Permanent URI for this collection
Browse
Recent Submissions
Publication Investigation of the correlation between odd oxygen and secondary organic aerosol in Mexico City and Houston(2010-01-01) Wood, Ezra; Canagaratna, M.; Herndon, S.; Kroll, J.; Onasch, T.; Kolb, C.; Worsnop, D.; Knighton, W.; Seila, R.; Zavala, M.; Molina, L.; DeCarlo, P.; Jimenez, J.; Weinheimer, A.; Knapp, D.; Jobson, B.; Stutz, J.; Kuster, W.; Williams, E.Many recent models underpredict secondary organic aerosol (SOA) particulate matter (PM) concentrations in polluted regions, indicating serious deficiencies in the models' chemical mechanisms and/or missing SOA precursors. Since tropospheric photochemical ozone production is much better understood, we investigate the correlation of odd-oxygen ([Ox]ā”[O3]+[NO2]) and the oxygenated component of organic aerosol (OOA), which is interpreted as a surrogate for SOA. OOA and Ox measured in Mexico City in 2006 and Houston in 2000 were well correlated in air masses where both species were formed on similar timescales (less than 8 h) and not well correlated when their formation timescales or location differed greatly. When correlated, the ratio of these two species ranged from 30 Ī¼g mā3/ppm (STP) in Houston during time periods affected by large petrochemical plant emissions to as high as 160 Ī¼g mā3/ppm in Mexico City, where typical values were near 120 Ī¼g mā3/ppm. On several days in Mexico City, the [OOA]/[Ox] ratio decreased by a factor of ~2 between 08:00 and 13:00 local time. This decrease is only partially attributable to evaporation of the least oxidized and most volatile components of OOA; differences in the diurnal emission trends and timescales for photochemical processing of SOA precursors compared to ozone precursors also likely contribute to the observed decrease. The extent of OOA oxidation increased with photochemical aging. Calculations of the ratio of the SOA formation rate to the Ox production rate using ambient VOC measurements and traditional laboratory SOA yields are lower than the observed [OOA]/[Ox] ratios by factors of 5 to 15, consistent with several other models' underestimates of SOA. Calculations of this ratio using emission factors for organic compounds from gasoline and diesel exhaust do not reproduce the observed ratio. Although not succesful in reproducing the atmospheric observations presented, modeling P(SOA)/P(Ox) can serve as a useful test of photochemical models using improved formulation mechanisms for SOA.Publication Short-term variation in near-highway air pollutant gradients on a winter morning(2010-01-01) Durant, J.; Ash, C.; Wood, Ezra; Herndon, S.; Jayne, J.; Knighton, W.; Canagaratna, M.; Trull, J.; Brugge, D.; Zamore, W.; Kolb, C.Quantification of exposure to traffic-related air pollutants near highways is hampered by incomplete knowledge of the scales of temporal variation of pollutant gradients. The goal of this study was to characterize short-term temporal variation of vehicular pollutant gradients within 200ā400 m of a major highway (>150 000 vehicles/d). Monitoring was done near Interstate 93 in Somerville (Massachusetts) from 06:00 to 11:00 on 16 January 2008 using a mobile monitoring platform equipped with instruments that measured ultrafine and fine particles (6ā1000 nm, particle number concentration (PNC)); particle-phase (>30 nm) equation M1, equation M2, and organic compounds; volatile organic compounds (VOCs); and CO2, NO, NO2, and O3. We observed rapid changes in pollutant gradients due to variations in highway traffic flow rate, wind speed, and surface boundary layer height. Before sunrise and peak traffic flow rates, downwind concentrations of particles, CO2, NO, and NO2 were highest within 100ā250 m of the highway. After sunrise pollutant levels declined sharply (e.g., PNC and NO were more than halved) and the gradients became less pronounced as wind speed increased and the surface boundary layer rose allowing mixing with cleaner air aloft. The levels of aromatic VOCs and equation M3, equation M4 and organic aerosols were generally low throughout the morning, and their spatial and temporal variations were less pronounced compared to PNC and NO. O3 levels increased throughout the morning due to mixing with O3-enriched air aloft and were generally lowest near the highway reflecting reaction with NO. There was little if any evolution in the size distribution of 6ā225 nm particles with distance from the highway. These results suggest that to improve the accuracy of exposure estimates to near-highway pollutants, short-term (e.g., hourly) temporal variations in pollutant gradients must be measured to reflect changes in traffic patterns and local meteorology.Publication Application of positive matrix factorization to on-road measurements for source apportionment of diesel- and gasoline-powered vehicle emissions in Mexico City(2010-01-01) Thornhill, D.; Williams, A.; Onasch, T.; Wood, Ezra; Herndon, S.; Kolb, C.; Knighton, W.; Zavala, M.; Molina, L.; Marr, L.The goal of this research is to quantify diesel- and gasoline-powered motor vehicle emissions within the Mexico City Metropolitan Area (MCMA) using on-road measurements captured by a mobile laboratory combined