Community and Family Medicine

Dartmouth, Lebanon

Community and Family Medicine

Dartmouth, Lebanon

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Gotham H.J.,University of Missouri - Kansas City | Claus R.E.,Westat Inc. | Xie H.,Community and Family Medicine
Administration and Policy in Mental Health and Mental Health Services Research | Year: 2014

Despite increased awareness of the benefits of integrated services for persons with co-occurring substance use and psychiatric disorders, estimates of the availability of integrated services vary widely. The present study utilized standardized measures of program capacity to address co-occurring disorders, the dual diagnosis capability in addiction treatment and dual diagnosis capability in mental health treatment indexes, and sampled 256 programs across the United States. Approximately 18 % of addiction treatment and 9 % of mental health programs met criteria for dual diagnosis capable services. This is the first report on public access to integrated services using objective measures. © 2012 Springer Science+Business Media New York.


Tosteson A.N.A.,Community and Family Medicine | Tosteson T.D.,Community and Family Medicine | Carragee E.J.,Stanford University | Carrino J.A.,Johns Hopkins Hospital | And 2 more authors.
Spine | Year: 2013

Study Design. A retrospective cohort design. Objective. To determine whether baseline magnetic resonance imaging findings, including central/foraminal stenosis, Modic change, disc morphology, facet arthropathy, disc degeneration, nerve root impingement, and thecal sac compression, are associated with differential surgical treatment effect. Summary of Background Data. Intervertebral disc herniation remains the most common source of lumbar radiculopathy treated either with discectomy or nonoperative intervention. Although magnetic resonance imaging remains the reliable "gold standard" for diagnosis, uncertainty surrounds the relationship between magnetic resonance imaging fi ndings and treatment outcomes. Methods. Three hundred seven "complete" images from patients enrolled in a previous trial were de-identified and evaluated by 1 of 4 independent readers. Findings were compared with outcome measures including the Oswestry Disability Index. Differences in surgery and nonoperative treatment outcomes were evaluated between image characteristic subgroups and TE determined by the difference in Oswestry Disability Index scores. Results. The cohort comprised 40% females with an average age of 41.5 ( ?± 11.6) years, 61% of whom underwent discectomy for intervertebral disc herniation. Patients undergoing surgery with Modic type I endplate changes had worse outcomes ( - 26.4 vs . - 39.7 for none and - 39.2 for type 2, P = 0.002) and smaller treatment effect ( - 3.5 vs . - 19.3 for none and - 15.7 for type 2, P = 0.003). Those with compression of ≥ 1/3 showed the greatest improvement within the surgical group ( - 41.9 for ≥ 1/3 vs . - 31.6 for none and - 38.1 for < 1/3, P = 0.007) and the highest TE ( - 23 compared with - 11.7 for none and - 15.2 for < 1/3, P = 0.015). Furthermore, patients with minimal nerve root impingement demonstrated worse surgical outcomes ( - 26.5 vs . - 41.1 for "displaced" and - 38.9 for "compressed," P = 0.016). Conclusion. Among patients with intervertebral disc herniation, those with thecal sac compression of 1/3 or more had greater surgical treatment effect than those with small disc herniations and Modic type I changes. In addition, patients with nerve root "compression" and "displacement" benefi t more from surgery than those with minimal nerve root impingement. Copyright © 2013 Lippincott Williams & Wilkins.


Xie H.,Community and Family Medicine
Journal of Nervous and Mental Disease | Year: 2012

This study assessed the impact of steady competitive or noncompetitive employment on nonvocational outcomes for clients with severe mental illness receiving employment services. We conducted a secondary analysis of 2-year data for 187 clients participating in a randomized controlled trial comparing two employment programs. Participants were classified according to 2-year employment outcomes into four groups: steady competitive work, steady noncompetitive work, minimal work, and no work. We compared these groups on 2-year outcomes including symptoms, hospitalizations, quality of life, and social networks. During follow-up, working clients had fewer days of hospitalization than the no-work group. The steady competitive group had greater reduction in negative symptoms than did the no-work group. The steady noncompetitive group showed greater improvement in social networks compared with the other groups. Extended periods of work are associated with improvements in nonvocational outcomes. Beneficial effects may vary according to the type of employment. Copyright © 2012 by Lippincott Williams & Wilkins.


