Faculty Bibliography
Searched for:
Department/Unit:Population Health
Total Results:
13299
Reprint of "Family economic strengthening and parenting stress among caregivers of AIDS-orphaned children: Results from a cluster randomized clinical trial in Uganda"
This study examines the impact of a family economic strengthening intervention on parenting stress among caregivers of AIDS-orphaned children in Uganda. The study uses data from a 4-year (2008-2012) NIMH randomized clinical trial for AIDS-orphaned children known as Suubi-Maka (N = 346 dyads). Child-caregiver dyads from 10 comparable primary schools were randomly assigned to either the control group (n = 167 dyads) receiving usual care for school-going orphaned children (such as food aid and scholastic materials) or the treatment group (n = 179 dyads) receiving a family economic strengthening intervention (focused on a matched savings account), financial planning and management workshops over and above the usual care. Interviews were conducted at baseline and at 12 month and 24 month follow-ups. This study uses data from baseline and 24 month post-intervention. We use multivariate regression methods, controlling for socioeconomic characteristics. At 24 months, caregivers in the treatment group reported significantly lower levels of parenting stress compared to caregivers in the control group. Findings from this study point to the potential of a family economic strengthening intervention to improve caregiver's psychosocial well-being and that of their families. We conclude that programs and policies aimed at improving the psychosocial well-being of families caring for AIDS-orphaned children may consider incorporating economic strengthening components in their programming to help support these kinds of families, caregivers of AIDS-orphaned children especially those residing in developing countries. (c) 2014 Elsevier Ltd. All rights reserved.
ISI:000347586200010
ISSN: 1873-7765
CID: 2429632
The Effects of Parental Loss on the Psychosocial Wellbeing of AIDS-Orphaned Children Living in AIDS-Impacted Communities: Does Gender Matter?
PMCID:4107308
PMID: 25067869
ISSN: 0190-7409
CID: 2429592
INTERDISCIPLINARY EVIDENCE-BASED MEDICINE COURSE DESIGN FOR NAS MILESTONE ASSESSMENT THROUGH ONLINE ADAPTIVE LEARNING STRATEGIES [Meeting Abstract]
ISI:000340996203127
ISSN: 1525-1497
CID: 2399012
Domestic child sex trafficking: the need for physician education [Meeting Abstract]
ISI:000333934900100
ISSN: 1931-843x
CID: 2384692
Fluid intake history and counseling in pediatric outpatients
OBJECTIVE: To determine if (a) during well visits physicians are discussing 6 common fluids and (b) if there is any association between fluid discussion and patient age, gender, or body mass index. METHODS: We performed a retrospective chart review of 500 pediatric well visits. We analyzed the relationships between history and/or counseling on fluid intake and patient age, gender, and body mass index percentile using logistic regression and likelihood ratio chi-square testing. RESULTS: Caffeinated beverages were discussed more with overweight/obese patients compared with normal weight patients. Juice, caffeinated, and carbonated beverages were all discussed more with obese patients compared with overweight patients. Water, carbonated, and caffeinated beverages were discussed more with older patients, and milk with younger patients. Juice was discussed more with female patients. CONCLUSION: Pediatricians discuss high-calorie fluids more frequently with obese children but not more frequently with overweight children, which may be an optimal time to prevent obesity.
PMID: 24028843
ISSN: 1938-2707
CID: 2384372
Can the Newest Vital Sign be used to assess health literacy in children and adolescents?
CONTEXT: We evaluated the validity of the Newest Vital Sign (NVS) as a brief screen for health literacy in children. OBJECTIVES: To (a) test the hypothesis that child performance on the NVS correlates with performance on a test of child reading comprehension and (b) establish age-based cutoffs for expected performance on the NVS. DESIGN: Children aged 7 to 17 years were administered the NVS followed by the Gray Silent Reading Test (GSRT). RESULTS: The NVS score correlated strongly with GSRT score (rho = 0.71, P < .0001) and increased with age. Children aged 7 to 9 years had a median NVS score of 1 (interquartile range = 1-2); children aged 10 to 17 years had a median score of 3 (interquartile range = 2-4), P < .0001. CONCLUSION: The NVS performs well in this population. Children aged 10 to 17 years with an NVS score lower than 2 may have low health literacy.