with positive matrix factorization (PMF) receptor modeling. During the MCMA-2006 ground-based component of the MILAGRO field campaign, the Aerodyne Mobile Laboratory (AML) measured many gaseous and particulate pollutants, including carbon dioxide, carbon monoxide (CO), nitrogen oxides (NOx), benzene, toluene, alkylated aromatics, formaldehyde, acetaldehyde, acetone, ammonia, particle number, fine particulate mass (PM2.5), and black carbon (BC). These serve as inputs to the receptor model, which is able to resolve three factors corresponding to gasoline engine exhaust, diesel engine exhaust, and the urban background. Using the source profiles, we calculate fuel-based emission factors for each type of exhaust. The MCMA's gasoline-powered vehicles are considerably dirtier, on average, than those in the US with respect to CO and aldehydes. Its diesel-powered vehicles have similar emission factors of NOx and higher emission factors of aldehydes, particle number, and BC. In the fleet sampled during AML driving, gasoline-powered vehicles are found to be responsible for 97% of total vehicular emissions of CO, 22% of NOx, 95ā97% of each aromatic species, 72ā85% of each carbonyl species, 74% of ammonia, negligible amounts of particle number, 26% of PM2.5, and 2% of BC; diesel-powered vehicles account for the balance. Because the mobile lab spent 17% of its time waiting at stoplights, the results may overemphasize idling conditions, possibly resulting in an underestimate of NOx and overestimate of CO emissions. On the other hand, estimates of the inventory that do not correctly account for emissions during idling are likely to produce bias in the opposite direction.The resulting fuel-based estimates of emissions are lower than in the official inventory for CO and NOx and higher for VOCs. For NOx, the fuel-based estimates are lower for gasoline-powered vehicles but higher for diesel-powered ones compared to the official inventory. While conclusions regarding the inventory should be interpreted with care because of the small sample size, 3.5 h of driving, the discrepancies with the official inventory agree with those reported in other studies.Publication Systemic sclerosis is associated with increased in-patient mortality in patients hospitalized for heart failure(2024-01-01) Rajendran, AiswaryaAims We aimed to analyse the characteristics and in-hospital outcomes of patients hospitalized for heart failure (HF) with co-morbid systemic sclerosis (SSc) and compare them to those without SSc, using data from the National Inpatient Sample from years 2016 to 2019. Conclusions In patients hospitalized for HF, those with SSc were noted to have higher odds of in-hospital mortality than those without SSc. Patients with HF and SSc were more likely to be younger, female, and have higher rates of co-morbid in-terstitial lung disease and pulmonary hypertension at baseline with fewer traditional cardiovascular risk factors.Publication A Nearly Continuous Measure of Birth Weight for Gestational Age Using a United States National Reference(2003-01-01) Kleinman, Ken; Oken, Emily; Rich-Edwards, Janet; Gillman, MatthewBackground Fully understanding the determinants and sequelae of fetal growth requires a continuous measure of birth weight adjusted for gestational age. Published United States reference data, however, provide estimates only of the median and lowest and highest 5th and 10th percentiles for birth weight at each gestational age. The purpose of our analysis was to create more continuous reference measures of birth weight for gestational age for use in epidemiologic analyses. Methods We used data from the most recent nationwide United States Natality datasets to generate multiple reference percentiles of birth weight at each completed week of gestation from 22 through 44 weeks. Gestational age was determined from last menstrual period. We analyzed data from 6,690,717 singleton infants with recorded birth weight and sex born to United States resident mothers in 1999 and 2000. Results Birth weight rose with greater gestational age, with increasing slopes during the third trimester and a leveling off beyond 40 weeks. Boys had higher birth weights than girls, later born children higher weights than firstborns, and infants born to non-Hispanic white mothers higher birth weights than those born to non-Hispanic black mothers. These results correspond well with previously published estimates reporting limited percentiles. Conclusions Our method provides comprehensive reference values of birth weight at 22 through 44 completed weeks of gestation, derived from broadly based nationwide data. Other approaches require assumptions of normality or of a functional relationship between gestational age and birth weight, which may not be appropriate. These data should prove useful for researchers investigating the predictors and outcomes of altered fetal growth.Publication The Effect of Remuneration Schedule on Data Completion and Retention in the Pregnancy Eating Attributes Study (PEAS)(2021-01-01) Terry, Ndeah; Lipsky, Leah M.; Siega-Riz, Anna Maria; Liu, Aiyi; Nansel, Tonja R.Maximizing data completion and study retention is essential in population research. This