This document compares three regression methods - ordinary least squares (OLS), Poisson regression, and negative binomial regression - for analyzing count data from infrequently occurring health events. It uses data on adolescent pregnancies from the National Longitudinal Survey of Adolescent Health to illustrate the different approaches. OLS regression is found to be inappropriate for modeling count data that is highly skewed and clustered around low values. Poisson and negative binomial regression are identified as more suitable alternatives that do not assume a normal distribution of error terms or dependent variables. The strengths and limitations of each method are discussed to help researchers choose the most appropriate analysis.
- The document summarizes research exploring the utility of the PATH Type assessment tool with males over 40 in the UK's National Health Service Northeast region.
- Results found response patterns and associations with demographics and socioeconomic factors consistent with US studies, suggesting the tool could work in the UK system.
- Higher rates of some less health-involved PATH Types in the sample may correlate with lower healthcare demand compared to other NHS regions. Larger studies are recommended.
This document discusses epidemiological research methods and their application to health informatics. It covers the basic principles of epidemiology including different study designs like cross-sectional, case-control, cohort, and experimental studies. Examples are provided of how these designs have been used in health informatics research to study topics like use of health IT in physician offices and relationships between variables in electronic health record data. The document also explains how to calculate measures like prevalence rates, sensitivity, specificity, odds ratios, relative risk, and incidence rates for different epidemiological study designs.
Parental alcohol consumption and the risk of congenital heart diseases in off...BARRY STANLEY 2 fasd
Conclusions: Although the role of potential bias and evidence of heterogeneity should be carefully evaluated, our review indicates that parental alcohol exposures are significantly associated with the risk of CHDs in offspring, which highlights the necessity of improving health awareness to prevent alcohol exposure during preconception and conception periods.
Lipid Screening in Childhood for Detection of Multifactorial DyslipidemiaGlobal Medical Cures™
Lipid Screening in Childhood for Detection of Multifactorial Dyslipidemia
IMPORTANT NOTE TO USERS OF WEBSITE & DOCUMENTS POSTED ON SLIDESHARE- Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
www.globalmedicalcures.com
This document summarizes a study examining non-adherence to contraceptive vaginal ring (CVR) use among women in Kisumu, Kenya from 2014-2015. Non-adherence was assessed through self-report, pharmacy records, and residual hormone levels in returned rings. Non-adherence was 14.0% by self-report and 54.5% by pharmacy records. Women with salary-based income had lower non-adherence. Participants dissatisfied with 4 or more aspects of the ring were more likely to report non-adherence. Over time, residual hormone levels showed increasing non-adherence in 46.5% of participants. Economic empowerment and education on CVR features may help reduce non
When reducing cancer risk in our population, let’s not exacerbate disparitiesGraham Colditz
The document discusses reducing cancer disparities through precision prevention approaches. It highlights that while precision medicine focuses on treating existing disease, precision prevention aims to tailor behavioral interventions to individual characteristics to reduce cancer risk. However, efforts to refine prevention strategies could inadvertently worsen disparities if factors like health literacy levels and access to care are not considered. Priorities for avoiding disparities include collaborating with diverse partners to improve communication and applying implementation research approaches to ensure evidence-based programs reach all groups.
The study presents a protocol to evaluate combining school and household interventions to reduce excessive weight gain in students in Brazil. It is a randomized community trial called PAAPPAS that will involve 2500 students from 18 schools. Schools will be randomly assigned to control or intervention groups. The intervention group will receive primary interventions led by trained teachers on healthy lifestyle and secondary interventions for overweight students through monthly home visits. Outcomes will be measured through questionnaires, anthropometric measurements, and assessing food consumption and physical activity to see if the interventions can reduce BMI levels. The study aims to provide evidence on whether integrating school and primary health care can prevent excessive weight gain in adolescents.
This document summarizes a study that used the Trauma Symptom Checklist for Children - Alternate Version (TSCC-A) to assess trauma symptoms in children ages 8-16 who were part of the LONGSCAN studies. The TSCC-A is a shortened version of the Trauma Symptom Checklist for Children (TSCC) that excludes questions about sexual issues. Results showed that LONGSCAN children scored higher than norms on clinical scales like anxiety, depression and dissociation. They were also more likely to underreport or overreport symptoms. Hispanic children and those from certain sites tended to score highest clinically. Reliability of the scales was generally good, suggesting the TSCC-A can validly assess trauma symptoms in
- The document summarizes research exploring the utility of the PATH Type assessment tool with males over 40 in the UK's National Health Service Northeast region.
- Results found response patterns and associations with demographics and socioeconomic factors consistent with US studies, suggesting the tool could work in the UK system.
- Higher rates of some less health-involved PATH Types in the sample may correlate with lower healthcare demand compared to other NHS regions. Larger studies are recommended.
This document discusses epidemiological research methods and their application to health informatics. It covers the basic principles of epidemiology including different study designs like cross-sectional, case-control, cohort, and experimental studies. Examples are provided of how these designs have been used in health informatics research to study topics like use of health IT in physician offices and relationships between variables in electronic health record data. The document also explains how to calculate measures like prevalence rates, sensitivity, specificity, odds ratios, relative risk, and incidence rates for different epidemiological study designs.
Parental alcohol consumption and the risk of congenital heart diseases in off...BARRY STANLEY 2 fasd
Conclusions: Although the role of potential bias and evidence of heterogeneity should be carefully evaluated, our review indicates that parental alcohol exposures are significantly associated with the risk of CHDs in offspring, which highlights the necessity of improving health awareness to prevent alcohol exposure during preconception and conception periods.
Lipid Screening in Childhood for Detection of Multifactorial DyslipidemiaGlobal Medical Cures™
Lipid Screening in Childhood for Detection of Multifactorial Dyslipidemia
IMPORTANT NOTE TO USERS OF WEBSITE & DOCUMENTS POSTED ON SLIDESHARE- Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
www.globalmedicalcures.com
This document summarizes a study examining non-adherence to contraceptive vaginal ring (CVR) use among women in Kisumu, Kenya from 2014-2015. Non-adherence was assessed through self-report, pharmacy records, and residual hormone levels in returned rings. Non-adherence was 14.0% by self-report and 54.5% by pharmacy records. Women with salary-based income had lower non-adherence. Participants dissatisfied with 4 or more aspects of the ring were more likely to report non-adherence. Over time, residual hormone levels showed increasing non-adherence in 46.5% of participants. Economic empowerment and education on CVR features may help reduce non
When reducing cancer risk in our population, let’s not exacerbate disparitiesGraham Colditz
The document discusses reducing cancer disparities through precision prevention approaches. It highlights that while precision medicine focuses on treating existing disease, precision prevention aims to tailor behavioral interventions to individual characteristics to reduce cancer risk. However, efforts to refine prevention strategies could inadvertently worsen disparities if factors like health literacy levels and access to care are not considered. Priorities for avoiding disparities include collaborating with diverse partners to improve communication and applying implementation research approaches to ensure evidence-based programs reach all groups.
The study presents a protocol to evaluate combining school and household interventions to reduce excessive weight gain in students in Brazil. It is a randomized community trial called PAAPPAS that will involve 2500 students from 18 schools. Schools will be randomly assigned to control or intervention groups. The intervention group will receive primary interventions led by trained teachers on healthy lifestyle and secondary interventions for overweight students through monthly home visits. Outcomes will be measured through questionnaires, anthropometric measurements, and assessing food consumption and physical activity to see if the interventions can reduce BMI levels. The study aims to provide evidence on whether integrating school and primary health care can prevent excessive weight gain in adolescents.
This document summarizes a study that used the Trauma Symptom Checklist for Children - Alternate Version (TSCC-A) to assess trauma symptoms in children ages 8-16 who were part of the LONGSCAN studies. The TSCC-A is a shortened version of the Trauma Symptom Checklist for Children (TSCC) that excludes questions about sexual issues. Results showed that LONGSCAN children scored higher than norms on clinical scales like anxiety, depression and dissociation. They were also more likely to underreport or overreport symptoms. Hispanic children and those from certain sites tended to score highest clinically. Reliability of the scales was generally good, suggesting the TSCC-A can validly assess trauma symptoms in
This report summarizes the findings from a survey of general acute care (GAC) hospital employers of registered nurses (RNs) in California, conducted in fall 2013. This is the fourth annual survey of hospital RN employers; together these surveys provide an opportunity to
evaluate overall demand for RNs in the state, and changes that have occurred as the economy in California has recovered from the economic recession that started in late 2007.
This study analyzed insurance claims data from 1999-2014 to examine trends in the use of long-acting reversible contraceptives (LARCs) compared to short-acting reversible contraceptives (SARCs) among privately insured women of childbearing age in the United States. The study found that the proportion of women using LARCs increased substantially over time, rising from 0.6% in 1999 to 16.6% in 2013. The introduction of new LARC devices, such as Mirena in 2001, Implanon in 2006 and Skyla in 2013, were associated with significant increases in overall LARC use compared to periods before the introductions. In particular, young women aged 18-24 saw the largest increases
Elikemi Cisco is conducting an internship at Robert Wood Johnson Hospital to improve care for transgender adolescents by informing them of fertility options before hormonal therapy. Many transgender individuals pursue medical interventions like hormones or surgery to alleviate gender dysphoria, but these treatments can impact fertility. While some countries require sterilization for legal gender changes, the US does not always discuss fertility preservation. Hormone therapy can cause issues like teratospermia and oligozoospermia. The internship involves researching transgender healthcare, fertility preservation, and hormones to develop supplemental materials on fertility options for patients. Over 2,600 articles were found and 45 fully reviewed, with 25 selected for a research paper providing background on transgender topics and medical interventions as
Perceived caregiver financial barriers and asthma outcomes in urban elementary school children
Minal R. Patel, MPH
Doctoral Student
Department of Health Behavior & Health Education
University of Michigan School of Public Health
American Thoracic Society International Conference , New Orleans, Louisiana
May 15, 2010
Center for Managing Chronic Disease
University of Michigan
This study examined the relationship between gender and sexual risk behaviors among males and females. A mixed methods approach was used, including focus groups with 12 participants and an online/hard copy survey completed by 90 participants. The survey assessed demographics, sexual activity levels, and risk behaviors. Results found no statistically significant difference between males and females in terms of risk behaviors. However, qualitative findings suggested alcohol and drug use contribute to higher risk behaviors. In conclusion, gender alone did not predict risk, though other factors like substance use were implicated.
This document describes a study that examined how unmet basic needs cluster in low-income populations and how the effectiveness of health interventions may vary based on levels of unmet basic needs. The study analyzed data from a randomized controlled trial where low-income callers to a 211 helpline received cancer screening referrals along with one of three interventions: verbal referral only, verbal referral plus a printed reminder, or verbal referral plus navigation from a health coach. Latent class analysis identified three classes of unmet basic needs among participants. Logistic regression found that for those with relatively more or money-specific unmet needs, the navigator intervention was more effective at linking them to health referrals, while the printed reminder worked as well as the navigator for those
Screening prevalence of fetal alcohol spectrum disorders in a region of the u...BARRY STANLEY 2 fasd
This study estimated the screening prevalence of fetal alcohol spectrum disorders (FASDs) in a region of the United Kingdom using existing data from a population-based birth cohort study (ALSPAC). The screening prevalence of FASD was estimated to be 6.0% using a single imputation method, 7.2% using complete case analysis, and 17.0% using multiple imputation. Missing data patterns suggested that complete case and single imputation methods likely underestimated FASD prevalence. The results indicate FASD may be a significant public health concern in the UK.
