1,721,048 research outputs found
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Association between Fear of COVID-19 Diagnosis and Cannabis Use Patterns Among Adults Living with a Chronic Disease
No full textLimited literature exists on the impact of the unprecedented SARS-CoV-2 (COVID-19) virus on cannabis consumers living with a chronic disease. According to global reporting, millions of adults consume cannabis to manage chronic health conditions. It is crucial to explore how the COVID-19 pandemic impacted the cannabis use patterns of adults with a chronic disease. The COVID-19 Cannabis Health study is a cross-sectional online survey aimed to examine how the COVID-19 pandemic impacted adult cannabis users by collecting self-report data on cannabis use patterns and health conditions. A subsample of 1,466 cannabis consumers living with a chronic disease was generated for analysis for this thesis. Prevalence estimates, chi-square analyses, and logistic regressions were conducted using SAS Studio. Majority (81.7%;n=1,118) of the subsample was non-Hispanic white, 52.2% were female, 12% lived outside of the US, and the mean (±SD) age was 47.1 (SD=15) years. Almost all (98.1%) of the subsample consumed cannabis in the past 30 days; and 59.3% feared a COVID-19 diagnosis. A significant difference was found in the crude relationship between cannabis dose and fear of diagnosis (p=0.03): 41.5% of adults who feared COVID-19 diagnosis increased their cannabis dosage since the pandemic compared to 37.6% of adults with no fear of diagnosis that increased their cannabis dose; 17% of the subsample reported a change in their cannabis route of use. Multiple logistic regressions showed an association between no change in cannabis dose and fear of diagnosis controlling for age, gender, and race/ethnicity (aOR=0.67,95%CI:(0.46-0.99,p=0.04), that those with no change in cannabis dosage were less likely to fear diagnosis compared to those that decreased cannabis dosage. With 10.6% of adults fearing COVID-19 diagnosis having decreased their cannabis dosage and an association found between fear of diagnosis and no change in dosage, it is crucial to examine the short and long-term impact of this change in cannabis dose on physical and mental health.</p
Association between Fear of COVID-19 Diagnosis and Cannabis Use Patterns Among Adults Living with a Chronic Disease
No full textLimited literature exists on the impact of the unprecedented SARS-CoV-2 (COVID-19) virus on cannabis consumers living with a chronic disease. According to global reporting, millions of adults consume cannabis to manage chronic health conditions. It is crucial to explore how the COVID-19 pandemic impacted the cannabis use patterns of adults with a chronic disease. The COVID-19 Cannabis Health study is a cross-sectional online survey aimed to examine how the COVID-19 pandemic impacted adult cannabis users by collecting self-report data on cannabis use patterns and health conditions. A subsample of 1,466 cannabis consumers living with a chronic disease was generated for analysis for this thesis. Prevalence estimates, chi-square analyses, and logistic regressions were conducted using SAS Studio. Majority (81.7%;n=1,118) of the subsample was non-Hispanic white, 52.2% were female, 12% lived outside of the US, and the mean (±SD) age was 47.1 (SD=15) years. Almost all (98.1%) of the subsample consumed cannabis in the past 30 days; and 59.3% feared a COVID-19 diagnosis. A significant difference was found in the crude relationship between cannabis dose and fear of diagnosis (p=0.03): 41.5% of adults who feared COVID-19 diagnosis increased their cannabis dosage since the pandemic compared to 37.6% of adults with no fear of diagnosis that increased their cannabis dose; 17% of the subsample reported a change in their cannabis route of use. Multiple logistic regressions showed an association between no change in cannabis dose and fear of diagnosis controlling for age, gender, and race/ethnicity (aOR=0.67,95%CI:(0.46-0.99,p=0.04), that those with no change in cannabis dosage were less likely to fear diagnosis compared to those that decreased cannabis dosage. With 10.6% of adults fearing COVID-19 diagnosis having decreased their cannabis dosage and an association found between fear of diagnosis and no change in dosage, it is crucial to examine the short and long-term impact of this change in cannabis dose on physical and mental health.</p
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Molecular Mechanisms of Breast Cancer Prognosis
No full textBreast cancer is the most frequently diagnosed cancer and the second leading cause of cancer death in American women. Racial/ethnic minority patients have worse prognosis compared to non-Hispanic white patients. This dissertation examined the effect of C-reactive protein (CRP) and transforming growth factor beta 1 (TGF-β1) levels before radiotherapy (pre-RT) and after radiotherapy (post-RT) on progression-free survival (PFS) in a tri-racial/ethnic breast cancer patient population.Data for this dissertation were obtained from prospective cohort studies on the effects of RT on the quality of life of breast cancer patients. Plasma CRP and TGF-β1 levels were measured pre- and post-RT. Patients were followed for up to 13 years after RT, and PFS was calculated from the date of diagnosis to the date of disease progression or the last date of follow-up. Univariable and multivariable Cox proportional hazards regression models were used to evaluate the associations between CRP, TGF-β1, and combined CRP/TGF-β1 and PFS.Elevated levels of post-RT CRP and RT-induced change in CRP were significantly associated with worse PFS in all tumor stages and among tumor stage III patients. Increases in pre-RT and post-RT TGF-β1 levels were associated with worse PFS in tumor stage 0-II patients. In the combined analysis, high levels of post-RT and change in both CRP and TGF-β1 were associated with worse PFS in all tumor stages, high levels of pre-RT CRP and TGF-β1 were associated with worse PFS in tumor stages 0-II, and high levels of change in CRP and TGF-β1 were associated with worse PFS in tumor stage III.Our data suggest that an RT-induced inflammatory response may contribute to worse breast cancer PFS and that the combination of CRP and TGF-β1 has a synergistic effect on breast cancer prognosis. Future larger studies in minority populations with a more comprehensive collection of socioeconomic variables in addition to different biomarkers are warranted to validate our findings and guide follow-up surveillance and targeted interventions.</p
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Competencies acquired in epidemiology doctoral programs
No full textThe purpose of the study was to compile and describe the range of competencies imparted by doctoral programs in epidemiology using publicly available information.
