<p> Heart failure (HF) is a debilitating clinical syndrome and the end stage of many heart diseases. Despite recent advances in treatment, it is a growing problem with a steadily increasing number of deaths annually. Costs of care have been rising and are projected to continue to do so over the next 20 years. Studies report that health related quality of life (HRQL) in HF adds prognostic information beyond that of traditional demographic and clinical risk factors, however findings vary. This research was conducted on data from The Cardiovascular Health Study (CHS), a large, population based cohort study of community dwelling older adults recruited in 2 annual waves (1989&ndash;1990; 1992&ndash;1993) and followed through 2009. The data were aligned into a data set that began at participant intake and continued with a maximum 20 year follow up (median 13.56) to examine changes in HRQL in participants newly diagnosed with HF. Changes in self-reported health, life satisfaction, depressive symptoms, physical functioning, and perceived social support were evaluated from the annual study visit immediately before to immediately after new HF diagnosis (N=987). In linear mixed models analysis, depressive symptoms (t(3150) = 3.13, p = .003), self-reported health (t(2968) = 4.85, p &lt; .001), and self-reported physical functioning (t(3139) = 3.16, p = .002) deteriorated more in those diagnosed with HF than in an age/gender matched comparison group over a similar period. In Cox proportional hazard regression, changes in self-reported physical functioning in the year of HF diagnosis and self-reported health prior to diagnosis contributed independently to mortality after adjusting for age, gender, and functional status (walk time). Mortality risk increased 9% for every one-point worsening in physical functioning from before to after diagnosis (HR 1.09, 95%CI 1.02, 1.17) and 17% for every one-point worse self-reported health prior to diagnosis (HR 1.17, 95%CI 1.04, 1.33). Missing data introduced potential selection bias. Understanding the contributors to mortality in HF may help develop interventions and assist in the selection of patient centered treatment options. Assessment of HRQL in routine practice is recommended. Further research is needed to improve the sensitivity of HRQL measures to detect change.</p>

<p> Hypertension is a serious medical condition. Although men and women of all racial groups in the US suffer from high blood pressure, black women have the highest rates of hypertension. For instance, the age-adjusted prevalence of hypertension among black women ages 20 and over is 44.3, compared to 28.1 among white women, 40.5 among black men, and 31.1 among white men.</p><p> Past research has focused on SES and behavioral factors as potential explanations for blood pressure disparities between black and white women. But, even after controlling for such factors, considerable disparities remain. The goal of this research is to examine cultural and social factors that have been shown to increase blood pressure. Specifically, I examine social support, psychosocial characteristics, and contextual factors associated with race/ethnicity and hypertension, in hopes of explaining some of the disparities in high blood pressure between black and white women.</p><p> Using data from Waves I, III, and IV of the National Longitudinal Study of Adolescent Health (Add Health), I estimated a sequence of multinomial logistic regression models predicting prehypertension and hypertension in young adulthood. Cross-sectional models show that racial disparities in hypertension remain after controlling for social support, psychosocial characteristics, and contextual factors. In fact, the only covariate that substantially reduced the racial disparity in hypertension was body mass index (BMI), a fairly reliable measure of body fatness for most people. I also estimated a set of multinomial logistic regression models predicting odds of prehypertension and hypertension by adolescent and cumulative social support, as well as psychosocial, contextual, and behavioral factors. These models were included to determine if early life and/or cumulative factors and conditions would help explain racial blood pressure disparities not explained by adulthood factors. Findings show that none of the early life or cumulative social support, psychosocial, contextual, or behavioral factors helped to explain racial differences in prehypertension or hypertension. Even after controlling for these factors, black women are still 1.18 times more likely than white women to have prehypertension and over two times more likely to suffer hypertension.</p><p> Indeed, my findings indicate that, of the factors included in all these models, only race, age, and BMI were significant predictors of blood pressure. Also, BMI was the only factor to explain some of the disparities between black and white women. These results are similar to other studies that have examined racial health disparities, suggesting that simply being a black woman in US society may be unhealthy. The health effects of racism, discrimination, and other sources of stress faced disproportionately by black women are not easily measured by social science research, which is possibly why racial disparities in blood pressure have yet to be explained. Future research should also explore possible epigenetic effects introduced by the health conditions experienced by previous generations, as well as the influence of prenatal and early life environments.</p>

<p>The purpose of this research was to investigate and elucidate the relationship between medication adherence and optimism-pessimism in a population of people living with HIV/AIDS. The first aim was to assess the association between optimism-pessimism and two different measures of medication adherence via two different multivariable models. The first measure of adherence was a self-report measure of the frequency with which a person missed their medications for various reasons where a higher score denoted less adherence to their current medication regimen. A robust Poisson regression model was used as the primary mechanism to analyze this measure of adherence. The second measure of adherence was an ordinal-scaled question that inquired about level of confidence to take medication as prescribed by a health care provider. An ordered logit regression (proportional odds regression) was used to analyze this measure of adherence. In both analyses, the quantification of optimism-pessimism on medication adherence began with unadjusted univariate models then progressed to fully-adjusted multivariable models. The second aim was to determine whether the hypothesized association between optimism-pessimism and medication adherence followed from the expression of optimism-pessimism as a single, bipolar metric or as two distinct, unipolar metrics. Both expressions of optimism-pessimism&mdash;the single continuum measure and the disaggregated unidimensional measures, respectively&mdash;were included in the multivariable models proposed in the first aim. The data used in this project came from a randomized controlled trial conducted between December 2005 and January 2007 by the International Nursing Network for HIV/AIDS Research. The findings from this research indicated that optimism (both dispositional and disaggregated) was positively associated with medication adherence in unadjusted and partially adjusted models but not when depression, quality of life, and self-efficacy were adjusted for. An exploratory analysis that led to the stratification of the sample by the median age, 44, returned a positive association between optimism and medication adherence across all models among subjects &lt;44 years of age. A similar pattern was observed for the association between optimism and confidence to take medications as directed. The analysis of optimism-pessimism as a single continuum or as two independent constructs suggested that optimism and pessimism are not opposite ends of the same continuum but represent two unipolar dimensions. Medication adherence is central to benefits realized at both the individual- and population-levels and these findings help to elucidate the relationship between adequate adherence and a not-yet-fully-understood psychological factor, optimism-pessimism. </p>

