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1.
J Am Med Inform Assoc ; 27(2): 254-264, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31633756

RESUMO

OBJECTIVE: Initiatives to reduce neighborhood-based health disparities require access to meaningful, timely, and local information regarding health behavior and its determinants. We examined the validity of Twitter as a source of information for neighborhood-level analysis of dietary choices and attitudes. MATERIALS AND METHODS: We analyzed the "healthiness" quotient and sentiment in food-related tweets at the census tract level, and associated them with neighborhood characteristics and health outcomes. We analyzed keywords driving the differences in food healthiness between the most and least-affluent tracts, and qualitatively analyzed contents of a random sample of tweets. RESULTS: Significant, albeit weak, correlations existed between healthiness and sentiment in food-related tweets and tract-level measures of affluence, disadvantage, race, age, U.S. density, and mortality from conditions associated with obesity. Analyses of keywords driving the differences in food healthiness revealed foods high in saturated fat (eg, pizza, bacon, fries) were mentioned more frequently in less-affluent tracts. Food-related discussion referred to activities (eating, drinking, cooking), locations where food was consumed, and positive (affection, cravings, enjoyment) and negative attitudes (dislike, personal struggles, complaints). DISCUSSION: Tweet-based healthiness scores largely correlated with offline phenomena in the expected directions. Social media offer less resource-intensive data collection methods than traditional surveys do. Twitter may assist in informing local health programs that focus on drivers of food consumption and could inform interventions focused on attitudes and the food environment. CONCLUSIONS: Twitter provided weak but significant signals concerning food-related behavior and attitudes at the neighborhood level, suggesting its potential usefulness for informing local health disparity reduction efforts.

2.
Arthritis Rheumatol ; 72(1): 125-136, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31342624

RESUMO

OBJECTIVE: T cells play a key role in the pathogenesis of early systemic sclerosis. This study was undertaken to assess the safety and efficacy of abatacept in patients with diffuse cutaneous systemic sclerosis (dcSSc). METHODS: In this 12-month, randomized, double-blind, placebo-controlled trial, participants were randomized 1:1 to receive either subcutaneous abatacept 125 mg or matching placebo, stratified by duration of dcSSc. Escape therapy was allowed at 6 months for worsening disease. The coprimary end points were change in the modified Rodnan skin thickness score (MRSS) compared to baseline and safety over 12 months. Differences in longitudinal outcomes were assessed according to treatment using linear mixed models, with outcomes censored after initiation of escape therapy. Skin tissue obtained from participants at baseline was classified into intrinsic gene expression subsets. RESULTS: Among 88 participants, the adjusted mean change in the MRSS at 12 months was -6.24 units for those receiving abatacept and -4.49 units for those receiving placebo, with an adjusted mean treatment difference of -1.75 units (P = 0.28). Outcomes for 2 secondary measures (Health Assessment Questionnaire disability index and a composite measure) were clinically and statistically significantly better with abatacept. The proportion of subjects in whom escape therapy was needed was higher in the placebo group relative to the abatacept group (36% versus 16%). In the inflammatory and normal-like skin gene expression subsets, decline in the MRSS over 12 months was clinically and significantly greater in the abatacept group versus the placebo group (P < 0.001 and P = 0.03, respectively). In the abatacept group, adverse events occurred in 35 participants versus 40 participants in the placebo group, including 2 deaths and 1 death, respectively. CONCLUSION: In this phase II trial, abatacept was well-tolerated, but change in the MRSS was not statistically significant. Secondary outcome measures, including gene expression subsets, showed evidence in support of abatacept. These data should be confirmed in a phase III trial.

