Papers by Judith Chamberlin
For more information about the Aflacontrol Project, please visit www.ifpri.org/afla/afla.asp. Afl... more For more information about the Aflacontrol Project, please visit www.ifpri.org/afla/afla.asp. Aflacontrol is a collaborative research project funded by the Bill & Melinda Gates Foundation and managed by the International Food Policy Research Institute.
JAMA: The Journal of the American Medical Association, 1997
To determine the number and kinds of programs that medical schools and managed care organizations... more To determine the number and kinds of programs that medical schools and managed care organizations offer or plan to offer to retrain physician specialists to practice primary care medicine and to discover physicians' attitudes toward such retraining. A survey was mailed in 1994 to all 126 medical schools and the 19 largest US managed care organizations to collect detailed information about existing and potential retraining programs. Physicians' attitudes toward retraining were elicited from participants in 3 geographically diverse focus groups. Selected specialists were polled through the national survey of the American Medical Association's Socioeconomic Monitoring System to ascertain the demand for retraining. The majority of institutions contacted perceived a need for retraining, but few programs had been established. Programs being "considered" varied widely in duration, class size, target audience, accreditation, and projected training settings. Although unenthusiastic about retraining, physicians preferred programs that would expand their patient base, maintain the practice population, be inexpensive and close to home, and provide hands-on training in the eventual practice environment. Physicians also preferred a goal-oriented, part-time retraining program in a large group practice or managed care setting that would allow them to practice their specialty while retraining. Few planned or existing programs incorporate many of these features. The most likely candidates for retraining are subspecialty physicians who currently provide some primary care and are employed by a medical plan. Despite efforts by those who perceive that a need for more generalist physicians is stimulating interest in retraining specialists and subspecialists to provide primary medical care, physician interest and program availability remain low, and programs under development are not being designed to attract those who may seek retraining. This situation is probably fortuitous, because changed perceptions about the adequacy of the generalist physician workforce since the beginning of this study have diminished the call for retraining.
The American Journal of Tropical Medicine and Hygiene, 1996
Adults in the Stann Creek District of Belize have a high prevalence of hepatitis B virus (HBV) in... more Adults in the Stann Creek District of Belize have a high prevalence of hepatitis B virus (HBV) infection, but the age of onset of these infections is unclear. We conducted a seroprevalence study of hepatitis B markers among Stann Creek school-age children to provide information for planning a hepatitis B vaccine program. The overall prevalence in 587 students was high for antibody to hepatitis B core antigen (anti-HBc) (43.3%) and hepatitis B surface antigen (HBsAg) (7.7%). There was marked variation of anti-HBc by school and by the predominant ethnic groups attending those schools. Maya had the highest prevalence (76%), followed by Mestizo (50%), Garifuna (37%), and Creole (25%). Children less than nine years of age attending the rural primary schools (mostly Mayan and Mestizo) had significantly higher prevalence of anti-HBc than did children attending the urban primary school (mostly Garifuna and Creole) (P < 0.05). Anti-HBc was found in 42% and 36% of students at the two high schools. Of the five schools tested, only at the urban primary school did anti-HBc positivity increase with age. Based on an analysis of the cost of serologic screening before immunization compared with mass vaccination, preimmunization serologic screening resulted in vaccine program cost savings in four of the five schools. Because most children in the rural areas contract hepatitis B before entering school, immunization against HBV should be integrated into the routine infant immunization program.
This article cites 7 articles, 4 of which can be accessed free at: CONTENT ALERTS more»articles c... more This article cites 7 articles, 4 of which can be accessed free at: CONTENT ALERTS more»articles cite this article), Receive: RSS Feeds, eTOCs, free email alerts (when new
Culex tritaeniorhynchus is the primary vector of Japanese encephalitis virus (JEV) throughout muc... more Culex tritaeniorhynchus is the primary vector of Japanese encephalitis virus (JEV) throughout much of the tropical and temperate climates of Asia. Several recent papers have used ecological niche modeling programs, e.g., Maxent and GARP, to predict the distribution of disease vectors (e.g. Peterson and Shaw 2003, Moffett et al. 2007). In this on-going study, we used the Maxent program to model the distribution of Cx. tritaeniorhynchus in the Republic of Korea. Using mosquito collection data, temperature, precipitation, elevation, land cover, and SPOT normalized difference vegetation index (NDVI), models were created for each month for a period of five years. Output maps from the models matched several known ecological characteristics of this species' distribution. The output maps show the highest probabilities of mosquito occurrence in August and September, which correlates to the observed mosquito population density peaks. The model demonstrated low probabilities for forest cov...
