Michael Nevitt

CSU Mentor, Long Beach, California, United States

Are you Michael Nevitt?

Claim your profile

Publications (179)787.39 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective. Investigate the relationship between sedentary behavior and physical function in adults with knee osteoarthritis (OA), controlling for moderate-vigorous physical activity () levels.Methods. Sedentary behavior was objectively measured by accelerometer on 1,168 participants in the Osteoarthritis Initiative aged 49-83 years with radiographic knee OA at the 48 month clinic visit. Physical function was assessed using 20-meter walk and chair stand testing. Sedentary behavior was identified by accelerometer activity counts/minute <100. The cross-sectional association between sedentary quartiles and physical function was examined by multiple linear regression adjusting for demographic factors (age, sex, race/ethnicity, education level), health factors (comorbidity, body mass index, knee pain, knee OA severity, presence of knee symptoms) and average daily MVPA minutes.Results. Adults with knee OA spent 2/3 their daily time in sedentary behavior. The average gait speed among the most sedentary quartile was 3.88 feet/second, which was significantly slower than the speed of the less sedentary groups (4.23, 4.33, 4.33 feet/second, respectively). The average chair stand rate among the most sedentary group was significantly lower (25.9 stands/minute) than the rates of the less sedentary behavior groups (28.9, 29.1, 31.1 stands/minute, respectively). These trends remained significant in multivariable analyses adjusted for demographic factors, health factors and average daily MVPA minutes.Conclusion. Being less sedentary was related to better physical function in adults with knee OA independent of MVPA time. These findings support guidelines to encourage adults with knee OA to decrease time spent in sedentary behavior in order to improve physical function. © 2014 American College of Rheumatology.
    Arthritis Care & Research. 08/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Knee osteoarthritis (OA) and frailty are two conditions that are associated with functional limitation and disability in elders, yet their relation to one another is not known.
    The Journals of Gerontology Series A Biological Sciences and Medical Sciences 07/2014; · 4.31 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To determine the diagnostic test performance of location of pain and activity-related pain in identifying knees with patellofemoral joint (PFJ) structural damage.
    The Journal of rheumatology. 06/2014;
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To examine if different rates of total knee replacement (TKR) in two similar cohorts with symptomatic knee osteoarthritis (OA) were associated with different functional impact of disease.
    BMC Musculoskeletal Disorders 05/2014; 15(1):145. · 1.88 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Knee replacement (KR) represents a clinically important endpoint of knee osteoarthritis (KOA). Here we examine the four-year trajectory of femoro-tibial cartilage thickness loss prior to KR vs. non-replaced controls. A nested case-control study was performed in Osteoarthritis Initiative (OAI) participants: Cases with KR between 12-60 month (M) follow-up were each matched with one control (without KR through 60M) by age, sex, and baseline radiographic stage. Femoro-tibial cartilage thickness was measured quantitatively using MRI at the annual visit prior to KR occurrence (T0), and at 1-4years prior to T0 (T-1 to T-4). Cartilage loss between cases and controls was compared using paired t-tests and conditional logistic regression. 189 knees of 164 OAI participants (55% women, age 64±8.7; BMI 29±4.5) had KR and longitudinal cartilage data. Comparison of annualized slopes of change across all time points revealed greater loss in the central medial tibia (primary outcome) in KRs than in controls (94±137 vs. 55±104μm; p=0.0017 [paired-t]; odds ratio [OR] 1.36 (95% confidence interval [CI]: 1.08-1.70). The discrimination was stronger for T-2→T0 (OR 1.61 [1.33-1.95], n=127) than for T-1→T0, and was not statistically significant for intervals prior to T-2 (i.e. T-4→T-2, OR 0.97 [0.67-1.41], n=60). Results were similar for total medial femoro-tibial cartilage loss (secondary outcome), and when adjusting for pain and BMI. In knees with subsequent replacement, cartilage loss accelerates in the two years, and particularly in the year prior to surgery, compared with controls. Whether slowing this cartilage loss can delay KR remains to be determined.