PMID: 24065737
ISSN: 1938-2707
CID: 2384362
Association between health literacy and child and adolescent obesity
OBJECTIVE: We tested the association between child and parental health literacy (HL) and odds of child and adolescent obesity. METHODS: We conducted an anonymous cross-sectional survey of a convenience sample of English-speaking child-parent dyads. Newest Vital Sign (NVS) measured HL. We used multivariable logistic regression to test adjusted association between child and parental NVS and obesity. Analyses were stratified for school-aged children (aged 7-11) vs. adolescents (aged 12-19). RESULTS: We surveyed 239 child-parent dyads. Median child age was 11 [inter-quartile range 9-13]; 123 (51%) were male; 84% Medicaid recipients; 27% obese. For children, the odds of obesity [adjusted odds ratio (95% confidence interval)] decreased with higher parent NVS [0.75 (0.56,1.00)] and increased with parent obesity [2.53 (1.08,5.94)]. For adolescents, odds of obesity were higher for adolescents with the lowest category of NVS [5.00 (1.26, 19.8)] and older parental age [1.07 (1.01,1.14)] and lower for Medicaid recipients [0.21 (0.06,0.78)] and higher parental education [0.38 (0.22,0.63)]. CONCLUSION: Obesity in school-aged children is associated with parental factors (obesity, parental HL); obesity in adolescents is strongly associated with the adolescent's HL. PRACTICE IMPLICATIONS: Strategies to prevent and treat obesity should consider limited HL of parents for child obesity and of adolescents for adolescent obesity.
PMID: 24120396
ISSN: 1873-5134
CID: 2384352
Predictors of Disapproval toward "Hard Drug" Use among High School Seniors in the US (vol 15, pg 725, 2014) [Correction]
ISI:000344806200013
ISSN: 1573-6695
CID: 2339392
European journal of gastroenterology & hepatology. 2014:26(11):1222-7.DOI: 10.1097/MEG.0000000000000201
Unemployment, public-sector healthcare spending and stomach cancer mortality in the European Union, 1981-2009
OBJECTIVES: We sought to determine the association between changes in unemployment, healthcare spending and stomach cancer mortality. METHODS: Multivariate regression analysis was used to assess how changes in unemployment and public-sector expenditure on healthcare (PSEH) varied with stomach cancer mortality in 25 member states of the European Union from 1981 to 2009. Country-specific differences in healthcare infrastructure and demographics were controlled for 1- to 5-year time-lag analyses and robustness checks were carried out. RESULTS: A 1% increase in unemployment was associated with a significant increase in stomach cancer mortality in both men and women [men: coefficient (R)=0.1080, 95% confidence interval (CI)=0.0470-0.1690, P=0.0006; women: R=0.0488, 95% CI=0.0168-0.0809, P=0.0029]. A 1% increase in PSEH was associated with a significant decrease in stomach cancer mortality (men: R=-0.0009, 95% CI=-0.0013 to -0.005, P<0.0001; women: R=-0.0004, 95% CI=-0.0007 to -0.0001, P=0.0054). The associations remained when economic factors, urbanization, nutrition and alcohol intake were controlled for, but not when healthcare resources were controlled for. Time-lag analysis showed that the largest changes in mortality occurred 3-4 years after any changes in either unemployment or PSEH. CONCLUSION: Increases in unemployment are associated with a significant increase in stomach cancer mortality. Stomach cancer mortality is also affected by public-sector healthcare spending. Initiatives that bolster employment and maintain public-sector healthcare expenditure may help to minimize increases in stomach cancer mortality during economic downturns.