Skin Cancer Screening
IMPORTANT NOTE TO USERS OF WEBSITE & DOCUMENTS POSTED ON SLIDESHARE- Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
www.globalmedicalcures.com
This document summarizes a seminar presentation on case control studies. It begins by defining epidemiological study cycles and analytical study types such as case control and cohort studies. It then focuses on case control studies, defining them, discussing their history, design, outcomes, limitations, advantages and applications. Examples of notable case control studies are provided, such as Lane Claypon's 1926 breast cancer study and studies from the 1950s linking smoking to lung cancer. Key aspects of case control study methodology like selection of cases and controls, and matching to control for confounding variables are explained.
This presentation outlines community interventions and effective prevention. It discusses two types of community interventions: research-driven prevention typically led by universities, and community-driven prevention led by local coalitions. Research-driven prevention uses experimental designs and careful measurement, while community-driven prevention addresses local health problems. Both approaches can have positive outcomes, such as reduced risk behaviors, when they incorporate individual and environmental strategies across multiple community settings.
This document describes a nested case-control study conducted within a cohort. A nested case-control study selects cases and controls from individuals enrolled in a cohort study and follows them over time. An example is given of a cohort study of 90,000 women being followed for breast cancer. To efficiently study the risk of past pesticide exposure, the nested case-control study would examine stored blood samples from the 1439 women who developed breast cancer (cases) and a sample of others who did not (controls).
Kouyate et al (2015) Transition from the Lactational Amenorrhea Method to oth...Robin Anthony Kouyate, PhD
This document summarizes a study that examined factors influencing women's transition from the Lactational Amenorrhea Method (LAM) of contraception to other modern family planning methods in rural Bangladesh. The study found that over half of women who transitioned switched methods before or at the same time LAM criteria were no longer met, while some delayed due to waiting for their period to return. Barriers for women who did not transition included misconceptions about fertility return and lack of family support. The timely transition from LAM is important for preventing unintended pregnancy but counseling is needed to address misconceptions and risks of delayed transition. Programs should train health workers and improve social support to better facilitate the transition from LAM
This document provides an overview of measures of effect in epidemiology. It defines and provides examples of various ratio and difference measures of effect including risk ratio, rate ratio, odds ratio, and prevalence ratio. It explains how these measures can be used to assess the strength of association between an exposure and outcome. The document also discusses concepts related to disease causation including necessary vs. sufficient causes, direct vs. indirect causes, and confounding. Various models of disease causation are described including the epidemiologic triangle. The stages in the natural history of disease and levels of prevention are also outlined.
Global Medical Cures™ | USA Chartbook on HealthCare for Blacks
IMPORTANT NOTE TO USERS OF WEBSITE & DOCUMENTS POSTED ON SLIDESHARE- Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
www.globalmedicalcures.com
Pediatric Hospital Medicine Top 10 (ish) 2014rdudas
The article "The survival time of chocolates on hospital wards: covert observational study" studied how long chocolates lasted on hospital wards before being eaten. Researchers covertly placed chocolates in hospital wards and recorded how long they remained. On average, chocolates lasted only 75 minutes before being consumed, with large variations based on ward type and time of day. The study highlights issues around food security and integrity on hospital wards.
The main purpose of the present study was to determine the effect of regular home visits on the developmental indices of low birth weight infants. The present study was an on-site clinical investigation. 90 infants ranging between 1500 to 2500g born in Razi Hospital of Marand town having the entrance criteria to the present study were taken into consideration through the available sampling method and then they were divided into two intervention and control groups. The intervention group has received the whole routine cares since the first to fourth week and then they were visited at home for 45 minutes a week. The control group received the routine cares. The evolutionary indices of both groups were also completed monthly for three months by referring homes. The related data gathering tool was also subjected to the demographic information through registration list and the Persian version of the Low Weight Infant Inventory (LWII) (2 months) that have been completed by the researcher on the birthday, first, second and third months of the birth through the interview. SPSS-15 software and the application of the inferential and descriptive statistical tests (K2 and T-tests) were also applied in order to analyze the related data in this study. The significance level was considered as p<0.05.
More than half of these related research units of both groups had experience (61.5%) and control (55.8%) regarding all women in this study; the mean score of the low weight infants on the first month had not shown any statistical significant difference; but on the second months (p=0.04) and the third months (p=0.001), they had shown statistical significant difference progressively. The healthcare based on home-visit had influence on the recovery indices of the low weight infants. Hence, nurses and other health monitors of the infants should apply for the healthcare programs based on home-visit particularly in caring infants.
Undernutrition and Mortality Risk Among Hospitalized Childrenasclepiuspdfs
This study assessed the frequency of undernutrition and risk of mortality among hospitalized children in Yemen. The study reviewed 299 patient files admitted for diarrhea and severe acute malnutrition from September 2015 to February 2016. It found that 75.3% had severe underweight, 71.6% had wasting, and 37.8% had stunting. Nine children died, most were male, aged 6-23 months, from rural areas, and had severe underweight and stunting. The study concluded that the simultaneous presence of severe underweight, wasting, and stunting increases the risk of death for children being treated for severe acute malnutrition in the hospital.
Medication Adherence in America reportcard full by National Community Pharmac...Fran Maciel
This document provides a summary of key findings from the National Report Card on Medication Adherence survey conducted by the National Community Pharmacists Association. Some key findings include:
- The average adherence score among those surveyed was 79 out of 100, equivalent to a C+ grade. Scores varied based on factors like affordability of medications, connection to healthcare providers, and side effects.
- The top reasons for non-adherence were simply forgetting to take medications (41% of respondents) and running out of medication (top reasons also included being away from home, cost, and side effects).
- Regression modeling identified the strongest independent predictors of adherence as personal connection to a pharmacist, ability to afford medications, continuity in
Genetic testing for breast cancer like HER2 and gene expression profiling (GEP) can impact healthcare disparities. While HER2 testing is widely used with trastuzumab treatment, there is still some underuse. GEP testing is only modestly used and is associated with less chemotherapy for low risk patients but more for high risk. Studies show black women may be less eligible for GEP and there is inadequate data on effectiveness in diverse groups. Ensuring validation in diverse populations, broad recruitment, and addressing social factors can help reduce disparities in precision medicine.
This study aimed to identify phenotypic predictors of quality of life (QOL) in youth with fragile X syndrome (FXS) by analyzing data from 27 individuals with FXS. The study found that social and school QOL were areas of reduced QOL compared to physical and emotional domains. High levels of irritability negatively correlated with family QOL. Significant social impairment also negatively correlated with individual QOL. Scores on measures of behaviors and abilities may help identify targets for clinical treatment to improve QOL. Larger and longitudinal studies are needed to generalize findings and track developmental trajectories of QOL over time.
Letter of Fray Domingo Salazar to the King of Spaindebnie
Fray Domingo Salazar responds to five decrees from the King of Spain. In the first, he states that restitution made to the natives was a small fraction of the actual damages caused. In the second, he defends cutting the hair of Chinese converts for their safety in the faith. In the third, he notes he had already banned clergy from trading over a year prior. In the fourth, he says he will maintain his proper place without challenging the Audencia's authority. In the fifth, he could not share secret inquisition records or damage the clergy's honor, and feels the Audencia has treated him unjustly.
This report summarizes the findings from a survey of general acute care (GAC) hospital employers of registered nurses (RNs) in California, conducted in fall 2013. This is the fourth annual survey of hospital RN employers; together these surveys provide an opportunity to
evaluate overall demand for RNs in the state, and changes that have occurred as the economy in California has recovered from the economic recession that started in late 2007.
This study analyzed insurance claims data from 1999-2014 to examine trends in the use of long-acting reversible contraceptives (LARCs) compared to short-acting reversible contraceptives (SARCs) among privately insured women of childbearing age in the United States. The study found that the proportion of women using LARCs increased substantially over time, rising from 0.6% in 1999 to 16.6% in 2013. The introduction of new LARC devices, such as Mirena in 2001, Implanon in 2006 and Skyla in 2013, were associated with significant increases in overall LARC use compared to periods before the introductions. In particular, young women aged 18-24 saw the largest increases
Elikemi Cisco is conducting an internship at Robert Wood Johnson Hospital to improve care for transgender adolescents by informing them of fertility options before hormonal therapy. Many transgender individuals pursue medical interventions like hormones or surgery to alleviate gender dysphoria, but these treatments can impact fertility. While some countries require sterilization for legal gender changes, the US does not always discuss fertility preservation. Hormone therapy can cause issues like teratospermia and oligozoospermia. The internship involves researching transgender healthcare, fertility preservation, and hormones to develop supplemental materials on fertility options for patients. Over 2,600 articles were found and 45 fully reviewed, with 25 selected for a research paper providing background on transgender topics and medical interventions as
Perceived caregiver financial barriers and asthma outcomes in urban elementary school children
Minal R. Patel, MPH
Doctoral Student
Department of Health Behavior & Health Education
University of Michigan School of Public Health
American Thoracic Society International Conference , New Orleans, Louisiana
May 15, 2010
Center for Managing Chronic Disease
University of Michigan
This study examined the relationship between gender and sexual risk behaviors among males and females. A mixed methods approach was used, including focus groups with 12 participants and an online/hard copy survey completed by 90 participants. The survey assessed demographics, sexual activity levels, and risk behaviors. Results found no statistically significant difference between males and females in terms of risk behaviors. However, qualitative findings suggested alcohol and drug use contribute to higher risk behaviors. In conclusion, gender alone did not predict risk, though other factors like substance use were implicated.
This document describes a study that examined how unmet basic needs cluster in low-income populations and how the effectiveness of health interventions may vary based on levels of unmet basic needs. The study analyzed data from a randomized controlled trial where low-income callers to a 211 helpline received cancer screening referrals along with one of three interventions: verbal referral only, verbal referral plus a printed reminder, or verbal referral plus navigation from a health coach. Latent class analysis identified three classes of unmet basic needs among participants. Logistic regression found that for those with relatively more or money-specific unmet needs, the navigator intervention was more effective at linking them to health referrals, while the printed reminder worked as well as the navigator for those
Screening prevalence of fetal alcohol spectrum disorders in a region of the u...BARRY STANLEY 2 fasd
This study estimated the screening prevalence of fetal alcohol spectrum disorders (FASDs) in a region of the United Kingdom using existing data from a population-based birth cohort study (ALSPAC). The screening prevalence of FASD was estimated to be 6.0% using a single imputation method, 7.2% using complete case analysis, and 17.0% using multiple imputation. Missing data patterns suggested that complete case and single imputation methods likely underestimated FASD prevalence. The results indicate FASD may be a significant public health concern in the UK.
Skin Cancer Screening
IMPORTANT NOTE TO USERS OF WEBSITE & DOCUMENTS POSTED ON SLIDESHARE- Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
www.globalmedicalcures.com
This document summarizes a seminar presentation on case control studies. It begins by defining epidemiological study cycles and analytical study types such as case control and cohort studies. It then focuses on case control studies, defining them, discussing their history, design, outcomes, limitations, advantages and applications. Examples of notable case control studies are provided, such as Lane Claypon's 1926 breast cancer study and studies from the 1950s linking smoking to lung cancer. Key aspects of case control study methodology like selection of cases and controls, and matching to control for confounding variables are explained.
This presentation outlines community interventions and effective prevention. It discusses two types of community interventions: research-driven prevention typically led by universities, and community-driven prevention led by local coalitions. Research-driven prevention uses experimental designs and careful measurement, while community-driven prevention addresses local health problems. Both approaches can have positive outcomes, such as reduced risk behaviors, when they incorporate individual and environmental strategies across multiple community settings.