    Osteoarthritis and Cartilage 04/2014; · 4.26 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To determine whether thigh muscle strength differs between symptomatic and asymptomatic knees, and/or different radiographic strata of knee osteoarthritis (KOA) Methods: Isometric extensor and flexor strength were analyzed in 3809 Osteoarthritis Initiative participants (2201 women/1608 men) with central radiographic Kellgren-Lawrence grade (KLG) readings. Isometric strength measurements were stratified by radiographic disease status (KLG0, 1, 2, 3/4) and WOMAC pain scores. Age-adjusted separate slopes ANCOVA models were used to compare strength between "symptomatic" (WOMAC=5-20) and "asymptomatic" (WOMAC=0) limbs within and across KLG strata. Exploratory analyses focused on strength normalized to body weight and symptom frequency. Results: Isometric strength was significantly lower in symptomatic than in asymptomatic limbs: -11 to -13% for extensor strength and -7 to -16% for flexor strength (both p<0.0001) in men, and -9 to -17% (p=0.029) for extensor strength, and -10 to -21% (p=0.049) for flexor strength in women. Similar observations were made for pain frequency strata. Extensor and flexor strength were not significantly different across KLG strata in asymptomatic limbs in either sex (p≥0.12). However, strength normalized to body weight was lower at higher KLGs in both sexes (p≤0.02), because the BMI was greater in participants with more advanced radiographic disease. Conclusion: Knee symptoms (i.e. pain) appear to be the relevant determinant of isometric knee extensor and flexor strength in KOA, whereas no direct association between strength and radiographic severity was observed. These findings suggest that the reduction in thigh muscle strength in KOA is related to pain but not to the structural (radiographic) disease status. © 2014 American College of Rheumatology.
    Arthritis care & research. 02/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Historically disease knowledge development and treatment innovation in osteoarthritis (OA) has been considered to be slow. One of the many reasons purported as responsible for this slow pace has been the alleged lack of valid and responsive biomarkers to ascertain efficacy, which itself has been dependent upon the slow evolution of the understanding of the complex nature of joint tissue biology. This narrative review outlines the rationale for why we need OA biomarkers with regard to biomarker validation and qualification. The main biomarkers in current development for OA are biochemical and imaging markers. We describe an approach to biomarker validation and qualification for OA clinical trials that has recently commenced with the Foundation of NIH OA Biomarkers Consortium study cosponsored by the Osteoarthritis Research Society International (OARSI). With this approach we endeavor to identify, develop, and qualify biological markers (biomarkers) to support new drug development, preventive medicine, and medical diagnostics for osteoarthritis.
    Best practice & research. Clinical rheumatology 02/2014; 28(1):61-71. · 2.90 Impact Factor
  • Osteoarthritis and Cartilage 01/2014; 22:S19–S20. · 4.26 Impact Factor
  • Osteoarthritis and Cartilage 01/2014; 22:S20–S21. · 4.26 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective Knee replacement (KR) represents a clinically important endpoint of knee osteoarthritis (KOA). Here we examine the four-year trajectory of femoro-tibial cartilage thickness loss prior to KR vs. non-replaced controls. Methods A nested case-control study was performed in Osteoarthritis Initiative (OAI) participants: Cases with KR between 12-60 month (M) follow-up were each matched with one control (without KR through 60M) by age, sex, and baseline radiographic stage. Femoro-tibial cartilage thickness was measured quantitatively using MRI at the annual visit prior to KR occurrence (T0), and at 1-4years prior to T0 (T-1 to T-4). Cartilage loss between cases and controls was compared using paired t-tests and conditional logistic regression. Results 189 knees of 164 OAI participants (55% women, age 64±8.7; BMI 29±4.5) had KR and longitudinal cartilage data. Comparison of annualized slopes of change across all time points revealed greater loss in the central medial tibia (primary outcome) in KRs than in controls (94±137 vs. 55±104μm; p=0.0017 [paired-t]; odds ratio [OR] 1.36 (95% confidence interval [CI]: 1.08-1.70). The discrimination was stronger for T-2→T0 (OR 1.61 [1.33-1.95], n=127) than for T-1→T0, and was not statistically significant for intervals prior to T-2 (i.e. T-4→T-2, OR 0.97 [0.67-1.41], n=60). Results were similar for total medial femoro-tibial cartilage loss (secondary outcome), and when adjusting for pain and BMI. Conclusions In knees with subsequent replacement, cartilage loss accelerates in the two years, and particularly in the year prior to surgery, compared with controls. Whether slowing this cartilage loss can delay KR remains to be determined.
