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Obadan-Udoh E, Sundararajan V, Sanchez GA, Howard R, Chandrupatla S, Worley D. Dental patients as partners in promoting quality and safety: a qualitative exploratory study. BMC Oral Health 2024; 24:438. [PMID: 38600495 PMCID: PMC11005277 DOI: 10.1186/s12903-024-04030-1] [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: 08/14/2023] [Accepted: 02/14/2024] [Indexed: 04/12/2024] Open
Abstract
OBJECTIVE Active patient involvement in promoting quality and safety is a priority for healthcare. We investigated how dental patients perceive their role as partners in promoting quality and safety across various dental care settings. METHODS Focus group sessions were conducted at three dental practice settings: an academic dental center, a community dental clinic, and a large group private practice, from October 2018-July 2019. Patients were recruited through flyers or word-of-mouth invitations. Each session lasted 2.5 h and patients completed a demographic and informational survey at the beginning. Audio recordings were transcribed, and a hybrid thematic analysis was performed by two independent reviewers using Dedoose. RESULTS Forty-seven participants took part in eight focus group sessions; 70.2% were females and 38.3% were aged 45-64 years. Results were organized into three major themes: patients' overall perception of dental quality and safety; patients' reaction to an adverse dental event; and patients' role in promoting quality and safety. Dental patients were willing to participate in promoting quality and safety by careful provider selection, shared decision-making, self-advocacy, and providing post-treatment provider evaluations. Their reactions towards adverse dental events varied based on the type of dental practice setting. Some factors that influenced a patient's overall perception of dental quality and safety included provider credentials, communication skills, cleanliness, and durability of dental treatment. CONCLUSION The type of dental practice setting affected patients' desire to work as partners in promoting dental quality and safety. Although patients acknowledged having an important role to play in their care, their willingness to participate depended on their relationship with their provider and their perception of provider receptivity to patient feedback.
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Affiliation(s)
- Enihomo Obadan-Udoh
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, School of Dentistry, 707 Parnassus Avenue, D3214, Box #1361, San Francisco, CA, 94143, USA.
| | - Vyshiali Sundararajan
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, School of Dentistry, 707 Parnassus Avenue, D3214, Box #1361, San Francisco, CA, 94143, USA
| | - Gustavo A Sanchez
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, School of Dentistry, 707 Parnassus Avenue, D3214, Box #1361, San Francisco, CA, 94143, USA
| | - Rachel Howard
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, School of Dentistry, 707 Parnassus Avenue, D3214, Box #1361, San Francisco, CA, 94143, USA
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JaKa MM, Henderson MSG, Gillesby AD, Zibley LJ, Basile SM, Michalowicz BS, Worley D, Kharbanda EO, Asche SE, Mabry PL, Rindal BD. "I'm Torn": Qualitative Analysis of Dental Practitioner-Perceived Barriers, Facilitators, and Solutions to HPV Vaccine Promotion. Healthcare (Basel) 2024; 12:780. [PMID: 38610203 PMCID: PMC11011463 DOI: 10.3390/healthcare12070780] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024] Open
Abstract
The human papillomavirus (HPV) vaccine can prevent HPV-related oropharyngeal cancers. Dental practitioners are uniquely positioned to promote HPV vaccines during routine dental care but experience barriers to doing so. Qualitative interviews were conducted with dental practitioners to understand barriers and inform intervention strategies to promote HPV vaccines. Dental practitioners were invited to participate in phone interviews about knowledge, self-efficacy, and the fear of negative consequences related to HPV vaccine promotion as well as feedback on potential interventions to address these barriers. Interviews were audio recorded, transcribed, and analyzed using rapid qualitative analysis with a sort-and-sift matrix approach. Interviews were completed with 11 practitioners from six dental clinics (avg. 31 min). Though most thought HPV vaccination was important, they lacked detailed knowledge about when and to whom the vaccine should be recommended. This led to a hypothesized need for discussions of sexual history, feelings of limited self-efficacy to make the recommendation, and fear of patient concerns. Still, practitioners were supportive of additional training opportunities and provided input into specific interventions. The nuance of how these barriers were described by practitioners, as well as the possible solutions they identified, will help shape future interventions supporting HPV vaccine promotion in dental care.