Through the Council on Education for Public Health database, institutions conferring doctoral (PhD, ScD, DrPH) degrees in epidemiology were identified. The competencies listed on the corresponding institutions' websites were extracted and summarized.
Forty-eight PhD and thirteen DrPH institutions indicate that their graduates will gain 11 common competencies. The most frequently noted competency for both PhD (93.7%) and DrPH (100%) degrees is related to the communication domain, reflecting the need for graduates to be able to effectively communicate epidemiologic information to others (epidemiology peers, other scientists, policy makers, students).
Although variations in the listed competencies exist among doctoral programs in epidemiology, there are common competencies across programs. Further examination of these programs is required to capture information beyond that conveyed on the websites. This preliminary report, along with those findings presented in previous reports on doctoral education, may stimulate further discussion with a group of faculty teaching at the doctoral level, employers of doctoral graduates, and/or the Association of Schools and Programs of Public Health representatives
Evaluation of Statin Use, Drug Interactions, and their Associations with Lipid Changes in People with HIV
No full textPeople with HIV (PWH) have a greater risk for cardiovascular disease (CVD) than the general population. Managing cholesterol levels with medications known as statins (hydroxymethylglutaryl-coenzyme A reductase inhibitors) effectively prevents CVD by reducing low-density lipoprotein (LDL) cholesterol and certain systemic inflammation indices.This dissertation utilizes data from the Multicenter AIDS Cohort Study (MACS)/Women’s Interagency HIV Study (WIHS) Combined Cohort Study (MWCCS) to 1) estimate the prevalence of statin use among PWH, compare it with people without HIV (PWOH), and evaluate the factors affecting statin use for both PWH and PWOH; 2) evaluate the association between statin use and LDL changes at follow-up and determine whether this association differs between PWH and PWOH; and 3) evaluate the longitudinal association between statin use (and types) and LDL changes over time among PWH, and examine the interactions between statins and antiretroviral therapy (ART) regimens in relation to LDL changes over time.We found that the prevalence of statin use was 39% (95% CI: 36–42%) among PWH and 37% (95% CI: 33–42%) among PWOH. After accounting for confounders, PWH were more likely to use statins than PWOH. Among PWH only, non-Hispanic Black adults were less likely to use statins than non-Hispanic white adults. Furthermore, statin users were more likely to meet a ≥30% LDL reduction goal than non-users and this association was not moderated by HIV status. Also, atorvastatin and rosuvastatin were associated with the lowest LDL levels over time, and we observed lower LDL levels over time for atorvastatin users on protease inhibitor-based therapy compared to atorvastatin users on integrase strand transfer inhibitor (INSTI)-based therapy.This dissertation, based on real-world data, emphasizes that while the use and effectiveness of statins for achieving desired LDL outcomes may be comparable between PWH and PWOH, significant racial/ethnic differences exist. The findings provide insights that can inform preventive cardiovascular care for people with HIV receiving ART
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Multiple Methods to Examine Discrimination, Microaggressions, Resilience, Mental Health and Covid-19 Impact Among Black Women Living With HIV In Miami, Florida
No full textThe Human Immunodeficiency Virus (HIV) has been a major public health concern since the 1980s and continues to be a major global health issue despite intense efforts to address this epidemic. This dissertation focused on Black Women Living with HIV (BWLWH), who have been disproportionately impacted by HIV. This dissertation utilized repeated psychosocial measurements of microaggression, discrimination, and resilience, and cross-sectional data on mental health status, COVID-19 impact on life, conduced measurement Invariance tests, 3-step approach, and Cross-Lagged Path Model (CLPM) to fulfill three study aims described below.First, this dissertation identified three latent factors of microaggression, discrimination, and resilience, established measurement invariance across time, formed three latent classes, and then compared factor scores of three psychosocial domains over time, as well as across latent subgroups.Second, to answer the question, “Does the impact of COVID-19 on life differ by constellation of microaggression, discrimination and resilience?” This dissertation utilized both variable-centered and person-centered approaches.Third, this dissertation examined the reciprocal relationships between factor scores of discrimination, mental health, and resilience among BWLWH. The Cross-Lagged Path Model (CLPM) was applied. The first set of panel models were built to examine the relations between factor score of resilience and the count of the number of mental health diagnoses. The second set of panel models were built to examine the relations between factor scores of discrimination and resilience.Collectively, this dissertation discovered complex relations between mental health, microaggression, resilience, discrimination, and impact of COVID-19 on life among 151 BWLWH from a longitudinal perspective. This study indicates that microaggressions and discrimination impacts mental health, and provides evidence on the role of resilience in coping with discrimination.</p