    Osteoarthritis and Cartilage 01/2014; · 4.26 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: It is not clear whether heightened pain sensitivity in knee osteoarthritis (OA) is related to sensitisation induced by nociceptive input from OA pathology ('state') versus other confounding factors. Conversely, some individuals may be predisposed to sensitisation irrespective of OA ('trait'). The Multicenter Osteoarthritis Study is a longitudinal cohort of persons with or at risk of knee OA. We obtained knee X-rays, pain questionnaires and comprehensive assessment of factors that can influence pain sensitivity. We examined the relation of sensitisation and sensitivity assessed by mechanical temporal summation (TS) and pressure pain thresholds (PPTs) to knee OA and knee pain severity. To test whether sensitisation and sensitivity is a 'state' induced by OA pathology, we examined the relation of PPT and TS to knee OA duration and severity. In 2126 subjects (mean age 68, mean body mass index (BMI) 31, 61% female), PPT and TS were not associated with radiographic OA (ORs 0.9-1.0 for PPT and TS; p>0.05). However, PPT and TS were associated with pain severity (ORs: 1.7-2.0 for PPT; 1.3-1.6 for TS; p<0.05). Knee OA duration and radiographic severity were not associated with PPT or TS. PPT and TS were associated with OA-related pain, but not radiographic OA after accounting for pertinent confounders in this large cohort. Lack of association with disease duration suggests at least some sensitisation and pain sensitivity may be a trait rather than state. Understanding the relationship between pathological pain and pain sensitivity/sensitisation offers insight into OA pain risk factors and pain management opportunities.
    Annals of the rheumatic diseases 12/2013; · 8.11 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To test the hypothesis that cartilage displays significant longitudinal thickening in the external subregions of the central medial (ecMF) and lateral (ecLF) femur in knees with early radiographic osteoarthritis (ROA) compared with contralateral knees without ROA, and to explore differences in change in other subregions and in radiographic joint space width (JSW). Methods: 50 participants (50% women; age 61.1±9.7y; BMI 27.7±4.7kg/m(2) ) were identified from the Osteoarthritis Initiative cohort with definite femorotibial osteophytes but no JSN in one knee (early ROA), and no osteophytes or JSN in the contralateral knee (non-ROA). A longitudinal within-person, between-knee comparison was performed using measures of subregional cartilage thickness based on analyses of sagittal DESSwe MR images obtained at baseline and 1-year. Medial JSW was evaluated from fixed flexion radiographs. Results: The change between baseline and 1-year was -6±94µm in ecMF and +18±91µm in ecLF in early ROA (p=0.78) vs. -1±68µm and +4±76µm in non-ROA knees (p=0.38). The variability of cartilage thickness change tended to be greater in early ROA than in non-ROA knees. Greater cartilage thickness loss in the lateral tibia and a greater reduction in minimum medial JSW was observed in early ROA vs. non-ROA knees. Conclusion: There was no direct evidence of longitudinal cartilage thickening in external subregions of the central femur in knees with early ROA compared with contralateral non-ROA knees. The observed greater variability in longitudinal thickness change in early ROA knees (but not in non-ROA knees) might be due to cartilage thickening and thinning occurring simultaneously in these knees. © 2013 American College of Rheumatology.
    Arthritis care & research. 09/2013;
  • [Show abstract] [Hide abstract]
    ABSTRACT: We evaluated the association of parity to both risk of knee replacement (KR) and knee osteoarthritis (OA). The NIH-funded Multicenter Osteoarthritis Study (MOST) is a longitudinal observational study of persons age 50 to 79 years with either symptomatic knee OA or at elevated risk of disease. Baseline and 30-month knee radiographic OA (ROA) was defined as Kellgren/Lawrence (K/L) grade≥2 or KR. Women were grouped based by number of births: 0; 1 (reference group); 2; 3; 4; and 5 or more. We examined the relation of parity to the incidence over 30 months of ROA and KR using a Poisson regression model. Generalized estimating equations were used to control for correlation between two knees within a subject. We adjusted for age, BMI, race, education, occupation, baseline estrogen use, clinical site, injury, and for KR analyses WOMAC pain and use of pain medication. Among 1618 women who reported parity information, mean age was 62.6 years, mean BMI 30.7 kg/m2, mean WOMAC pain subscale score 3.7 at baseline. There were 115 KRs and 134 cases of incident knee ROA over 30 months. The relative risk of incident KR was 2.7 times as high (95% CI: 1.0, 7.3) and relative risk of incident knee ROA was 2.6 times as high (95% CI: 1.2, 5.3) among women with 5-12 children compared with those with one birth. Parity in women at risk for OA is associated with both incident ROA and KR, particularly for those with more than 4 children.