This document describes a nested case-control study conducted within a cohort. A nested case-control study selects cases and controls from individuals enrolled in a cohort study and follows them over time. An example is given of a cohort study of 90,000 women being followed for breast cancer. To efficiently study the risk of past pesticide exposure, the nested case-control study would examine stored blood samples from the 1439 women who developed breast cancer (cases) and a sample of others who did not (controls).
Kouyate et al (2015) Transition from the Lactational Amenorrhea Method to oth...Robin Anthony Kouyate, PhD
This document summarizes a study that examined factors influencing women's transition from the Lactational Amenorrhea Method (LAM) of contraception to other modern family planning methods in rural Bangladesh. The study found that over half of women who transitioned switched methods before or at the same time LAM criteria were no longer met, while some delayed due to waiting for their period to return. Barriers for women who did not transition included misconceptions about fertility return and lack of family support. The timely transition from LAM is important for preventing unintended pregnancy but counseling is needed to address misconceptions and risks of delayed transition. Programs should train health workers and improve social support to better facilitate the transition from LAM
This document provides an overview of measures of effect in epidemiology. It defines and provides examples of various ratio and difference measures of effect including risk ratio, rate ratio, odds ratio, and prevalence ratio. It explains how these measures can be used to assess the strength of association between an exposure and outcome. The document also discusses concepts related to disease causation including necessary vs. sufficient causes, direct vs. indirect causes, and confounding. Various models of disease causation are described including the epidemiologic triangle. The stages in the natural history of disease and levels of prevention are also outlined.
Global Medical Cures™ | USA Chartbook on HealthCare for Blacks
IMPORTANT NOTE TO USERS OF WEBSITE & DOCUMENTS POSTED ON SLIDESHARE- Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
www.globalmedicalcures.com
Pediatric Hospital Medicine Top 10 (ish) 2014rdudas
The article "The survival time of chocolates on hospital wards: covert observational study" studied how long chocolates lasted on hospital wards before being eaten. Researchers covertly placed chocolates in hospital wards and recorded how long they remained. On average, chocolates lasted only 75 minutes before being consumed, with large variations based on ward type and time of day. The study highlights issues around food security and integrity on hospital wards.
The main purpose of the present study was to determine the effect of regular home visits on the developmental indices of low birth weight infants. The present study was an on-site clinical investigation. 90 infants ranging between 1500 to 2500g born in Razi Hospital of Marand town having the entrance criteria to the present study were taken into consideration through the available sampling method and then they were divided into two intervention and control groups. The intervention group has received the whole routine cares since the first to fourth week and then they were visited at home for 45 minutes a week. The control group received the routine cares. The evolutionary indices of both groups were also completed monthly for three months by referring homes. The related data gathering tool was also subjected to the demographic information through registration list and the Persian version of the Low Weight Infant Inventory (LWII) (2 months) that have been completed by the researcher on the birthday, first, second and third months of the birth through the interview. SPSS-15 software and the application of the inferential and descriptive statistical tests (K2 and T-tests) were also applied in order to analyze the related data in this study. The significance level was considered as p<0.05.
More than half of these related research units of both groups had experience (61.5%) and control (55.8%) regarding all women in this study; the mean score of the low weight infants on the first month had not shown any statistical significant difference; but on the second months (p=0.04) and the third months (p=0.001), they had shown statistical significant difference progressively. The healthcare based on home-visit had influence on the recovery indices of the low weight infants. Hence, nurses and other health monitors of the infants should apply for the healthcare programs based on home-visit particularly in caring infants.
Undernutrition and Mortality Risk Among Hospitalized Childrenasclepiuspdfs
This study assessed the frequency of undernutrition and risk of mortality among hospitalized children in Yemen. The study reviewed 299 patient files admitted for diarrhea and severe acute malnutrition from September 2015 to February 2016. It found that 75.3% had severe underweight, 71.6% had wasting, and 37.8% had stunting. Nine children died, most were male, aged 6-23 months, from rural areas, and had severe underweight and stunting. The study concluded that the simultaneous presence of severe underweight, wasting, and stunting increases the risk of death for children being treated for severe acute malnutrition in the hospital.
Medication Adherence in America reportcard full by National Community Pharmac...Fran Maciel
This document provides a summary of key findings from the National Report Card on Medication Adherence survey conducted by the National Community Pharmacists Association. Some key findings include:
- The average adherence score among those surveyed was 79 out of 100, equivalent to a C+ grade. Scores varied based on factors like affordability of medications, connection to healthcare providers, and side effects.
- The top reasons for non-adherence were simply forgetting to take medications (41% of respondents) and running out of medication (top reasons also included being away from home, cost, and side effects).
- Regression modeling identified the strongest independent predictors of adherence as personal connection to a pharmacist, ability to afford medications, continuity in
Genetic testing for breast cancer like HER2 and gene expression profiling (GEP) can impact healthcare disparities. While HER2 testing is widely used with trastuzumab treatment, there is still some underuse. GEP testing is only modestly used and is associated with less chemotherapy for low risk patients but more for high risk. Studies show black women may be less eligible for GEP and there is inadequate data on effectiveness in diverse groups. Ensuring validation in diverse populations, broad recruitment, and addressing social factors can help reduce disparities in precision medicine.
This study aimed to identify phenotypic predictors of quality of life (QOL) in youth with fragile X syndrome (FXS) by analyzing data from 27 individuals with FXS. The study found that social and school QOL were areas of reduced QOL compared to physical and emotional domains. High levels of irritability negatively correlated with family QOL. Significant social impairment also negatively correlated with individual QOL. Scores on measures of behaviors and abilities may help identify targets for clinical treatment to improve QOL. Larger and longitudinal studies are needed to generalize findings and track developmental trajectories of QOL over time.
Letter of Fray Domingo Salazar to the King of Spaindebnie
Fray Domingo Salazar responds to five decrees from the King of Spain. In the first, he states that restitution made to the natives was a small fraction of the actual damages caused. In the second, he defends cutting the hair of Chinese converts for their safety in the faith. In the third, he notes he had already banned clergy from trading over a year prior. In the fourth, he says he will maintain his proper place without challenging the Audencia's authority. In the fifth, he could not share secret inquisition records or damage the clergy's honor, and feels the Audencia has treated him unjustly.
This 1-hour course on safe food preparation and storage provides continuing education credits for caregivers in multiple states. It has been approved by organizations in California, District of Columbia, Florida, Oregon, and Washington. Upon completion, students receive a certificate documenting the training date, title of the course, and number of credit hours earned.
1. Tagalog society was divided into three castes: nobles called Maharlica who did not pay taxes; commoners called Aliping Mamamahay who owned property; and slaves called Aliping Saguiguilid who served their masters.
2. Social status was inherited, with Maharlica status passing through both parents, and children of mixed unions between castes being divided.
3. The head of a barangay or village was called a Dato who governed the people and led them in war, and all legal proceedings had to be conducted in their presence.
CASL is Canada's anti-spam legislation that prohibits the sending of commercial electronic messages without consent. It applies to all organizations in Canada and violations can result in substantial penalties. The document discusses what CASL prohibits, whether it applies to certain organizations like charities, and provides tips for compliance including understanding what messages require consent and how to obtain valid express or implied consent.
Las facilitadoras Gladis Pereira y Ellicely Lara impartieron una sesión de capacitación para estudiantes de Psicopedagogía I, Seminario "Procesos Cognitivos - Trastornos de Aprendizaje" y Didáctica II el 15 de junio de 2013 bajo la orientación de la Profesora Adda Rodríguez sobre estrategias y medios instruccionales.
Van den Bergh Rietdekkers sluit 2014 goed af: veel mooie projecten gerealiseerd en nieuwe contacten gelegd.
Een fotoselectie van opgeleverde woningen met rieten dak en bijgebouwen vatten het jaar samen: Rietwerk - het jaar 2014 in beeld.
04 12 2012 - El gobernador Javier Duarte de Ochoa inauguró la remodelación de...Organización política
El Gobernador de Veracruz, Javier Duarte de Ochoa, inauguró la remodelación de la avenida Salvador Díaz Mirón de la ciudad de Veracruz, el 04 de diciembre de 2012, donde expresó que en Veracruz se impulsa el desarrollo integral de los municipios con obras de infraestructura que permiten la tranquilidad, el crecimiento económico y el progreso de las familias veracruzanas.
Javier Duarte dijo que obras como la remodelación de las calles del Puerto de Veracruz, permiten dar un nuevo rostro a la ciudad, para atraer a más turistas y visitantes, logrando el progreso de Veracruz.
El mandatario estatal aseguró que con el apoyo del Gobierno Federal y del presidente Enrique Peña Nieto, se realizarás más obras de calidad, que beneficien a los ciudadanos veracruzanos y les permita vivir en un estado más próspero y en desarrollo.
This document is the sixth issue of The Elliott School Undergraduate Scholars Journal published in 2015. It contains 16 research papers written by undergraduate students in the Elliott School Undergraduate Scholars Program at the George Washington University on various topics related to international affairs. The journal provides an overview of the program and lists the student editors and scholars who participated in 2014-2015. It also acknowledges the faculty advisors and graduate student mentors who supported the student researchers.
This document provides information about Castle Hill in Budapest, Hungary. It includes contact information for Buğra Madran and then provides general information about Hungary, Budapest, and the climate and transportation options in Budapest. It also lists some of the major landmarks in Budapest, including Castle Hill, Fishermen's Bastion, and the Church of Our Lady (Matthias Church). The document concludes by thanking the reader for their attention.
This document appears to contain a list of student records including names, registration numbers, institutions, grades, courses and other academic details. There are over 300 entries in the list with information about each student on a separate line. The data is in Portuguese and includes fields for name, registration number, institution, grade, course code, semester and other academic results.
El documento resume la anatomía del sistema digestivo. Describe que el sistema digestivo está compuesto por un tubo digestivo y glándulas anexas. El tubo digestivo incluye la boca, faringe, esófago, estómago, intestino delgado e intestino grueso. Las glándulas anexas son las glándulas salivales, hígado y páncreas. A continuación, describe en detalle cada una de las estructuras del tubo digestivo, incluyendo su localización, funciones y componentes.
O documento apresenta uma série de anúncios para causas sociais e ambientais, utilizando imagens e mensagens impactantes para conscientizar sobre problemas como maus-tratos a animais, mudanças climáticas, violência contra mulheres e crianças, doenças como AIDS, entre outros. Os anúncios buscam chamar atenção para esses problemas de forma a mobilizar as pessoas para ajudar nessas causas.
Este documento presenta información sobre dispositivos de electrónica de potencia como rectificadores, diodos de potencia, transistores de potencia y tiristores de potencia. Describe las características, encapsulados y aplicaciones de estos dispositivos importantes para el acondicionamiento de señales eléctricas en circuitos como televisores y radios.
Addressing the needs of fertility patientsLauri Pasch
This study examined the mental health of 352 women and 274 men undergoing fertility treatment. The researchers found high rates of depressive and anxiety symptoms among participants, with over half of women and a third of men experiencing clinical depression, and over 75% of women and 60% of men experiencing clinical anxiety. However, only 21% of women and 11.3% of men received mental health services, and about a quarter were provided information about such services by their fertility clinic. Those with the most severe or prolonged distress were no more likely to receive services or information. The researchers concluded that while psychological distress is common among fertility patients, most do not receive mental health support, and services are not targeted to those most in need.