3.
J Clin Rheumatol ; 2019 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-31415480

RESUMO

BACKGROUND: Management guidelines have identified unmet educational needs in gout patients. Our objective was to develop and pilot test MyGoutCare (MGC©)-a web-based, interactive educational resource for gout patients, tailored to improve knowledge. METHODS: The website was developed with input from patients and experts. A health informatics expert tailored content areas so the patient could walk through a journey to learn various aspects of gout. During the pilot study, patients completed baseline demographics and a 10-item validated gout knowledge questionnaire. After reviewing the website, patients completed a post-survey within 2 weeks of their physician visit. Data was analyzed using paired t-tests and effect size (ES) was calculated for the changed scores. RESULTS: Gout patients and experts agreed on these content areas-triggers of flares, comorbidities, pharmacologic and non-pharmacologic treatment, healthy gout diet, and lifestyle choices. In the pilot study, 50 patients (mean age of 54 years, mean disease duration of 9.5 years, and mean 3-5 flares/year) were recruited. Their post-survey scores (0-10) on knowledge questions improved significantly when compared to pre-survey scores with mean (SD) of 1.95 (1.76) p < 0.0001, ES = 0.95. Patients identified actionable changes moving forward after reviewing the website-decision to continue lifelong urate-lowering therapy, complying with periodic monitoring of serum urate, and making dietary changes. CONCLUSIONS: Web-based platforms that offer patient-focused materials can serve as a practical tool to address ongoing educational needs of gout patients. Additional studies are needed to evaluate if the website can improve patient-physician communication and lead to better long-term outcomes.

4.
Int J Rheum Dis ; 22(6): 1036-1040, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30838791

RESUMO

AIM: The modified Rodnan skin score (mRSS) is a validated outcome measure for skin thickness in systemic sclerosis (SSc). Training has been shown to reduce variability in the measurement of mRSS. Our objective was to assess the inter- and intra-observer variability of mRSS scoring using the proposed recommendations for training by the Scleroderma Clinical Trials Consortium (SCTC) and World Scleroderma Foundation (WSF). METHOD: Fifty-two trainees and eight adult SSc patients participated in the SSc skin scoring workshop that was conducted in two sessions by four teachers. Each session, attended by 26 trainees, had a teaching and evaluation phase. The teaching phase comprised of: (a) lecture on mRSS scoring; (b) video demonstration of mRSS scoring; and (c) live demonstration of mRSS on one SSc patient. In the evaluation phase, each trainee independently assessed the mRSS in four SSc patients. For intra-observer reliability, 14 trainees re-assessed the mRSS of two SSc patients whom they had previously examined. We computed the inter- and intra-observer variability using a linear mixed model. RESULTS: For the evaluation phase, 34 (65.4%) trainees were within five units of the established teachers' score in 3 out of 4 patients. Overall, the whole group had acceptable inter-observer variability (intra-class correlation coefficient [ICC] = 0.71, mean = 8.64 and within-patient standard deviation [SD] = 4.25). The intra-observer ICC was 0.85 and within-patient SD was 2.73. CONCLUSION: There was good inter-observer and excellent intra-observer reliability. This is the first study examining the training of assessors using the SCTC/WSF recommendations and our results support the importance of standardized training for skin scoring.


Assuntos
Técnicas de Apoio para a Decisão , Escleroderma Sistêmico/patologia , Pele/patologia , Estudos de Viabilidade , Humanos , Variações Dependentes do Observador , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Índice de Gravidade de Doença
5.
Am J Trop Med Hyg ; 100(3): 733-741, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30675841

RESUMO

There is increasing appreciation that latrine access does not imply use-many individuals who own latrines do not consistently use them. Little is known, however, about the determinants of latrine use, particularly among those with variable defecation behaviors. Using the integrated behavior model of water, sanitation, and hygiene framework, we sought to characterize determinants of latrine use in rural Ecuador. We interviewed 197 adults living in three communities with a survey consisting of 70 psychosocial defecation-related questions. Questions were excluded from analysis if responses lacked variability or at least 10% of respondents did not provide a definitive answer. All interviewed individuals had access to a privately owned or shared latrine. We then applied adaptive elastic nets (ENET) and supervised principal component analysis (SPCA) to a reduced dataset of 45 questions among 154 individuals with complete data to select determinants that predict self-reported latrine use. Latrine use was common, but not universal, in the sample (76%). The SPCA model identified six determinants and adaptive ENET selected five determinants. Three indicators were represented in both models-latrine users were more likely to report that their latrine is clean enough to use and also more likely to report daily latrine use; while those reporting that elderly men were not latrine users were less likely to use latrines themselves. Our findings suggest that social norms are important predictors of latrine use, whereas knowledge of the health benefits of sanitation may not be as important. These determinants are informative for promotion of latrine adoption.