    Osteoarthritis and Cartilage 09/2013; · 4.26 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Conflicting associations between imaging biomarkers and pain in knee osteoarthritis (OA) have been reported. A relation between pain and denuded areas of subchondral bone (dABs) has been suggested and this study explores this relationship further by relating the presence, phenotype, location and size of dABs to different measures of knee pain. 633 right knees from the Osteoarthritis Initiative (OAI) (250 men, age 61.7 ± 9.6 yrs, BMI 29.4 ± 4.7 kg/m(2)) were included. Manual segmentation of the femorotibial cartilage plates was performed on 3 T coronal fast low angle shot with water excitation (FLASHwe) images. dABs were defined as areas where the subchondral bone was uncovered by cartilage. The following measures of pain were used: weightbearing-, non-weightbearing-, moderate-to-severe-, infrequent- and frequent knee pain. Using pain measures from subjects without dABs as a reference, those with at least one dAB had a 1.64-fold higher prevalence ratio [PR, 95% confidence interval (CI) 1.24-2.18] to have frequent and 1.45-fold higher for moderate-to-severe knee pain (95% CI 1.13-1.85). Subjects with dABs in central subregions had a 1.53-fold increased prevalence of having weightbearing pain (95% CI 1.20-1.97), especially when the central subregion was moderately (>10%) denuded (PR 1.81, 95% CI 1.35-2.42). Individuals with cartilage-loss-type dABs had a slightly higher prevalence (PR 1.13, 95% CI 1.00-1.27) of having frequent knee pain compared to individuals with intra-chondral-osteophyte-type dABs. This study supports a positive relation between femorotibial dABs and knee pain, especially when the dABs are located centrally (i.e., in weightbearing regions) or when the respective central subregion is moderately denuded.
    Osteoarthritis and Cartilage 09/2013; 21(9):1214-22. · 4.26 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Knee osteoarthritis is associated with structural changes in the joint. Despite its many drawbacks, radiography is the current standard for evaluating joint structure in trials of potential disease-modifying osteoarthritis drugs. MRI is a non-invasive alternative that provides comprehensive imaging of the whole joint. Frequently used MRI measurements in knee osteoarthritis are cartilage volume and thickness; others include synovitis, synovial fluid effusions, bone marrow lesions (BML) and meniscal damage. Joint replacement is considered a clinically relevant outcome in knee osteoarthritis; however, its utility in clinical trials is limited. An alternative is virtual knee replacement on the basis of symptoms and structural damage. MRI may prove to be a good alternative to radiography in definitions of knee replacement. One of the MRI parameters that predicts knee replacement is medial compartment cartilage volume/thickness, which correlates with radiographic joint space width, is sensitive to change, and predicts outcomes in a continuous manner. Other MRI parameters include BML and meniscal lesions. MRI appears to be a viable alternative to radiography for the evaluation of structural changes in knee osteoarthritis and prediction of joint replacement.