This randomized clinical trial evaluated the effects of social needs screening and in-person resource navigation (the intervention) compared to an active control of written resource information on social needs and child health. The trial involved 1809 caregiver-child pairs from low-income families seen at pediatric clinics. At 4-month follow-up, families receiving in-person navigation reported greater reductions in social needs and greater improvements in their child's overall health compared to the control group. This study provides evidence that addressing social needs in pediatric care can positively impact both family circumstances and child health.
The document summarizes key findings from several studies on interventions to increase HPV vaccination rates. The studies commonly used educational interventions such as presentations and text messages to increase knowledge about HPV and the vaccine. While many interventions were not theory-based, one study found that a text message intervention grounded in the Transtheoretical Model successfully increased vaccination intent and rates. Overall, the reviewed studies found that educational awareness interventions generally improved knowledge and attitudes toward the HPV vaccine.
LITERATURE SELECTION2LITERATURE SELECTION6Lite.docxSHIVA101531
LITERATURE SELECTION 2
LITERATURE SELECTION 6
Literature Selection
Augustina Ferguson
Grand Canyon University: NRS-441V
August 30, 2015
Running head: LITERATURE SELECTION 1
Literature Selection
#1
Nwaru, B. I., & Hemminki, E (2011). Infant Care practice in rural China and their relation to prenatal care utilization.Global Public Health, 6(1), 1- 14.doi:10.1080/17441691003667307.
How does each article describe the nature of the problem, issue, or deficit you have identified?
Studies describing postpartum childcare practices and the influence of prenatal care on infant care outcomes in rural China are scarce. Inadequate care was positively associated with never breastfeeding, early introduction of milk formula and cereal/porridge, and early start of work after delivery.
Does each article provide statistical information to demonstrate the gravity of the issue, problem, or deficit?
Yes! Data were available from a Knowledge, Attitude and Perception cross-sectional survey collected from 2001 to 2003, after a prenatal care intervention in Anhui County, China, with a response rate of 97%.
What are example(s) of morbidity, mortality, and rate of incidence or rate of occurrence in the general population?
None Identified
Does each article support your proposed change?
Yes, it does
#2
Udgiri, R., K. J., S., & Sorganvi, V. (2015). Breast Feeding Practices among Postnatal Mothers-a Hospital based Study. Journal of Advanced Scientific Research, 6(1), 10-13. Grand Canyon University Library. (2015). Research & Resource LopeSearch. Retrieved from http://library.gcu.edu/
How does each article describe the nature of the problem, issue, or deficit you have identified?
It assesses the knowledge and practices of mothers about breastfeeding Practices Cross- sectional study was carried out for a period of one month.
Does each article provide statistical information to demonstrate the gravity of the issue, problem, or deficit?
A total of 162 postnatal mothers admitted in postnatal ward constitute the sample size. The data was collected using semi-structured questionnaires. Data was analyzed by using SPSS 16th version. The study shows that 21(12.9%) of the babies were feed with prelacteal feeds like honey and sugar water.
What are example(s) of morbidity, mortality, and rate of incidence or rate of occurrence in the general population?
None was identified.
Does each article support your proposed change?
Yes.
# 3
Geçkil, E., Şahin, T., & Tunçdemir, A. (2012). The Effect of * The Following and Supporting Breast-feeding Programme*, That Is Applied by Family Health Staff, on The Mother's Effective Breastfeeding Behaviors in The First Six Months of The Post-Birth Period. (English)
How does each article describe the nature of the problem, issue, or deficit you have identified?
This study investigates the effect of the education and observation of supporting breast-feeding programme that is applied by family health staff on the mothers of the post birt ...
Running head CRITIQUE QUANTITATIVE, QUALITATIVE, OR MIXED METHODS.docxtodd271
Running head: CRITIQUE QUANTITATIVE, QUALITATIVE, OR MIXED METHODS DESIGN
5
CRITIQUE OF QUANTITATIVE, QUALITATIVE, OR MIXED METHODS DESIGN
Critiquing Quantitative, Qualitative, or Mixed Methods Studies
Adenike George
Walden University
NURS 6052: Essentials of Evidence-Based Practice
April 11, 2019
Critique of Quantitative, Qualitative, or Mixed Method Design
Both quantitative and qualitative methods play a pivotal role in nursing research. Qualitative research helps nurses and other healthcare workers to understand the experiences of the patients on health and illness. Quantitative data allows researchers to use an accurate approach in data collection and analysis. When using quantitative techniques, data can be analyzed using either descriptive statistics or inferential statistics which allows the researchers to derive important facts like demographics, preference trends, and differences between the groups. The paper comprehensively critiques quantitative and quantitative techniques of research. Furthermore, the author will also give reasons as to why qualitative methods should be regarded as scientific.
The overall value of quantitative and Qualitative Research
Quantitative studies allow the researchers to present data in terms of numbers. Since data is in numeric form, researchers can apply statistical techniques in analyzing it. These include descriptive statistics like mean, mode, median, standard deviation and inferential statistics such as ANOVA, t-tests, correlation and regression analysis. Statistical analysis allows us to derive important facts from data such as preference trends, demographics, and differences between groups. For instance, by conducting a mixed methods study to determine the feeding experiences of infants among teen mothers in North Carolina, Tucker and colleagues were able to compare breastfeeding trends among various population groups. The multiple groups compared were likely to initiate breastfeeding as follows: Hispanic teens 89%, Black American teens 41%, and White teens 52% (Tucker et al., 2011).
The high strength of quantitative analysis lies in providing data that is descriptive. The descriptive statistics helps us to capture a snapshot of the population. When analyzed appropriate, the descriptive data enables us to make general conclusions concerning the population. For instance, through detailed data analysis, Tucker and co-researchers were able to observe that there were a large number of adolescents who ceased breastfeeding within the first month drawing the need for nurses to conduct individualized follow-ups the early days after hospital discharge. These follow-ups would significantly assist in addressing the conventional technical problems and offer support in managing back to school transition (Tucker et al., 2011).
Qualitative research allows researchers to determine the client’s perspective on healthcare. It enables researchers to observe certain behaviors and experiences amo.
Sociocultural and Health Correlates Related to Colorectal Cancer Screening Ad...Kelly Brittain
This study examined factors that influence colorectal cancer (CRC) screening adherence among urban African Americans. The researchers analyzed data from 129 African American participants to identify correlations between CRC screening and cultural identity, social support, CRC beliefs, informed decision making, and health factors. Key findings included: 1) religiosity and having a primary care provider predicted colonoscopy adherence; 2) collectivism, present-time orientation, and informed decision predicted fecal occult blood testing. The results suggest nurses should consider patients' social support, CRC beliefs, and health concerns when discussing CRC screening.
Rosemary Frasso's presentation from the
Penn Urban Doctoral Symposium
May 13, 2011
Co-sponsored with Penn’s Urban Studies program, this symposium celebrates the work of graduating urban-focused doctoral candidates. Graduates present and discuss their dissertation findings. Luncheon attended by the students, their families and their committees follows.
The document discusses the role of statistics and mathematicians in public health practice and HIV/AIDS surveillance. It provides examples of how HIV/AIDS data is collected through disease reporting and used by statisticians to analyze trends, identify at-risk groups, and inform prevention strategies. Specific projects highlighted include using population attributable risk to quantify how social determinants influence racial disparities in HIV incidence among women and analyzing mediators of behavioral interventions.
Objective: To identify the prevalence, demographics, resource utilization, and outcomes of Children with Special Health Care Needs (CSHCN) in a Pediatric Intensive Care Unit (PICU).
Methods: All children (< 21 years) admitted during a six-month period were included in the study. CSHCN were identified using
the CSHCN screener and Federal Maternal and Child Health Bureau definition. Demographic data, Pediatric Index of Mortality (PIM-2), and hospital mortality were recorded. Resource utilization was assessed by the use of health care services, the cumulative Therapeutic Intervention Severity Score, and hospital charges.
Applying and Sharing Evidence Discussion.docxwrite22
This document discusses implementing routine distress screening for gynecologic cancer patients using the Distress Thermometer and Problem List. A study found that 66% of patients screened had moderate to high distress levels. The top problems identified were nervousness, worry, fatigue and sleep issues. Healthcare providers saw benefits for patients in validating their concerns and opening discussion. They also felt it enhanced holistic care. However, finding time for screening in busy clinics was challenging.
This document summarizes a review of research evaluating the effectiveness of semantic feature analysis (SFA) on reducing anomia (word finding difficulties) in individuals with aphasia. The review identified 11 relevant studies that examined SFA as a treatment method for adults with neurological injury and aphasia. The studies were assessed for quality and effect sizes were calculated. The majority of participants showed small effect sizes, indicating SFA did not significantly improve word finding ability for most. Some participants did show medium or high effect sizes. Overall, SFA was found to be effective for reducing anomia based on calculations of percent of non-overlapping data.
Quality Data Sources Organizer Discussion Paper.docxwrite22
The document discusses five quality data sources from the 2017 National Healthcare Quality and Disparities Report. It provides details on each data source such as the primary content collected, target population, demographic data included, frequency of data collection, and whether it is a primary or secondary source. The sources discussed are the National Health and Nutrition Examination Survey, Behavioral Risk Factor Surveillance System, National Ambulatory Medical Care Survey, National Consumer Assessment of Healthcare Providers and Systems Benchmarking Database, and National Health Interview Survey.
Think of your local community. What health-related issue current.docxirened6
Think of your local community. What health-related issue currently affects a large number of people within your community? How could research help address this issue? How would you go about obtaining more data on the health-related issue you identified?
This is an opportunity for you to explore the practical application of how to create a plan to obtain data on a health-related topic, specifically in your community. Please respond in first person, share personal experiences to further develop your understanding of how evidence-based practice can affect health-related issues at the community level.
Use as references:
National Center for Health Statistics (NCHS)
- National and state data sets as well as statistic reports. Information about ordering data sets that cannot be downloaded.
CDC Data and Statistics page
- much more than NCHS
CDC WONDER
- WONDER provides a single point of access to a wide variety of reports and numeric public health data.
Agency for Healthcare Research and Quality
- Data and Surveys
Statewide Planning and Research Cooperative System (SPARCS)
- Data dictionaries, documentation and request forms. No searchable data online.
U.S. Census Bureau
,
Current census data including information broken down by state, city, and region.
WHOSIS
-- WHO Statistical Information System
In two different paragraph give your personal opinion to Valencia Matilus and Malika Nelson, them do not need a different referents use the same as them.
Valencia Matilus
In the community in Florida many people are infected by the chronic illness hypertension is a common disease cholesterol, fatigues, and stress. Patients are major risks cardiovascular, stokes, and leading causes of death, respectively in the community. In 2016, 80,722 deaths were caused by high blood pressures. In 2014, high blood pressures were five times more deaths than it was in 2016. Hypertension has referred to high blood pressures. Hypertension is a big major cause of premature death worldwide (Benjamin, 2016).
Hypertension very often had no signs or symptoms. Once the primary care doctor has diagnosed the patient had high blood pressures as a medication. Patients can lower their blood pressures by changing their diet, and exercises. In 2015-2016, in the communities 1/3 patients have controlled high blood pressures. 2017, recent revised guidelines more than one patient have unknown or undiagnosed if they have high blood pressures. In 2016, the total costs directed for high blood pressures were $54.8 billion. It’s projected for the year 2035, the total costs will be reach $221.8 billion. I’ll suggest implementing public health to have more programs to help to reduce the hypertension problems. Healthcare providers have provided more information, have classes for the patient, and show them how to eat, have nutrition in the clinic or private doctor offices to reduce mortality. (Benjanmin, 2016).Florida, adults ages 18-39; 45 to 79, nearly half of patients can .
