Loma Linda University

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Noha Daher, DrPH
Associate Professor, Allied Health Studies
School of Allied Health Professions
Assistant Professor, School of Public Health
School of Public Health
Member, Allied Health Studies, SAHP, Faculty of Graduate Studies
Publications    Scholarly Journals--Published
  • Pollard P, Taylor M, Daher N, Davis N. Sex differences in health care: the compensation experience of registered dietitians. Health Care Manag (Frederick)2008;27(3):259-268. ( 9/2008 )
  • Pollard P, Taylor M, Daher N. "Gender-based wage differentials among registered dietitians." The Health care Manager 26.1 (2007): 52-63. ( 3/2007 )
    The debate on compensation equity is broad-based, addressing many organizational, personal, and outcome factors. Central to compensation philosophy is the issue of gender equity. Health care, like many other industries, remains fraught with gender inequity in compensation. This inequity is partially explained by choice of practice area. However, much remains unexplained. Health care is a female-dominated industry with most of the women working in the allied health professions (eg, nurses, dietitians, etc). Registered dietitians (RD) may experience wage discrimination, similar to registered nurses, but prior to the present study, the assumption was not tested. Using data from the first comprehensive study of RD compensation, we examined gender equity in total cash compensation to RDs. Data were collected on total cash compensation, and questions focused on career progression and work outcomes. For purposes of our study, we analyzed data on 5,477 full-time RDs. Ninety-six percent were women, the median age was 43, and median total cash compensation for RDs employed in the position for at least 1 year was $45,500.00. Women earned $45,285.00 and men earned $50,250.00. A median wage gap of $4,965.00 between women and men was observed. Variability in total cash compensation to women was best explained by size of budget, years of experience, work setting, and educational level. Variability for men was explained by size of budget, years of experience, educational level, and employer status. Conclusions suggest that given the wage discrimination that female RDs experience, work organizations should evaluate their pay plans to monitor pay equity. Factors that women can manage to receive compensation that is equal to that of the men include size of budgets they manage, years of experience in the field, employer status, work setting, and educational level attained. Findings are useful for career advisers, human resource specialists, compensation specialists, supervisors, RDs, and compensation researchers.
  • Wilkins RL; Restrepo RD; Bourne KC, Daher N. "Contamination Level of Stethoscopes used by Physicians and Physician Assistants.." The Journal of Physician Assistant Education 18.2 (2007): 41-43. ( 1/2007 )
    To identify the presence and degree of bacterial contamination on stethoscopes used by physicians and physician assistants (PAs) in an outpatient setting, we swabbed and cultured 61 stethoscopes. We defined the degree of contamination as follows:We defined contamination as follows: minimal contamination 1-2 isolates, moderate contamination 3 isolates, and severe contamination 4 or more isolates.All stethoscopes were contaminated. Coagulase-negative Staphylococcus was detected on 93.4% of the stethoscopes. Stethoscopes used by physicians were found to have more ?moderate to severe? contamination than those used by PAs (p=.03). No difference was found in the reported frequency of stethoscope cleaning between physicians and PAs. Nearly 25% of the participants reported that they never cleaned their stethoscopes. it is recommended that all health care providers clean their stethoscopes on a daily basis.