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Affiliation(s)
- Meghan M. JaKa
- Center for Evaluation & Survey Research, HealthPartners Institute, Bloomington, MN 55425, USA
| | - Maren S. G. Henderson
- Center for Evaluation & Survey Research, HealthPartners Institute, Bloomington, MN 55425, USA
| | - Amanda D. Gillesby
- Center for Oral Health Integration, HealthPartners Institute, Bloomington, MN 55425, USA (B.S.M.); (B.D.R.)
| | - Laura J. Zibley
- Center for Evaluation & Survey Research, HealthPartners Institute, Bloomington, MN 55425, USA
| | - Sarah M. Basile
- Center for Oral Health Integration, HealthPartners Institute, Bloomington, MN 55425, USA (B.S.M.); (B.D.R.)
| | - Bryan S. Michalowicz
- Center for Oral Health Integration, HealthPartners Institute, Bloomington, MN 55425, USA (B.S.M.); (B.D.R.)
| | - Donald Worley
- HealthPartners Dental Group, Bloomington, MN 55425, USA;
| | | | | | | | - Brad D. Rindal
- Center for Oral Health Integration, HealthPartners Institute, Bloomington, MN 55425, USA (B.S.M.); (B.D.R.)
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Tokede O, Walji M, Ramoni R, Rindal DB, Worley D, Hebballi N, Kumar K, van Strien C, Chen M, Navat-Pelli S, Liu H, Etolue J, Yansane A, Obadan-Udoh E, Easterday C, Enstad C, Kane S, Rush W, Kalenderian E. Quantifying Dental Office-Originating Adverse Events: The Dental Practice Study Methods. J Patient Saf 2021; 17:e1080-e1087. [PMID: 29206706 PMCID: PMC10941983 DOI: 10.1097/pts.0000000000000444] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Indexed: 11/26/2022]
Abstract
BACKGROUND Preventable medical errors in hospital settings are the third leading cause of deaths in the United States. However, less is known about harm that occurs in patients in outpatient settings, where the majority of care is delivered. We do not know the likelihood that a patient sitting in a dentist chair will experience harm. Additionally, we do not know if patients of certain race, age, sex, or socioeconomic status disproportionately experience iatrogenic harm. METHODS We initiated the Dental Practice Study (DPS) with the aim of determining the frequency and types of adverse events (AEs) that occur in dentistry on the basis of retrospective chart audit. This article discusses the 6-month pilot phase of the DPS during which we explored the feasibility and efficiency of our multistaged review process to detect AEs. RESULTS At sites 1, 2, and 3, respectively, 2 reviewers abstracted 21, 11, and 23 probable AEs, respectively, from the 100 patient charts audited per site. At site 2, a third reviewer audited the same 100 charts and found only 1 additional probable AE. Of the total 56 probable AEs (from 300 charts), the expert panel confirmed 9 AE cases. This equals 3 AEs per 100 patients per year. Patients who experienced an AE tended to be male and older and to have undergone more procedures within the study year. CONCLUSIONS This article presents an overview of the DPS. It describes the methods used and summarizes the results of its pilot phase. To minimize threats to dental patient safety, a starting point is to understand their basic epidemiology, both in terms of their frequency and the extent to which they affect different populations.
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Affiliation(s)
- Oluwabunmi Tokede
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston Massachusetts
| | - Muhammad Walji
- School of Dentistry, University of Texas at Houston, Health Science Center, Houston, Texas
| | - Rachel Ramoni
- Office of Research & Development, US Department of Veterans Affairs, Washington, District of Columbia
| | | | | | - Nutan Hebballi
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston Massachusetts
| | - Krishna Kumar
- School of Dentistry, University of Texas at Houston, Health Science Center, Houston, Texas
| | - Claire van Strien
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston Massachusetts
| | - Mengxia Chen
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston Massachusetts
| | - Shaked Navat-Pelli
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston Massachusetts
| | - Hongchun Liu
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston Massachusetts
| | - Jini Etolue
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston Massachusetts
| | - Alfa Yansane
- Department of Preventive & Restorative Dental Sciences, UCSF School of Dentistry, San Francisco, California
| | - Enihomo Obadan-Udoh
- Department of Preventive & Restorative Dental Sciences, UCSF School of Dentistry, San Francisco, California
| | - Casey Easterday
- Survey Research Center, Bloomington, Minnesota
- HealthPartners Institute for Education and Research, Bloomington, Minnesota
| | - Chris Enstad
- HealthPartners Institute for Education and Research, Bloomington, Minnesota
| | - Sheryl Kane
- HealthPartners Institute for Education and Research, Bloomington, Minnesota
| | - William Rush
- HealthPartners Institute for Education and Research, Bloomington, Minnesota
| | - Elsbeth Kalenderian
- Department of Preventive & Restorative Dental Sciences, UCSF School of Dentistry, San Francisco, California
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Yansane A, Lee JH, Hebballi N, Obadan-Udoh E, White J, Walji M, Easterday C, Rindal B, Worley D, Kalenderian E. Assessing the Patient Safety Culture in Dentistry. JDR Clin Trans Res 2020; 5:399-408. [PMID: 31923373 DOI: 10.1177/2380084419897614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/17/2022] Open
Abstract
