Other Masters of Science Program Theses
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Item Evaluation of All-Cause Mortality Associated with Vascular Access Restoration Procedures: A Self-Controlled Case Series and Cohort Analysis Using USRDS Database(Albany College of Pharmacy and Health Sciences Theses, 2020-12) Paratane, Deepika '20Objectives: The goal of this thesis was to evaluate the association between vascular access restoration procedures for thrombosis and mortality among end-stage renal disease (ESRD) patients. The specific aims are to: (i) estimate the risk of all-cause mortality, and (ii) identify risk factors associated with mortality, within 7 days of a vascular access restoration procedure. Methods: Data are from the United States Renal Data System (USRDS) and encompass 2011-2015. A self-controlled case series design with conditional Poisson regression was implemented in aim (i) to compare 7-day mortality risk with a control period of 8 to 90 days following the procedure. In aim (ii), a cohort study with logistic regressions adjusted for patient age and comorbidities were performed to examine the relationship between patient and procedural characteristics and 7-day mortality. In both objectives, models were stratified by procedure setting (i.e., inpatient vs. outpatient) to examine potential effect measure modification. Results: In aim (i), 516 patients were included in the study population. The risk of 7-day mortality was 1.4 (95% confidence interval (CI): 1.1, 1.9) times higher in comparison with the control period. In stratified analyses, inpatients experienced 2.8 (95% CI: 1.8, 4.4) times greater 7-day mortality than the control period, however, no differences in mortality was found among outpatients (RR: 1.0, 95% CI: 0.7, 1.5). In aim (ii), 10,821 patients were included in the study cohort. In adjusted analyses, outpatients undergoing a catheterization or combined procedure had a 3.9 (95% CI: 1.2, 13.3) and 2.9 (95% CI: 1.4, 5.9) times greater 7-day mortality risk than participants undergoing an endovascular procedure, respectively, and a 5.2 (95% CI: 1.5, 17.8) times greater risk of mortality if the procedure was performed by a provider with a specialty other than ESRD/vascular access procedures. Among inpatients, each additional day since the last date of dialysis and the procedure was associated with a 1.1 (95% CI: 1.0, 1.3) times greater mortality risk. Conclusions: Our study suggests there exists an increased risk of 7-day mortality following a vascular access restoration procedure among inpatients, and that several patient and procedure-related characteristics were associated with a higher risk of death.Item Effects of Education and Other Socioeconomic Variables on Human Immunodeficiency Virus Seroprevalence in India, Russia, South Africa and the United States of America(Albany College of Pharmacy and Health Sciences Theses, 2016) Chikermane, Soumya Gourang '16Objective: According to the World Bank, increasing global funding to eradicate HIV in developing countries has not been successful as newly-diagnosed HIV cases continue to emerge. Given the widespread presence of this disease in the world, this research aims to establish the link between education and macro-level socioeconomic variables with the HIV epidemic in India, Russia, South Africa and the United States of America (USA). Methods: Socioeconomic variables were extracted from the World Development Indicators dataset of the World Bank Data Repository. The HIV variables were identified from the surveillance reports of individual countries. A time series analysis was performed for the study countries and a multivariate regression analysis was conducted for which a significance level was established at a p-value \342\211\244 0.10. A panel analysis was performed to examine the impact of independent variables on the HIV epidemic in the developing countries by reducing heterogeneity. Results: These results provide a comparison between the study countries to determine if there is a common factor that countries could put resources into to combat the HIV epidemic. The regression analysis demonstrated that in India, HIV incidence had an inverse relationship with secondary school enrollment for females (p < 0.0001). Furthermore, in Russia HIV prevalence increased with improved access to water sources in rural areas (p = 0.0082). Likewise, HIV prevalence in South Africa was positively related to the change in iv improved access to sanitation facilities in the urban areas (p = 0.001). These results are consistent with the literature however an unusual relationship was observed between enrollment and HIV incidence in the USA and Russia. Results of the panel analysis demonstrated a significant effect of school enrollment on HIV incidence in the three developing countries. This study looked at various socioeconomic aspects of the four countries to give a plausible explanation for the results which were not consistent with the literature. Conclusion: This research provides an important indication of which macro-level factors can be addressed to curb HIV in the developing world. Additionally, this research can potentially provide an important indication of how best to employ limited resources.Item Temporal and Geographic Trends and Outcomes of Surgical Procedures for Diseases of the Pancreas in New York State(Albany College of Pharmacy and Health Sciences Theses, 2016) Nair, Abhishek Anil '16Aim: Pancreatic resection is performed for a wide range of malignant (e.g., pancreatic cancer) and non-malignant indications (e.g., traumatic injury and cysts).This research aims to determine the volume-outcome relationship between hospital volume and surgeon volume with in-hospital mortality as well as to determine the temporal trends in utilization of the three most commonly used pancreatectomy procedures (Whipple, distal pancreatectomy and total pancreatectomy). The study also indirectly determines the regionalization of pancreatectomy procedures in New York State.Item The Impact of High Deductible Health Plans on Preventive Care Use(Albany College of Pharmacy and Health Sciences Theses, 2015) Wright, Daniel John '15Background: With rising health insurance costs, high deducible health plans (HDHPs) are becoming more prevalent as a means to prevent overutilization and to control spending. However, there are concerns that despite the well-documented cost effectiveness of preventive services (e.g., hypertension screening, colorectal cancer screening), HDHPs may decrease preventive service utilization. Therefore, the increasing prevalence of HDHPs combined with their potential to reduce uptake of key preventive services merits further investigation.Item The Influence of Race, Gender and Age on Hypertension(Albany College of Pharmacy and Health Sciences Theses, 2014) Alamoudi, Jawaher '14AIMS: To estimate the prevalence of hypertension in New York State and demonstrate the influence of race, ethnicity, gender and age on hypertension; to illustrate that race is a significant predictor of blood pressure; to show that ethnicity, gender and age are also factors for hypertension.