The author hereby cenifies thai the use of any copyrighted material in the thesis manuscript enti... more The author hereby cenifies thai the use of any copyrighted material in the thesis manuscript entitled: "'The Epidemiology of BartoaeUosis in Peru" is appropriately acknowledged an«i beyond brief excerpts" is with the permission of the copyright owner.
Eos, Transactions American Geophysical Union, 2002
Abstract The consequences of climate variability on human health, especially for poor and medical... more Abstract The consequences of climate variability on human health, especially for poor and medically underserved populations, have received much attention in recent years. Some of the most severe health hazards induced by climate variability are epidemics of vector-...
The consequences of climate variability on human health, especially for poor and medically unders... more The consequences of climate variability on human health, especially for poor and medically underserved populations, have received much attention in recent years. Some of the most severe health hazards induced by climate variability are epidemics of vector-borne infectious diseases. Entomologic studies have shown that insect vectors that transmit diseases, such as malaria, yellow fever, dengue, etc., are sensitive to temperature, humidity wind, and rainfall patterns, and therefore, their abundance is potentially influenced by climate variability. Because of its geographical location, the climate of tropical South America is strongly influenced by El Niño. The episodic outbreaks of various diseases in this region have been linked to the El Niño cycles. Yet, according to a report of the World Health Organization [1999], early results from South American epidemiological studies, which were based on the aggregated national disease data irrespective of the regional meteorological impacts, found no consistent correlation between the El Niño effect with the epidemics of malaria and yellow fever.
Journal of Clinical Microbiology, 2004
␣-proteobacterium Bartonella bacilliformis. Distribution of the disease is considered coincident ... more ␣-proteobacterium Bartonella bacilliformis. Distribution of the disease is considered coincident with the distribution of its known vector, the sand fly Lutzomyia verrucarum. Recent epidemics of B. bacilliformis infections associated with atypical symptomatology in nonendemic regions have raised questions regarding the historic and present distribution of this bacterium and the scope of disease that infection causes. Phylogenetic relationships and genomic diversity of 18 B. bacilliformis isolates (10 isolates from a region where Carrion's disease is epidemic, Cuzco, Peru, and 8 isolates from a region where Carrion's disease is endemic, Caraz, Peru) were assessed using genomic data generated by infrequent restriction site PCR and gene sequence analysis of the flagellin gltA and ialB genes. A population genetic analysis of the genomic diversity suggests that what was once considered an epidemic region of Peru did not result from the recent introduction of B. bacilliformis.
The Journal of Infectious Diseases, 2002
Bartonella bacilliformis has caused debilitating illness since pre-Incan times, but relatively li... more Bartonella bacilliformis has caused debilitating illness since pre-Incan times, but relatively little is known about its epidemiology. A population-based, prospective cohort investigation was conducted in a Peruvian community with endemic bartonellosis. By use of house-to-house and hospital surveillance methods, cohort participants were monitored for evidence of bartonellosis. Of 690 participants, 0.5% had asymptomatic bacteremia at study initiation. After 2 years of follow-up, the incidence of infection was 12.7/100 person-years. The highest rates were in children <5 years old, and there was a linear decrease in incidence with increasing age. Seventy percent of cases were clustered in 18% of households. Age and bartonellosis in a family member were the best predictors of B. bacilliformis infection. There were multiple clinical presentations and significant subclinical infection. A cost-effective control strategy should include vector control and surveillance efforts focused on children and clusters of households with highest endemicity.
Journal of Clinical Microbiology, Nov 1, 2000
Bartonella bacilliformis causes bartonellosis, a potentially life-threatening emerging infectious... more Bartonella bacilliformis causes bartonellosis, a potentially life-threatening emerging infectious disease seen in the Andes Mountains of South America. There are no generally accepted serologic tests to confirm the disease. We developed an indirect fluorescence antibody (IFA) test for the detection of antibodies to B. bacilliformis and then tested its performance as an aid in the diagnosis of acute bartonellosis. The IFA is 82% sensitive in detecting B. bacilliformis antibodies in acute-phase blood samples of laboratory-confirmed bartonellosis patients. When used to examine convalescent-phase sera, the IFA is positive in 93% of bartonellosis cases. The positive predictive value of the test is 89% in an area of Peru where B. bacilliformis is endemic and where the point prevalence of infection is 45%.
