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Magaldino A, Dang C, In E, Nguyen K, Nguyen OT, Motwani K, Feller DB. Patient-Level Characteristics Associated with Tobacco Users and Nonusers at a Student-Run Free Clinic. South Med J 2023; 116:906-912. [PMID: 37913811 PMCID: PMC10624112 DOI: 10.14423/smj.0000000000001614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
OBJECTIVES Many tobacco users are motivated to quit but lack the resources to do so. To date, studies characterizing tobacco users at student-run free clinics have used small sample sizes, which may not be large enough to detect differences across key variables. As such, we assessed sociodemographic differences between tobacco users and nonusers at a student-run free clinic using a pooled cross-sectional design. METHODS We used patient-level data from the electronic health records for all of the patients who were seen during January 2012 to February 2020 inclusive. Our dependent variable was whether patients self-reported tobacco use. We assessed for differences across age, sex, race/ethnicity, and education level using a multivariable logistic regression model. RESULTS Across 4264 patients, 28.7% reported tobacco use. When controlling for other factors, greater odds of tobacco use were observed in this cohort for patients who were male (odds ratio [OR] 1.690, 95% confidence interval [CI] 1.468-1.944), those with educational attainment of 9th to 11th grade (OR 2.291, 95% CI 1.558-3.369), and those who were high school graduates/completed the General Education Development test (OR 1.849, 95% CI 1.295-2.638) compared with those with less than a high school education. Similarly, patients of older age had greater odds of tobacco use. CONCLUSIONS Our study found patient-level differences that may need to be integrated into improving the reach of intervention methods. Future research should look at a broader set of metrics (eg, geographic location, socioeconomic status) and ascertain reasons for sociodemographic differences observed.
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Affiliation(s)
- Alexandra Magaldino
- Department of Community Health & Family Medicine, University of Florida, Gainesville
| | - Corina Dang
- Department of Community Health & Family Medicine, University of Florida, Gainesville
| | - Emily In
- Department of Community Health & Family Medicine, University of Florida, Gainesville
| | - Ken Nguyen
- Department of Community Health & Family Medicine, University of Florida, Gainesville
| | - Oliver T. Nguyen
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Kartik Motwani
- Department of Community Health & Family Medicine, University of Florida, Gainesville
| | - David B. Feller
- Department of Community Health & Family Medicine, University of Florida, Gainesville
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Nguyen OT, Katoju S, Pons EE, Motwani K, Daniels GM, Reed AC, Alfred J, Feller DB, Hong YR. Predictors of intent to utilize the emergency department among a free clinic's patients. Am J Emerg Med 2023; 71:25-30. [PMID: 37327708 PMCID: PMC10527010 DOI: 10.1016/j.ajem.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/26/2023] [Accepted: 06/04/2023] [Indexed: 06/18/2023] Open
Abstract
OBJECTIVE Primary care use helps reduce utilization of more expensive modes of care, such as the emergency department (ED). Although most studies have investigated this association among patients with insurance, few have done so for patients without insurance. We used data from a free clinic network to assess the association between free clinic use and intent to use the ED. METHODS Data were collected from a free clinic network's electronic health records on adult patients from January 2015 to February 2020. Our outcome was whether patients reported themselves as 'very likely' to visit the ED if the free clinics were unavailable. The independent variable was frequency of free clinic use. Using a multivariable logistic regression model, we controlled for other factors, such as patient demographic factors, social determinants of health, health status, and year effect. RESULTS Our sample included 5008 visits. When controlling for other factors, higher odds of expressing ED interest were observed for patients who are non-Hispanic Black, older, not married, lived with others, had lower education, were homeless, had personal transportation, lived in rural areas, and had a higher comorbidity burden. In sensitivity analyses, higher odds were observed for dental, gastrointestinal, genitourinary, musculoskeletal, or respiratory conditions. CONCLUSIONS In the free clinic space, several patient demographic, social determinants of health and medical conditions were independently associated with greater odds of reporting intent on visiting the ED. Additional interventions that improve access and use of free clinics (e.g., dental) may keep patients without insurance from the ED.