study examined the effect of remuneration schedule and data collection modality on data completion and retention in the Pregnancy Eating Attributes Study cohort. Participants (n = 458) completed online surveys and attended six in-person study visits. Initially, remuneration was a prespecified amount per visit, then was changed mid-study to be prorated based on the number of forms completed. Additionally, survey data collection modality was changed to in-person at the sixth study visit. In this secondary data analysis, there was no effect of remuneration schedule on withdrawal rates or time-to-withdrawal. Survey completion was significantly lower under prorated remuneration at the first visit but did not significantly differ at subsequent visits. The lump sum group had significantly greater odds of completely the first and second trimester dietary record (OR = 4.1, OR = 2.6, respectively) then the prorated group but were almost half as likely to complete the dietary record at the 6-month postpartum visit (OR = 0.5). Survey completion at sixth visit was significantly higher for in-person versus online completion (68.6% vs. 93.1%). Findings suggest that remuneration schedule and data collection modality can impact completion of self- reported assessments.Publication Obesogenic Home Food Availability, Diet, and BMI in Pakistani and White Toddlers(2021-01-01) LeCroy, Madison N.; Bryant, Maria; Albrecht, Sandra S.; Siega-Riz, Anna Maria; Ward, Dianne S.; Cai, Jianwen; Stevens, JuneIndividuals of South Asian ethnicity have an increased risk for obesity and related diseases. Foods available in the home during the first 1000 days (conception to 24 months old) are an important determinant of diet, yet no study has examined the association of early-life home food availability (HFA) with later diet and obesity risk in South Asian households. We examined whether obesogenic HFA at 18 months of age is associated with dietary intake and body mass index (BMI) at 36 months of age in low-income Pakistani and White households in the United Kingdom. In this prospective birth cohort study (Born in Bradford 1000), follow-up assessments occurred at 18 (n = 1032) and 36 (n = 986) months of age. Variety and quantity of snack foods and sugar-sweetened beverages (SSBs) in the home and consumed were measured using the HFA Inventory Checklist and food frequency questionnaires, respectively. BMI was calculated using measured length/height and weight. Multinomial logistic regression models examined associations between HFA and tertiles of dietary intake, and multivariable linear regression models assessed associations between HFA and BMI. Pakistani households had a greater variety and quantity of snack foods and SSBs available compared with White households. Variety and quantity of snack foods and SSBs in the home at 18 months were positively associated with children's intake of these items at 36 months, but associations between HFA and BMI were null. Reducing obesogenic HFA during the first 1000 days may promote the development of more healthful diets, though this may not be associated with lower obesity risk during toddlerhood.Publication A Scoring System Derived from Electronic Health Records to Identify Patients at High Risk for Noninvasive Ventilation Failure(2021-01-01) Stefan, Mihaela S.; Priya, Aruna; Pekow, Penelope S.; Steingrub, Jay S.; Hill, Nicholas S.; Lagu, Tara; Raghunathan, Karthik; Bhat, Anusha G.; Lindenaur, Peter K.Objective To develop and validate a clinical risk prediction score for noninvasive ventilation (NIV) failure defined as intubation after a trial of NIV in non-surgical patients. Design Retrospective cohort study of a multihospital electronic health record database. Patients Non-surgical adult patients receiving NIV as the first method of ventilation within two days of hospitalization. Measurement Primary outcome was intubation after a trial of NIV. We used a non-random split of the cohort based on year of admission for model development and validation. We included subjects admitted in years 2010-2014 to develop a risk prediction model and built a parsimonious risk scoring model using multivariable logistic regression. We validated the model in the cohort of subjects hospitalized in 2015 and 2016. Main results Of all the 47,749 patients started on NIV, 11.7% were intubated. Compared with NIV success, those who were intubated had worse mortality (25.2% vs. 8.9%). Strongest independent predictors for intubation were organ failure, principal diagnosis group (substance abuse/psychosis, neurological conditions, pneumonia, and sepsis), use of invasive ventilation in the prior year, low body mass index, and tachypnea. The c-statistic was 0.81, 0.80 and 0.81 respectively, in the derivation, validation and full cohorts. We constructed three risk categories of the scoring system built on the full cohort; the median and interquartile range of risk of intubation was: 2.3% [1.9%-2.8%] for low risk group; 9.3% [6.3%-13.5%] for intermediate risk category; and 35.7% [31.0%-45.8%] for high risk category. Conclusions In patients started on NIV, we found that in addition to factors known to be associated with intubation, neurological, substance