[Show abstract][Hide abstract] ABSTRACT: Angiotensin Converting Enzyme Inhibitors (ACEI) and Angiotensin II Receptor Blockers (ARB) are two common medication classes used for heart failure treatment. The ADAHF (Automated Data Acquisition for Heart Failure) project aimed at automatically extracting heart failure treatment performance metrics from clinical narrative documents, and these medications are an important component of the performance metrics. We developed two different systems to detect these medications, rule-based and machine learning-based. The rule-based system used dictionary lookups with fuzzy string searching and showed successful performance even if our corpus contains various misspelled medications. The machine learning-based system uses lexical and morphological features and produced similar results. The best performance was achieved when combining the two methods, reaching 99.3% recall and 98.8% precision. To determine the prescription status of each medication (i.e., active, discontinued, or negative), we implemented a SVM classifier with lexical features and achieved good performance, reaching 95.49% accuracy, in a five-fold cross-validation evaluation.
Studies in health technology and informatics 08/2015; 216:609-613. DOI:10.3233/978-1-61499-564-7-609
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVES
We examined whether the interactions between primarily speaking English at home and community-level measures (median household income and immigrant composition) are associated with physical inactivity and obesity.
We pooled the 2005 and 2007 Los Angeles County Health Survey data to construct a multilevel data set, with community-level median household income and immigrant density as predictors at the community level. After controlling for individual-level demographic variables, we included the respondent's perceived community safety as a covariate to test the hypothesis that perceived public safety mediates the association between acculturation and health outcomes.
The interaction between community median household income and primarily speaking English at home was associated with lower likelihoods of physical inactivity (odds ratio [OR] = 0.644; 95% confidence interval [CI] = 0.502, 0.825) and obesity (OR = 0.674; 95% CI = 0.514, 0.882). These odds remained significant after we controlled for perceived community safety.
Resources in higher-income areas may be beneficial only to residents fully integrated into the community. Future research could focus on understanding how linguistic isolation affects community-level social learning and access to resources and whether this differs by family-level acculturation.
American Journal of Public Health 05/2015; · 4.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The “Chevalier” John Taylor was perhaps the most important itinerant oculist of 18th
century Europe. His professional legacy is controversial, and he was accused by many contemporaries
and subsequent historians of being a quack. Nevertheless, his writings demonstrate
an understanding of ocular anatomy and disease better than that of most of his contemporaries,
including the first published illustration of the semidecussation of the optic nerves. Taylor’s
personal legacy is more favorable. His son, John Taylor, Jr., and his grandsons John and Jeremiah
Taylor, were respected oculists. Their lives give perspective on ophthalmic practice in
18th and 19th century Europe.
[Show abstract][Hide abstract] ABSTRACT: In Ethiopia, the under-five mortality rate (U5MR) was reduced by 28% between 2005 and 2011, but the neonatal mortality rate (NMR) remains unchanged and now accounts for 42% of all U5 deaths. This burden is even greater for the large rural population due to poor access to and utilization of maternal and newborn health services. To achieve Millennium Development Goal 4, neonatal mortality must be addressed, specifically the major direct causes – sepsis, birth asphyxia, and preterm delivery. Neonatal sepsis, the major newborn killer in Ethiopia, accounts for more than one third of neonatal deaths, 75% in first week of life when even modest delays in receiving effective care can be deadly. The national scale-up of integrated Community Case Management (iCCM) in 2010-2012 provided a needed boost to the Health Extension Program (HEP) by introducing a package of high quality basic curative interventions meeting the demand of the communities. According to the national guidelines for iCCM, Health Extension Workers assess and classify newborn infections and then refer them to health centers and hospitals for treatment. When re-ferral is not possible or delayed, they can provide pre-referral or even complete treatment with oral antibiotics. There is limited care seeking by caregivers for sick young infants under 2 months of age in the iCCM program. The Federal Ministry of Health (FMOH) established a working group that presented a strategy paper, " Exploring the potential for community-based case management of neonatal sepsis in Ethiopia " in February 2012. The paper analyzed the potential benefits and challenges of introducing community-based sepsis management. Reducing neo-natal mortality is increasingly important not only because the proportion of U5 deaths in the neonatal period is increasing, but also because the health interventions to address neonatal deaths generally differ from those to address other under-five deaths. High levels of home delivery (90%) and cultural beliefs of secluding the newborn challenge identifying and treating sick newborns. Active pregnancy and birth surveillance and postpartum home visits early in the first week are required to identify and manage sick neonates.