Culex tritaeniorhynchus is the primary vector of Japanese encephalitis virus (JEV) throughout muc... more Culex tritaeniorhynchus is the primary vector of Japanese encephalitis virus (JEV) throughout much of the tropical and temperate climates of Asia. Several recent papers have used ecological niche modeling programs, e.g., Maxent and GARP, to predict the distribution of disease vectors (e.g. Shaw 2003, Moffett et al. 2007). In this on-going study, we used the Maxent program to model the distribution of Cx. tritaeniorhynchus in the Republic of Korea. Using mosquito collection data, temperature, precipitation, elevation, land cover, and SPOT normalized difference vegetation index (NDVI), models were created for each month for a period of five years. Output maps from the models matched several known ecological characteristics of this species' distribution. The output maps show the highest probabilities of mosquito occurrence in August and September, which correlates to the observed mosquito population density peaks. The model demonstrated low probabilities for forest covered mountains, which corresponds to findings in the literature that Cx. tritaeniorhynchus is infrequently found above 1,000 meters. The modeling effort demonstrated several limitations in the data set, including a low number of collection sites that did not cover the full range of environmental conditions within the study area. Additional collection sites would improve the models and allow for improved testing of the results. Future goals of this project include developing real-time predictions based on NDVI data and expanding the prediction to a larger geographical area.
Journal of clinical microbiology, 2000
Bartonella bacilliformis causes bartonellosis, a potentially life-threatening emerging infectious... more Bartonella bacilliformis causes bartonellosis, a potentially life-threatening emerging infectious disease seen in the Andes Mountains of South America. There are no generally accepted serologic tests to confirm the disease. We developed an indirect fluorescence antibody (IFA) test for the detection of antibodies to B. bacilliformis and then tested its performance as an aid in the diagnosis of acute bartonellosis. The IFA is 82% sensitive in detecting B. bacilliformis antibodies in acute-phase blood samples of laboratory-confirmed bartonellosis patients. When used to examine convalescent-phase sera, the IFA is positive in 93% of bartonellosis cases. The positive predictive value of the test is 89% in an area of Peru where B. bacilliformis is endemic and where the point prevalence of infection is 45%.
Archives of family medicine
To study whether physician awareness of symptom-related expectations and mental disorders reduces... more To study whether physician awareness of symptom-related expectations and mental disorders reduces unmet expectations or improves patient satisfaction. Prospective, before-after trial, with control (n = 250) and intervention (n = 250) groups. Outcomes were assessed immediately after the index office visit, at 2 weeks, and at 3 months. Ambulatory walk-in clinic. Five hundred adults with physical complaints. Exclusion criteria included upper respiratory tract infection and dementia. Follow-up was accomplished in 100% immediately after the visit, 92.6% at 2 weeks, and 82.6% at 3 months. Two-hour physician workshop followed by information provided before each visit on patient expectations, illness worry, and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) disorders. Symptom-related expectations, satisfaction with care, symptom improvement, functional status, physician-perceived difficulty of the encounter, visit costs, and use of health care services. Serio...
ABSTRACT Fig. 1 One-grid correlation of TRMM TMI rainfall at test sites of Caraz (a) and Cusco (b... more ABSTRACT Fig. 1 One-grid correlation of TRMM TMI rainfall at test sites of Caraz (a) and Cusco (b) with that over surroundings.
Geospatial health, 2010
Over 35,000 cases of Japanese encephalitis (JE) are reported worldwide each year. Culex tritaenio... more Over 35,000 cases of Japanese encephalitis (JE) are reported worldwide each year. Culex tritaeniorhynchus is the primary vector of the JE virus, while wading birds are natural reservoirs and swine amplifying hosts. As part of a JE risk analysis, the ecological niche modeling programme, Maxent, was used to develop a predictive model for the distribution of Cx. tritaeniorhynchus in the Republic of Korea, using mosquito collection data, temperature, precipitation, elevation, land cover and the normalized difference vegetation index (NDVI). The resulting probability maps from the model were consistent with the known environmental limitations of the mosquito with low probabilities predicted for forest covered mountains. July minimum temperature and land cover were the most important variables in the model. Elevation, summer NDVI (July-September), precipitation in July, summer minimum temperature (May-August) and maximum temperature for fall and winter months also contributed to the model. Comparison of the Cx. tritaeniorhynchus model to the distribution of JE cases in the Republic of Korea from 2001 to 2009 showed that cases among a highly vaccinated Korean population were located in high-probability areas for Cx. tritaeniorhynchus. No recent JE cases were reported from the eastern coastline, where higher probabilities of mosquitoes were predicted, but where only small numbers of pigs are raised. The geographical distribution of reported JE cases corresponded closely with the predicted high-probability areas for Cx. tritaeniorhynchus, making the map a useful tool for health risk analysis that could be used for planning preventive public health measures.