abuse, or psychiatric diagnoses were highly predictive for intubation. The prognostic score that we have developed may provide quantitative guidance for decision-making in patients who are started on NIV.Publication Perceived Discrimination During the Childbirth Hospitalization and Postpartum Visit Attendance and Content: Evidence From the Listening to Mothers in California Survey(2021-01-01) Attanasio, Laura B.; Ranchoff, Brittany L.; Geissler, Kimberley H.Objective Postpartum visits are an important opportunity to address ongoing maternal health. Experiences of discrimination in healthcare can impact healthcare use, including postpartum visits. However, it is unknown whether discrimination is associated with postpartum visit content. This study aimed to examine the relationship between perceived discrimination during the childbirth hospitalization and postpartum visit attendance and content. Research design Data were from Listening to Mothers in California, a population-based survey of people with a singleton hospital birth in California in 2016. Adjusted logistic regression models estimated the association between perceived discrimination during the childbirth hospitalization and 1) postpartum visit attendance, and 2) topics addressed at the postpartum visit (birth control, depression and breastfeeding) for those who attended. Results 90.6% of women attended a postpartum visit, and 8.6% reported discrimination during the childbirth hospitalization. In adjusted models, any discrimination and insurance-based discrimination were associated with 7 and 10 percentage point (pp) lower predicted probabilities of attending a postpartum visit, respectively. There was a 7pp lower predicted probability of discussing birth control for women who had experienced discrimination (81% vs. 88%), a 15pp lower predicted probability of being asked about depression (64% vs. 79%), and a 9 pp lower predicted probability of being asked about breastfeeding (57% vs. 66%). Conclusions Amid heightened attention to the importance of postpartum care, there is a need to better understand determinants of postpartum care quality. Our findings highlight the potential consequences of healthcare discrimination in the perinatal period, including lower quality of postpartum care.Publication Community Engaged Cumulative Risk Assessment of Exposure to Inorganic Well Water Contaminants, Crow Reservation, Montana(2018-01-01) Eggers, Margaret J.; Doyle, John T.; Lefthand, Myra J.; Young, Sara L.; Moore-Nall, Anita L.; Kindness, Larry; Medicine, Roberta Other; Ford, Timothy E.; Dietrich, Eric; Parker, Albert E.; Hoover, Joseph H.; Camper, Anne K.An estimated 11 million people in the US have home wells with unsafe levels of hazardous metals and nitrate. The national scope of the health risk from consuming this water has not been assessed as home wells are largely unregulated and data on well water treatment and consumption are lacking. Here, we assessed health risks from consumption of contaminated well water on the Crow Reservation by conducting a community-engaged, cumulative risk assessment. Well water testing, surveys and interviews were used to collect data on contaminant concentrations, water treatment methods, well water consumption, and well and septic system protection and maintenance practices. Additive Hazard Index calculations show that the water in more than 39% of wells is unsafe due to uranium, manganese, nitrate, zinc and/or arsenic. Most familiesā financial resources are limited, and 95% of participants do not employ water treatment technologies. Despite widespread high total dissolved solids, poor taste and odor, 80% of families consume their well water. Lack of environmental health literacy about well water safety, pre-existing health conditions and limited environmental enforcement also contribute to vulnerability. Ensuring access to safe drinking water and providing accompanying education are urgent public health priorities for Crow and other rural US families with low environmental health literacy and limited financial resources.Publication Patient Follow-Up After Participating in a Beach-Based Skin Cancer Screening Program(2012-01-01) Greaney, Mary L.; Puleo, Elaine; Geller, Alan C.; Hu, Stephanie W.; Werchniak, Andrew E.; DeCristofaro, Susan; Emmons, Karen M.Many skin cancer screenings occur in non-traditional community settings, with the beach being an important setting due to beachgoers being at high risk for skin cancer. This study is a secondary analysis of data from a randomized trial of a skin cancer intervention in which participants (n = 312) had a full-body skin examination by a clinician and received a presumptive diagnosis (abnormal finding, no abnormal finding). Participantsā pursuit of follow-up was assessed post-intervention (n = 283). Analyses examined: (1) participantās recall of screening results; and (2) whether cognitive and behavioral variables were associated with follow-up being as advised. Just 12% of participants (36/312) did not correctly recall the results of their skin examination. One-third (33%, 93/283) of participantsā follow-up was classified as being not as advised (recommend follow-up not pursued, unadvised