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Affiliation(s)
- Oliver T Nguyen
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA; Department of Community Health & Family Medicine, University of Florida, Gainesville, FL, USA.
| | - SriVarsha Katoju
- Department of Community Health & Family Medicine, University of Florida, Gainesville, FL, USA
| | - Erick E Pons
- Department of Community Health & Family Medicine, University of Florida, Gainesville, FL, USA; College of Medicine, Ohio State University, Columbus, OH, USA
| | - Kartik Motwani
- Department of Community Health & Family Medicine, University of Florida, Gainesville, FL, USA
| | - Gabriel M Daniels
- Department of Community Health & Family Medicine, University of Florida, Gainesville, FL, USA; Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Austin C Reed
- Department of Community Health & Family Medicine, University of Florida, Gainesville, FL, USA; Department of Emergency Medicine, University of Florida, Gainesville, FL, USA
| | - Joanne Alfred
- Department of Community Health & Family Medicine, University of Florida, Gainesville, FL, USA; Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David B Feller
- Department of Community Health & Family Medicine, University of Florida, Gainesville, FL, USA
| | - Young-Rock Hong
- Department of Health Services Research, Management, and Policy, Gainesville, FL, USA
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Daga A, Nguyen OT, Moothedan E, Czyz DM, Faldu A, Ham T, Goyal A, Motwani K, Feller DB. Antibiotic prescribing patterns for acute respiratory infections in a free clinic network: A pooled cross-sectional study. Drugs Ther Perspect 2022; 38:51-55. [PMID: 35755971 PMCID: PMC9232164 DOI: 10.1007/s40267-021-00883-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In the United States, overprescribing of antibiotics for viral respiratory infections and antimicrobial resistance continue to be public health concerns. To date, no literature has focused on antibiotic prescribing patterns from free clinics. To address this gap, we used patient-level data from a student-run free clinic network of four primary care clinics to assess factors associated with inappropriate antibiotic prescribing for viral respiratory infections. Treatment plans were deemed inappropriate if any type of antibiotic was prescribed. We used unpaired t-tests and chi-square tests to assess for differences in receiving an inappropriate antibiotic prescription by patient-level factors (i.e., age, race/ethnicity, sex, educational attainment, preferred language, insurance status). Of 298 visits, 22.5% did not meet treatment guidelines. No patient-level factors studied were associated with inappropriate antibiotic prescribing. Our findings suggest other factors, beyond patient-level, may be drivers of variation in antibiotic prescribing in free clinics.
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Affiliation(s)
- Anshul Daga
- Department of Community Health & Family Medicine, University of Florida, Gainesville, FL
| | - Oliver T. Nguyen
- Department of Community Health & Family Medicine, University of Florida, Gainesville, FL
| | - Elijah Moothedan
- Department of Community Health & Family Medicine, University of Florida, Gainesville, FL
| | - Daniel M. Czyz
- Department of Microbiology and Cell Science, University of Florida, Gainesville, FL
| | - Aashi Faldu
- Department of Community Health & Family Medicine, University of Florida, Gainesville, FL
| | - Taylor Ham
- Department of Community Health & Family Medicine, University of Florida, Gainesville, FL
| | - Arshia Goyal
- Department of Community Health & Family Medicine, University of Florida, Gainesville, FL
| | - Kartik Motwani
- Department of Community Health & Family Medicine, University of Florida, Gainesville, FL
| | - David B. Feller
- Department of Community Health & Family Medicine, University of Florida, Gainesville, FL
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Ware MR, Feller DB, Hall KL. Neuroleptic Malignant Syndrome. Prim Care Companion CNS Disord 2018; 20. [DOI: 10.4088/pcc.17r02185] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 10/10/2017] [Indexed: 12/16/2022] Open
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Wacker JL, Feller DB, Tang XB, Defino MC, Namkung Y, Lyssand JS, Mhyre AJ, Tan X, Jensen JB, Hague C. Disease-causing mutation in GPR54 reveals the importance of the second intracellular loop for class A G-protein-coupled receptor function. J Biol Chem 2008; 283:31068-78. [PMID: 18772143 PMCID: PMC2576551 DOI: 10.1074/jbc.m805251200] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Revised: 08/26/2008] [Indexed: 11/06/2022] Open
Abstract
The G-protein-coupled receptor (GPCR) GPR54 is essential for the development and maintenance of reproductive function in mammals. A point mutation (L148S) in the second intracellular loop (IL2) of GPR54 causes idiopathic hypogonadotropic hypogonadism, a disorder characterized by delayed puberty and infertility. Here, we characterize the molecular mechanism by which the L148S mutation causes disease and address the role of IL2 in Class A GPCR function. Biochemical, immunocytochemical, and pharmacological analysis demonstrates that the mutation does not affect the expression, ligand binding properties, or protein interaction network of GPR54. In contrast, diverse GPR54 functional responses are markedly inhibited by the L148S mutation. Importantly, the leucine residue at this position is highly conserved among class A GPCRs. Indeed, mutating the corresponding leucine of the alpha(1A)-AR recapitulates the effects observed with L148S GPR54, suggesting the critical importance of this hydrophobic IL2 residue for Class A GPCR functional coupling. Interestingly, co-immunoprecipitation studies indicate that L148S does not hinder the association of Galpha subunits with GPR54. However, fluorescence resonance energy transfer analysis strongly suggests that L148S impairs the ligand-induced catalytic activation of Galpha. Combining our data with a predictive Class A GPCR/Galpha model suggests that IL2 domains contain a conserved hydrophobic motif that, upon agonist stimulation, might stabilize the switch II region of Galpha. Such an interaction could promote opening of switch II of Galpha to facilitate GDP-GTP exchange and coupling to downstream signaling responses. Importantly, mutations that disrupt this key hydrophobic interface can manifest as human disease.