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Health Disparities in the Incidence and Survival of Women with Ovarian Cancer in Florida: A Florida Cancer Database System Analysis
No full textOvarian cancer is the deadliest gynecological cancer in the United States. Despite improvements in the incidence and survival of women with ovarian cancer, racial/ethnic disparities still exist. Determining the epidemiology of a disease and the distribution within the population is critical to establish research priority areas and help guide public health programs and policies. Identifying and describing population disparities in health is important to provide evidence for targeted interventions. As the Ecosocial theory of disease distribution explicates, racial/ethnic disparities are multifactorial and often emerge from the embodiment of biological, social and historical exposures both within the individual and high-level factors such as neighborhoods. Despite having a lower incidence of ovarian cancer, non-Hispanic Black (NHB) women have been showed to have the worse survival compared to other race/ethnic groups. Hispanic women have been showed to have similar socioeconomic, access to care, and treatment challenges as NHB women but have similar ovarian cancer incidence and survival as non-Hispanic White (NHW) women. Many of the previous studies of ovarian cancer disparities have focused on differences between white and Black women with few including Hispanic women. The diverse population of Florida presents a unique opportunity to explore potential disparities in ovarian cancer particularly among Hispanics. Hispanics make up the largest minority group in Florida with 23.4% of the population being Hispanic. As most previous studies have been conducted in primarily Hispanic populations of Mexican origin, Florida contains a different composition of Hispanics from that of previous studies. In addition to individual factors, such as insurance status and receipt of optimal treatment, leading to racial/ethnic disparities in ovarian cancer, the place we live affect our health and can lead to racial inequalities. Residential segregation, both as a product of race and class, remain a problem within the United States. According to Diez-Roux, residential segregation can create an inequality in resources which impact overall health through a multitude of reinforcing pathways. Guided by the Ecosocial theory, this dissertation aims to evaluate the current epidemiology of ovarian cancer disparities in Florida by exploring multilevel factors including race/ethnicity, tumor characteristics, and neighborhood residential segregation.</p
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Evaluation of Statin Use, Drug Interactions, and their Associations with Lipid Changes in People with HIV
No full textPeople with HIV (PWH) have a greater risk for cardiovascular disease (CVD) than the general population. Managing cholesterol levels with medications known as statins (hydroxymethylglutaryl-coenzyme A reductase inhibitors) effectively prevents CVD by reducing low-density lipoprotein (LDL) cholesterol and certain systemic inflammation indices.This dissertation utilizes data from the Multicenter AIDS Cohort Study (MACS)/Women’s Interagency HIV Study (WIHS) Combined Cohort Study (MWCCS) to 1) estimate the prevalence of statin use among PWH, compare it with people without HIV (PWOH), and evaluate the factors affecting statin use for both PWH and PWOH; 2) evaluate the association between statin use and LDL changes at follow-up and determine whether this association differs between PWH and PWOH; and 3) evaluate the longitudinal association between statin use (and types) and LDL changes over time among PWH, and examine the interactions between statins and antiretroviral therapy (ART) regimens in relation to LDL changes over time.We found that the prevalence of statin use was 39% (95% CI: 36–42%) among PWH and 37% (95% CI: 33–42%) among PWOH. After accounting for confounders, PWH were more likely to use statins than PWOH. Among PWH only, non-Hispanic Black adults were less likely to use statins than non-Hispanic white adults. Furthermore, statin users were more likely to meet a ≥30% LDL reduction goal than non-users and this association was not moderated by HIV status. Also, atorvastatin and rosuvastatin were associated with the lowest LDL levels over time, and we observed lower LDL levels over time for atorvastatin users on protease inhibitor-based therapy compared to atorvastatin users on integrase strand transfer inhibitor (INSTI)-based therapy.This dissertation, based on real-world data, emphasizes that while the use and effectiveness of statins for achieving desired LDL outcomes may be comparable between PWH and PWOH, significant racial/ethnic differences exist. The findings provide insights that can inform preventive cardiovascular care for people with HIV receiving ART
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