  • Suk kK, Dunbar J, Liu A, Daher N, Fayard E. "Human Recombinant Erythropoietin and the Incidence of Retinopathy of prematurity: a multiple ression model." JAAPOS . (2007): -. ( 1/2007 )
    Background: Recombinant human erythropoietin (rhEPO) is used for the treatment of anemia of prematurity. However, it has also been found to have properties similar to vascular endothelial growth factor (VEGF), the major angiogenic factor implicated in the pathogenesis of Retinopathy of Prematurity (ROP). We sought to determine whether rhEPO is an independent risk factor for the development of ROP. Methods: Data were analyzed from 264 infants admitted to the Loma Linda University Children?s Hospital neonatal intensive care unit (NICU) in 1994 and 2002. The data included baseline characteristics, incidence of major morbidities, rhEPO treatment, number of red blood cell (RBC) transfusions received, and incidence and severity of ROP. A multiple logistic regression model was used to determine the relation of the studied risk factors to the incidence (any stage) and severity (threshold ROP requiring cryotherapy or laser photocoagulation) of ROP.Results: The risk of developing ROP increased among infants who received >20 doses of rhEPO compared to those who received
  • Checchia PA, McGuire JK, Daher N, Huddleston C, Levy F. "A risk assessment scoring system predicts survival following the Norwood Procedure." Pediatric Cardiology 27.1 (2006): 62-66. ( 2/2006 )
    No one set of characteristics has been consistently predictive of perioperative mortality and morbidity associated with the Norwood procedure. The purpose of the current study is to further validate a scoring system shown to be predictive of mortality following the Norwood procedure. We performed a retrospective review of all infants with the diagnosis of hypoplastic left heart syndrome (HLHS) who underwent the Norwood procedure at St. Louis Children's Hospital from July 1, 1994, to December 31, 2002. A weighted score for each of six factors comprised the scoring system. The factors included ventricular function, tricuspid regurgitation, ascending aortic diameter, atrial septal defect blood flow characteristics, blood type, and age. A score of > or = 7 points indicated lower reconstructive mortality risk, and a total score of < 7 points indicated a higher mortality risk. A total of 57 patients were analyzed. Twenty-five infants (44%) had a low risk score. These infants had a significantly greater survival at 48 hours compared to infants with a score of < 7 (92 vs 75%, p < 0.05). Infants with a high risk score had a significantly greater relative risk of mortality at 48 hours [OR = 2.04; confidence interval (CI) 1.04-4.00; p = 0.036]. The area under the receiver operating characteristic (ROC) curve is 0.8534 (95% CI, 0.78-0.922). This suggests that the scoring system has a very good degree of discriminatory power in selecting children who did not survive. Based on the results of the ROC, a cutoff score of >7 gives the best sensitivity and specificity for survival. When applied retrospectively, the survival outcomes predicted by our scoring system significantly correlated with actual outcomes. This supports the conclusion that a specific population of HLHS patients may have a higher mortality risk independent of surgical technique and postoperative care based on factors that can be assessed preoperatively.
  • Bourne KC, Arend W, Johnson D, Daher N, Martin B.. "The Influence of Personality Characteristics and Test Anxiety on Physician Assistant Clinical Knowledge Rating and Assessment Tool (PACKRAT) performance." The Journal of Physician assistant Education 17.4 (2006): 42-46. ( 1/2006 )
    Purpose: This study was designed to examine the degree of association between the Physician Assistant Clinical Knowledge Rating and Assessment tool (PACKRAT) scores of Physician Assistant students in their last year of study, and the personality characteristics and anxiety levels innate to them. Methods: A convenience sample of students from Physician Assistant programs in the western United States participated in this study. Subjects were required to complete a survey instrument (consisting of a test anxiety scale, overall anxiety level rating, and personality characteristics), and to submit their PACKRAT scores. Results: Sixty-one students responded to the survey. No significant association between PACKRAT scores and personality characteristics was demonstrated. ?During tests I get so nervous I forget facts I really know?, was the only anxiety statement that was a significant predictor of PACKRAT scores (p=.004). Cumulatively 29% of the variability in student performance was attributed to the fifteen anxiety predictors; therefore, the residual percentage is explained by other factors that need to be identified and evaluated. Conclusion: Success on the PACKRAT appears to be multi-factorial, and was not successfully predicted by anxiety level, personality, and demographic characteristics.