Social Science & Medicine, 2001
Correlates of patient satisfaction at varying points in time were assessed using a survey with 2-... more Correlates of patient satisfaction at varying points in time were assessed using a survey with 2-week and 3-month follow-up in a general medicine walk-in clinic, in USA. Five hundred adults presenting with a physical symptom, seen by one of 38 participating clinicians were surveyed and the following measurements were taken into account: patient symptom characteristics, symptom-related expectations, functional status (Medical Outcomes Study Short-Form Health Survey [SF-6]), mental disorders (PRIME-MD), symptom resolution, unmet expectations, satisfaction (RAND 9-item survey), visit costs and health utilization. Physician perception of difficulty (Difficult Doctor-Patient Relationship Questionnaire), and Physician Belief Scale. Immediately after the visit, 260 (52%) patients were fully satisfied with their care, increasing to 59% at 2 weeks and 63% by 3 months. Patients older than 65 and those with better functional status were more likely to be satisfied. At all time points, the presence of unmet expectations markedly decreased satisfaction: immediately post-visit (OR: 0.14, 95% CI: 0.07-0.30), 2-week (OR: 0.07, 95% CI: 0.04-0.13) and 3-month (OR: 0.05, 95% CI: 0.03-0.09). Other independent variables predicting immediate after visit satisfaction included receiving an explanation of the likely cause as well as expected duration of the presenting symptom. At 2 weeks and 3 months, experiencing symptomatic improvement increased satisfaction while additional visits (actual or anticipated) for the same symptom decreased satisfaction. A lack of unmet expectations was a powerful predictor of satisfaction at all time-points. Immediately post-visit, other predictors of satisfaction reflected aspects of patient-doctor communication (receiving an explanation of the symptom cause, likely duration, lack of unmet expectations), while 2week and 3-month satisfaction reflected aspects of symptom outcome (symptom resolution, need for repeat visits, functional status). Patient satisfaction surveys need to carefully consider the sampling time frame as well as adjust for pertinent patient characteristics. #
Psychosomatics, 2003
The authors sought to explore gender differences among patients with physical symptoms who came t... more The authors sought to explore gender differences among patients with physical symptoms who came to see internists. The women were younger, more likely to report stress, endorsed more "other, currently bothersome" symptoms, were more likely to have a mental disorder, and were less likely to be satisfied with their care. The men were slower to improve, but there was no difference between the sexes after 3 months. There were no differences in the number, type, duration, or severity of symptoms or in the expectation of care, costs of visits, intervention received, use of health care services, or likelihood of being considered difficult by their physician. The gender of the clinician had no effect on any outcome.
The Journal of Infectious Diseases, 2002
Bartonella bacilliformis has caused debilitating illness since pre-Incan times, but relatively li... more Bartonella bacilliformis has caused debilitating illness since pre-Incan times, but relatively little is known about its epidemiology. A population-based, prospective cohort investigation was conducted in a Peruvian community with endemic bartonellosis. By use of house-to-house and hospital surveillance methods, cohort participants were monitored for evidence of bartonellosis. Of 690 participants, 0.5% had asymptomatic bacteremia at study initiation. After 2 years of follow-up, the incidence of infection was 12.7/100 person-years. The highest rates were in children <5 years old, and there was a linear decrease in incidence with increasing age. Seventy percent of cases were clustered in 18% of households. Age and bartonellosis in a family member were the best predictors of B. bacilliformis infection. There were multiple clinical presentations and significant subclinical infection. A cost-effective control strategy should include vector control and surveillance efforts focused on children and clusters of households with highest endemicity.
Journal of Clinical Microbiology, 2004
␣-proteobacterium Bartonella bacilliformis. Distribution of the disease is considered coincident ... more ␣-proteobacterium Bartonella bacilliformis. Distribution of the disease is considered coincident with the distribution of its known vector, the sand fly Lutzomyia verrucarum. Recent epidemics of B. bacilliformis infections associated with atypical symptomatology in nonendemic regions have raised questions regarding the historic and present distribution of this bacterium and the scope of disease that infection causes. Phylogenetic relationships and genomic diversity of 18 B. bacilliformis isolates (10 isolates from a region where Carrion's disease is epidemic, Cuzco, Peru, and 8 isolates from a region where Carrion's disease is endemic, Caraz, Peru) were assessed using genomic data generated by infrequent restriction site PCR and gene sequence analysis of the flagellin gltA and ialB genes. A population genetic analysis of the genomic diversity suggests that what was once considered an epidemic region of Peru did not result from the recent introduction of B. bacilliformis.
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Papers by Judith Chamberlin