Community Resources TemplateMental Health ProvidersH.docxmccormicknadine86
Community Resources Template
Mental Health Providers
Hospitals
Education Services
Rehabilitation Services
Pharmacies
DME Equipment Providers
Incontinence Service Providers
Parenteral Service Providers
Enteral Nutrition Providers
Social Services
Transition Services
https://courserooma.capella.edu/bbcswebdav/institution/NURS-…050/200100/Course_Files/cf_community_resources_template.docx 1/20/20, 8:07 PM
Page 1 of 2
Transportation Services
Skilled Nursing Services
Hourly Nursing Services
Respite Care Services
Hospice Care Providers
Community Services
1
https://courserooma.capella.edu/bbcswebdav/institution/NURS-…050/200100/Course_Files/cf_community_resources_template.docx 1/20/20, 8:07 PM
Page 2 of 2
Cameron, L., Erkal, N., Gangadharan, L., Meng, X. (2013). Little emperors: Behavioral impacts of China's one-child policy. Science, 339, 953-957. doi: 10.3886/ICPSR34521.v1.
This article investigated the effect of China’s one-child policy on different behaviors, comparing behavioral trends in people who were born in the years just before and just after the implementation of the one-child policy. One of the more notable results was that participants born under the one-child policy scored higher in neuroticism and lower in contentiousness in comparison with those born before the policy. The study concluded that the observed behavioral differences between those born just before and just after the one-child policy would greatly magnify as time went on, due to very limited extended family and living in a world of predominantly only children. This article provides valuable insight into the behavioral changes of the average person in China as a result of the one-child policy. The authors were able to use data that was actively generated for this article, rather than piecing together already-existing data like many other studies on the subject, which was very refreshing to see. This article would provide a solid resource to use as it presents a very data-based approach to this aspect of the one-child policy.
Huang, W., Lei, X., Zhao, Y. (2016). One-child policy and the rise of man-made twins. Review of Economics and Statistics, 98(3), 467-476. doi: 10.1162/REST_a_00567
The authors of this study examined the correlation between China’s one-child policy and China’s sharp increase of reported twin births. The authors found that although China’s fertility rate was already decreasing before the advent of the policy, the number of reported twins had increased by one third in the last 30 years, sharply rising in 1979 when the one-child policy was fully implemented. The data suggested that there was a strong correlation between reported twin births and areas of China with higher fines for having more children than allowed. One of the key indicators used by the authors to determine fake twins was height differences between the children. Some of the limitations of this study included that the evidence for fake twins was merely s ...
Black, Hispanic, and AIAN students remain underrepresented among medical school matriculants compared with the US population. This underrepresentation has not changed significantly since the institution of the Liaison Committee of Medical Education diversity accreditation guidelines in 2009. This study’s findings suggest a need for both the development and the evaluation of more robust policies and programs to create a physician workforce that is demographically representative of the US population.
The prevalence, patterns of usage and people's attitude towards complementary...home
The prevalence of CAM in Chatsworth is similar to findings in other parts of the
world. Although CAM was used to treat many different ailments, this practice could not be
attributed to any particular demographic profile. The majority of CAM users were satisfied with
the effects of CAM. Findings support a need for greater integration of allopathic medicine and
CAM, as well as improved communication between patients and caregivers regarding CAM usage.
This document summarizes the challenges of communicating risk in prenatal screening tests. It discusses how:
1) Prenatal screening tests have a high rate of false positives, leading many women with healthy pregnancies to undergo invasive follow-up tests that carry risks of miscarriage. For example, a first trimester screening test with a 5% false positive rate could lead to around 50 unnecessary miscarriages among 100,000 screened women.
2) Calculating and understanding the positive predictive value of screening tests, which is needed for informed decision making, requires Bayesian reasoning that most people struggle with. As a result, risks are often underestimated.
3) While research has identified effective ways to communicate Bayesian concepts
This document summarizes a systematic review of 146 studies on determinants of adherence to antiretroviral therapy (ART) among HIV-positive adults in sub-Saharan Africa. The main findings were:
1) Main determinants of non-adherence included use of alcohol, male gender, use of traditional medicine, dissatisfaction with healthcare, depression, stigma, and poor social support.
2) Promoters of adherence included counseling, education, memory aids, and disclosure of HIV status.
3) Determinants of health status had conflicting effects on adherence.
"Does Foreign Direct Investment Negatively Affect Preservation of Culture in the Global South? Case Studies in Thailand and Cambodia."
Do elements of globalization, such as Foreign Direct Investment (FDI), negatively affect the ability of countries in the Global South to preserve their culture? This research aims to answer this question by employing a cross-sectional comparative case study analysis utilizing methods of difference. Thailand and Cambodia are compared as they are in the same region and have a similar culture. The metric of difference between Thailand and Cambodia is their ability to preserve their culture. This ability is operationalized by their respective attitudes towards FDI; Thailand imposes stringent regulations and limitations on FDI while Cambodia does not hesitate to accept most FDI and imposes fewer limitations. The evidence from this study suggests that FDI from globally influential countries with high gross domestic products (GDPs) (e.g. China, U.S.) challenges the ability of countries with lower GDPs (e.g. Cambodia) to protect their culture. Furthermore, the ability, or lack thereof, of the receiving countries to protect their culture is amplified by the existence and implementation of restrictive FDI policies imposed by their governments.
My study abroad in Bali, Indonesia, inspired this research topic as I noticed how globalization is changing the culture of its people. I learned their language and way of life which helped me understand the beauty and importance of cultural preservation. I believe we could all benefit from learning new perspectives as they could help us ideate solutions to contemporary issues and empathize with others.
Falcon stands out as a top-tier P2P Invoice Discounting platform in India, bridging esteemed blue-chip companies and eager investors. Our goal is to transform the investment landscape in India by establishing a comprehensive destination for borrowers and investors with diverse profiles and needs, all while minimizing risk. What sets Falcon apart is the elimination of intermediaries such as commercial banks and depository institutions, allowing investors to enjoy higher yields.
Falcon stands out as a top-tier P2P Invoice Discounting platform in India, bridging esteemed blue-chip companies and eager investors. Our goal is to transform the investment landscape in India by establishing a comprehensive destination for borrowers and investors with diverse profiles and needs, all while minimizing risk. What sets Falcon apart is the elimination of intermediaries such as commercial banks and depository institutions, allowing investors to enjoy higher yields.
Solution Manual For Financial Accounting, 8th Canadian Edition 2024, by Libby...Donc Test
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Seminar: Gender Board Diversity through Ownership NetworksGRAPE
Seminar on gender diversity spillovers through ownership networks at FAME|GRAPE. Presenting novel research. Studies in economics and management using econometrics methods.
STREETONOMICS: Exploring the Uncharted Territories of Informal Markets throug...sameer shah
Delve into the world of STREETONOMICS, where a team of 7 enthusiasts embarks on a journey to understand unorganized markets. By engaging with a coffee street vendor and crafting questionnaires, this project uncovers valuable insights into consumer behavior and market dynamics in informal settings."
Economic Risk Factor Update: June 2024 [SlideShare]Commonwealth
May’s reports showed signs of continued economic growth, said Sam Millette, director, fixed income, in his latest Economic Risk Factor Update.
For more market updates, subscribe to The Independent Market Observer at https://blog.commonwealth.com/independent-market-observer.
5 Tips for Creating Standard Financial ReportsEasyReports
Well-crafted financial reports serve as vital tools for decision-making and transparency within an organization. By following the undermentioned tips, you can create standardized financial reports that effectively communicate your company's financial health and performance to stakeholders.
Lecture slide titled Fraud Risk Mitigation, Webinar Lecture Delivered at the Society for West African Internal Audit Practitioners (SWAIAP) on Wednesday, November 8, 2023.
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Vicinity Jobs’ data includes more than three million 2023 OJPs and thousands of skills. Most skills appear in less than 0.02% of job postings, so most postings rely on a small subset of commonly used terms, like teamwork.
Laura Adkins-Hackett, Economist, LMIC, and Sukriti Trehan, Data Scientist, LMIC, presented their research exploring trends in the skills listed in OJPs to develop a deeper understanding of in-demand skills. This research project uses pointwise mutual information and other methods to extract more information about common skills from the relationships between skills, occupations and regions.
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BONKMILLON Unleashes Its Bonkers Potential on Solana.pdf
Hutchinson and holtman, 2005
1. Research in Nursing & Health, 2005, 28, 408–418
Focus on Research Methods
Analysis of Count Data Using
Poisson Regression*
M. Katherine Hutchinson1
,{
Matthew C. Holtman2z
1
University of Pennsylvania School of Nursing, 420 Guardian Drive, Philadelphia,
Pennsylvania 19104-6096
2
Fels Institute of Government and Department of Criminology, University of Pennsylvania
Accepted 16 May 2005
Abstract: Nurses and other health researchers are often concerned with
infrequently occurring, repeatable, health-related events such as number of
hospitalizations, pregnancies, or visits to a health care provider. Reports on
the occurrence of such discrete events take the form of non-negative integer
or count data. Because the counts of infrequently occurring events tend to be
non-normally distributed and highly positively skewed, the use of ordinary
least squares (OLS) regression with non-transformed data has several
shortcomings. Techniques such as Poisson regression and negative binomial
regression may provide more appropriate alternatives for analyzing
these data. The purpose of this article is to compare and contrast the use of
these three methods for the analysis of infrequently occurring count data. The
strengths, limitations, and special considerations of each approach are
discussed. Data from the National Longitudinal Survey of Adolescent Health
(AddHealth) are used for illustrative purposes.ß 2005 Wiley Periodicals, Inc. Res
Nurs Health 28:408–418, 2005
Keywords: Poisson regression; count data; data analysis
Nurses and other health researchers are often
concerned with infrequently occurring, repeatable,
health-related events such as number of hospitali-
zations, pregnancies, or visits to a health care
provider.Reportsontheoccurrenceofsuchdiscrete
events take the form of non-negative integer or
count data. Counts of infrequently occurring, repe-
atable events tend to cluster around the values of
*This research uses data from Add Health, a program project designed by J.
Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris, and funded by a grant
P01-HD31921 from the National Institute of Child Health and Human Development,
with cooperative funding from 17 other agencies. Special acknowledgment is due
Ronald R. Rindfuss and Barbara Entwisle for assistance in the original design.
Persons interested in obtaining data files from Add Health should contact Add Health,
Carolina Population Center, 123 W. Franklin Street, Chapel Hill, NC 27516-2524
(www.cpc.unc.edu/addhealth/contract.html).
Contract grant sponsor: National Institute of Mental Health (to MKH); Contract
grant number: R03 MH63659.
Contract grant sponsor: National Institute of Child Health and Human
Development; Contract grant number: P01-HD31921.
Correspondence to M. Katherine Hutchinson.
{
Assistant Professor and Associate Director.
z
Lecturer.
Published online in Wiley InterScience (www.interscience.wiley.com)
DOI: 10.1002/nur.20093
408 ß2005 Wiley Periodicals, Inc.
2. 0 and/or 1 and exhibit low frequencies at higher
values.Thistypeofdistributionhasa positive skew.
They are truncated at 0, and gradually trail off
toward higher values; the mean is characteristically
low but greater than the median because of the
influence of a few relatively large observations. In a
regression model, the distribution of the error term
mirrors the distribution of the dependent variable
itself (Lewis-Beck, 1989). Because ordinary least
squares (OLS) regression assumes normality in the
distribution of error terms and hence in the depen-
dent variable, its use with this type of data is pro-
blematic if the data are not transformed to address
the effects of the positive skew (Lewis-Beck).