[Show abstract][Hide abstract] ABSTRACT: Previous surveys of men who have sex with men (MSM) in Africa have not adequately profiled HIV status and risk factors by sex work status. MSM in Nairobi, Kenya, were recruited using respondent-driven sampling (RDS), completed a behavioral interview, and were tested for HIV and STIs. Overlapping recruitment among 273 male sex workers and 290 other MSM was common. Sex workers were more likely to report receptive anal sex with multiple partners (65.7% versus 18.0%, P<0.001) and unprotected receptive anal intercourse (40.0% versus 22.8%, P=0.005). Male sex workers were also more likely to be HIV infected (26.3% versus 12.2%, P=0.007).
[Show abstract][Hide abstract] ABSTRACT: Background: The Performance Review and Clinical Mentoring Meeting (PRCMM) is an approach to improve and sustain Health Extension Worker (HEW) skills and performance in integrated Community Case Management (iCCM). Objective: To compare HEW performance in recording case management before and after they participated in PRCMM. Methods: We conducted a historical cohort analysis of iCCM case records between September 2010 and Decem-ber 2012 from 622 randomly selected health posts representing 31 intervention woredas (districts) of Amhara, Oromia and Southern Nations Nationalities and Peoples' Regions. We used longitudinal regression analysis comparing the trend in the consistency of the classification with the assessment, treatment and follow-up date as well as caseload in the periods before and after PRCMM, with 5511 and 7901 case records, respectively. Results: Overall consistency improved after PRCMM for all common classifications as follows: pneumonia (54.1% [95% CI: 47.7%–60.5%] vs. 78.2% [73.9%–82.5%]), malaria (50.8% [42.9%–58.7%] vs. 78.9% [73.4%– 84.4%]), and diarrhea (33.7% [27.9%–39.5%] vs. 70.0% [64.7%–75.3%]). This improvement was consistently observed comparing the six months before and the six months after PRCMM in all the common classifications except for malaria where the improvement observed during the first three post-PRCMM months disappeared during the fifth and sixth months. Caseload increased significantly after PRCMM (6.6 [95% CI: 5.9–7.3] vs. 9.2 [8.5–9.9] cases/health post/month). Conclusion: PRCMM seemed to improve iCCM performance of HEWs and should be integrated within the PHC system and given about every six months, at least at first, to sustain improvement.
[Show abstract][Hide abstract] ABSTRACT: Importance Understanding the major health problems in the United States and how they are changing over time is critical for informing national health policy.
Objectives To measure the burden of diseases, injuries, and leading risk factors in the United States from 1990 to 2010 and to compare these measurements with those of the 34 countries in the Organisation for Economic Co-operation and Development (OECD) countries.
Design We used the systematic analysis of descriptive epidemiology of 291 diseases and injuries, 1160 sequelae of these diseases and injuries, and 67 risk factors or clusters of risk factors from 1990 to 2010 for 187 countries developed for the Global Burden of Disease 2010 Study to describe the health status of the United States and to compare US health outcomes with those of 34 OECD countries. Years of life lost due to premature mortality (YLLs) were computed by multiplying the number of deaths at each age by a reference life expectancy at that age. Years lived with disability (YLDs) were calculated by multiplying prevalence (based on systematic reviews) by the disability weight (based on population-based surveys) for each sequela; disability in this study refers to any short- or long-term loss of health. Disability-adjusted life-years (DALYs) were estimated as the sum of YLDs and YLLs. Deaths and DALYs related to risk factors were based on systematic reviews and meta-analyses of exposure data and relative risks for risk-outcome pairs. Healthy life expectancy (HALE) was used to summarize overall population health, accounting for both length of life and levels of ill health experienced at different ages.
