Papers by Gilbert Ramirez
Journal of AIDS & Clinical Research, 2012
Western journal of nursing research, Jan 19, 2014
A relatively novel type of meta-analysis, a model-driven meta-analysis, involves the quantitative... more A relatively novel type of meta-analysis, a model-driven meta-analysis, involves the quantitative synthesis of descriptive, correlational data and is useful for identifying key predictors of health outcomes and informing clinical guidelines. Few such meta-analyses have been conducted and thus, large bodies of research remain unsynthesized and uninterpreted for application in health care. We describe the unique challenges of conducting a model-driven meta-analysis, focusing primarily on issues related to locating a sample of published and unpublished primary studies, extracting and verifying descriptive and correlational data, and conducting analyses. A current meta-analysis of the research on predictors of key health outcomes in diabetes is used to illustrate our main points.
Diabetes Care, 1992
OBJECTIVE To assess the efficacy of combination therapy with insulin and sulfonylurea in the trea... more OBJECTIVE To assess the efficacy of combination therapy with insulin and sulfonylurea in the treatment of NIDDM. RESEARCH DESIGN AND METHODS Studies published between January 1966 and January 1991 were identified through a computerized Medline search and by hand searching the bibliographies of identified articles. We identified 17 eligible randomized, controlled trials of combination therapy in NIDDM. These trials had a minimum duration of 8 wk and at least one of three outcome measures (fasting glucose, HbA1, or C-peptide) with SD or SE of the mean reported to do metaanalysis. With standardized forms, three independent reviews abstracted measures of study quality and specific descriptive information about population, intervention, and outcome measurements. RESULTS We calculated effect size and weighted mean changes of the three outcome measures for control and treatment groups. In the treatment group, the fasting plasma glucose decreased from a mean of 11.4 mM (206 mg/dl) at baseli...
Frontiers in Public Health, 2020
Background: The scientific evidence of the health risks associated with the consumption of raw mi... more Background: The scientific evidence of the health risks associated with the consumption of raw milk has been known for a long time. However, less clear is the impact of acquiring infectious diseases from raw milk consumption in the United States (US) due to incomplete reporting of cases and the complex factors associated with the sale and consumption of raw milk. Investigations of this current study focused on human brucellosis, one of the infectious diseases commonly acquired through the consumption of raw milk and milk products, and which continues to be a public health threat worldwide. Methodology: A qualitative systematic review of the sources of opinions that contribute to the increased trend of raw milk sales and consumption in the US was conducted. Results: Interestingly, opinions about the sale of raw milk and/or the benefits arising from its consumption varied by US region, with the proportion of messages supporting raw milk consumption being highest in the Northeast compared to other US regions. Several evidence gaps and factors that possibly contribute to the increased prevalence of raw milk-acquired brucellosis were identified including inadequate monitoring of the raw milk sales process and lack of approved diagnostic methods for validating the safety of raw milk for human consumption. Conclusions: The unavailability of data specifying brucellosis cases acquired from raw milk consumption have precluded the direct association between raw milk and increased brucellosis prevalence in the United States. Nevertheless, the evidence gaps identified in this study demonstrate the need for intensified surveillance of raw-milk acquired infectious diseases including human brucellosis; establishment of safety and quality control measures for the process of selling raw milk; and design of an effective strategy for the prevention of raw milk-acquired infectious diseases including brucellosis. Overall, for the first time, this study has not only shown the gaps in evidence that require future investigations, but also, variations in the perception of raw milk consumption that may impact disease acquisition in different US regions.
Patient education and counseling, Oct 19, 2016
To conduct a model-driven meta-analysis of correlational research on psychological and motivation... more To conduct a model-driven meta-analysis of correlational research on psychological and motivational predictors of diabetes outcomes, with adherence factors as mediators. A comprehensive literature search of published and unpublished studies located a sample of 775 individual correlational or predictive studies reported across 739 research reports. Results varied according to the outcome variable included in the regression models. Depression had a larger negative effect on adherence to physical activity than on dietary adherence. Coping and self-efficacy were strongly related to dietary adherence, which was strongly related to improved glycemic control. Medication adherence was related to glycosylated hemoglobin, whereas medications and self-monitoring were related to fasting blood glucose. Adding appointment keeping to the models did not significantly alter the results. Self-efficacy was the most consistent predictor of all adherence behaviors and dietary adherence was the most sign...