Poisson regression and negative binomial
regression may provide more appropriate alter-
natives for the analysis of infrequently occurring,
untransformed count data. Neither of these alter-
native types of regression analysis assumes
normal distribution of the error terms and depen-
dent variables. Poisson regression assumes a
Poisson distribution—a specific type of distribu-
tion in which scores take the form of non-negative
whole number or integer values. The Poisson
distribution is truncated at 0, highly skewed in the
positive direction, and exhibits equidispersion
(i.e., a mean that is equal to the variance; Allison,
1999; Cameron & Trivedi, 1998). For the use of
uncorrected Poisson regression, these character-
istics should be present. When overdispersion is
present (i.e., the variance is greater than the mean)
Poisson regression may still be employed but
statistical corrections must be incorporated into
the model to correct for the overdispersion).
In contrast, negative binomial regression is
based on the assumption of a Poisson-like dis-
tribution (Allison, 1999) and no assumptions
regarding equidispersion are made. When over-
dispersion is present, negative binomial regression
can be employed without any special corrections.
The purpose of this article is to compare and
contrast the use of these three methods for the
analysis of infrequently occurring count data. The
strengths, limitations, and special considerations
of each approach are discussed. Data from the
National Longitudinal Survey of Adolescent
Health (AddHealth) public use dataset are used
for illustrative purposes.
METHODS
In our initial attempts to build comparative
regression models, we used independent variables
from Wave 1 of the AddHealth public use dataset
to predict number of pregnancies reported at Wave
II. However, in order to demonstrate the range of
options available in Poisson regression, we felt
that it was important to include a varying exposure
variable (e.g., years of sexual activity) and model
an outcome variable that exhibited overdispersion
(i.e., model a dependent variable with a variance
greater than its mean). When we restricted our
sample to sexually experienced young women and
used Wave II reports of numbers of pregnancies as
our outcome, the resultant model did not exhibit
overdispersion. Therefore, although we would
have preferred to use more than one wave of data
in order to more accurately model the longitudinal
dynamics of pregnancy, for illustrative purposes,
we have confined the analyses to a cross-sectional
analysis using only data from Wave I.
National Longitudinal
Study of Adolescent Health
The National Longitudinal Study of Adolescent
Health (AddHealth) was mandated to the National
Institute of Child Health and Human Development
(NICHD) by a Congressional act. Detailed infor-
mation about the study can be obtained on its web
site at http://www.cpc.unc.edu/addhealth. The
studyincludesaschool-basedsampleofadolescents
in7ththrough12thgrades.Studentswhocompleted
the in-school questionnaire (n ¼ 90,000) and those
who were listed on the school roster were used as a
samplingframe for a corerandomsampleof12,105
adolescents,stratifiedbygenderandgrade.In-home
interviewswereconductedwiththiscoresample,as
wellasoversamplesofethnicminoritiesandspecial
populations based on self-report data from the in-
school questionnaire. The analyses reported here
were limited to Wave 1 data from in-home inter-
views with adolescents who were included in the
public use dataset subsample.
Sample
The AddHealth public use dataset includes a
subsample of approximately 6,500 respondents.
Of the 3,356 female respondents, 36% (n ¼ 1,241)
were sexually experienced, based on self-reports
of ever having sexual intercourse. Analyses were
limited to those respondents who were sexually
experienced and whose years of sexual experience
could be calculated from their current age and
their age at first sexual intercourse. We deleted a
few outlier cases whose reported ages at first
intercourse were so low that their calculated years
of sexual experience exceeded 10. Of those
ANALYSIS OF COUNT DATA / HUTCHINSON AND HOLTMAN 409
3. sexually experienced girls remaining in the analy-
sis (n ¼ 1,241), most (n ¼ 1,011, 81%) reported no
pregnancies. Of those who had been pregnant, 190
(15%) reported only one pregnancy; 40 (3%)
reported more than one pregnancy (Table 1).
Independent Variables
For our analyses, we included nine important
predictor variables that have been shown to be
related to adolescent pregnancy—age, race (Afri-
can American, Asian, Hispanic/Latino), marital
status, sexual experience, college plans, contra-
ceptive self-efficacy, and consistent contraceptive
use. The descriptive statistics for all variables are
summarized in Table 2.
Age. Agewas included in all of our analyses, as
sexual activity, childbearing intentions, and con-
traceptive behaviors tend to vary with age. Age, as
self-reported at Wave 1, was recorded in years.
Race. Race was included in the analyses as age
at first intercourse and rates of adolescent
pregnancy have been shown to vary by race (Blum
et al., 2000; Kann et al., 2000). In addition, African
American adolescents have been found to be less
compliant with oral contraceptive use than their
White peers (Scher, Emans, & Grace, 1982).
Three dichotomous dummy variables, coded 1
for yes and 0 for no, were included to repre-
sent respondents’ self-identification as African
American, Hispanic/Latino, and/or Asian.
Marital status. Although the vast majority
(98%) of girls in the sample had never been
married, those who had been married may have
had different attitudes and intentions towards
becoming pregnant than girls who were never
married. Marital status was coded as single/never
married (1) or other (0) and included as a
dichotomous dummy variable in our analyses.
Sexual experience. Pregnancy is directly
related to sexual activity. Sexual experience was
calculated as the number of years that had elapsed
between the year when the Wave I interview was
conducted and the year the respondent reported
having sexual intercourse for the first time.
College plans. Because feelings of hopeless-
ness and lack of future plans may act as contri-
buting factors in adolescent sexual risk-taking and
unintended pregnancy, whether or not respondents
had college plans was assessed at Wave I. The
single-item measure was worded: ‘‘How much do
you want to go to college?’’ The item was scored
on a Likert-type scale from 1 to 5; higher scores
indicated a greater desire to attend college. The
mean score was 4.4 (SD ¼ 1.1).
Contraceptive self-efficacy. Greater sexual
self-efficacy has consistently been shown to be
related to both condom use and contraceptive
use (DiClemente, Lodico, & Grinstead, 1996;
Hutchinson, 2002; Hutchinson & Cooney, 1998;
Hutchinson, Jemmott, Jemmott, Braverman, &
Fong, 2003; Jemmott, Jemmott, & Hacker, 1992).
Four items on the Wave I survey assessed self-
efficacy related to sexual behavior and contra-
ceptive use. Items were scored from 1 to 5. Higher
scores indicated greater contraceptive self-efficacy.
The overall contraceptive self-efficacy score was
computed as the simple average of the four items.
Total possible scores ranged from 1 to 5; the mean
contraceptive self-efficacy score was 3.8 (SD¼ .8).
Consistent contraceptive use. In the Add-
Health survey, a number of questions addressed
contraceptivebehavior.Forthe present analysis,we
Table 1. Frequency Distribution of Outcome
Variable
Pregnancies
reported n %
0 1,011 81.5
1 190 15.3
2 32 2.6
3 6 0.5
4 2 0.2
Table 2. Descriptive Statistics for Sample: Girls Reporting Sexual Experience
Variable n Mean SD Minimum Maximum
Number of pregnancies 1,241 .23 .52 .0 4.0
Current age (age) 1,241 17.01 1.39 12.7 20.7
African American (Black) 1,241 .30 .46 .0 1.0
Hispanic (Hisp) 1,241 .10 .30 .0 1.0
Asian (Asian) 1,241 .03 .18 .0 1.0
Never married (single) (0 ¼ false;1 ¼ true) 1,236 .98 .14 .0 1.0
Years of sexual activity (years) 1,169 1.74 1.42 .0 8.0
College plans (college) 1,237 4.38 1.06 1.0 5.0
Contraceptive self-efficacy (effic) 1,233 3.76 .81 1.0 5.0
Consistent contraceptive use (contrac) 1,241 1.27 .80 .0 2.0
410 RESEARCH IN NURSING & HEALTH
4. created a proxy measure for consistent contra-
ceptive use based on two questions that asked
whether respondents used contraception during
intercourse the first time and the most recent time
they had sexual intercourse. Possible values on the
scale range from0 (did not use contraceptioneither
time) to 2 (used contraception both times). The
average score on this measure was 1.29 (SD ¼ .8).
In summary, we designated nine predictor
variables to include in our models—age, race,
marital status, sexual experience, college plans,
contraceptive self-efficacy, and consistent contra-
ceptive use. In all of our models, we expected age,
race, marital status, and sexual experience to be
positively associated with number of pregnancies.
College plans, contraceptive self-efficacy, and
consistent contraceptive use were expected to be
inversely related to number of pregnancies.
Outcome Variable
The outcome variable of interest, number of pre-
gnancies, was taken from respondents’ self-
reports. We did not include information on
whether pregnancies were carried to term or
whether they resulted in live births. Almost 19%
of the sexually experienced female adolescents
who participated in AddHealth reported having
been pregnant at least once at Wave I; slightly less
than 82% reported they had never been pregnant.
The number of reported pregnancies ranged from
0 to 4. The number of pregnancies was non-
normally distributed and highly skewed with a
mean of .22 and a variance of .27.
DATA ANALYSES AND RESULTS
Our goal was to compare the use of OLS, Poisson,
and negative binomial regressions for modeling
the effects of nine independent variables on the
number of pregnancies experienced by sexually
experienced adolescent females from the National
Longitudinal Survey of Adolescent Health.
The outcome of interest, number of pregnan-
cies, is an infrequently occurring, discrete and
repeatable event. More than 80% of the sample
had a pregnancy count of 0. Of those who had been
pregnant, 190 had had only one pregnancy; 40
reported more than one pregnancy.
OLS Regression
Ignoring the specific characteristics of a Poisson-
distributed outcome variable, a typical OLS re-
gression model to address these effects might look
like the following: Number of pregnancies ¼ a þ
b1 (age) þ b2 (African American) þ b3 (His-
panic) þ b4 (Asian) þ b5 (single) þ b6 (years of
sexual experience) þ b7 (college) þ b8 (contra-
ceptive self-efficacy) þ b9 (consistent contracep-
tive use).
The results fromthismodel are shownin Table3.
All but two of the effects are significant at the .05
level. In interpreting the estimated effects, we see
that, controlling for the other variables, each addi-
tional year of age increases the predicted number of
pregnancies by .05. African American girls are
expected to have .18 more pregnancies than White
girls. Being single decreases the expected number
of pregnancies by nearly .72. Each year of sexual
activity increases the predicted number of preg-
nancies by .07. Greater aspiration for college
reduces the predicted number of pregnancies
by.04 per point, greater contraceptive self-efficacy
by .05 per point. Each additional point on the
consistent contraceptive use scale decreases the
predicted number of pregnancies by .07.
So what is wrong with using the OLS approach?
The answer is that OLS is inappropriate for models
in which the dependent variable is highly skewed.
Table 3. OLS Regression Output for Model Predicting Number of Pregnancies
Variable DF
Parameter
Estimate
Standard
Error t value p > j t j
Intercept 1 .37410 .22441 1.67 .0958
Current age 1 .04718 .01223 3.86 .0001
African American 1 .17686 .03219 5.49 <.0001
Hispanic 1 .03127 .04971 .63 .5295
Asian 1 .08816 .08171 1.08 .2808
Never married 1 À.71671 .09796 À7.32 <.0001
Years of sexual activity 1 .07221 .01092 6.61 <.0001
College plans 1 À.03711 .01402 À2.65 .0082
Contraceptive self-efficacy 1 À.04573 .02005 À2.28 .0227
Consistent contraceptive use 1 À.07412 .01879 À3.94 <.0001
OLS, ordinary least squares.