News Article | December 14, 2016
Site: www.eurekalert.org

DALLAS, Dec. 14, 2016 -- People who were in a stable marriage, and had never been divorced or widowed, had the best prospects of survival after having a stroke, according to new research in Journal of the American Heart Association, the Open Access Journal of the American Heart Association/American Stroke Association. "Our research is the first to show that current and past marital experiences can have significant consequences for one's prognosis after a stroke," said Matthew E. Dupre, Ph.D., lead author and associate professor in the Department of Community and Family Medicine and the Clinical Research Institute at Duke University in Durham, North Carolina. "We hope that a greater recognition and understanding of these associations may enable healthcare providers to better identify and treat patients who may be at a potentially high risk of dying after suffering a stroke." Stroke, one of the leading causes of disability and death in the United States, affects nearly 800,000 adults each year. The risk factors associated with stroke -- high blood pressure, smoking and diabetes -- are well established, as are the factors related to recovering from stroke and improving survival, such as access to quality healthcare, reducing risk factors, and adhering to treatment plans. While studies have shown that social support, such as marriage, can have a significant impact on treatment of cardiovascular disease, the influence of marital status on stroke survival in adults remains poorly understood. To determine whether one's marital history plays a role in survival after suffering a stroke, Dupre and Renato D. Lopes, M.D., Ph.D., professor of medicine at Duke University Medical Center, used data from a nationally representative sample of older U.S. adults. The sample was collected as part of the Health and Retirement Study (HRS), an ongoing, prospective, study of older U.S. adults sponsored by the National Institute on Aging and the Institute for Social Research at the University of Michigan. The HRS includes marital histories from more than 50 years of prospective and retrospective interview data. For this study, the researchers selected respondents who reported a stroke from 1992 to 2010. The final sample included 2,351 adults aged 41 and older who were observed an average of 5.3 years over the 18-year study period. The researchers found: The risks of dying after a stroke were 71 percent greater for adults who never married than for adults who were continuously married. For patients who were divorced or widowed, the risks of dying after a stroke were 23 percent and 25 percent greater, respectively, than continuously married adults. In patients who were divorced or widowed more than once, the risks of dying after a stroke were 39 percent and 40 percent greater, respectively, than for continuously married adults. There was no evidence that the findings significantly differed between men and women or by race or ethnicity. Analysis of the data suggests that some of these risks are affected by differences in psychological and social factors, such as lack of children, limited social support and depressive symptoms that may have impeded recovery after a stroke. Multiple marital losses in one's lifetime were especially detrimental to recovery, regardless of one's current marital status. Unexpectedly, the researchers found that remarriage did not reduce the risks from past divorce or widowhood. A limitation of the study is that it only included adults who survived to hospital discharge and did not include those who died shortly after having a stroke. The results of this study have possible implications for public health awareness and practice, Dupre said. "More research is needed to know the full clinical implications of our findings. Greater knowledge about the risks associated with marital life and marital loss may be useful for personalizing care and improving outcomes for those who are recovering from a stroke." Author disclosures are on the manuscript. The National Institute on Aging funded the study. Stroke images are located in the right column of this release link http://newsroom. After Dec. 14, 2016, view the manuscript online. About Stroke Follow AHA/ASA news on Twitter @HeartNews. For updates and new science from JAHA, follow @JAHA_AHA. Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association's policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at http://www. .


Bynum J.P.W.,Dartmouth Institute for Health Policy and Clinical Practice | Andrews A.,Dartmouth Institute | Sharp S.,Dartmouth Institute | McCullough D.,Community and family medicine | Wennberg J.E.,Dartmouth Institute
Health Affairs | Year: 2011

Meeting the medical and social needs of elderly people is likely to be costly, disruptive, and at odds with personal preferences if efforts to do so are not well coordinated. We compared two different models of primary care in four different continuing care retirement communities. In the first model, used in one community, the physicians and two parttime nurse practitioners delivered clinical care only at that site, covered all settings within it, and provided all after-hours coverage. In the second model, used in three communities, on-site primary care physician hours were limited; the same physicians also had independent practices outside the retirement community; and after-hours calls were covered by all members of the practices, including physicians who did not practice on site. We found that residents in the first model had two to three times fewer hospitalizations and emergency department visits. Only 5 percent of those who died did so in a hospital, compared to 15 percent at the other sites and 27 percent nationally. These findings provide insight into what is possible when medical care is highly integrated into a residential retirement setting. © 2011 Project HOPE-The People-to-People Health Foundation, Inc.