Assuntos
Defecação , Higiene , População Rural/estatística & dados numéricos , Saneamento/estatística & dados numéricos , Toaletes/estatística & dados numéricos , Adolescente , Adulto , Coleta de Dados , Equador , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
6.
J R Stat Soc Ser C Appl Stat ; 68(1): 79-97, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30636815

RESUMO

Distributed lag models (DLMs) have been widely used in environmental epidemiology to quantify the lagged effects of air pollution on a health outcome of interest such as mortality and morbidity. Most previous DLM approaches only consider one pollutant at a time. In this article, we propose distributed lag interaction model (DLIM) to characterize the joint lagged effect of two pollutants. One natural way to model the interaction surface is by assuming that the underlying basis functions are tensor products of the basis functions that generate the main-effect distributed lag functions. We extend Tukey's one-degree-of-freedom interaction structure to the two-dimensional DLM context. We also consider shrinkage versions of the two to allow departure from the specified Tukey's interaction structure and achieve bias-variance tradeoff. We derive the marginal lag effects of one pollutant when the other pollutant is fixed at certain quantiles. In a simulation study, we show that the shrinkage methods have better average performance in terms of mean squared error (MSE) across different scenarios. We illustrate the proposed methods by using the National Morbidity, Mortality, and Air Pollution Study (NMMAPS) data to model the joint effects of PM10 and O3 on mortality count in Chicago, Illinois, from 1987 to 2000.

7.
Stat Methods Med Res ; 28(9): 2569, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29649940
8.
Arthritis Care Res (Hoboken) ; 71(3): 435-447, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-29741230

RESUMO

OBJECTIVE: In a pilot study, our group showed that an internet-based self-management program improves self-efficacy in systemic sclerosis (SSc). The objective of the current study was to compare an internet-based self-management program to a patient-focused educational book developed to assess measures of self-efficacy and other patient-reported outcomes in patients with SSc. METHODS: We conducted a 16-week randomized, controlled trial. RESULTS: Of the 267 participants who completed baseline questionnaires and were randomized to the intervention (internet: www.selfmanagescleroderma.com) or control (book) group, 123 participants (93%) in the internet group and 124 participants (94%) in the control group completed the 16-week randomized controlled trial (RCT). The mean ± SD age of all participants was 53.7 ± 11.7 years, 91% were women, and 79.4% had some college or a higher degree. The mean ± SD disease duration after diagnosis of SSc was 8.97 ± 8.50 years. There were no statistical differences between the 2 groups for the primary outcome measure (Patient-Reported Outcomes Measurement Information System Self-Efficacy for Managing Symptoms: mean change of 0.35 in the internet group versus 0.94 in the control group; P = 0.47) and secondary outcome measures, except the EuroQol 5-domain instrument visual analog scale score (P = 0.05). Internet group participants agreed that the self-management modules were of importance to them, the information was presented clearly, and the website was easy to use and at an appropriate reading level. CONCLUSION: Our RCT showed that the internet-based self-management website was not statistically superior to an educational patient-focused book in improving self-efficacy and other measures. The participants were enthusiastic about the content and presentation of the self-management website.


Assuntos
Internet/normas , Escleroderma Sistêmico/terapia , Autocuidado/métodos , Autocuidado/normas , Autogestão/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Escleroderma Sistêmico/psicologia , Autocuidado/psicologia , Autoeficácia , Autogestão/psicologia
9.
J Rheumatol ; 46(1): 78-84, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30442827

RESUMO

OBJECTIVE: Validated gastrointestinal (GI) symptoms scales are used in clinical practice to assess patient-reported GI involvement. We sought to determine whether University of California, Los Angeles (UCLA) GI Tract Questionnaire (GIT) 2.0 Reflux scale, Patient-Reported Outcomes Measurement Information System (PROMIS) Reflux scale, and the Quality of Life in Reflux and Dyspepsia questionnaire (QOLRAD) are sensitive to identifying changes in GI symptoms following therapeutic intervention in participants with systemic sclerosis (SSc) and gastroesophageal reflux disease (GERD). METHODS: Participants with active GERD were recruited during clinical visits at 6 international SSc centers. Patient-reported outcome surveys and the GI self-reported questionnaire were completed at baseline and again at 4 weeks following a single intervention, and patients were classified as "improved" or "not improved." Effect size (ES) was calculated to assess the sensitivity to change. ES was interpreted as 0.50-0.79 as moderate effect and ≥ 0.80 as large effect. RESULTS: There were 116 participants with SSc and active GERD who enrolled. The average age was 53.8 years and mean disease duration was 12.0 years. The UCLA GIT 2.0 Reflux scale and PROMIS Reflux scale had a significant correlation at baseline (0.61, p < 0.0001), and both instruments correlated with the QOLRAD domains (-0.56 to -0.71). In participants who had the UCLA GIT 2.0, PROMIS Reflux scale, and QOLRAD administered over 2 timepoints (n = 57) and were classified as improved, the ES was large for the UCLA GIT 2.0 and PROMIS Reflux scale, and moderate to large across all QOLRAD domains. CONCLUSION: The UCLA GIT 2.0 Reflux scale, PROMIS Reflux scale, and QOLRAD are sensitive to change and can be included in future clinical trials.