Current prediction equations for glomerular filtration rate (GFR), the most important measure of renal function, are neither accurate nor precise in children. Clinical data were abstracted from 207 charts of pediatric patients with renal disease attending the Montreal Children's Hospital from 1999-2004, to derive serum creatinine (SCR)-based equations and test their ability to predict iothalamate clearance, a gold standard measure of GFR, using linear regression and the Bayesian Information Criterion. In a separate study, CysC-based equations were derived from data on cystatin C (CysC) previously measured in 103 children between 1999 and 2003. Two SCR equations were derived for patients with or without spina bifida. Mean biases were -0.97 ml/min/1.73m 2 and +1.2 ml/min/1.73m2, respectively. Precision, 95% limits of agreement, and sensitivity for detecting abnormal renal function were superior for the new formulae compared to previously published equations. Two CysC-based equations were derived with or without the inclusion of SCR, which were less biased and more precise than comparison formulae and more sensitive but less specific for detecting GFR &lt; 90 ml/min/1.73m 2. Future studies should evaluate the equations derived here, in different populations of children.

<p> Prior research has indicated that healthcare personnel (HCP) who work in areas where <i>Mycobacterium tuberculosis</i> poses an occupational hazard are at high risk of tuberculin skin test (TST) positivity and subsequent conversion to active tuberculosis (TB). U.S. medical laboratory microbiologists confront similar hazards but have not been studied outside of the HCP aggregate. The purpose of this study was to fill this gap by examining the relationships between the predictor variables of self-reported history of bacille Calmette-Gu&eacute;rin (BCG) immunization, place of birth, and years of laboratory experience and the outcomes of self-reported lifetime TST positivity, preventive treatment noninitiation, and barriers to treatment adherence for this subgroup. This quantitative, cross-sectional study was guided by the epidemiologic triad model. A researcher-designed self-administered questionnaire including Part A of the Brief Medication Questionnaire was mailed to 4,335 U.S. microbiologist members of the American Society for Clinical Pathology. From the 1,628 eligible respondents, results showed that prevalence of positive TSTs (17.0%) and treatment noninitiation (9.8%) was low. Multivariate analysis identified BCG and foreign birth, as well as age, nonoccupational exposure, history of TB, work in mycobacteriology, and work outside of microbiology as predictors of a positive TST; foreign birth was a predictor of treatment noninitiation. Additional research is needed to identify other laboratorian groups at increased risk for developing TB. These results enhance positive social change by helping to inform recommendations in the global fight to stop the spread of TB, as well as improve allocation of resources among this specific group of HCP.</p>

This study compared the cost-effectiveness of four tuberculosis (TB) control strategies for detecting and treating latent tuberculosis infection (LTBI) among long-term travellers to countries where TB incidence is elevated. The decision analysis considered hypothetical cohorts of travellers from Canada and the United States (U.S.) to Mexico, Haiti, and the Dominican Republic. Strategy I consisted of screening for incident infection via two-step tuberculin skin testing prior to travel and skin testing upon return from abroad, followed by standard LTBI treatment with isoniazid for skin test converters. Strategy II carried the additional recommendation of isoniazid treatment for individuals who screen positive for LTBI before travel. Strategy III consisted of post-travel tuberculin skin testing alone, and isoniazid for all reactors. Strategy IV consisted of post-travel chest radiographic screening alone, and LTBI treatment for travellers with inactive TB. All strategies were compared with the status quo strategy of passive case detection. Costs were assessed from the viewpoint of the health system, in year 2003 Canadian dollars, and effectiveness was measured as cases of active TB prevented. In the base analysis, travel duration was 3 months. Strategy III (the single post-trip tuberculin test) was most effective in reducing future incidence of active TB, with the lowest incremental cost per TB case prevented. The best candidates for TB screening were travellers born in Haiti who visited Haiti, for whom Strategy III cost an estimated $37,613 per TB case prevented. Even for this group, however, no net cost-savings resulted from any screening strategy.

Thesis (Ph.D.)--University of California, San Francisco, 2007. / Source: Dissertation Abstracts International, Volume: 68-07, Section: B, page: 4393. Adviser: Geraldine Padilla.

Thesis (Ph.D.)--University of Illinois at Urbana-Champaign, 2008. / Source: Dissertation Abstracts International, Volume: 69-05, Section: B, page: 2889. Adviser: Uriel Kitron. Includes bibliographical references (leaves 113-123) Available on microfilm from Pro Quest Information and Learning.

Thesis (Ph.D.)--Indiana University, School of Health, Physical Education, and Recreation, 2006. / "Title from dissertation home page (viewed July 2, 2007)." Source: Dissertation Abstracts International, Volume: 67-06, Section: B, page: 3087. Advisers: David Lohrmann; Erick Janssen.

Thesis (Ph.D.)--University of Illinois at Urbana-Champaign, 2006. / Source: Dissertation Abstracts International, Volume: 67-07, Section: B, page: 3736. Adviser: Janet Reis. Includes bibliographical references (leaves 94-99) Available on microfilm from Pro Quest Information and Learning.