American Journal of Preventive Medicine, 2016
, MPH, 7 and the Community Preventive Services Task Force Context: Sedentary time spent with scre... more , MPH, 7 and the Community Preventive Services Task Force Context: Sedentary time spent with screen media is associated with obesity among children and adults. Obesity has potentially serious health consequences, such as heart disease and diabetes. This Community Guide systematic review examined the effectiveness and economic efficiency of behavioral interventions aimed at reducing recreational (i.e., neither school-nor work-related) sedentary screen time, as measured by screen time, physical activity, diet, and weight-related outcomes. Evidence acquisition: For this review, an earlier ("original") review (search period, 1966 through July 2007) was combined with updated evidence (search period, April 2007 through June 2013) to assess effectiveness of behavioral interventions aimed at reducing recreational sedentary screen time. Existing Community Guide systematic review methods were used. Analyses were conducted in 2013-2014. Evidence synthesis: The review included 49 studies. Two types of behavioral interventions were evaluated that either (1) focus on reducing recreational sedentary screen time only (12 studies); or (2) focus equally on reducing recreational sedentary screen time and improving physical activity or diet (37 studies). Most studies targeted children aged r13 years. Children's composite screen time (TV viewing plus other forms of recreational sedentary screen time) decreased 26.4 (interquartile interval¼-74.4,-12.0) minutes/day and obesity prevalence decreased 2.3 (interquartile interval¼-4.5,-1.2) percentage points versus a comparison group. Improvements in physical activity and diet were reported. Three study arms among adults found composite screen time decreased by 130.2 minutes/day. Conclusions: Among children, these interventions demonstrated reduced screen time, increased physical activity, and improved diet-and weight-related outcomes. More research is needed among adolescents and adults.
Preventing Chronic Disease, 2015
The Community Preventive Services Task Force recommends reducing patient out-of-pocket costs (ROP... more The Community Preventive Services Task Force recommends reducing patient out-of-pocket costs (ROPC) for medications to control high blood pressure and high cholesterol when combined with additional interventions aimed at improving patient-provider interaction and patient knowledge, such as team-based care with medication counseling, and patient education.
Evidence report/technology assessment (Summary), 2000
Study selection Study designs of evaluations included in the review Efficacy: randomised controll... more Study selection Study designs of evaluations included in the review Efficacy: randomised controlled trials (RCTs), downgraded to prospective controlled trials after the initial search, were included. Harm: RCTs, cohort studies, case series and case reports were included. Specific interventions included in the review Supplemental milk thistle. The eligible controls were placebo, no supplement, other oral supplements, and drugs. Of the 16 placebo-controlled studies subject to meta-analysis, 12 used Legalon. In 8 trials, the dosages were 240 to 800 mg/day and the trial duration ranged from 7 days to 6 years; the dosage and duration were not given in the other 4 studies. Two studies used silymarin (210 and 800 mg) and 2 used silipide (240 mg/day); the treatment duration ranged from 7 to 446 days in 3 studies, but was not reported for the fourth. Participants included in the review Humans with liver disease of various aetiologies, e.g. alcoholic and non-alcoholic cirrhosis, alcoholic hepatitis, hepatitis B, hepatitis C, drug-induced liver disease, fatty degeneration. Outcomes assessed in the review Efficacy: physiological (laboratory or histological assessment of in vivo liver function) and clinical outcomes were assessed. The clinical outcomes were morbidity, mortality, hospitalisation, quality of life, symptoms, and Child's score for chronic liver disease. Harm: any reported adverse effect was assessed. The clinical outcomes were morbidity, mortality, hospitalisation, quality of life, symptoms, and Child's score. The majority of the accepted papers used laboratory tests as the primary outcome. How were decisions on the relevance of primary studies made? At least two independent reviewers scanned the titles and abstracts using pre-specified criteria for each question. The full texts that were retrieved were screened in the same manner.