follow-up pursued). Among participants whose follow-up was not as advised, 71% (66/93) did not seek recommended care. None of the measured behavioral and cognitive variables were significantly associated with recall of screening examination results or whether follow-up was as advised. Research is needed to determine what factors are associated with follow-up being as advised and to develop messages that increase receipt of advised follow-up care.Publication Spatial Environmental Modeling of Autoantibody Outcomes among an African American Population(2014-01-01) Carroll, Rachel; Lawson, Andrew B.; Voronca, Delia; Rotenjanaprasert, Chawarat; Vena, John E.; Aelion, Claire Marjorie; Kamen, Diane L.In this study of autoimmunity among a population of Gullah African Americans in South Carolina, the links between environmental exposures and autoimmunity (presence of antinuclear antibodies (ANA)) have been assessed. The study population included patients with systemic lupus erythematosus (n = 10), their first degree relatives (n = 61), and unrelated controls (n = 9) where 47.5% (n = 38) were ANA positive. This paper presents the methodology used to model ANA status as a function of individual environmental influences, both self-reported and measured, while controlling for known autoimmunity risk factors. We have examined variable dimension reduction and selection methods in our approach. Following the dimension reduction and selection methods, we fit logistic spatial Bayesian models to explore the relationship between our outcome of interest and environmental exposures adjusting for personal variables. Our analysis also includes a validation āstripā where we have interpolated information from a specific geographic area for a subset of the study population that lives in that vicinity. Our results demonstrate that residential proximity to exposure site is important in this form of analysis. The use of a validation strip network demonstrated that even with small sample numbers some significant exposure-outcome relationships can be detected.Publication Assessment of Toxicological Perturbations and Variants of Pancreatic Islet Development in the Zebrafish Model(2016-01-01) Sant, Karilyn E.; Jacobs, Haydee M.; Xu, Jiali; Borofski, Katrina A.; Moss, Larry G.; Moss, Jennifer B.; Timme-Laragy, Alicia R.The pancreatic islets, largely comprised of insulin-producing beta cells, play a critical role in endocrine signaling and glucose homeostasis. Because they have low levels of antioxidant defenses and a high perfusion rate, the endocrine islets may be a highly susceptible target tissue of chemical exposures. However, this endpoint, as well as the integrity of the surrounding exocrine pancreas, is often overlooked in studies of developmental toxicology. Disruption of development by toxicants can alter cell fate and migration, resulting in structural alterations that are difficult to detect in mammalian embryo systems, but that are easily observed in the zebrafish embryo model (Danio rerio). Using endogenously expressed fluorescent protein markers for developing zebrafish beta cells and exocrine pancreas tissue, we documented differences in islet area and incidence rates of islet morphological variants in zebrafish embryos between 48 and 96 h post fertilization (hpf), raised under control conditions commonly used in embryotoxicity assays. We identified critical windows for chemical exposures during which increased incidences of endocrine pancreas abnormalities were observed following exposure to cyclopamine (2ā12 hpf), Mono-2-ethylhexyl phthalate (MEHP) (3ā48 hpf), and Perfluorooctanesulfonic acid (PFOS) (3ā48 hpf). Both islet area and length of the exocrine pancreas were sensitive to oxidative stress from exposure to the oxidant tert-butyl hydroperoxide during a highly proliferative critical window (72 hpf). Finally, pancreatic dysmorphogenesis following developmental exposures is discussed with respect to human disease.Publication Longitudinal Study of Birth Weight and Adult Body Mass Index in Predicting Risk of Coronary Heart Disease and Stroke in Women(2005-01-01) Kleinman, Ken; Rich-Edwards, Janet; Michels, Karin; Stampfer, Meir; Manson, JoAnn; Rexrode, Kathryn; Hibert, Eileen; Willett, WalterObjectives To determine whether birth weight and adult body size interact to predict coronary heart disease in women, as has been observed for men. To determine whether birth weight and adult body size interact to predict risk of stroke. Design Longitudinal cohort study. Setting and participants 66 111 female nurses followed since 1976 who were born of singleton, term pregnancies and reported their birth weight in 1992. Main outcome measures 1504 events of coronary heart disease (myocardial infarction or sudden cardiac death) and 1164 strokes. Results For each kilogram of higher birth weight, age adjusted hazard ratios from prospective analysis were 0.77 (95% confidence interval 0.69 to 0.87) for coronary heart disease and 0.89 (0.78 to 1.01) for total stroke. In combined prospective and retrospective analysis, hazard ratios were 0.84 (0.76 to 0.93) for total stroke, 0.83 (0.71 to 0.96) for ischaemic stroke, and 0.86 (0.66 to 1.11) for haemorrhagic