Results US life expectancy for both sexes combined increased from 75.2 years in 1990 to 78.2 years in 2010; during the same period, HALE increased from 65.8 years to 68.1 years. The diseases and injuries with the largest number of YLLs in 2010 were ischemic heart disease, lung cancer, stroke, chronic obstructive pulmonary disease, and road injury. Age-standardized YLL rates increased for Alzheimer disease, drug use disorders, chronic kidney disease, kidney cancer, and falls. The diseases with the largest number of YLDs in 2010 were low back pain, major depressive disorder, other musculoskeletal disorders, neck pain, and anxiety disorders. As the US population has aged, YLDs have comprised a larger share of DALYs than have YLLs. The leading risk factors related to DALYs were dietary risks, tobacco smoking, high body mass index, high blood pressure, high fasting plasma glucose, physical inactivity, and alcohol use. Among 34 OECD countries between 1990 and 2010, the US rank for the age-standardized death rate changed from 18th to 27th, for the age-standardized YLL rate from 23rd to 28th, for the age-standardized YLD rate from 5th to 6th, for life expectancy at birth from 20th to 27th, and for HALE from 14th to 26th.
Conclusions and Relevance From 1990 to 2010, the United States made substantial progress in improving health. Life expectancy at birth and HALE increased, all-cause death rates at all ages decreased, and age-specific rates of years lived with disability remained stable. However, morbidity and chronic disability now account for nearly half of the US health burden, and improvements in population health in the United States have not kept pace with advances in population health in other wealthy nations.
The United States spends the most per capita on health care across all countries,1- 2 lacks universal health coverage, and lags behind other high-income countries for life expectancy3 and many other health outcome measures.4 High costs with mediocre population health outcomes at the national level are compounded by marked disparities across communities, socioeconomic groups, and race and ethnicity groups.5- 6 Although overall life expectancy has slowly risen, the increase has been slower than for many other high-income countries.3 In addition, in some US counties, life expectancy has decreased in the past 2 decades, particularly for women.7- 8 Decades of health policy and legislative initiatives have been directed at these challenges; a recent example is the Patient Protection and Affordable Care Act, which is intended to address issues of access, efficiency, and quality of care and to bring greater emphasis to population health outcomes.9 There have also been calls for initiatives to address determinants of poor health outside the health sector including enhanced tobacco control initiatives,10- 12 the food supply,13- 15 physical environment,16- 17 and socioeconomic inequalities.18
With increasing focus on population health outcomes that can be achieved through better public health, multisectoral action, and medical care, it is critical to determine which diseases, injuries, and risk factors are related to the greatest losses of health and how these risk factors and health outcomes are changing over time. The Global Burden of Disease (GBD) framework19 provides a coherent set of concepts, definitions, and methods to do this. The GBD uses multiple metrics to quantify the relationship of diseases, injuries, and risk factors with health outcomes, each providing different perspectives. Burden of disease studies using earlier variants of this approach have been published for the United States for 199620- 22 and for Los Angeles County, California.23 In addition, 12 major risk factors have also been compared for 2005.24
In this report, we use the GBD Study 2010 to identify the leading diseases, injuries, and risk factors associated with the burden of disease in the United States, to determine how these health burdens have changed over the last 2 decades, and to compare the United States with other Organisation for Economic Co-operation and Development (OECD) countries.
JAMA The Journal of the American Medical Association 07/2013; 310(6). DOI:10.1001/jama.2013.13805 · 35.29 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: For four successive semesters, early in their first semester, community college nursing students (N = 602), completed the diagnostic-prescriptive Personal Background and Preparation Survey (PBPS) screening instrument to early identify those having high academic risks and target interventions. Following PBPS-risk-based assignment to interventions, retention-visit participants' adverse academic status events (AASE) and nonadvancement adverse academic status events (NAASE) rates were substantially (p < .05) less than retention-visit nonparticipants', statistically controlling for other interventions and covariates.