10.
Am J Trop Med Hyg ; 100(2): 374-376, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30457098

RESUMO

Small-scale farming may have large impacts on the selection and spread of antimicrobial resistance to humans. We conducted an observational study to evaluate antibiotic-resistant Escherichia coli populations from poultry and humans in rural northwestern Esmeraldas, Ecuador. Our study site is a remote region with historically low resistance levels of third-generation antibiotics such cefotaxime (CTX), a clinically relevant antibiotic, in both poultry and humans. Our study revealed 1) high CTX resistance (66.1%) in farmed broiler chickens, 2) an increase in CTX resistance over time in backyard chicken not fed antibiotics (2.3-17.9%), and 3) identical bla CTX-M sequences from human and chicken bacteria, suggesting a spillover event. These findings provide evidence that small-scale meat production operations have direct impacts on the spread and selection of clinically important antibiotics among underdeveloped settings.


Assuntos
Farmacorresistência Bacteriana Múltipla/genética , Infecções por Escherichia coli/veterinária , Proteínas de Escherichia coli/genética , Escherichia coli/genética , Doenças das Aves Domésticas/epidemiologia , beta-Lactamases/genética , Agricultura/métodos , Animais , Antibacterianos/farmacologia , Cefotaxima/farmacologia , Galinhas , Equador/epidemiologia , Escherichia coli/efeitos dos fármacos , Escherichia coli/enzimologia , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/microbiologia , Infecções por Escherichia coli/transmissão , Proteínas de Escherichia coli/metabolismo , Expressão Gênica , Humanos , Testes de Sensibilidade Microbiana , Aves Domésticas , Doenças das Aves Domésticas/microbiologia , Doenças das Aves Domésticas/transmissão , Prevalência , Resistência beta-Lactâmica/genética , beta-Lactamases/metabolismo
11.
Public Health Nutr ; 22(2): 257-264, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30406742

RESUMO

OBJECTIVE: To examine the feasibility of using social media to assess the consumer nutrition environment by comparing sentiment expressed in Yelp reviews with information obtained from a direct observation audit instrument for grocery stores. DESIGN: Trained raters used the Nutrition Environment Measures Survey in Stores (NEMS-S) in 100 grocery stores from July 2015 to March 2016. Yelp reviews were available for sixty-nine of these stores and were retrieved in February 2017 using the Yelp Application Program Interface. A sentiment analysis was conducted to quantify the perceptions of the consumer nutrition environment in the review text. Pearson correlation coefficients (ρ) were used to compare NEMS-S scores with Yelp review text on food availability, quality, price and shopping experience. SETTING: Detroit, Michigan, USA.ParticipantsNone. RESULTS: Yelp reviews contained more comments about food availability and the overall shopping experience than food price and food quality. Negative sentiment about food prices in Yelp review text and the number of dollar signs on Yelp were positively correlated with observed food prices in stores (ρ=0·413 and 0·462, respectively). Stores with greater food availability were rated as more expensive on Yelp. Other aspects of the food store environment (e.g. overall quality and shopping experience) were captured only in Yelp. CONCLUSIONS: While Yelp cannot replace in-person audits for collecting detailed information on the availability, quality and cost of specific food items, Yelp holds promise as a cost-effective means to gather information on the overall cost, quality and experience of food stores, which may be relevant for nutrition outcomes.