Psychopharmacology bulletin, 1998
Depressive disorders are persistent, recurring illnesses that impose enormous personal suffering ... more Depressive disorders are persistent, recurring illnesses that impose enormous personal suffering on individuals and their families. Major depression alone is estimated as the fourth most important cause of worldwide loss in disability-adjusted life years and is likely to become the second most important within 20 years. A continued quest for more effective treatments has spawned newer antidepressants and herbal treatments, which have contributed to explosive growth in antidepressant prescribing, increasing pharmacy costs, and wider but sometimes confusing choices for clinicians and patients. This evidence report provides a comprehensive evaluation of the benefits and adverse effects of newer pharmacotherapies and herbal treatments for depressive disorders in adults and children. Pertinent literature from 1980 to January 1998 was identified from a specialized registry of controlled trials, meta-analyses, and experts. The registry contained trials addressing depression that had been i...
Vascular Health and Risk Management, 2012
Background: Dyslipidemia and type 2 diabetes are two of the most significant risk factors for the... more Background: Dyslipidemia and type 2 diabetes are two of the most significant risk factors for the development of cardiovascular disease. Measurement of lipoprotein subclasses provides important information about derangements in lipid metabolism and helps refine cardiovascular risk assessment. Exenatide, a glucagon-like peptide 1 receptor agonist, improved glycemic control, obesity, hypertension, and dyslipidemia in patients with type 2 diabetes in clinical trials. Methods: In the DURATION-1 trial, patients with type 2 diabetes were treated with exenatide once weekly or twice daily for 30 weeks. This post hoc analysis evaluated the impact of exenatide on lipoprotein subclasses in 211 DURATION-1 patients using vertical auto profile methodology and the Statistical Package for the Social Sciences general linear model adjusted for glycosylated hemoglobin (HbA 1c) and weight. Results: Baseline lipids and high sensitivity C-reactive protein were normal overall based on the standard lipid panel. Once-weekly exenatide reduced apolipoprotein B and the apolipoprotein B to apolipoprotein A1 ratio (P , 0.05), independent of glycemic improvement and weight loss. A significant shift in lipoprotein pattern away from small, dense low-density lipoprotein-4 cholesterol was also observed (P , 0.05). Exenatide once weekly increased high-density lipoprotein-2 cholesterol, even after adjustment for changes in HbA 1c and weight (P , 0.05). Triglycerides, very low-density lipoprotein cholesterol, and high sensitivity C-reactive protein were reduced with both the once-weekly and twice-daily exenatide regimens (P , 0.05). Conclusion: In this post hoc analysis, exenatide significantly improved a number of cardiovascular risk markers. Continuous exenatide exposure with exenatide once weekly elicited a greater response than did immediate-release exenatide twice daily, generally independent of glycemic improvement and weight loss. Thus, in addition to improving glycemic control, exenatide induced favorable changes in lipid and lipoprotein metabolism and decreased systemic inflammation.