Rabbi M.,Cornell University | Ali S.,Community and Family Medicine | Choudhury T.,Cornell University | Berke E.,Community and Family Medicine
UbiComp'11 - Proceedings of the 2011 ACM Conference on Ubiquitous Computing | Year: 2011

The idea of continuously monitoring well-being using mobile-sensing systems is gaining popularity. In-situ measurement of human behavior has the potential to overcome the short comings of gold-standard surveys that have been used for decades by the medical community. However, current sensing systems have mainly focused on tracking physical health; some have approximated aspects of mental health based on proximity measurements but have not been compared against medically accepted screening instruments. In this paper, we show the feasibility of a multi-modal mobile sensing system to simultaneously assess mental and physical health. By continuously capturing fine-grained motion and privacy-sensitive audio data, we are able to derive different metrics that reflect the results of commonly used surveys for assessing well-being by the medical community. In addition, we present a case study that highlights how errors in assessment due to the subjective nature of the responses could potentially be avoided by continuous mobile sensing. © 2011 ACM.


Su C.,Dartmouth College | Andrew A.,Community and Family Medicine | Karagas M.R.,Community and Family Medicine | Borsuk M.E.,Dartmouth College
BioData Mining | Year: 2013

We review the applicability of Bayesian networks (BNs) for discovering relations between genes, environment, and disease. By translating probabilistic dependencies among variables into graphical models and vice versa, BNs provide a comprehensible and modular framework for representing complex systems. We first describe the Bayesian network approach and its applicability to understanding the genetic and environmental basis of disease. We then describe a variety of algorithms for learning the structure of a network from observational data. Because of their relevance to real-world applications, the topics of missing data and causal interpretation are emphasized. The BN approach is then exemplified through application to data from a population-based study of bladder cancer in New Hampshire, USA. For didactical purposes, we intentionally keep this example simple. When applied to complete data records, we find only minor differences in the performance and results of different algorithms. Subsequent incorporation of partial records through application of the EM algorithm gives us greater power to detect relations. Allowing for network structures that depart from a strict causal interpretation also enhances our ability to discover complex associations including gene-gene (epistasis) and gene-environment interactions. While BNs are already powerful tools for the genetic dissection of disease and generation of prognostic models, there remain some conceptual and computational challenges. These include the proper handling of continuous variables and unmeasured factors, the explicit incorporation of prior knowledge, and the evaluation and communication of the robustness of substantive conclusions to alternative assumptions and data manifestations. © 2013 Su et al.; licensee BioMed Central Ltd.


News Article | December 8, 2016
Site: www.PR.com

Chapel Hill, NC, December 08, 2016 --( The Practical Playbook is a collaboration between the Department of Community and Family Medicine at Duke School of Medicine and the de Beaumont Foundation. The organization’s mission is to foster collaborations between public health, primary care, and other groups to improve population health by providing practical implementation tools, guidance, and resources. The Practical Playbook Blog features timely, relevant resources and thought-leadership about pressing issues in population health management. The Blog features perspectives from Practical Playbook staff members and experts from partner organizations such as the Prevention Institute and the Illinois Public Health Institute. The eHealthcare Leadership Awards is an elite program that recognizes healthcare professionals for excellence in their digital communications efforts. A total of 116 judges looked at how websites and other digital communications compared with others in their organization’s classification. They also reviewed entries based on a proprietary multi-point standard of Internet excellence. Best Social Networking was among the categories with the highest number of entries. All winners are posted on the Strategic Health Care Communication website (http://www.strategichealthcare.com/award-winners), as well as published in the December 2016 issue of eHealthcare Strategy & Trends, a national healthcare marketing magazine. About Jennings Jennings, founded in 1979, is a healthcare marketing agency specializing in audience engagement. For more information, please visit jenningshealthcaremarketing.com. Chapel Hill, NC, December 08, 2016 --( PR.com )-- Jennings, the North Carolina-based healthcare marketing and consumer engagement firm, is pleased to announce that its client, the Practical Playbook, won a Social Networking Award of Distinction in the 2016 eHealthcare Leadership Awards competition. The winning entry was the Practical Playbook Blog.The Practical Playbook is a collaboration between the Department of Community and Family Medicine at Duke School of Medicine and the de Beaumont Foundation. The organization’s mission is to foster collaborations between public health, primary care, and other groups to improve population health by providing practical implementation tools, guidance, and resources. The Practical Playbook Blog features timely, relevant resources and thought-leadership about pressing issues in population health management. The Blog features perspectives from Practical Playbook staff members and experts from partner organizations such as the Prevention Institute and the Illinois Public Health Institute.The eHealthcare Leadership Awards is an elite program that recognizes healthcare professionals for excellence in their digital communications efforts. A total of 116 judges looked at how websites and other digital communications compared with others in their organization’s classification. They also reviewed entries based on a proprietary multi-point standard of Internet excellence. Best Social Networking was among the categories with the highest number of entries.All winners are posted on the Strategic Health Care Communication website (http://www.strategichealthcare.com/award-winners), as well as published in the December 2016 issue of eHealthcare Strategy & Trends, a national healthcare marketing magazine.About JenningsJennings, founded in 1979, is a healthcare marketing agency specializing in audience engagement. For more information, please visit jenningshealthcaremarketing.com. Click here to view the list of recent Press Releases from Jennings