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Affiliation(s)
- Jennifer L Wacker
- Department of Pharmacology, University of Washington, Seattle, Washington 98195, USA
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Lyssand JS, DeFino MC, Tang XB, Hertz AL, Feller DB, Wacker JL, Adams ME, Hague C. Blood pressure is regulated by an alpha1D-adrenergic receptor/dystrophin signalosome. J Biol Chem 2008; 283:18792-800. [PMID: 18468998 DOI: 10.1074/jbc.m801860200] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Hypertension is a cardiovascular disease associated with increased plasma catecholamines, overactivation of the sympathetic nervous system, and increased vascular tone and total peripheral resistance. A key regulator of sympathetic nervous system function is the alpha(1D)-adrenergic receptor (AR), which belongs to the adrenergic family of G-protein-coupled receptors (GPCRs). Endogenous catecholamines norepinephrine and epinephrine activate alpha(1D)-ARs on vascular smooth muscle to stimulate vasoconstriction, which increases total peripheral resistance and mean arterial pressure. Indeed, alpha(1D)-AR KO mice display a hypotensive phenotype and are resistant to salt-induced hypertension. Unfortunately, little information exists about how this important GPCR functions because of an inability to obtain functional expression in vitro. Here, we identified the dystrophin proteins, syntrophin, dystrobrevin, and utrophin as essential GPCR-interacting proteins for alpha(1D)-ARs. We found that dystrophins complex with alpha(1D)-AR both in vitro and in vivo to ensure proper functional expression. More importantly, we demonstrate that knock-out of multiple syntrophin isoforms results in the complete loss of alpha(1D)-AR function in mouse aortic smooth muscle cells and abrogation of alpha(1D)-AR-mediated increases in blood pressure. Our findings demonstrate that syntrophin and utrophin associate with alpha(1D)-ARs to create a functional signalosome, which is essential for alpha(1D)-AR regulation of vascular tone and blood pressure.
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Affiliation(s)
- John S Lyssand
- Department of Pharmacology, University of Washington, Seattle, Washington 98195, USA
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Lyssand JS, DeFino MC, Hertz AL, Feller DB, Tang X, Adams ME, Wacker JL, Hague C. Functional characterization of the alpha1D‐AR/syntrophin signaling complex. FASEB J 2008. [DOI: 10.1096/fasebj.22.1_supplement.726.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | - Xiaobo Tang
- PharmacologyUniversity of WashingtonSeattleWA
| | - Marvin E Adams
- Physiology and BiophysicsUnversity of WashingtonSeattleWA
| | | | - Chris Hague
- PharmacologyUniversity of WashingtonSeattleWA
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Wacker JL, Feller DB, Tang X, DeFino MC, Namkung Y, Lyssand J, Mhyre AJ, Tan X, Hague C. Unraveling the molecular mechanism by which the L148S mutation of GPR54 causes idiopathic hypogonadotrophic hypogonadism. FASEB J 2008. [DOI: 10.1096/fasebj.22.1_supplement.729.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | | | | | - Andrew J. Mhyre
- Clinical ResearchFred Hutchinson Cancer Research CenterSeattleWA
| | - Xu Tan
- PharmacologyUniversity of WashingtonSeattleWA
| | - Chris Hague
- PharmacologyUniversity of WashingtonSeattleWA
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Hertz AL, Feller DB, Hague C. Accessory proteins and alpha 1D‐AR function in ASMCs. FASEB J 2007. [DOI: 10.1096/fasebj.21.5.a422-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Angie L Hertz
- Department of PharmacologyUniversity of Washington, UW School of MedicineSeattleWA98195
| | - David B Feller
- Department of PharmacologyUniversity of Washington, UW School of MedicineSeattleWA98195
| | - Chris Hague
- Department of PharmacologyUniversity of Washington, UW School of MedicineSeattleWA98195
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10
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Wacker JL, Feller DB, Hague C. Functional characterization of endogenous GPR54 mutants. FASEB J 2007. [DOI: 10.1096/fasebj.21.5.a422-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jennifer L Wacker
- Department of PharmacologyUniversity of Washington1959 Pacific St, UW School of MedicineSeattleWA98195
| | - David B Feller
- Department of PharmacologyUniversity of Washington1959 Pacific St, UW School of MedicineSeattleWA98195
| | - Chris Hague
- Department of PharmacologyUniversity of Washington1959 Pacific St, UW School of MedicineSeattleWA98195