Patient Education and Counseling, 1997
To examine the overall effectiveness of patient education and counselling on preventative health ... more To examine the overall effectiveness of patient education and counselling on preventative health behaviours and to examine the effects of various approaches for modifying specific types of behaviours. Searching Searches were made of the following: MEDLINE; Healthline; Dissertation Abstracts; and Psychological Abstracts; and bibliographies from review articles. Contact was made with experts identified through authorship and presentations at scientific meetings. A first search was conducted through 1990 and a second identified citations from 1990 through 1993. Search terms are specified. Study selection Study designs of evaluations included in the review Published and unpublished studies that measured the effect of any education or counselling intervention on a preventative health behaviour were included if they fulfilled the following criteria: a research design with high internal validity through use of an investigator assigned control group, whether randomised or not; proportion lost to follow-up < 40%; 15 or more subjects per group at post-test; analysis by intention to treat with no imputation of values for subjects lost to follow-up. Studies reporting means without standard deviations or standard errors were excluded unless exact sample sizes and t-values were also reported. Specific interventions included in the review Education or counselling interventions on a preventative health behaviour provided in a clinical setting in developed countries were included. The range of settings included office-based care, home health care, worksite and school clinics, nursing homes, and inpatient medical services. Prevention areas were grouped according to the following classification of behaviour: addictive, subtractive behaviours including smoking and alcohol misuse; non-addictive, subtractive/substitutive behaviours including nutrition and weight control; and other behaviours including contraception, breast self-exam, injury prevention, stressor reduction and exercise. Participants included in the review The participants were apparently healthy individuals of the following three types: from a general population for which disease was to be prevented; from a population with identified risk factors for disease who were at higher risk than the general population; and victims with acute problems (eg injury) for which future occurrences of the acute events were to be prevented. Excluded were patients with diagnosed disease and patients with extremely specialised learning needs. Outcomes assessed in the review Outcome measures of preventative health behaviour (such as weight loss and stopping smoking) that allowed a calculation of effect size were assessed. The behaviour could be measured directly by self-report, with or without objective verification, or indirectly by a physical measure. How were decisions on the relevance of primary studies made? At least two members of the research team scanned retrieved abstracts and reports. Reviewers were not blinded to authorship, journal or other information. Assessment of study quality The following validity criteria were used: study design (randomised or not), and objectivity of outcome measure (low medium or high). Other criteria of validity were incorporated into inclusion criteria. The authors do not state how the papers were assessed for validity, or how many of the authors performed the validity assessment.
Journal of General Internal Medicine, 1997
To evaluate whether laxatives and fibre therapy improve symptoms and bowel movement frequency in ... more To evaluate whether laxatives and fibre therapy improve symptoms and bowel movement frequency in adults with chronic constipation. The following sources were searched: MEDLINE from 1966 to 1995 (the search terms are given), Biological Abstracts, a drug information service, and bibliographies from articles and textbooks. Laxative manufacturers in North America and experts were also contacted. Only English language studies were included. Study designs of evaluations included in the review Randomised controlled trials (RCTs) were included. Bulk, stimulant, osmotic and softening (surfactant) laxatives. Specific treatments included in the review were psyllium, ispaghula, bran, prucara, lactulose, lactitol, propylethylene glycol, docusate sodium, docusate calcium, cisapride, senna, agiolax, lunelax, calcium polycarbophil, methylcellulose, magnesium hydroxide, laxamucil, sorbitol, dorbanex and sodium picosulphate. Patients with a constipation for a minimum of two weeks, whose constipation was treated for a minimum of one week. Patients from special populations, such as peripartum and tube-fed patients, were excluded. Mean bowel movement frequency per week; symptom improvement, and reduction in abdominal pain; need for breakthrough laxatives; and stool consistency. Not all trials included assessment of all of these outcomes. How were decisions on the relevance of primary studies made? Two independent reviewers selected the papers for the review. Validity was assessed using a 6-point scale assessing inclusion and exclusion criteria, randomisation method, whether adverse effects were assessed in a standardised fashion, double-blinding, description of withdrawals, and statistical analysis. These criteria were used in the overall narrative summary of the studies. Two independent reviewers performed the validity assessment. Two independent reviewers extracted the data for the review. How were the studies combined? The studies were combined by a narrative review, and also statistically by calculating an overall weighted average for the bowel movement frequency data.
General Hospital Psychiatry, 2002
We evaluated the usefulness of case-finding instruments for identifying patients with major depre... more We evaluated the usefulness of case-finding instruments for identifying patients with major depression or dysthymia in primary care settings using English language literature from Medline, a specialized trials registry and bibliographies of selected papers. Studies were done in primary care settings with unselected patients and compared case-finding instruments with accepted diagnostic criterion standards for major depression were selected. A total of 16 case-finding instruments were assessed in 38 studies. More than 32,000 patients received screening with a case-finding instrument; approximately 12,900 of these received criterion standard assessment. Case-finding instruments ranged in length from 1 to 30 questions. Average administration times ranged from less than 2 min to 6 min. Median sensitivity for major depression was 85% (range 50% to 97%); median specificity was 74% (range 51% to 98%). No significant differences between instruments were found. However for individual instruments, estimates of sensitivity and specificity varied significantly between studies. For the combined diagnoses of major depression or dysthymia, overall sensitivity was 79% (CI, 74% to 83%) and overall specificity 75% (CI, 70% to 81%). Stratified analyses showed no significant effects on overall instrument performance for study methodology, criterion standard choice, or patient characteristics. We found that multiple instruments with reasonable operating characteristics are available to help primary care clinicians identify patients with major depression. Because operating characteristics of these instruments are similar, selection of a particular instrument should depend on issues such as feasibility, administration and scoring times, and the instruments' ability to serve additional purposes, such as monitoring severity or response to therapy.