12.
Stat Methods Med Res ; 28(4): 1203-1215, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-29334860

RESUMO

Spatial resolution plays an important role in functional magnetic resonance imaging studies as the signal-to-noise ratio increases linearly with voxel volume. In scientific studies, where functional magnetic resonance imaging is widely used, the standard spatial resolution typically used is relatively low which ensures a relatively high signal-to-noise ratio. However, for pre-surgical functional magnetic resonance imaging analysis, where spatial accuracy is paramount, high-resolution functional magnetic resonance imaging may play an important role with its greater spatial resolution. High spatial resolution comes at the cost of a smaller signal-to-noise ratio. This begs the question as to whether we can leverage the higher signal-to-noise ratio of a standard functional magnetic resonance imaging study with the greater spatial accuracy of a high-resolution functional magnetic resonance imaging study in a pre-operative patient. To answer this question, we propose to regress the statistic image from a high resolution scan onto the statistic image obtained from a standard resolution scan using a mixed-effects model with spatially varying coefficients. We evaluate our model via simulation studies and we compare its performance with a recently proposed model that operates at a single spatial resolution. We apply and compare the two models on data from a patient awaiting tumor resection. Both simulation study results and the real data analysis demonstrate that our newly proposed model indeed leverages the larger signal-to-noise ratio of the standard spatial resolution scan while maintaining the advantages of the high spatial resolution scan.

13.
JMIR Mhealth Uhealth ; 6(8): e168, 2018 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-30104185

RESUMO

BACKGROUND: Mobile devices are increasingly used to collect location-based information from individuals about their physical activities, dietary intake, environmental exposures, and mental well-being. Such research, which typically uses wearable devices or mobile phones to track location, benefits from the growing availability of fine-grained data regarding human mobility. However, little is known about the comparative geospatial accuracy of such devices. OBJECTIVE: In this study, we compared the data quality of location information collected from two mobile devices that determine location in different ways-a global positioning system (GPS) watch and a mobile phone with Google's Location History feature enabled. METHODS: A total of 21 chronically ill participants carried both devices, which generated digital traces of locations, for 28 days. A mobile phone-based brief ecological momentary assessment (EMA) survey asked participants to manually report their location at 4 random times throughout each day. Participants also took part in qualitative interviews and completed surveys twice during the study period in which they reviewed recent mobile phone and watch trace data to compare the devices' trace data with their memory of their activities on those days. Trace data from the devices were compared on the basis of (1) missing data days, (2) reasons for missing data, (3) distance between the route data collected for matching day and the associated EMA survey locations, and (4) activity space total area and density surfaces. RESULTS: The watch resulted in a much higher proportion of missing data days (P<.001), with missing data explained by technical differences between the devices as well as participant behaviors. The mobile phone was significantly more accurate in detecting home locations (P=.004) and marginally more accurate (P=.07) for all types of locations combined. The watch data resulted in a smaller activity space area and more accurately recorded outdoor travel and recreation. CONCLUSIONS: The most suitable mobile device for location-based health research depends on the particular study objectives. Furthermore, data generated from mobile devices, such as GPS phones and smartwatches, require careful analysis to ensure quality and completeness. Studies that seek precise measurement of outdoor activity and travel, such as measuring outdoor physical activity or exposure to localized environmental hazards, would benefit from the use of GPS devices. Conversely, studies that aim to account for time within buildings at home or work, or those that document visits to particular places (such as supermarkets, medical facilities, or fast food restaurants), would benefit from the greater precision demonstrated by the mobile phone in recording indoor activities.

14.
J Biomed Inform ; 79: 7-19, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29355784

RESUMO

Research regarding place and health has undergone a revolution due to the availability of consumer-focused location-tracking devices that reveal fine-grained details of human mobility. Such research requires that participants accept such devices enough to use them in their daily lives. There is a need for a theoretically grounded understanding of acceptance of different location-tracking technology options, and its research implications. Guided by an extended Unified Theory of Acceptance and Use of Technology (UTAUT), we conducted a 28-day field study comparing 21 chronically ill people's acceptance of two leading, consumer-focused location-tracking technologies deployed for research purposes: (1) a location-enabled smartphone, and (2) a GPS watch/activity tracker. Participants used both, and completed two surveys and qualitative interviews. Findings revealed that all participants exerted effort to facilitate data capture, such as by incorporating devices into daily routines and developing workarounds to keep devices functioning. Nevertheless, the smartphone was perceived to be significantly easier and posed fewer usability challenges for participants than the watch. Older participants found the watch significantly more difficult to use. For both devices, effort expectancy was significantly associated with future willingness to participate in research although prosocial motivations overcame some concerns. Social influence, performance expectancy and use behavior were significantly associated with intentions to use the devices in participants' personal lives. Data gathered via the smartphone was significantly more complete than data gathered via the watch, primarily due to usability challenges. To make longer-term participation in location tracking research a reality, and to achieve complete data capture, researchers must minimize the effort involved in participation; this requires usable devices. For long-term location-tracking studies using similar devices, findings indicate that only smartphone-based tracking is up to the challenge.