    Annals of the rheumatic diseases 07/2013; · 8.11 Impact Factor
  • Annals of the rheumatic diseases 07/2013; · 8.11 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective To determine the predictive value of unicompartimental joint space narrowing (JSN) for MRI-based cartilage thickness loss in the narrowed and the non-narrowed femorotibial compartment. Methods 922 knees from 922 Osteoarthritis Initiative (OAI) participants (62.2 ± 9.0 years, 61% females) with radiographic OA (158 without JSN [noJSN], 175 with lateral JSN [latJSN], 589 with medial JSN [medJSN]) were analyzed using 3 T MRI. One-year cartilage thickness change was determined in the lateral (LFTC) and medial femorotibial compartment (MFTC), and in femorotibial subregions. The probability of subsequent cartilage loss was calculated using predefined thresholds. The predictive value of JSN for the probability and magnitude of cartilage loss was compared between latJSN, medJSN and noJSN knees using Fisher's exact and Mann–Whitney-U tests. Results The probability of cartilage loss was greater in the narrowed compartment of latJSN/medJSN knees (34.9%/32.4%) than in noJSN knees (13.3%/12.7%, P ≤ 6.4 × 10−6) and so was the magnitude of cartilage thickness change (P ≤ 8.2 × 10−6). No significant differences were observed between the narrowed compartments of latJSN vs medJSN knees (probability: P = 0.58, magnitude: P = 0.19) or between the non-narrowed compartment of latJSN/medJSN vs noJSN knees (probability: P ≥ 0.35, magnitude: P = ≥0.23). These results were confirmed by the location-independent ordered value (OV) analyses of femorotibial subregions. Conclusion The predictive value of latJSN for lateral compartment cartilage loss was comparable to that of medJSN for medial compartment cartilage loss, whereas cartilage loss in the non-narrowed compartment was similar to that in noJSN knees. These findings provide important clues to predicting progression of knee OA, and in tailoring inclusion criteria for clinical trials.
    Osteoarthritis and Cartilage 01/2013; · 4.26 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE: To study if step goals (e.g. walking 10,000 steps/day) approximate meeting 2008 Physical Activity Guidelines for Americans among adults with or at high risk of knee OA. DESIGN: Cross-sectional observational cohort SETTING: Community PARTICIPANTS: People with or at high risk of knee OA INTERVENTIONS: None MAIN OUTCOME MEASURES: Objective physical activity data were collected over 7 consecutive days from people with or at high risk of knee (OA) participating in the Multicenter Osteoarthritis Study. Using activity monitor data, we determined the proportion that 1) walked ≥10,000 steps/day, 2) met the 2008 Physical Activity Guidelines, and 3) achieved both recommendations. RESULTS: Of 1788 subjects studied (age 67 ± 8 yrs, BMI 31 ± 6 kg/m(2), 60% women), 16.7% of men and 12.6% of women walked ≥10,000 steps/day, while 6% of men and 5% of women met the 2008 Physical Activity Guidelines for Americans. Of those walking ≥10,000 steps/day, 16.7% and 26.7% of men and women also met the 2008 Physical Activity Guidelines. CONCLUSIONS: Among this sample of older adults with or at high risk of knee OA, walking ≥10,000 steps/day did not translate into meeting public health guidelines. These findings highlight the disparity between number of steps/day believed to be needed and recommended time-intensity guidelines to achieve positive health benefits.
    Archives of physical medicine and rehabilitation 12/2012; · 2.18 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE: Knee Osteoarthritis (OA) and pain are assumed to be barriers for meeting physical activity guidelines, but this has not been formally evaluated. The purpose of this study was to determine the proportion of people with and without knee OA and knee pain who met recommended physical activity levels through walking. METHODS: Cross-sectional analysis of community dwelling adults who have or who are at high risk of knee OA from The Multicenter Osteoarthritis Study. Participants wore a StepWatch activity monitor to record steps/day over 7 days. The proportion that met the recommended physical activity levels was determined as those accumulating ≥150 minutes/week at ≥100 steps/minute in bouts lasting ≥10 minutes. These proportions were also determined for those with and without knee OA, as classified by radiograph, and by severity of knee pain. RESULTS: Of the 1788 study participants (age 67 sd 8 yrs, BMI 31 sd 6 kg/m(2) , 60% female), lower overall percentages of participants with radiographic knee OA and knee pain met recommended physical activity levels. However, these differences were not statistically significant between those with and without knee OA; 7.3% and 10.1% of men (p=0.34), and 6.3% and 7.8% of women (p=0.51), respectively, met recommended physical activity levels. Similarly, for those with moderate/severe pain versus no pain, 12.9% and 10.9% of men (p=0.74) and 6.7% and 11.0% (p=0.40) of women met recommended physical activity levels. CONCLUSIONS: Disease and pain have little impact on achieving recommended physical activity levels among people with or at high risk of knee OA. © 2012 American College of Rheumatology.
