR=2.39; p<0.001). For boys, the odds of consuming fruit-flavored drinks was higher ( p=0.019) and the odds of drinking soda was lower (p=0.018) with participation in increasing number of sports teams whereas for girls, sports participation was positively associated with diet soda consumption (p=0.006). ^ Study 3: Parents and peers have been shown to have a strong influence over the physical activity, dietary, and sedentary behaviors of youth. Youth sports teams have the potential to offer physical activity, displace sedentary behaviors, and promote a healthy diet. The purpose of this study is to assess how peer and parental support for physical activity and healthy eating, coupled with sport participation, is associated obesity related risk factors including diet and sedentary behaviors. A secondary analysis of data from the School Physical Activity and Nutrition study, a state-representative survey, was conducted. Eighth (n=3,931) and 11th (n=2,785) grade students were categorized into four groups based upon the level of peer and parental support derived from a three item scale and their participation in sports (sports/high support, sports/low support, no sports/high support, no sports/low support). Linear models were conducted to determine the difference in means between these groups for the following outcome variables: previous day fruit and vegetable intake, scores for an unhealthy and healthy food index, and hours spent watching television, playing video games, and working on a computer. Eighth graders had significantly greater levels of parental support for healthy eating and physical activity compared to 11th grade. Both 8 th and 11th graders in the sport/high support for healthy eating from peers and parents scored significantly higher on the healthy food index than other groups. Eighth and 11th graders in the sport/high support for physical activity from peers participated in fewer hours of sedentary behaviors than any other group (p ≤ 0.032). Although it is thought that sport participation may offer opportunities to support a healthy diet and displace sedentary time by offering providing physical activity, our study found that parental and peer support for activity and healthy eating may further attenuate this association. Parents and peer support should be an important target when developing strategies to improve healthy diets and reduce sedentary time among youth, especially in the context of youth sports. (Abstract shortened by UMI.)^

Behavioral responses to methylphenidate: correlations with neuronal activity in the caudate nucleus

Methylphenidate is currently a drug of abuse and readily prescribed to both adolescents and adults. Chronic methylphenidate (MPH) exposure results in an increase in DA in the motive circuit, including the caudate nucleus (CN), similar to other drugs of abuse. This study focuses on research aimed to elucidate if there are intrinsic underlying differences in the CN electrophysiological activity of animals exhibiting different chronic responses to the same dose of MPH. Behavioral and caudate nucleus (CN) neuronal activity following acute and chronic doses of MPH was assessed by simultaneously recording the behavioral and neuronal activity. The experimental protocol lasted for 10 days using four groups; saline, 0.6, 2.5 and 10.0mg/kg MPH. Initially, the study determined that animals exposed to the same dose of MPH exhibited either behavioral sensitization or behavioral tolerance. Therefore animals were classified into two groups (behaviorally sensitized/tolerant) and their neuronal activity was evaluated. Four hundred and fifty one units were evaluated. Overall, a mixture of increases and decreases in CN neuronal populations was observed at initial MPH exposure, and at ED10 baseline and ED10 rechallenge. When separated based on their behavioral response (sensitized/tolerant), significant differences in neuronal response patterns was revealed. Animals exhibiting sensitization were more likely to increase their neuronal activity at ED1 and ED10 baseline, expressing the opposite response at ED10 rechallenge. Furthermore, when neuronal populations recorded from those animals exhibiting behavioral sensitization were statistically compared to those from animals exhibiting behavioral tolerance significant differences were observed. Collectively, these findings tell us that animals exposed to the same dose of MPH can respond oppositely and moreover that there is in fact some intrinsic difference in the two population’s neuronal activity. This study offers new insight into the electrophysiological differences between sensitized and tolerant animals.

Robust effect sizes and their confidence intervals for group difference between trajectories in hierarchical linear growth model

Hierarchical linear growth model (HLGM), as a flexible and powerful analytic method, has played an increased important role in psychology, public health and medical sciences in recent decades. Mostly, researchers who conduct HLGM are interested in the treatment effect on individual trajectories, which can be indicated by the cross-level interaction effects. However, the statistical hypothesis test for the effect of cross-level interaction in HLGM only show us whether there is a significant group difference in the average rate of change, rate of acceleration or higher polynomial effect; it fails to convey information about the magnitude of the difference between the group trajectories at specific time point. Thus, reporting and interpreting effect sizes have been increased emphases in HLGM in recent years, due to the limitations and increased criticisms for statistical hypothesis testing. However, most researchers fail to report these model-implied effect sizes for group trajectories comparison and their corresponding confidence intervals in HLGM analysis, since lack of appropriate and standard functions to estimate effect sizes associated with the model-implied difference between grouping trajectories in HLGM, and also lack of computing packages in the popular statistical software to automatically calculate them. ^ The present project is the first to establish the appropriate computing functions to assess the standard difference between grouping trajectories in HLGM. We proposed the two functions to estimate effect sizes on model-based grouping trajectories difference at specific time, we also suggested the robust effect sizes to reduce the bias of estimated effect sizes. Then, we applied the proposed functions to estimate the population effect sizes (d ) and robust effect sizes (du) on the cross-level interaction in HLGM by using the three simulated datasets, and also we compared the three methods of constructing confidence intervals around d and du recommended the best one for application. At the end, we constructed 95% confidence intervals with the suitable method for the effect sizes what we obtained with the three simulated datasets. ^ The effect sizes between grouping trajectories for the three simulated longitudinal datasets indicated that even though the statistical hypothesis test shows no significant difference between grouping trajectories, effect sizes between these grouping trajectories can still be large at some time points. Therefore, effect sizes between grouping trajectories in HLGM analysis provide us additional and meaningful information to assess group effect on individual trajectories. In addition, we also compared the three methods to construct 95% confident intervals around corresponding effect sizes in this project, which handled with the uncertainty of effect sizes to population parameter. We suggested the noncentral t-distribution based method when the assumptions held, and the bootstrap bias-corrected and accelerated method when the assumptions are not met.^