Assuntos
Doença Crônica/terapia , Confiabilidade dos Dados , Coleta de Dados/métodos , Sistemas de Informação Geográfica , Monitorização Ambulatorial/instrumentação , Smartphone , Adulto , Idoso , Comportamento , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aplicativos Móveis , Monitorização Ambulatorial/métodos , Aceitação pelo Paciente de Cuidados de Saúde , Projetos de Pesquisa , Inquéritos e Questionários , Tecnologia
15.
Biostatistics ; 19(4): 461-478, 2018 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-29040386

RESUMO

Distributed lag models (DLMs) have been widely used in environmental epidemiology to quantify the lagged effects of air pollution on an outcome of interest such as mortality or cardiovascular events. Generally speaking, DLMs can be applied to time-series data where the current measure of an independent variable and its lagged measures collectively affect the current measure of a dependent variable. The corresponding distributed lag (DL) function represents the relationship between the lags and the coefficients of the lagged exposure variables. Common choices include polynomials and splines. On one hand, such a constrained DLM specifies the coefficients as a function of lags and reduces the number of parameters to be estimated; hence, higher efficiency can be achieved. On the other hand, under violation of the assumption about the DL function, effect estimates can be severely biased. In this article, we propose a general framework for shrinking coefficient estimates from an unconstrained DLM, that are unbiased but potentially inefficient, toward the coefficient estimates from a constrained DLM to achieve a bias-variance trade-off. The amount of shrinkage can be determined in various ways, and we explore several such methods: empirical Bayes-type shrinkage, a hierarchical Bayes approach, and generalized ridge regression. We also consider a two-stage shrinkage approach that enforces the effect estimates to approach zero as lags increase. We contrast the various methods via an extensive simulation study and show that the shrinkage methods have better average performance across different scenarios in terms of mean squared error (MSE).We illustrate the methods by using data from the National Morbidity, Mortality, and Air Pollution Study (NMMAPS) to explore the association between PM$_{10}$, O$_3$, and SO$_2$ on three types of disease event counts in Chicago, IL, from 1987 to 2000.


Assuntos
Bioestatística/métodos , Inquéritos Epidemiológicos/estatística & dados numéricos , Modelos Estatísticos , Poluição do Ar/estatística & dados numéricos , Teorema de Bayes , Simulação por Computador , Exposição Ambiental/estatística & dados numéricos , Epidemiologia/estatística & dados numéricos , Humanos
16.
J Urban Health ; 94(3): 429-436, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28455606

RESUMO

An established body of research has used secondary data sources (such as proprietary business databases) to demonstrate the importance of the neighborhood food environment for multiple health outcomes. However, documenting food availability using secondary sources in low-income urban neighborhoods can be particularly challenging since small businesses play a crucial role in food availability. These small businesses are typically underrepresented in national databases, which rely on secondary sources to develop data for marketing purposes. Using social media and other crowdsourced data to account for these smaller businesses holds promise, but the quality of these data remains unknown. This paper compares the quality of full-line grocery store information from Yelp, a crowdsourced content service, to a "ground truth" data set (Detroit Food Map) and a commercially-available dataset (Reference USA) for the greater Detroit area. Results suggest that Yelp is more accurate than Reference USA in identifying healthy food stores in urban areas. Researchers investigating the relationship between the nutrition environment and health may consider Yelp as a reliable and valid source for identifying sources of healthy food in urban environments.


Assuntos
Cidades/estatística & dados numéricos , Abastecimento de Alimentos/estatística & dados numéricos , Valor Nutritivo , Características de Residência/estatística & dados numéricos , Mídias Sociais , Conjuntos de Dados como Assunto , Humanos , Michigan
17.
J Rheumatol ; 44(6): 791-794, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28298560

RESUMO

OBJECTIVE: To determine the inter/intraobserver reliability of the tender and swollen joint counts (TJC, SJC) and the modified Rodnan Skin Score (mRSS) in diffuse cutaneous systemic sclerosis (dcSSc) and to assess content validity of the TJC/SJC. METHODS: Ten rheumatologists completed the SJC, TJC, and mRSS on 7 patients. Musculoskeletal ultrasound (MSUS) was performed. RESULTS: Interobserver and intraobserver reliability for the TJC was 0.97 and 0.99, for the SJC was 0.24 and 0.71, and for the mRSS was 0.81 and 0.94, respectively. MSUS abnormalities did not correspond with SJC/TJC. CONCLUSION: We demonstrate excellent inter- and intraobserver reliability for the mRSS and TJC in dcSSc. However, the SJC and TJC did not correspond to MSUS.


