School of Public Health
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The collections in this community comprise faculty research works, as well as graduate theses and dissertations.
Note: Prior to July 1, 2007, the School of Public Health was named the College of Health & Human Performance.
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Item Trusted and Relevant Medical Knowledge: The Promise of Information Retrieval(2006-06) Silfen, EricAs the world of medicine becomes increasingly digitized, the Web has become a de facto resource for physicians to quickly glean pertinent clinical information to carry out diagnostic and therapeutic decisions.At present, physicians face the dual challenge of judging the relevance of the information and trusting its Web source.This paper proposes a trust-relevance framework for conceptualizing computer-accessed medical information resources, a set of criteria for evaluating these information resources, and descriptions of a sample of available online resources. It also presents a usable framework for evaluating information retrieval innovations and explains the different capabilities of representative information retrieval tools and applications. By demystifying the concepts associated with information resources, search engines, and retrieval tools, and presenting a reasonable view of current opportunities as well as future possibilities, the authors hope to provide guidance so physicians can more rapidly adopt innovative computer-assisted search tools for acquiring information that facilitate patient care decision-making.Item Clinical Bioinformatics(Philips Research, 2007-05) E. Z. SilfenThis article describes the emergence of the hybrid discipline of clinical bioinformatics. Specifically, it defines biomedical informatics as well as the four compositional domains of bioinformatics, imaging informatics, clinical informatics and public health informatics. Furthermore, it describes the relationship between bioinformatics, molecular medicine and clinical decision support, and offers a definition of clinical bioinformatics that arises from the integration of these domains. After establishing this background, the article discusses use cases for clinical bioinformatics, summarizes the field of clinical bioinformatics, and posits its potential for biomedicine research.Item The relationship between ciliary neurotrophic factor (CNTF) genotype and motor unit physiology: preliminary studies(Springer Nature, 2005-09-23) Conwit, Robin A; Ling, Shari; Roth, Stephen; Stashuk, Daniel; Hurley, Ben; Ferrell, Robert; Metter, E JeffreyCiliary neurotrophic factor (CNTF) is important for neuronal and muscle development, and genetic variation in the CNTF gene has been associated with muscle strength. The effect of CNTF on nerve development suggests that CNTF genotype may be associated with force production via its influence on motor unit size and firing patterns. The purpose of this study is to examine whether CNTF genotype differentially affects motor unit activation in the vastus medialis with increasing isometric force during knee extension. Sixty-nine healthy subjects were genotyped for the presence of the G and A (null) alleles in the CNTF gene (n = 57 G/G, 12 G/A). They were tested using a dynamometer during submaximal isometric knee extension contractions that were from 10–50% of their maximal strength. During the contractions, the vastus medialis was studied using surface and intramuscular electromyography with spiked triggered averaging to assess surface-detected motor unit potential (SMUP) area and mean firing rates (mFR) from identified motor units. CNTF genotyping was performed using standard PCR techniques from DNA obtained from leucocytes of whole blood samples. The CNTF G/A genotype was associated with smaller SMUP area motor units and lower mFR at higher force levels, and fewer but larger units at lower force levels than G/G homozygotes. The two groups used motor units with different size and activation characteristics with increasing force generation. While G/G subjects tended to utilize larger motor units with increasing force, G/A subjects showed relatively less increase in size by using relatively larger units at lower force levels. At higher force levels, G/A subjects were able to generate more force per motor unit size suggesting more efficient motor unit function with increasing muscle force. Differential motor unit responses were observed between CNTF genotypes at force levels utilized in daily activities.Item The relationship between unsupervised time after school and physical activity in adolescent girls(Springer Nature, 2006-07-31) Rushovich, Berenice R; Voorhees, Carolyn C; Davis, CE; Neumark-Sztainer, Dianne; Pfeiffer, Karin A; Elder, John P; Going, Scott; Marino, Vivian GRising obesity and declining physical activity levels are of great concern because of the associated health risks. Many children are left unsupervised after the school day ends, but little is known about the association between unsupervised time and physical activity levels. This paper seeks to determine whether adolescent girls who are without adult supervision after school are more or less active than their peers who have a caregiver at home. A random sample of girls from 36 middle schools at 6 field sites across the U.S. was selected during the fall of the 2002–2003 school year to participate in the baseline measurement activities of the Trial of Activity for Adolescent Girls (TAAG). Information was collected using six-day objectively measured physical activity, self-reported physical activity using a three-day recall, and socioeconomic and psychosocial