PMID: 25210778
ISSN: 1473-5687
CID: 2281572
Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013
BACKGROUND: The Millennium Declaration in 2000 brought special global attention to HIV, tuberculosis, and malaria through the formulation of Millennium Development Goal (MDG) 6. The Global Burden of Disease 2013 study provides a consistent and comprehensive approach to disease estimation for between 1990 and 2013, and an opportunity to assess whether accelerated progress has occured since the Millennium Declaration. METHODS: To estimate incidence and mortality for HIV, we used the UNAIDS Spectrum model appropriately modified based on a systematic review of available studies of mortality with and without antiretroviral therapy (ART). For concentrated epidemics, we calibrated Spectrum models to fit vital registration data corrected for misclassification of HIV deaths. In generalised epidemics, we minimised a loss function to select epidemic curves most consistent with prevalence data and demographic data for all-cause mortality. We analysed counterfactual scenarios for HIV to assess years of life saved through prevention of mother-to-child transmission (PMTCT) and ART. For tuberculosis, we analysed vital registration and verbal autopsy data to estimate mortality using cause of death ensemble modelling. We analysed data for corrected case-notifications, expert opinions on the case-detection rate, prevalence surveys, and estimated cause-specific mortality using Bayesian meta-regression to generate consistent trends in all parameters. We analysed malaria mortality and incidence using an updated cause of death database, a systematic analysis of verbal autopsy validation studies for malaria, and recent studies (2010-13) of incidence, drug resistance, and coverage of insecticide-treated bednets. FINDINGS: Globally in 2013, there were 1.8 million new HIV infections (95% uncertainty interval 1.7 million to 2.1 million), 29.2 million prevalent HIV cases (28.1 to 31.7), and 1.3 million HIV deaths (1.3 to 1.5). At the peak of the epidemic in 2005, HIV caused 1.7 million deaths (1.6 million to 1.9 million). Concentrated epidemics in Latin America and eastern Europe are substantially smaller than previously estimated. Through interventions including PMTCT and ART, 19.1 million life-years (16.6 million to 21.5 million) have been saved, 70.3% (65.4 to 76.1) in developing countries. From 2000 to 2011, the ratio of development assistance for health for HIV to years of life saved through intervention was US$4498 in developing countries. Including in HIV-positive individuals, all-form tuberculosis incidence was 7.5 million (7.4 million to 7.7 million), prevalence was 11.9 million (11.6 million to 12.2 million), and number of deaths was 1.4 million (1.3 million to 1.5 million) in 2013. In the same year and in only individuals who were HIV-negative, all-form tuberculosis incidence was 7.1 million (6.9 million to 7.3 million), prevalence was 11.2 million (10.8 million to 11.6 million), and number of deaths was 1.3 million (1.2 million to 1.4 million). Annualised rates of change (ARC) for incidence, prevalence, and death became negative after 2000. Tuberculosis in HIV-negative individuals disproportionately occurs in men and boys (versus women and girls); 64.0% of cases (63.6 to 64.3) and 64.7% of deaths (60.8 to 70.3). Globally, malaria cases and deaths grew rapidly from 1990 reaching a peak of 232 million cases (143 million to 387 million) in 2003 and 1.2 million deaths (1.1 million to 1.4 million) in 2004. Since 2004, child deaths from malaria in sub-Saharan Africa have decreased by 31.5% (15.7 to 44.1). Outside of Africa, malaria mortality has been steadily decreasing since 1990. INTERPRETATION: Our estimates of the number of people living with HIV are 18.7% smaller than UNAIDS's estimates in 2012. The number of people living with malaria is larger than estimated by WHO. The number of people living with HIV, tuberculosis, or malaria have all decreased since 2000. At the global level, upward trends for malaria and HIV deaths have been reversed and declines in tuberculosis deaths have accelerated. 101 countries (74 of which are developing) still have increasing HIV incidence. Substantial progress since the Millennium Declaration is an encouraging sign of the effect of global action. FUNDING: Bill & Melinda Gates Foundation.
PMCID:4202387
PMID: 25059949
ISSN: 1474-547x
CID: 2281592