Archives of Internal Medicine, 2012
Background: The effect of statins on the prevention of cardiovascular events is well demonstrated... more Background: The effect of statins on the prevention of cardiovascular events is well demonstrated. Whether this protective effect is equal for women and men remains less well established. Our objective was to evaluate if statin therapy is equally effective in decreasing recurrent cardiovascular events in women and men. Data Sources: Randomized clinical trials were searched in PubMed using as indexing terms (statins OR cholesterol lowering medications) AND (cardiovascular events OR stroke OR myocardial infarction OR cardiovascular death). Study Selection: We included randomized, doubleblinded, placebo-controlled trials evaluating statins for secondary prevention of cardiovascular events. Studies with an open-label design and observational studies were excluded. Data Extraction: The earliest citation was used to determine the characteristic of the studied population and the methodology. All subsequent citations corresponding to the trial were evaluated for outcome rates by sex. Data Synthesis: Eleven trials representing 43 193 patients were included in the analysis. Overall, statin therapy was associated with a reduced risk of cardiovascular events in all outcomes for women (relative risk [RR], 0.81 [95% CI, 0.74-0.89]) and men (RR, 0.82 [95% CI, 0.78-0.85]). However, they did not reduce all-cause mortality in women vs men (RR, 0.92 [95% CI, 0.76-1.13] vs RR, 0.79 [95% CI, 0.720.87]) or stroke (RR, 0.92 [95% CI, 0.76-1.10] vs RR, 0.81 [95% CI, 0.72-0.92]). Conclusions: Statin therapy is an effective intervention in the secondary prevention of cardiovascular events in both sexes, but there is no benefit on stroke and allcause mortality in women.
International Journal of Environmental Research and Public Health, 2022
Religion can have a favorable impact on individual-level health. The influence of religion on pop... more Religion can have a favorable impact on individual-level health. The influence of religion on population health, however, remains less clear. This study investigated the association between religion and mortality at the population-level. Using county data, a meta-regression was performed to examine between-county mortality heterogeneity. The percent heterogeneity associated with religion variables were compared to demographics (i.e., place, race, language, age, and gender) and health factors (i.e., individual behaviors, clinical care, social and economic, and physical environment) as predictors of mortality. Religion was measured in terms of adherence (i.e., prevalence attending/belonging to a congregation), congregation density, and the diversity of adherents and congregation by denominations. Results showed counties with lower mortality were associated with higher proportions of religion adherents and a greater diversity of adherents and congregations. Counties with higher mortali...
Hospital practice (1995), Jan 1, 1996
1. Hosp Pract (Minneap). 1996 Apr 15;31(4):11-4. Evidence-based medicine: the Cochrane Collaborat... more 1. Hosp Pract (Minneap). 1996 Apr 15;31(4):11-4. Evidence-based medicine: the Cochrane Collaboration. Ramirez G. PMID: 8609178 [PubMed - indexed for MEDLINE]. Publication Types: Editorial; Research Support, Non-US Gov't. MeSH Terms. ...
General hospital …, Jan 1, 2002
American journal of …, Jan 1, 2010
Journal of …, Jan 1, 2011
135th APHA Annual Meeting & Exposition, Jan 1, 2007
... 8:30 AM. Changing Graduate Public Health Education Sondos Islam, PhD and GilbertRamirez, DrPH... more ... 8:30 AM. Changing Graduate Public Health Education Sondos Islam, PhD and GilbertRamirez, DrPH Slides (pdf) or Handout. 8:50 AM. Teaching through the Use of Reflection in a Public Health Practicum Course Barbara R. Gottlieb, MD, MPH ...
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Papers by Gilbert Ramirez