measures. Complete information was available for 1422 out of a total of 1596 respondents. Categorical variables were analyzed using chi square and continuous variables were analyzed by t-tests. The four categories of time alone were compared using a mixed linear model controlling for clustering effects by study center. Girls who spent more time after school (≥2 hours per day, ≥2 days per week) without adult supervision were more active than those with adult supervision (p = 0.01). Girls alone for ≥2 hours after school, ≥2 days a week, on average accrue 7.55 minutes more moderate to vigorous physical activity (MVPA) per day than do girls who are supervised (95% confidence interval ([C.I]). These results adjusted for ethnicity, parent's education, participation in the free/reduced lunch program, neighborhood resources, or available transportation. Unsupervised girls (n = 279) did less homework (53.1% vs. 63.3%), spent less time riding in a car or bus (48.0% vs. 56.6%), talked on the phone more (35.5% vs. 21.1%), and watched more television (59.9% vs. 52.6%) than supervised girls (n = 569). However, unsupervised girls also were more likely to be dancing (14.0% vs. 9.3%) and listening to music (20.8% vs. 12.0%) (p < .05). Girls in an unsupervised environment engaged in fewer structured activities and did not immediately do their homework, but they were more likely to be physically active than supervised girls. These results may have implications for parents, school, and community agencies as to how to structure activities in order to encourage teenage girls to be more physically active.Item Girls' perception of physical environmental factors and transportation: reliability and association with physical activity and active transport to school(Springer Nature, 2006-09-14) Evenson, Kelly R; Birnbaum, Amanda S; Bedimo-Rung, Ariane L; Sallis, James F; Voorhees, Carolyn C; Ring, Kimberly; Elder, John PPreliminary evidence suggests that the physical environment and transportation are associated with youth physical activity levels. Only a few studies have examined the association of physical environmental factors on walking and bicycling to school. Therefore, the purpose of this study was (1) to examine the test-retest reliability of a survey designed for youth to assess perceptions of physical environmental factors (e.g. safety, aesthetics, facilities near the home) and transportation, and (2) to describe the associations of these perceptions with both physical activity and active transport to school. Test and retest surveys, administered a median of 12 days later, were conducted with 480 sixth- and eighth-grade girls in or near six U.S. communities. The instrument consisted of 24 questions on safety and aesthetics of the perceived environment and transportation and related facilities. Additionally, girls were asked if they were aware of 14 different recreational facilities offering structured and unstructured activities, and if so, whether they would visit these facilities and the ease with which they could access them. Test-retest reliability was determined using kappa coefficients, overall and separately by grade. Associations with physical activity and active transport to school were examined using mixed model logistic regression (n = 610), adjusting for grade, race/ethnicity, and site. Item-specific reliabilities for questions assessing perceived safety and aesthetics of the neighborhood ranged from 0.31 to 0.52. Reliabilities of items assessing awareness of and interest in going to the 14 recreational facilities ranged from 0.47 to 0.64. Reliabilities of items assessing transportation ranged from 0.34 to 0.58. Some items on girls' perceptions of perceived safety, aesthetics of the environment, facilities, and transportation were important correlates of physical activity and, in some cases, active transport to school. This study provides some psychometric support for the use of the questionnaire on physical environmental factors and transportation for studying physical activity and active transport to school among adolescent girls. Further work can continue to improve reliability of these self-report items and examine their association of these factors with objectively measured physical activity.Item A method for analyzing censored survival phenotype with gene expression data(Springer Nature, 2008-10-06) Wu, Tongtong; Sun, Wei; Yuan, Shinsheng; Chen, Chun-Houh; Li, Ker-ChauSurvival time is an important clinical trait for many disease studies. Previous works have shown certain relationship between patients' gene expression profiles and survival time. However, due to the censoring effects of survival time and the high dimensionality of gene expression data, effective and unbiased selection of a gene expression signature to predict survival probabilities requires further study. We propose a method for an integrated study of survival time and gene expression. This method can be summarized as a two-step procedure: in the first step, a moderate number of genes are pre-selected using correlation or liquid association (LA). Imputation and transformation methods are employed for the correlation/LA calculation. In the second step, the dimension of the predictors is further reduced using the modified sliced inverse regression for censored data (censorSIR). The new method is tested via both simulated and real data. For the real data application, we employed a set of 295 breast cancer patients and found a linear combination of 22 gene expression profiles that are significantly correlated with patients' survival rate. By an appropriate combination of feature selection and dimension reduction, we find a method