    Arthritis & Rheumatology 11/2012; · 7.48 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE: Estimate the frequency and spatial location of rapid femorotibial cartilage thinning or thickening in knees with, or at risk of, osteoarthritis and examine their association with clinical and radiographic covariates. DESIGN: Knee cartilage thickness change over 12 months was measured using magnetic resonance imaging in the right knee of 757 Osteoarthritis Initiative (OAI) participants that had radiographic findings of osteophytes or joint space narrowing. Thickness changes in individual knees were classified as having rapid thinning or thickening or no detectable OA-related change when compared to asymptomatic OAI Control cohort knees. RESULTS: Cartilage thinning, found in 18.5% of subjects, was more frequent in knees with OAI calculated Kellgren-Lawrence Grade (cKLG)>2 (p<0.001) and with frequent pain (p=0.047). No link was found between body mass index, sex, and age and cartilage thinning (p>0.15). The percent of knees with thickening was small (4.4%), but greater in knees with frequent pain (p=0.02). Rapid thinning was most common in the central (36.4%) and external (32.1%) subregions of the medial weight-bearing femur. Mean cartilage loss in rapidly thinning subregions ranged from 11.2%/y to 24.6%/y. Knees with cKLG>2, but classified as having no detectable OA-related change had mean cartilage loss rates significantly >0 (0.4%/y to 1.3%/y) in 10 subregions. CONCLUSION: Most observed subregional changes in OA knees were indistinguishable from changes found in an asymptomatic cohort, but a fraction of subregions showed rapid progression. The relative frequency of rapid thinning increases when cKLG>2, a classification closely associated with joint space narrowing and/or frequent knee pain are present.
    Osteoarthritis and Cartilage 10/2012; · 4.26 Impact Factor

Publication Stats

5k Citations
787.39 Total Impact Points

Institutions

  • 2009–2014
    • CSU Mentor
      Long Beach, California, United States
    • CHA University
      • Department of Internal Medicine
      Seoul, Seoul, South Korea
  • 1993–2014
    • University of California, San Francisco
      • • Department of Epidemiology and Biostatistics
      • • Division of Prevention Science
      San Francisco, California, United States
  • 2010–2013
    • Paracelsus Medical University Salzburg
      • Institute of Anatomy und Musculoskeletal Research
      Salzburg, Salzburg, Austria
  • 2012
    • Northwestern University
      • Feinberg School of Medicine
      Evanston, IL, United States
    • The University of Tennessee Health Science Center
      • Department of Medicine
      Memphis, TN, United States
  • 2009–2012
    • University of Oxford
      • Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS)
      Oxford, ENG, United Kingdom
    • University of Iowa
      • Department of Orthopaedics and Rehabilitation
      Iowa City, IA, United States
  • 1996–2012
    • University of San Francisco
      San Francisco, California, United States
  • 2011
    • Diakonhjemmet Hospital (Norway)
      Kristiania (historical), Oslo County, Norway
  • 2009–2011
    • University of Massachusetts Boston
      • Clinical Epidemiology Research and Training Unit
      Boston, MA, United States
  • 2006–2010
    • Boston Medical Center
      Boston, Massachusetts, United States
    • Stanford Medicine
      Stanford, California, United States
  • 2008
    • Weill Cornell Medical College
      New York City, New York, United States
  • 2004–2008
    • Boston University
      Boston, Massachusetts, United States
  • 2007
    • Wake Forest School of Medicine
      • Sticht Center on Aging
      Winston-Salem, NC, United States
  • 1996–2007
    • University of Pittsburgh
      • • Department of Epidemiology
      • • Department of Medicine
      Pittsburgh, PA, United States
  • 2002–2005
    • VU University Medical Center
      • Department of Psychiatry
      Amsterdam, North Holland, Netherlands
    • VU University Amsterdam
      Amsterdamo, North Holland, Netherlands
  • 2000–2004
    • National Institutes of Health
      • Laboratory of Epidemiology, Demography, and Biometry (LEDB)
      Bethesda, MD, United States
  • 2000–2003
    • University of Tennessee
      • Department of Preventive Medicine
      Knoxville, TN, United States