Assuntos
Articulações/patologia , Esclerodermia Difusa/diagnóstico , Pele/patologia , Adulto , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exame Físico , Estudos Prospectivos , Sistema de Registros , Reprodutibilidade dos Testes , Esclerodermia Difusa/patologia , Índice de Gravidade de Doença , Adulto Jovem
18.
J Scleroderma Relat Disord ; 1(2): 226-233, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27840853

RESUMO

OBJECTIVE: To examine the effect of acupressure on Raynaud's phenomenon (RP) in a randomized controlled clinical trial (RCT) and to evaluate the difficulties of conducting a RP RCT. METHODS: A pilot single center RCT of acupressure vs. targeted patient education was conducted for the treatment of RP. Patients with either primary (N = 15) or secondary (N = 8) RP were randomized in an 8-week study. The primary endpoints included a decrease in the frequency and duration of RP. Secondary endpoints included several serum biomarkers including endothelial dysfunction, Raynaud's attack symptoms, Raynaud's Condition Score, and patient and physician global assessments of RP. Primary data analysis was conducted using the last observation carried forward and t-tests or a Wilcoxon rank test was used to compare the two groups. RESULTS: 23 patients were randomized and 7 discontinued prematurely. 78% of patients were female, 96% were Caucasian, and the mean age was 49.8 (SD=16) years. No statistically significant differences were detected between the acupressure vs. education groups in primary and secondary outcomes (p> 0.05). Frequency of attacks decreased by 6.7 attacks (SD=8.8) in the acupressure group vs. 7.2 (SD=12.8) in the education group (p=0.96), and the duration of attacks decreased by 11.4 (SD=19.9) minutes in the acupressure group vs. an increase of 0.8 minutes (SD=11.2) in the education group (p=0.14). There were no adverse events noted in the RCT. CONCLUSION: This pilot study does not support efficacy of acupressure for RP.

19.
Health Place ; 42: 30-36, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27614064

RESUMO

We investigated the relationships between neighborhood socio-demographic characteristics (socioeconomic status [SES], percentage of Black residents, and percentage of Hispanic residents) and survey-based measures of the social environment (social cohesion, safety) and the physical environment (healthy food environment, walking environment) in six sites from 2000 through 2011. Neighborhood environments were patterned by area SES and racial/ethnic composition, such that higher SES and lower percentage minority neighborhoods had better physical and social environments. Increasing disparities over time were observed for some neighborhood environments. Further research should explore the role of neighborhood environments in maintaining or increasing social disparities in health.


Assuntos
Afro-Americanos/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Características de Residência , Comportamento Social , Classe Social , Meio Social , Idoso , Idoso de 80 Anos ou mais , Censos , Grupos de Populações Continentais , Grupos Étnicos , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Características de Residência/estatística & dados numéricos , Segurança , Fatores Socioeconômicos , Inquéritos e Questionários , Caminhada
20.
Stat Methods Med Res ; 25(4): 1224-43, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27566774

RESUMO

Preferential sampling refers to any situation in which the spatial process and the sampling locations are not stochastically independent. In this paper, we present two examples of geostatistical analysis in which the usual assumption of stochastic independence between the point process and the measurement process is violated. To account for preferential sampling, we specify a flexible and general Bayesian geostatistical model that includes a shared spatial random component. We apply the proposed model to two different case studies that allow us to highlight three different modeling and inferential aspects of geostatistical modeling under preferential sampling: (1) continuous or finite spatial sampling frame; (2) underlying causal model and relevant covariates; and (3) inferential goals related to mean prediction surface or prediction uncertainty.


Assuntos
Teorema de Bayes , Mapeamento Geográfico , Modelos Estatísticos , Animais , Itália/epidemiologia , Prevalência , Ovinos/parasitologia , Doenças dos Ovinos/epidemiologia , Doenças dos Ovinos/parasitologia , Processos Estocásticos , Incerteza
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