  • Wilkins RL, Samson M, Dudley G, McElvian R, Valera R, Daher N. . "The Description of Adventitious Lung Sounds by Physician Assistants.." The Journal of Physician Assistant Education 17.3 (2006): 23-27. ( 1/2006 )
    Pupose: Studies have been done to examine the terms used by physicians to describe adventitious lung sounds (ALS), however, no studies have documented the preferences of physician assistants (PAs). The objectives of this study were 1) to assess the terminology and qualifying adjectives used by PAs in describing ALS, 2) to identify the relationship between background variables such as age, gender, and level of education, and the terms used to describe various ALS. Methods: We surveyed 115 PAs who listened to five ALS heard through the use of stethophones and wrote descriptions of each sound. We used the Chi-square test to assess the relationship between the terms used and age, gender, musical training, and educational level. Results: One hundred one (88%) of the participants described sound 1 (fine inspiratory discontinuous ALS) as ?rales? or ?crackles?. Sound two (coarse inspiratory and expiratory discontinuous ALS) was described as ?rhonchi? by 58 participants (50%). Sound 3 (polyphonic high-pitched continuous ALS) was described with the term ?wheeze? by 90 participants (78%). Sound 4 (low-pitched monophonic continuous ALS) was described as ?rhonchi? or ?wheeze? by 31 participants (27%). Sound 5 (high-pitched monophonic ALS) was described as ?wheeze? or "stridor" by 84 participants (74%). Only 36 of the 115 participants used a qualifying adjective to describe any of the five ALS. None of the background variables predicted the terminology chosen by the PAs (p > .05). Conclusion: The PAs participating in this study used the terms ?rales? and ?crackles? interchangeably to describe discontinuous ALS. They used the term ?rhonchi? inappropriately to describe sounds associated with excessive secretions in the lung. High-pitched polyphonic and monophonic wheezing were well recognized, but low-pitched wheezing was not and was poorly described. The majority of the PAs in this study did not use a qualifying adjective. More education on the importance of this issue is needed.
  • Checchia PA, McCollegan J, Daher N, Kolovos N, Levy F, Markovitz B.. "The effect of surgical case volume on outcome following the Norwood procedure.." The Journal of Thoracic and Cardiovascular Surgery 129. (2005): 754-759. ( 4/2005 )
    OBJECTIVES: We analyze the effect of surgical case volume on the survival of infants with hypoplastic left heart syndrome who underwent stage I surgical palliation (the Norwood procedure). The purpose of our study was to understand more clearly the relative effects of institution and surgeon experience on patient outcome. METHODS: Using the Pediatric Health Information System database belonging to the pediatric hospital members of the Child Health Corporation of America, we identified newborn infants (< 30 days old on admission) from 1998 through 2001 admitted with the diagnosis of hypoplastic left heart syndrome. Stepwise multiple regression analysis was used to examine the association between both institutional and surgeon case volume with 28-day survival after the Norwood procedure. RESULTS: Twenty-nine hospitals and 87 surgeons performed 801 Norwood procedures during the study period. In the 4 of 29 institutions that averaged 1 or more Norwood procedures per month during the study period, survival averaged 78%. The remaining 25 institutions averaged 1 Norwood procedure every 9.6 weeks, with a survival of 59%. Data analysis revealed that higher institutional volume (P = .02) but not the number of cases performed by surgeons (P = .13) increased survival after the Norwood procedure. There was no such association with average length of stay in survivors or the time to mortality in nonsurvivors. CONCLUSION: Survival after the Norwood procedure is associated with institutional Norwood procedure volume but not with individual surgeon case volume, suggesting the need for improvements in institutional-based approaches to the care of children with hypoplastic left heart syndrome and the need for establishing regional referral centers for such high-risk procedures to improve patient survival.
  • Checchia PA, Sehra R, Daher N, Chinnock R, Bailey L. "An examination of the incidence of intubation and mechanical ventilation beyond the perioperative period in pediatric heart transplant recipients." Journal of Heart and Lung Transplant 23. (2004): 379-382. ( 1/2004 )
  • Daher N, Lindsted KD, Fraser GE, Zimmerman GJ. "Secular Trends in Life Expectancy by Diet Status among Never Smoking Seventh-day Adventists." American Journal of Epidemiology . (): -. (*)
    To evaluate how life expectancy changed by age and calendar time from 1960 through 1988, we combined two overlapping cohorts, the Adventist Mortality Study (AMS, 1960-1985, n = 27 530) and the Adventist Health Study (AHS, 1976-1988, n = 34 192). After combining both cohorts, a total of 38,237 subjects were identified with 10 329 deaths. In order to determine the impact of diet on life expectancy, we compared the life expectancy of omnivores to vegetarians separately in never smoking males and females at different ages and different calendar periods. We calculated life expectancies for subjects who had survived to ages 30, 50, 70, and 80 during six calendar periods: 1960-1964, 1965-1969, 1970-1974, 1975-1979, 1980-1984, and 1985-1988. The basis for the life table calculations was the age-specific mortality rates, which were calculated using the Multiple Decrement Life Table Analysis Program (MDLTAP) allowing for the control of confounders for competing causes of death. We conducted both univariate and multivariate analyses controlling for the potential confounders: education, body mass index (BMI), and exercise. We examined the secular trends in life expectancies using weighted linear regression, where inverse variances obtained from the MDLTAP program were used as weights for the respective calendar periods. Life expectancy for both males and females increased with secular time from 1960 to 1988 for all ages. There was a significant linear trend for both males and females at most ages. The trend tended to be steeper in omnivores compared to vegetarians, and females as compared to males. The life expectancy of vegetarian females who had survived to 30, 50, and 70 years of age was 1-2 years higher than that of omnivores for the calendar periods 1965-1969, 1975-1979 and 1980 -1984. The life expectancy of vegetarian males up to 80 years of age was 1-4 years higher than that of omnivores for all calendar periods. Females had a higher life expectancy than males. The gender differences in life expectancy were much less in vegetarians compared to omnivores. We conclude that the life expectancy increased with secular time from 1960 to 1988 in both males and females, and for both vegetarians and omnivores. A vegetarian diet does contribute to greater longevity, and this lifestyle decreases the gender gap in life expectancy.