Von Reyn C.F.,Dartmouth Hitchcock Medical Center | Mtei L.,Muhimbili University of Health and Allied Sciences | Arbeit R.D.,Tufts University | Waddell R.,Dartmouth Hitchcock Medical Center | And 8 more authors.
AIDS | Year: 2010

Objective: To determine whether a multiple-dose series of an inactivated whole cell mycobacterial vaccine, Mycobacterium vaccae, can prevent HIV-associated tuberculosis. Design and Methods: The DarDar trial was a randomized, placebo-controlled, double-blind trial. The study was carried in an outpatient facility in Dar es Salaam, Tanzania. HIV-infected patients with CD4 cell counts of at least 200 cells/μl and a Bacille Calmette-Guérin scar were chosen for the study. The intervention was carried out by random 1:1 assignment to five intradermal doses of M. vaccae or placebo. Tuberculin skin tests were performed, and patients with reactions of at least 5 mm were administered isoniazid for 6 months. The main outcome measures were disseminated (primary endpoint), definite, and probable tuberculosis (secondary endpoints). Results: Two thousand thirteen individuals were randomized (1006 to M. vaccae, 1007 to placebo) and followed every 3 months for a median of 3.3 years. The trial was terminated early because of slow accrual of cases of disseminated tuberculosis and significant protection against definite tuberculosis. Hazard ratios were disseminated tuberculosis 0.52 (95% confidence interval 0.21-1.34; seven cases in M. vaccae, 13 cases in placebo; log-rank P = 0.16), definite tuberculosis 0.61 (95% confidence interval 0.39-0.96; 33 cases in M. vaccae, 52 cases in placebo; P = 0.03), and probable tuberculosis 1.17 (95% confidence interval 0.76-1.80; 48 cases in M. vaccae, 40 cases in placebo; P = 0.46). Immunization was well tolerated, with no adverse effect on CD4 cell count or HIV viral load, and no increase in the rate of serious adverse events. Conclusion: Administration of a multiple-dose series of M. vaccae to HIV-infected adults with childhood Bacille Calmette-Guérin immunization is safe and is associated with significant protection against definite tuberculosis. These results provide evidence that immunization with a whole cell mycobacterial vaccine is a viable strategy for the prevention of HIV-associated tuberculosis. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Yan J.,Indiana University | Du L.,Indiana University | Kim S.,Indiana University | Risacher S.L.,Indiana University | And 4 more authors.
Bioinformatics | Year: 2014

Motivation: Imaging genetics is an emerging field that studies the influence of genetic variation on brain structure and function. The major task is to examine the association between genetic markers such as single-nucleotide polymorphisms (SNPs) and quantitative traits (QTs) extracted from neuroimaging data. The complexity of these datasets has presented critical bioinformatics challenges that require new enabling tools. Sparse canonical correlation analysis (SCCA) is a bi-multivariate technique used in imaging genetics to identify complex multi-SNP-multi-QT associations. However, most of the existing SCCA algorithms are designed using the soft thresholding method, which assumes that the input features are independent from one another. This assumption clearly does not hold for the imaging genetic data. In this article, we propose a new knowledge-guided SCCA algorithm (KG-SCCA) to overcome this limitation as well as improve learning results by incorporating valuable prior knowledge. Results: The proposed KG-SCCA method is able to model two types of prior knowledge: one as a group structure (e.g. linkage disequilibrium blocks among SNPs) and the other as a network structure (e.g. gene co-expression network among brain regions). The new model incorporates these prior structures by introducing new regularization terms to encourage weight similarity between grouped or connected features. A new algorithm is designed to solve the KG-SCCA model without imposing the independence constraint on the input features. We demonstrate the effectiveness of our algorithm with both synthetic and real data. For real data, using an Alzheimer's disease (AD) cohort, we examine the imaging genetic associations between all SNPs in the APOE gene (i.e. top AD gene) and amyloid deposition measures among cortical regions (i.e. a major AD hallmark). In comparison with a widely used SCCA implementation, our KG-SCCA algorithm produces not only improved cross-validation performances but also biologically meaningful results. © The Author 2014. Published by Oxford University Press. All rights reserved.

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