ANALYSIS OF COUNT DATA / HUTCHINSON AND HOLTMAN 411
5. Our dependent variable, number of pregnancies, is
in this category. Its range is restricted by the fact
that its lower bound is zero. Furthermore, although
the number of girls who have been pregnant is
quite low, at the same time, a small handful of girls
reported several pregnancies, up to a maximum of
4. The result is a highly skewed distribution.
An OLS model does not perform well under
these conditions. OLS requires, as a basic assump-
tion, that the dependent variable and the error term
in the model be at least approximately normally
distributed (Lewis-Beck, 1989). With an outcome
variable this skewed, these assumptions are violat-
ed. Using OLS also risks violating the homosce-
dasticity assumption of OLS, which is that the error
terms are evenly distributed across values of the
dependent variable. When one or both of these
violations occur, the standard errors of the para-
meters will be estimated incorrectly, and as a result,
it does not produce accurate estimates for the t-tests
associated with the parameters. The user will be
unable to tell whether the effects are statistically
significant or not. Worse, because one can almost
always mechanically run such a model (even when
the model is inappropriate), there is a risk of taking
the results at face value, making a Type I error, and
reaching the wrong conclusions.
A second reason why a Poisson model is
preferred over OLS regression is that risk exposure
to the outcome of interest varies. OLS assumes
linear relationships between each independent
variable and the outcomes. Although using
OLSallowedcontrollingforyearsofsexualactivity
in the model, in doing so we were implicitly
assuming that the relationship between years and
pregnancies was linear. With a highly skewed
outcomevariable like pregnancy, thisassumptionis
not reasonable. As we will see, Poisson regression
has a more natural way of incorporating this
information into the model, producing more
realistic estimates of how likely a girl is to get
pregnant, holding constant the number of years she
has been sexually active.
Alternative Poisson-Type Models
There are two Poisson-type models (a true Poisson
and a negative binomial model, which is a
generalization of the Poisson) that are better
suited than OLS to analyzing the type of data in
the example. In specifying a Poisson-type model,
there are two initial choices to make: (a) whether
or not to incorporate time-frame adjustments in
the model and (b) whether to specify a true Poisson
approach or a negative binomial approach.
UnlikeOLSmodels,Poisson-type modelscanbe
specified in such a way as to take varying time-
frames or levels of exposure into account. Varying
time-frames or levels of exposure can be addressed
by including a predictor variable that adjusts the
model to account for the time-frame in which
the observations were made, or by standardizing
the outcome variable per time unit. Investigators
can also choose not to include such adjustments. In
the present example, the appropriate variable to
think about is the length of the interval of sexual
activity. Although the risk remains constant for
each exposure, the cumulative risk of becoming
pregnant increases with the number of sexual
encounters, and those encounters are likely to
increase with an increase in the interval of
exposure. Unfortunately, there is no direct measure
ofhow many times a girlhas had sex.Therefore, we
used years of sexual activity to give us an idea of
how much exposure each girl is likely to have
experienced. An 18-year-old girl who has been
sexually active since age fourteen, for example, has
probably had many more chances to become
pregnant than a girl who initiated sexual activity
at age 17. There may, of course be other diffe-
rences—the girl who started at 14 may be, in many
ways, less responsible or less able to plan than the
other girl. This kind of effect is not captured with
the time variable, just different levels of exposure.
A Poisson type regression can incorporate such
an exposure variable in one of two ways: by
including exposure as a standard predictor vari-
able, or incorporating exposure as an offset of the
outcome variable. In the latter case, the researcher
would include the log-transformed value of the
exposure variable (years sexually active) on
the right-hand-side of the equation, and instruct
the computer to assume that its coefficient is equal
to 1. In this kind of model, the outcome variable
predicted will be the rate of log-pregnancies per
unit of exposure (e.g., per year of sexual activity).
The reasons for these minor adjustments are
algebraic. The other alternative is simply to
include the untransformed (e.g., not logged)
exposure variable as a predictor on the right-hand
side of the equation. This slightly simpler specifi-
cation gives fairly comparable results, but requires
a slight shift in interpretation of the coefficients.
The second major option is whether to use a true
Poisson specification, or a negative binomial
specification. A true Poisson model assumes that
the distribution of the outcome variable (number of
pregnancies) has a mean equal to its variance. This
is part of the definition of the Poisson distribution.
The negative binomial (NB) distribution, on the
other hand, makes no such assumption and can
412 RESEARCH IN NURSING & HEALTH
6. have a variance that is larger or smaller than its
mean. The negative binomial distribution is said,
therefore, to be overdispersed compared to the true
Poisson distribution. The models are interpreted in
exactly the same way. The researcher needs to be
aware of the possibility of overdispersion when
estimating a model, and to pick the better of the two
models (Poisson or NB) depending on whether
there is evidence for overdispersion or not. When
overdispersion is present, true Poisson modeling
can still be employed; however, a standardized
correction must be made for the overdispersion.
Poisson modeling. A Poisson model uses a
maximum likelihood estimation technique (much
like a logistic regression), and can be run in SAS
using the GENMOD procedure. A Poissonversion
of our model is shown below. In this variation, we
used the simpler approach for the exposure
variable by including it in raw form as a predictor
variable. Notice the line that specifies the log link
function. For technical reasons, Poisson and
negative binomial regression model the natural
log of the outcome variable.
Example SAS instructions are provided below
and the output from these instructions is included
in Table 4.
proc genmod data ¼ adhealth.PoissonAnalysis;
model numpreg ¼ age black hisp asian single
years college effic contrac
/link ¼ log
dist ¼ poisson;
run;
The output is similar to that of an OLS
regression, a parameter estimate, a standard error
for each predictor variable, and a p value that is
based on a w2
statistic. The upper and lower limits
of a 95% confidence interval for the parameter also
are provided. Finally, an extra line labeled scale,
which is set to 1 in this first model, appears. The
scale parameter identifies how much the output
was adjusted to take overdispersion into account.
We have not dealt with overdispersion yet in this
model, so this parameter is not yet relevant.
There are significant effects (p < .05) for most
of the predictors, just as before. Each of the effects
is again in the expected direction. In interpreting
the coefficients recall that the outcome variable is
really the natural log (log base e—the power that e
has to be raised to get the original number, where e
is about 2.718) of the number of pregnancies. This
is a somewhat unnatural way to think about
pregnancies (‘‘how many logged pregnancies did
you have?’’), so it may be helpful to transform the
parameter estimates into slightly more accessible
form. This can be accomplished using spreadsheet
software or a scientific calculator. For years of
sexual experience, for example, the estimated
coefficient is .22. Taking e to the .22 power, we get
1.25 pregnancies for every year of sexual experi-
ence: e.22
¼ 1.25.
There is a simple way to interpret these
estimates. The percentage change in the outcome
count (Y) expected with each one unit increase in
the independent variable (X) equals 100 times the
inverse natural log of the coefficient minus one
(Y% ¼ 100 Â [eB
À 1]; Allison, 1999). In this
example, the percent increase in the expected
number of pregnancies for each additional year of
sexual experience would be 100 Â (1.25À1) ¼
25%.
But how reasonable are these estimates? What
is the predicted number of pregnancies for an
average girl in the sample—that is, a girl who has
average values on all of the predictor variables?
No such girl may actually exist in the dataset, but
applying the averages of all the predictors is an
easy way to see whether the model gives reason-
able results. In calculating the predicted number of
Table 4. Poisson Regression Output for Model Predicting Number of Pregnancies, with Years of Sexual
Activity Included as a Predictor
Parameter DF Estimate
Standard
Error
Wald 95% Confidence
Limits w2
Probability > w2
Intercept 1 À3.5182 .9551 À5.3903 À1.6462 13.57 .0002
Current age 1 .2278 .0556 .1188 .3368 16.78 <.0001
African American 1 .6958 .1297 .4416 .9500 28.78 <.0001
Hispanic 1 .1498 .2195 À.2804 .5801 .47 .4949
Asian 1 .5333 .3290 À.1116 1.1782 2.63 .1051
Never married 1 À1.1035 .2122 À1.5194 À.6876 27.04 <.0001
Years of sexual activity 1 .2195 .0381 .1447 .2942 33.13 <.0001
College plans 1 À.1198 .0515 À.2208 À.0188 5.41 .0201
Contraceptive self-efficacy 1 À.1939 .0852 À.3609 À.0268 5.17 .0230
Consistent contraceptive use 1 À.3106 .0812 À.4697 À.1514 14.62 .0001
Scale 0 1 0 1 1
ANALYSIS OF COUNT DATA / HUTCHINSON AND HOLTMAN 413
7. pregnancies, it is necessary to take into account the
effects of all the predictor variables (not just years
of sexual experience or exposure), and those
effects have to be added up before taking the expo-
nent of e. Referring to the descriptive statistics in
Table 2, multiply each predictor variable’s average
(current age, Black, Hispanic, Asian, single, years
of sexual activity, college plans, contraceptive
self-efficacy, consistent contraceptive use) by its
estimated effect from the model, and include the
intercept:
À3.52þ (.23 Â 17.01) þ (.70 Â .30) þ (.15 Â
.10) þ (.53 Â .03) þ (À1.10 Â .98) þ (.22 Â
1.74) þ (À.12 Â 4.38) þ (À.19 Â 3.76) þ (À.31
 1.27) ¼ À1.75
The total obtained is À1.75 for the log of the
predicted number of pregnancies, or .17 for the
predicted number of pregnancies (eÀ1.75
¼ .17).
The .17 figure is not far off the average number of
pregnancies in the sample, .20.
Model fit can be assessed usingthe deviance and
w2
statistics that are reported in the model output.
Under certain large-sample conditions, both sta-
tistics are approximately distributed as w2
with
degrees of freedom equal to the number of obser-
vations minus the number of parameters. In this
example, the deviance is 781.6 and the w2
is
3,359.9, both with 1,144 degrees of freedom. Both
statistics are non-significant (p ¼ 1 and .95,
respectively; the p values were calculated using
the w2
formula from standard spreadsheet soft-
ware). This suggests that the fit between the model
and the data is very good. A significant deviance or
w2
value would have indicated poor correspon-
dence between the model and the data, perhaps
due to inappropriate use of the Poisson specifica-
tion or due to the omission of an important pre-
dictor variable. In practice, the model fit statistics
will tend to get larger and become statistically
significant as the dataset gets larger, so they are not
always useful for assessing a single model by
itself. An alternative is to use the deviance statistic
to compare nested models with each other; for
details, refer to Cameron and Trivedi (1998).
The next step is to attempt a better specification
of the Poisson model using the offset method to
adjust for varying lengths of exposure to pregnancy
risk, in this case the interval of being sexually
active. In this approach, the log-transformed value
of years sexually activewill be included, calculated
using the following SAS code:
logyrs ¼ log(actvyrs);
In setting up the model, this variable is not
included with the other predictors, but instead a
line is included that says:
/offset ¼ logyrs
The resultant SAS code reads as follows:
proc genmod data ¼ adhealth.PoissonAnalysis;
model numpreg ¼ age black hisp asian single
college effic contrac
/link ¼ log
dist ¼ poisson
offset ¼ lactvyrs;
run;
Thissetsthecoefficientforlogyrsequalto1,and
adjusts the other estimates accordingly. It is done
this way as an algebraic reduction of the ratio
log(pregnancies/years). The logarithm of any
ratio is equal to the log of the numerator minus
the log of the denominator: log(a/b) ¼
log(a) À log(b), therefore log(pregnancies/years)
¼ log(pregnancies) À log(years). To estimate a
model predicting log(pregnancies) alone, add
log(years) to both sides of the regression equation.