stroke. Exclusion of macrosomic infants (> 4536 g) yielded stronger estimates. Risk of coronary heart disease was especially high for women who crossed from a low centile of weight at birth to a high centile of body mass index in adulthood. The association of lower birth weight with increased risk of stroke was apparent across categories of body mass index in adults and was not especially strong among heavier women. Conclusions Higher body mass index in adulthood is an especially strong risk factor for coronary heart disease among women who were small at birth. In this large cohort of women, size at birth and adiposity in adulthood interacted to predict events of coronary heart disease but not stroke events.Publication A socioecological framework for research on work and obesity in diverse urban transit operators based on gender, race, and ethnicity(2017-01-01) Choi, BongKyoo; Schnall, Peter; Dobson, Marnie; Yang, Haiou; Baker, Dean; Seo, YoungJuUrban transit (bus and rail) operators, totaling nearly 700,000 persons, are one of the heaviest occupational groups in the United States (US). Little is known about occupational risk factors for weight gain and obesity and their interrelationship with health-related behaviors, particularly among female minority (African Americans and Hispanics) transit operators who are at greater risk for obesity. As a step towards developing successful obesity interventions among urban transit operators, this paper aims to present a new socioecological framework for studying working conditions, chronic strain, health-related behaviors, weight gain/obesity, and obesity disparity in diverse urban transit operators based on gender, race, and ethnicity. Our framework is a synthesis of several different theories and disciplines: the resource-work load model (work stress), occupational ergonomics, the theory of intersectionality, and worksite health promotion. The framework was developed utilizing an extensive literature review, results from our on-going research on obesity, input from focus groups conducted with Los Angeles transit operators as well as interviews and meetings with transit operator stakeholders (management, unions, and worksite transit wellness program), and ride-along observations. Our hypotheses highlighted in the framework (see Fig. 1) are that adverse working conditions, largely characterized as a combination of high demands and low resources, will increase the risk for weight gain/obesity among transit operators directly through chronic strain and hypothalamic dysfunction (hyper-and hypo-activations), and indirectly through health-related behaviors and injuries/chronic severe pain. We also hypothesize that the observed increase in adiposity among female minority operators is due to their greater exposure to adverse occupational and non-occupational conditions that reflect their intersecting social identities of lower social class and being a minority woman in the US. Our proposed framework could greatly facilitate future transit worksite obesity studies by clarifying the complex and important roles of adverse working conditions in the etiology of weight gain/obesity and obesity disparity among transit operators and other working populations.Publication Acculturation and gestational weight gain in a predominantly puerto rican population(2012-01-01) Tovar, Alison; Chasan-Taber, Lisa; Bermudez, Odilia I; Hyatt, Raymond R; Must, AvivaBackground Identifying risk factors that affect excess weight gain during pregnancy is critical, especially among women who are at a higher risk for obesity. The goal of this study was to determine if acculturation, a possible risk factor, was associated with gestational weight gain in a predominantly Puerto Rican population. Methods We utilized data from Proyecto Buena Salud, a prospective cohort study of Hispanic women in Western Massachusetts, United States. Height, weight and gestational age were abstracted from medical records among participants with full-term pregnancies (n=952). Gestational weight gain was calculated as the difference between delivery and prepregnancy weight. Acculturation (measured via a psychological acculturation scale, generation in the US, place of birth and spoken language preference) was assessed in early pregnancy. Results Adjusting for age, parity, perceived stress, gestational age, and prepregnancy weight, women who had at least one parent born in Puerto Rico/Dominican Republic (PR/DR) and both grandparents born in PR/DR had a significantly higher mean total gestational weight gain (0.9 kg for at least one parent born in PR/DR and 2.2kg for grandparents born in PR/DR) and rate of weight gain (0.03 kg/wk for at least one parent born in PR/DR and 0.06 kg/wk for grandparents born in PR/DR) vs. women who were of PR/DR born. Similarly, women born in the US had significantly higher mean total gestational weight gain (1.0 kg) and rate of weight gain (0.03 kg/wk) vs. women who were PR/ DR born. Spoken language preference and psychological acculturation were not significantly associated with total or rate of pregnancy weight gain. Conclusion We found that psychological acculturation was not associated with gestational weight gain while