of identifying gene expression signatures which is effective for survival prediction.Item Hepatitis B vaccinations among Koreans: Results from 2005 Korea National Cancer Screening Survey(Springer Nature, 2009-11-25) Juon, Hee-Soon; Choi, Kui Son; Park, Eun-Cheol; Kwak, Min-Son; Lee, SunminLiver cancer is one of most commonly diagnosed cancers among Koreans. Chronic hepatitis B virus (HBV) infection is a major risk factor for liver cancer. HBV infection can be prevented by effective screening and vaccination programs. The purpose of this study is to examine the status of HBV infection and the predictors associated with HBV vaccination. The study population was derived from the 2005 Korea National Cancer Screening Survey (KNCSS). The KNCSS is an annual cross-sectional survey that uses a nationally-representative random sampling to investigate cancer screening rates. A total of 1,786 Koreans over 40 years of age participated in this study. Of all the participants, 5.9% reported HBV positive (HBsAg+, HBsAb-), 41.8% were HBV negative but protected (HBsAg-, HBsAb+), and 52.3% were unprotected (HBsAg-, HBsAb-). Among unprotected individuals (n = 934), 23.1% reported to have received the vaccination. About half of those who had vaccinations completed the 3-shot vaccine series. In multiple analyses, education, having private cancer insurance, alcohol use, having regular check-up, and doing regular exercise were associated with completed HBV vaccination. This study result suggests that we need a liver cancer education program to increase HBV awareness and to increase the liver cancer prevention message among low educated populations.Item Identifying the Tuskegee Syphilis Study: implications of results from recall and recognition questions(Springer Nature, 2009-12-16) Katz, Ralph V; Jean-Charles, Germain; Green, B Lee; Kressin, Nancy R; Claudio, Cristina; Wang, MinQi; Russell, Stefanie L; Outlaw, JasonThis analysis assessed whether Blacks, Whites and Puerto-Rican (PR) Hispanics differed in their ability to identify the Tuskegee Syphilis Study (TSS) via open-ended questions following lead-in recognition and recall questions. The Tuskegee Legacy Project (TLP) Questionnaire was administered via a Random-Digit Dial (RDD) telephone survey to a stratified random sample of Black, White and PR Hispanic adults in three U.S. cities. The TLP Questionnaire was administered to 1,162 adults (356 African-Americans, 313 PR Hispanics, and 493 non-Hispanic Whites) in San Juan, PR, Baltimore, MD and New York City, NY. Recall question data revealed: 1) that 89% or more of Blacks, Whites, and PR Hispanics were not able to name or definitely identify the Tuskegee Syphilis Study by giving study attributes; and, 2) that Blacks were the most likely to provide an open-ended answer that identified the Tuskegee Syphilis Study as compared to Whites and PR Hispanics (11.5% vs 6.3% vs 2.9%, respectively) (p ≤ 0.002). Even when probed by a recognition question, only a minority of each racial/ethnic group (37.1%, 26.9%, and 8.6%, for Blacks, Whites and PR Hispanics, respectively) was able to clearly identify the TSS (p < 0.001). The two major implications of these findings for health disparity researchers are 1) that it is unlikely that detailed knowledge of the Tuskegee Syphilis Study has any current widespread influence on the willingness of minorities to participate in biomedical research, and 2) that caution should be applied before assuming that what community leaders 'know and are aware of' is equally 'well known' within their community constituencies.Item The Community Environmental Health Assessment Workbook: A Guide to Evaluating your Community's Health(Environmental Law Institute, 2000-12) Payne-Sturges, Devon; Locke, Paul; Keiner, SuellenThis Workbook will help community leaders, local organizers, and citizens groups assess environmental health problems in their neighborhoods and assist them in tackling these problems. It outlines an approach to identifying problems, gathering information, and establishing the community’s priorities for improving the environmental health of its residents. The Workbook is divided into four parts. It is written mainly for the citizen organizer, community leader, or other person who will serve as the project manager and take the lead in organizing the assessment. Part One is a brief introduction and discussion of this Workbook. Part Two discusses the reasons why your community should undertake an environmental health assessment, and outlines the assessment process. Part Three explains the community environmental health assessment process step-by-step, and shows citizens in detail how to conduct an assessment. Part Four suggests possible next steps after a community assessment is completed.Item Guide to Considering Children’s Health When Developing EPA Actions: Implementing Executive Order 13045 and EPA’s Policy on Evaluating Health Risks to Children(U.S. Environmental Protection Agency, 2006-10) Payne-Sturges, Devon; Miles-McLean, Stuart; Kataoka, Mark; Patel, M; Owens, NicoleThis document is a step-by-step guide to assist Agency staff in integrating children’s health considerations into EPA’s Action Development Process (ADP). It describes the provisions of Executive Order 13045 “Protection of Children from Environmental Health Risks and Safety Risks” and EPA’s “Policy on Evaluating Health Risks to Children.” This guide also is designed to assist EPA staff in determining whether rules are subject to the Executive Order, whether the Agency Policy applies to an action and what should be done to address the Executive Order and/or EPA’s policy in the development of a rule or Agency action.