The log(years) term then cancels out of the left
side, leaving log(pregnancies) by itself:
log(pregnancies/years) ¼ a þ b1(age) þb2-
(African American) þ b3(Hisp) þ b4(Asian) þ
b5(single) þ b6(college) þ b7(effic) þ b8(contrac)
When log(years) is added to both sides of the
equation, the result is:
log(pregnancies) ¼ a þ log(years) þ b1(age) þ
b2(African American) þ b3(Hispanic) þ b4-
(Asian) þ b5(single) þ b6(college) þ b7(effic) þ
b8(contrac)
The coefficient for log(years) is set to one in
order to maintain the correct scale. The results of
this model are shown in Table 5. In contrast to the
previous models, the effects for age and college
plans are no longer significant. If the sum of
the products of the means of all the predictor
variables with their coefficients is calculated, the
following is the result:
(À2.04) þ (.12 Â 17.01) þ (.66 Â .30) þ (.21
 .10) þ (.49  .03) þ (À.93  .98) þ (À.09 Â
4.38) þ (À.22 Â 3.76) þ (À.27 Â 1.27) ¼ À2.21
The model predicts À2.21 log pregnancies per
year for an average girl, or eÀ2.21
¼ .11 pregnan-
cies per year. Because the average number of years
of sexual activity in the sample is 1.7, this would
give a total of 1.7 Â .11 ¼ .19 pregnancies for an
average girl, one who has average values on all the
predictor variables that we included in the model.
This estimate is the best fit with the known values
in our dataset.
Overdispersion. Overdispersion means having
a Poisson-like distribution that is not quite Pois-
son, because its variance is larger than its mean.
When overdispersion is present, Poisson regres-
sion coefficients are reliable but the variance is
larger than the statistical program would expect
for a Poisson distribution. As a result, the standard
414 RESEARCH IN NURSING & HEALTH
8. errors calculated by the program are artificially
smaller than the true standard errors, and thus may
lead to more liberal significance test results and a
greater likelihood of Type I errors.
Overdispersion can be detected by comparing
the reported model w2
statistic with its degrees of
freedom (divide w2
by the degrees of freedom). An
overdispersed model will have a ratio greater than
2; the greater the ratio, the greater the over-
dispersion. An omitted predictor variable can
result in apparent overdispersion or underdisper-
sion; the researcher should investigate this possi-
bility while examining the diagnostics.
Overdispersion is corrected for by dividing each
standard error by the square root of the model
Pearson’s w2
divided by the degrees of freedom.
SAS will perform this adjustment automatically if
the PSCALE option is specified (Allison, 1999). In
this example, the code is as follows. Notice it is the
same as before except for the PSCALE option at
the end.
proc genmod data ¼ adhealth.PoissonAnalysis;
model numpreg ¼ age black hisp asian single
college effic contrac
/link ¼ log
dist ¼ poisson
offset ¼ lactvyrs
pscale;
run;
The output, presented in Table 6, looks very
similar to the previous Poisson analysis. The
coefficient estimates are exactly the same. The
difference is in the estimated standard errors,
which are now a little larger. The scale parameter
has also been adjusted upward from 1, reflecting
the degree of adjustment made. The increase in the
standard errors affects the hypotheses tests, redu-
cing the w2
statistics and increasing the p values
slightly. This means that some statistically sig-
nificant effect estimates will no longer reach
significance. In this case, only African American
race and marital status remain as significant
effects. The correction for overdispersion takes a
conservative approach to estimating the standard
errors, which means it tends to err on the side
of type-II errors—saying that an effect is not
significant even if it might be. In order to gain a
little more power to detect significant effects,
Table 5. Poisson Regression Output for Model Predicting Number of Pregnancies, with Years of Sexual
Activity Included as an Offset to Account for Varying Time-Frame of Exposure
Parameter DF Estimate
Standard
Error
Wald 95% Confidence
Limits w2
Probability > w2
Intercept 1 À2.0420 .9607 À3.9248 À.1591 4.52 .0335
Current age 1 .1220 .0543 .0156 .2283 5.05 .0246
African American 1 .6604 .1287 .4082 .9126 26.33 <.0001
Hispanic 1 .2070 .2186 À.2215 .6354 .90 .3438
Asian 1 .4896 .3294 À.1561 1.1352 2.21 .1373
Never married 1 À.9294 .2080 À1.3371 À.5218 19.97 <.0001
College plans 1 À.0871 .0515 À.1881 .0139 2.86 .0909
Contraceptive self-efficacy 1 À.2241 .0845 À.3897 À.0585 7.04 .0080
Consistent
contraceptive use
1 À.2729 .0825 À.4346 À.1113 10.95 .0009
Scale 0 1 0 1 1
Table 6. Poisson Regression Output for Model with Correction for Overdispersion
Parameter DF Estimate
Standard
Error
Wald 95% Confidence
Limits w2
Probability > w2
Intercept 1 À2.0420 1.6456 À5.2673 1.1834 1.54 .2147
Current age 1 .1220 .0929 À.0602 .3041 1.72 .1894
African American 1 .6604 .2205 .2283 1.0925 8.97 .0027
Hispanic 1 .2070 .3745 À.5270 .9409 .31 .5805
Asian 1 .4896 .5643 À.6165 1.5956 .75 .3857
Never married 1 À.9294 .3563 À1.6277 À.2312 6.81 .0091
College plans 1 À.0871 .0883 À.2601 .0859 .97 .3237
Contraceptive self-efficacy 1 À.2241 .1447 À.5078 .0596 2.40 .1215
Consistent contraceptive use 1 À.2729 .1413 À.5498 .0039 3.73 .0533
Scale 0 1.713 0 1.713 1.713
ANALYSIS OF COUNT DATA / HUTCHINSON AND HOLTMAN 415
9. an alternative approach would be to use a negative
binomial specification.
Negative binomial modeling. Another option
if overdispersion is present is to use the negative
binomial specification rather than the Poisson.
This is easily accomplished by changing the DIST
line in the model statement from POISSON to NB,
as follows:
proc genmod data ¼ adhealth.PoissonAnalysis;
model numpreg ¼ age black hisp asian single
college effic contrac
/link ¼ log
dist ¼ nb
offset ¼ lactvyrs;
run;
The output is very similar and can be interpreted
in the same way. As with the PSCALE adjustment,
the negative binomial specification results in
exactly the same coefficient estimates as in the
main Poisson model, but with slightly larger
standard errors. The negative binomial specifica-
tion takes care of the overdispersion problem, but
is a little less conservative than using corrected
standard errors. When using this model there are
highly significant effects for most of the pre-
dictors, and marginally significant effects for age
and college plans. Table 7 presents the results from
this analytical approach.
Table 8 compares the parameter estimates and
standard errors from all four models: OLS,
Poisson, Poisson with the correction for over-
dispersion, and negative binomial. The parameter
estimates for the Poisson-type models are quite
similar, and the standard errors for the negative
binomial model are closer to those of the uncor-
rected than the corrected Poisson. Because it is not
possible to compare directly the OLS and Poisson-
type parameter estimates (because the former deal
with raw pregnancies and the latter with log-
pregnancies), in the last column of the table, the
expected percent change in pregnancies due to a
unit change in each predictor variable for the
Poisson and negative binomial models are pro-
vided. These transformed parameter estimates
were calculated in the way described above.
DISCUSSION
When making decisions about which modeling
approach is most appropriate for use with a given
data set, consider the degree of normality or non-
normality in the distribution of the outcome vari-
able. If the dependent variable is fairly normally
distributed, OLS regression may be the simplest
approach and an appropriate choice in many cases.
However, when the outcome variable of interest
takes the form of infrequently occurring count
data with highly skewed distributions, Poisson, or
negative binomial regression approaches may be
more appropriate. Through the use of SAS or
similar statistical software, such analyses are also
fairly simple to execute and generate results that
are meaningful and easy to interpret.
In choosing between Poisson and negative
binomial regression, the factors to consider are
overdispersion and power. When overdispersion is
present, and the Poisson assumption of equidis-
persion is violated, either a Poisson model with
corrected standard errors or a negative binomial
model may be used. Negative binomial modeling
may give you a little more statistical power.
Negativebinomialregressionmakesnoassump-
tions of equidispersion and no adjustments need to
be made when overdispersion is present. If Pois-
son modeling is chosen, the statistical adjustments
described above must be made to correct the
standard errors. Hutchinson et al. (2003) provided
examples of Poisson regressions that incorporate
corrections for overdispersion. In their analysis of
Table 7. Negative Binomial Regression Output
Parameter DF Estimate
Standard
Error
Wald 95% Confidence
Limits w2
Probability > w2
Intercept 1 À2.0414 .9608 À3.9245 À.1584 4.51 .0336
Current age 1 .1220 .0543 .0156 .2283 5.05 .0246
African American 1 .6605 .1287 .4082 .9128 26.33 <.0001
Hispanic 1 .2070 .2187 À.2216 .6355 .90 .3439
Asian 1 .4897 .3295 À.1561 1.1354 2.21 .1372
Never married 1 À.9297 .2081 À1.3375 À.5219 19.96 <.0001
College plans 1 À.0871 .0515 À.1882 .0139 2.86 .0909
Contraceptive self-efficacy 1 À.2241 .0845 À.3898 À.0585 7.03 .0080
Consistent contraceptive use 1 À.2730 .0825 À.4347 À.1113 10.96 .0009
Dispersion 0 .0007 0 .0007 .0007
416 RESEARCH IN NURSING & HEALTH
10. sexual risk behaviors among inner-city adoles-
cent females, only one of the three sexual risk
outcomes measured (number of male sexual
partners during the past 3 months) showed
equidispersion. The other two outcomes (number
of days had sexual intercourse and number of days
had unprotected sexual intercourse) were over-
dispersed and corrected using the procedures
described above.
As is described above and illustrated in Table 8,
OLS, Poisson, and negative binomial regressions
yield regression coefficients that are quite similar.
However, because of the non-normality of the
distributions, the size of the standard errors and the
resultant level of significance of the coefficients
vary. The inappropriate use of OLS regression
could lead one to commit Type I errors and erro-
neously conclude that some variables are sig-
nificant predictors of the number of adolescent
pregnancies when in fact their effects are null.
A related problem is that OLS will model
pregnancies as a linear function of the predictor
variables, which can lead to inaccurate predictions
for the number of pregnancies for girls who
measure even moderately high or low on those
variables. Because the Poisson and negative bino-
mial models build nonlinearity into the model by
way of the log transformation, one gets a much
better model fit to the data and more realistic
predicted values.
Finally, the Poisson and negative binomial
models have a natural way of dealing with the
problem of differential exposure among subjects.
In our example, we take into account the number
of years of sexual experience of each girl, an
important predictor of pregnancies. By using years
of experience or exposure as an ‘‘offset’’ variable,
the models are automatically adjusted to give
results that reflect the risk of pregnancy per year of
exposure.
In conclusion, Poisson and negative binomial
regression may provide more appropriate means
for modeling infrequently occurring repeatable
events or counts. In addition to being better suited
to the data when the outcome variable is skewed,
these approaches have the additional advantages
of being able to accommodate differential expo-
sure and non-linear effects. Although researchers
may be less familiar with these regression models,
they are no more difficult to execute than tradi-
tional OLS regression when using SAS or similar
statistical software packages.
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Negative
Binomial
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ANALYSIS OF COUNT DATA / HUTCHINSON AND HOLTMAN 417
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418 RESEARCH IN NURSING & HEALTH