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Lyssand JS, Hertz A, Feller DB, Adams M, Hague CB. Syntrophins regulate alpha 1D‐adrenergic receptor function. FASEB J 2007. [DOI: 10.1096/fasebj.21.5.a422-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | - Marv Adams
- PhysiologyUniversity of Washington, 1959 Pacific St, School of MedicineHealth Sciences BuildingSeattleWA98195
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12
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Quillen DM, Feller DB. Diagnosing rhinitis: allergic vs. nonallergic. Am Fam Physician 2006; 73:1583-90. [PMID: 16719251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Allergic rhinitis, the most common type of rhinitis, generally can be differentiated from the numerous types of nonallergic rhinitis through a thorough history and physical examination. Allergic rhinitis may be seasonal, perennial, or occupational. The most common cause of nonallergic rhinitis is acute viral infection. Other types of nonallergic rhinitis include vasomotor, hormonal, drug-induced, structural, and occupational (irritant) rhinitis, as well as rhinitis medicamentosa and nonallergic rhinitis with eosinophilia syndrome. Since 1998, three large expert panels have made recommendations for the diagnosis of allergic and nonallergic rhinitis. Allergy testing (e.g., percutaneous skin testing, radioallergosorbent testing) is not necessary in all patients but may be useful in ambiguous or complicated cases.
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Affiliation(s)
- David M Quillen
- University of Florida College of Medicine, Department of Community Health and Family Medicine, 32601, USA
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Abstract
The purpose of this study was to develop and test two interventions designed to improve provider compliance with diabetes management guidelines: the use of a diabetes management flowsheet inserted into patient charts and the use of a diabetes management flowsheet plus quarterly provider feedback about compliance levels. Diabetic patient charts from six family practice clinics were randomly selected and audited at baseline and at 12 months. The analysis indicated that the use of the flowsheet was associated with improved provider compliance in the completion of foot examinations only. Providers involved in the study believed that the process of the flowsheet plus feedback contributed to their greater awareness of diabetes management guidelines.
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Affiliation(s)
- Siegfried O F Schmidt
- University of Florida, Department of Community Health and Family Medicine, Gainesville, USA
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Silverman H, Nunez L, Feller DB. Treatment of common eye emergencies. Am Fam Physician 1992; 45:2279-87. [PMID: 1575122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Some ocular conditions represent serious emergencies requiring immediate treatment. Chemical exposure requires prompt irrigation with saline. Major trauma with possible globe perforation requires eye shielding and referral for surgical evaluation. Sudden loss of vision may represent vascular occlusion and should be evaluated promptly by an ophthalmologist. Angle closure glaucoma is rare; drug treatment may be instituted in consultation with an ophthalmologist. Patients with orbital cellulitis should be hospitalized for intravenous antibiotic therapy. Less urgent eye conditions can be treated within 24 hours of onset. Minor trauma with hyphema requires cycloplegic medications, eye shielding and ophthalmologic consultation. Visual floaters, light flashes or "curtains" may represent vitreous or retinal detachment and should be evaluated by an ophthalmologist. Foreign bodies can usually be removed by irrigation or careful instrumentation.
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Affiliation(s)
- H Silverman
- Good Samaritan Regional Medical Center, Phoenix, Arizona
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Abstract
Seventeen patients with primary open-angle glaucoma underwent laser trabeculoplasty. Measurement of fluorescein leakage into the anterior chamber showed significant differences between surgically treated eyes and control eyes (not surgically treated) one day postoperatively and one week postoperatively. The increase in fluorescein leakage probably represents a disruption of the blood-aqueous barrier. In contrast, there were no differences between the eyes preoperatively or one month postoperatively. Hence, the long-term pressure-lowering effects of laser trabeculoplasty do not seem to be related to any permanent change in the blood-aqueous barrier.
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