  • Daher N, Lindsted KD, Fraser GE, Zimmerman GJ. "Secular Trends in Life Expectancy for Subjects who Died from Heart Disease and Cancer by Diet Status in Never Smoking Seventh-day Adventists." American Journal of Epidemiology . (): -. (*)
    The objectives of the study were: 1) to evaluate how life expectancies changed in subjects who died from heart disease and all-site cancer from 1960 through 1988 using the Adventist Studies; 2) to compare the life expectancies from heart disease and all-site cancer between vegetarians and omnivores for different ages and calendar times, and separately in males and females. We combined the two cohort studies, the Adventist Mortality Study (AMS, 1960-1985; n = 27,517), and the Adventist Health Study (AHS, 1970-1988; n = 34,192). Life expectancies from specific causes were calculated for subjects who had survived to ages 30, 50, 70, and 80 during three calendar periods: 1960-1969, 1970-1979, and 1980-1988. The basis for the life table calculations was the age disease-specific mortality rates, which were calculated using the Multiple Decrement Life Table Analysis Program (MDLTAP), taking into account competing causes of death and allowing for the control of confounders. We conducted both univariate and multivariate analyses controlling for the potential confounders: education, body mass index (BMI), and exercise. We examined the secular trends in life expectancies using weighted linear regression, where inverse variances obtained from the MDLTAP program were used as weights for the respective calendar periods. During 28 years of follow-up, 2,646 deaths from coronary heart disease, and 1,549 deaths from cancer were identified. The life expectancy for vegetarian and omnivorous males and females who eventually died from heart disease increased with secular time from 1960 to 1988 for all ages. This increase was 4-10 years in females and 2-6 years in males. The life expectancy at all ages of vegetarian females who died from heart disease was 0.5-2.0 years higher than that of omnivores for all the calendar periods. This difference was statistically significant at younger ages during the calendar period 1960-1988. The life expectancy of vegetarian males who died from heart disease was 2-4 years higher than that of omnivores for the calendar periods 1960-1969 and 1970-1979 and this difference was statistically significant at most ages. The life expectancy at all ages of both females and males who eventually died from cancer increased with secular time from 1960-1988, irrespective of their type of diet. This increase was 2-9 years in females and 3-7 years in males. The life expectancy at all ages of vegetarian females who died from cancer was 1-2 years higher than that of omnivores in the calendar period 1970-1979. The difference in life expectancy that was attributed to a vegetarian status in males who died of cancer was 1-4 years. In conclusion, the life expectancy from specific causes of death, increased with secular time from 1960 to 1988, irrespective of gender and type of diet. Vegetarians had 1-4 years greater life expectancy from these causes when compared to omnivores. The gender differences in life expectancy of subjects who died from heart disease or cancer were less in vegetarians compared to omnivores. Among those subjects, a vegetarian diet contributes to greater longevity, and this lifestyle decreases the gender gap in life expectancy in those dying from specific causes of death.
  Scholarly Journals--Accepted
  • Chan C, Abraham P, Meyer C, Kokame G, Kaiser P, Rauser M, Gross J, Daher N. OCT-measured Pigment epithelial detachment height as a predictor for RPE tears associated with intravitreal bevacizumab injections. Retina ( 8/2009 )