place of birth and higher generation in the US were significantly associated with higher gestational weight gain. We interpret these findings to suggest the potential importance of the US āobesogenicā environment in influencing unhealthy pregnancy weight gains over specific aspects of psychological acculturation.Publication Associations between the patient-centered medical home and preventive care and healthcare quality for non-elderly adults with mental illness: A surveillance study analysis(2016-01-01) Bowdoin, Jennifer J.; Rodriguez-Monguio, Rosa; Puleo, Elaine; Keller, David; Roche, JoanBackground Patient-centered medical homes (PCMHs) may improve outcomes for non-elderly adults with mental illness, but the extent to which PCMHs are associated with preventive care and healthcare quality for this population is largely unknown. Our study addresses this gap by assessing the associations between receipt of care consistent with the PCMH and preventive care and healthcare quality for non-elderly adults with mental illness. Methods This surveillance study used self-reported data for 6,908 non-elderly adults with mental illness participating in the 2007ā2012 Medical Expenditure Panel Survey. Preventive care and healthcare quality measures included: participant rating of all healthcare; cervical, breast, and colorectal cancer screening; current smoking; smoking cessation advice; flu shot; foot exam and eye exam for people with diabetes; and follow-up after emergency room visit for mental illness. Multiple logistic regression models were developed to compare the odds of meeting preventive care and healthcare quality measures for participants without a usual source of care, participants with a non-PCMH usual source of care, and participants who received care consistent with the PCMH. Results Compared to participants without a usual source of care, those with a non-PCMH usual source of care had better odds of meeting almost all measures examined, while those who received care consistent with the PCMH had better odds of meeting most measures. Participants who received care consistent with the PCMH had better odds of meeting only one measure compared to participants with a non-PCMH usual source of care. Conclusions Compared with having a non-PCMH usual source of care, receipt of care consistent with the PCMH does not appear to be associated with most preventive care or healthcare quality measures. These findings raise concerns about the potential value of the PCMH for non-elderly adults with mental illness and suggest that alternative models of primary care are needed to improve outcomes and address disparities for this population.Publication A new analytical framework of 'continuum of prevention and care' to maximize HIV case detection and retention in care in Vietnam(2012-01-01) Fujita, Masami; Poudel, Krishna C; Thi, Nhan Do; Duc, Duong Bui; Van, Kinh Nguyen; Green, Kimberly; Thi Minh, Thu Nguyen; Kato, Masaya; Jacka, David; Thi Thanh, Thuy Cao; Thanh, Long Nguyen; Jimba, MasamineBackground The global initiative āTreatment 2.0ā calls for expanding the evidence base of optimal HIV service delivery models to maximize HIV case detection and retention in care. However limited systematic assessment has been conducted in countries with concentrated HIV epidemic. We aimed to assess HIV service availability and service connectedness in Vietnam. Methods We developed a new analytical framework of the continuum of prevention and care (COPC). Using the framework, we examined HIV service delivery in Vietnam. Specifically, we analyzed HIV service availability including geographical distribution and decentralization and service connectedness across multiple services and dimensions. We then identified system-related strengths and constraints in improving HIV case detection and retention in care. This was accomplished by reviewing related published and unpublished documents including existing service delivery data. Results Identified strengths included: decentralized HIV outpatient clinics that offer comprehensive care at the district level particularly in high HIV burden provinces; functional chronic care management for antiretroviral treatment (ART) with the involvement of people living with HIV and the links to community- and home-based care; HIV testing and counseling integrated into tuberculosis and antenatal care services in districts supported by donor-funded projects, and extensive peer outreach networks that reduce barriers for the most-at-risk populations to access services. Constraints included: fragmented local coordination mechanisms for HIV-related health services; lack of systems to monitor the expansion of HIV outpatient clinics that offer comprehensive care; underdevelopment of pre-ART care; insufficient linkage from HIV testing and counseling to pre-ART care; inadequate access to HIV-related services in districts not supported by donor-funded projects particularly in middle and low burden provinces and in mountainous remote areas; and no systematic monitoring of referral services. Conclusions Our COPC analytical framework was instrumental in identifying system-related strengths and constraints that contribute to HIV case detection