[Show abstract][Hide abstract] ABSTRACT: Wide-spread adoption of electronic medical records (EMRs) containing rich amounts of longitudinal clinical data and the formation of EMR-linked biobanks represent an opportunity to rapidly expand sample sizes and efficiently phenotype subjects for genomic studies. The Electronic Medical Records & Genomics (eMERGE) Network consists of five leading institutions involved in EMR phenotyping with linked DNA biobanks. The goal of eMERGE is to conduct genome-wide association studies (GWAS) in approximately 19,000 individuals using EMR-derived phenotypes and biorepository-derived genome-wide genotypes. These institutions include Group Health Research Institute, Marshfield Clinic, Mayo Clinic, Northwestern University and Vanderbilt University. Each site has used electronic algorithms to identify both site-specific phenotypes and network-wide phenotypes (applied at all five sites) for genomic analysis. The panel will present data from site-specific and network-wide studies illustrating the strengths and limitations of EMRs for genomic studies. Panelists will discuss and compare approaches to developing phenotypic electronic algorithms, challenges in implementing algorithms at each site, and approaches to validation of the algorithms and genomic results. Panelists will also present results from initial studies into performing phenome-wide analyses for genetic associations. Finally, the panel will present lessons learned from these efforts.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: The association of Helicobacter Pylori with gastritis, peptic ulcer diseases and gastric cancer is established now days. Frequency of these diseases is very high in developing countries including Pakistan. PATIENTS AND METHODS: This was a descriptive study expanded over twelve months during which frequency of H. Pylori was noted in 50 patients suffering from dyspepsia manifestation suspecting case of acid peptic disease. The patients were collected from surgical and medical in/out patients department of civil hospital Karachi. RESULTS: Out of 50 (n=50) patients, 30 (60 %) were male and 20 (40 %) were female with a male: female ratio of 3:2. Age range was 20-50 years with a mean of + / -SD of 37.74 ± 7.31. All patients were of low and middle socio-economic class living in congested overcrowded areas. All patients reported with epigastric pain while 43 (86%) patients were having heartburn. Upper gastrointestinal endoscopy revealed 16 % gastric ulcer, 25 % duodenal ulcer, 40 % gastritis, 6 % Oesophagitis and 12 % normal results. Frequency of H. Pylori as per upper gastrointestinal endoscopy and ELISA Test result was 78 % . CONCLUSION: H. Pylori plays a definite role in causing acid peptic disease. The patient presented with symptoms of peptic ulcer and therefore majority showed positive, endoscopy and ELISA test result. Various epidemiological factors like gender variations, increasing age and lower socioeconomic status were also positively associated.
[Show abstract][Hide abstract] ABSTRACT: Background: Nonadherence to asthma medications is associated with increased emergency
department visits and hospitalizations. If adherence is to be improved, first-fill adherence is the
first goal to meet after the physician and patient have decided to begin treatment. Little is known
about first-fill adherence with asthma medications and the factors for no-fill.
Objective: The goal of the study was to examine the proportion of patients who fill a new prescription for an asthma medication and analyze characteristics associated with this first-fill.
Methods: This retrospective cohort study linked electronic health records with pharmacy claims.
The cohort was comprised of 2023 patients aged 18 years or older who sought care from the
Geisinger Clinic, had Geisinger Health Plan pharmacy benefits, and were prescribed an asthma
medication for the first time between 2002 and 2006. The primary outcome of interest was first-time prescription
filled by the patient within 30 days of the prescription order date. Covariates examined included factors related to the
patient (ie, age, sex, and ethnicity), comorbidities and utilization (ie, Charlson comorbidity index, number of office visits, number of additional medications), asthma treatment (ie, delivery route, pharmacologic class), and pharmacy copay amount. A logistic-regression model was used to determine covariates associated with first-fill.
Results: The overall first-fill rate for new asthma medications was 78%. First-fill rate was lower for patients with a
copay above the mean of $12 (odds ratio = 0.76; 95% confidence interval, 0.58-0.99) and higher for patients prescribed oral plus inhaled medications (versus inhaled only, odds ratio = 3.91; 95% confidence interval, 2.15-7.11).
Conclusions: Several factors associated with failing to fill an initial prescription for asthma can be addressed through
simple interventions: screening for difficulties a patient may have in filling prescriptions, avoiding nonformulary medications, and recognizing the barrier that high copays present. In addition, for employers and policymakers, decreasing copay may improve adherence and, therefore, asthma control. [AHDB. 2009;2(4):174-180.
American Health and Drug Benefits 01/2009; 2(4):174-180.
[Show abstract][Hide abstract] ABSTRACT: The first 2 issues of Prescriptions for Excellence in Health Care addressed quality improvement in general terms ("Doing Things Right and Doing the Right Things - Quality and Safety in Health Care," Fall 2007) and from the hospital's perspective ("Hospitals Take Ownership for Quality Improvement and Patient Safety," Winter 2007). In this issue, we feature innovative strategies for improving quality of care in 4 different clinical settings.