and retention in care. The national HIV program plans to strengthen provincial programming by re-defining various service linkages and accelerate the transition from project-based approach to integrated service delivery in line with the āTreatment 2.0ā initiative.Publication A functional difficulty and functional pain instrument for hip and knee osteoarthritis(2009-01-01) Jette, Alan M; McDonough, Christine M; Ni, Pengsheng; Haley, Stephen M; Hambleton, Ronald K; Olarsch, Sippy; Hunter, David J; Kim, Young-jo; Felson, David TIntroduction The objectives of this study were to develop a functional outcome instrument for hip and knee osteoarthritis research (OA-FUNCTION-CAT) using item response theory (IRT) and computer adaptive test (CAT) methods and to assess its psychometric performance compared to the current standard in the field. Methods We conducted an extensive literature review, focus groups, and cognitive testing to guide the construction of an item bank consisting of 125 functional activities commonly affected by hip and knee osteoarthritis. We recruited a convenience sample of 328 adults with confirmed hip and/or knee osteoarthritis. Subjects reported their degree of functional difficulty and functional pain in performing each activity in the item bank and completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Confirmatory factor analyses were conducted to assess scale uni-dimensionality, and IRT methods were used to calibrate the items and examine the fit of the data. We assessed the performance of OA-FUNCTION-CATs of different lengths relative to the full item bank and WOMAC using CAT simulation analyses. Results Confirmatory factor analyses revealed distinct functional difficulty and functional pain domains. Descriptive statistics for scores from 5-, 10-, and 15-item CATs were similar to those for the full item bank. The 10-item OA-FUNCTION-CAT scales demonstrated a high degree of accuracy compared with the item bank (r = 0.96 and 0.89, respectively). Compared to the WOMAC, both scales covered a broader score range and demonstrated a higher degree of precision at the ceiling and reliability across the range of scores. Conclusions The OA-FUNCTION-CAT provided superior reliability throughout the score range and improved breadth and precision at the ceiling compared with the WOMAC. Further research is needed to assess whether these improvements carry over into superior ability to measure change.Publication A call for parental monitoring to improve condom use among secondary school students in Dar es Salaam, Tanzania(2012-01-01) Mlunde, Linda B; Poudel, Krishna C; Sunguya, Bruno F; Mbwambo, Jessie K K; Yasuoka, Junko; Otsuka, Keiko; Ubuguyu, Omary; Jimba, MasamineBackground The number of people newly infected with human immunodeficiency virus (HIV) has been decreasing in sub-Saharan Africa, but prevalence of the infection remains unacceptably high among young people. Despite the alarming pervasiveness of the virus, young people in this region continue to engage in risky sexual behaviors including unprotected sexual intercourse. In developed countries, parents can play important roles in protecting young people from such behaviors, but evidence regarding the impact of parental involvement is still limited in sub-Saharan Africa. Therefore, we conducted this study to examine the magnitude of risky sexual behaviors and the association of parental monitoring and parental communication with condom use at last sexual intercourse among secondary school students in Dar es Salaam, Tanzania. Methods We conducted this cross-sectional study among 2,217 male and female students aged 15 to 24 years from 12 secondary schools in Dar es Salaam. From October to November 2011, we collected data using a self-administered questionnaire. Multiple logistic regression analyses were conducted to examine the association of parental monitoring and parental communication with condom use at last sexual intercourse, adjusting for potential confounders. Results A total of 665 (30.3%) secondary school students reported being sexually active within the year prior to data collection. Among them, 41.7% had multiple sexual partners, 10.5% had concurrent sexual partners, and 41.1% did not use a condom at last sexual intercourse. A higher level of parental monitoring was associated with increased likelihood of condom use at last sexual intercourse among male students (AOR: 1.56, 95% CI: 1.05-2.32; pā=ā0.03) but not among female students (AOR: 1.54, 95% CI: 0.71-3.37; pā=ā0.28). The association between parental communication and condom use at last sexual intercourse among both male and female students was not statistically significant. Conclusions A high level of parental monitoring is associated with more consistent condom use among male students in Dar es Salaam, Tanzania -- many of whom have engaged in high-risk sexual behaviors such as multiple sexual partnerships, concurrent sexual partnerships, and unprotected sexual intercourse in the past one year. Interventions should thus be strengthened to reduce multiple sexual partnerships, concurrent sexual partnerships, and to improve parental monitoring among such students toward increasing condom use.