OBJECTIVES Medical errors are among the leading causes of death within the United States. Studies have shown that patients can be harmed while receiving care, sometimes resulting in permanent injury or, in extreme cases, death. To reduce the risk of patient safety incidents, it is imperative that a robust culture of safety be established. The primary objective of this study was to evaluate the patient safety culture among providers at 4 US dental institutions, comparing the results with their medical counterparts in 2016. METHODS This cross-sectional study uses the Medical Office Survey on Patient Safety Culture that was modified for dentistry and administered at 4 US dental institutions during the 2016 calendar year. All dental team members were invited to complete electronic or paper-based versions of the questionnaire. RESULTS Among 1,615 invited participants, 656 providers responded (rate, 40.6%). Medical institutions outperformed the dental institutions on 9 of the 10 safety culture dimensions, 6 of the 6 overall quality items, and 8 of the 9 patient safety and quality issues. The surveyed dental institutions reported the strongest average percentage positive scores in organizational learning (85%) and teamwork (79%). CONCLUSION These findings suggest that the patient safety culture progressed over time. However, there is still heterogeneity within safety culture among academic dental, private (nonacademic), and medical clinics. KNOWLEDGE TRANSFER STATEMENT Patient safety is the first dimension of quality improvement. Administering the Medical Office Survey on Patient Safety Culture within dental clinics represents a key measure to understand where improvements can be made with respect to patient care safety.
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Affiliation(s)
- A Yansane
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco/UCSF School of Dentistry, San Francisco, CA, USA
| | - J H Lee
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco/UCSF School of Dentistry, San Francisco, CA, USA
| | - N Hebballi
- School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - E Obadan-Udoh
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco/UCSF School of Dentistry, San Francisco, CA, USA
| | - J White
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco/UCSF School of Dentistry, San Francisco, CA, USA
| | - M Walji
- School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - C Easterday
- HealthPartners Institute, Minneapolis, MN, USA
| | - B Rindal
- HealthPartners Institute, Minneapolis, MN, USA
| | - D Worley
- HealthPartners Institute, Minneapolis, MN, USA
| | - E Kalenderian
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco/UCSF School of Dentistry, San Francisco, CA, USA
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Blue CM, Funkhouser DE, Riggs S, Rindal DB, Worley D, Pihlstrom DJ, Benjamin P, Gilbert GH. Utilization of nondentist providers and attitudes toward new provider models: findings from the National Dental Practice-Based Research Network. J Public Health Dent 2013; 73:237-44. [PMID: 23668892 DOI: 10.1111/jphd.12020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 04/07/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The purpose of this study was to quantify, within the National Dental Practice-Based Research Network, current utilization of dental hygienists and assistants with expanded functions and quantify network dentists' attitudes toward a new nondentist provider model - the dental therapist. METHODS National Dental Practice-Based Research Network practitioner-investigators participated in a single, cross-sectional administration of a questionnaire. RESULTS Current nondentist providers are not being utilized by network practitioner-investigators to the fullest extent allowed by law. Minnesota practitioners, practitioners in large group practices, and those with prior experience with expanded-function nondentist providers delegate at a higher rate and had more-positive perceptions of the new dental therapist model. CONCLUSIONS Expanding scopes of practice for dental hygienists and assistants has not translated to the maximal delegation allowed by law among network practices. This finding may provide insight into dentists' acceptance of newer nondentist provider models.
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Affiliation(s)
- Christine M Blue
- Department of Primary Dental Care, University of Minnesota, Minneapolis, MN, USA
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Gilbert GH, Gordan VV, Funkhouser EM, Rindal DB, Fellows JL, Qvist V, Anderson G, Worley D. Caries treatment in a dental practice-based research network: movement toward stated evidence-based treatment. Community Dent Oral Epidemiol 2012; 41:143-53. [PMID: 23036131 DOI: 10.1111/cdoe.12008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 08/23/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Practice-based research networks (PBRNs) provide a venue to foster evidence-based care. We tested the hypothesis that a higher level of participation in a dental PBRN is associated with greater stated change toward evidence-based practice. METHODS A total of 565 dental PBRN practitioner-investigators completed a baseline questionnaire entitled 'Assessment of Caries Diagnosis and Treatment'; 405 of these also completed a follow-up questionnaire about treatment of caries and existing restorations. Certain questions (six treatment scenarios) were repeated at follow-up a mean (SD) of 36.0 (3.8) months later. A total of 224 were 'full participants' (enrolled in clinical studies and attended at least one network meeting); 181 were 'partial participants' (did not meet 'full' criteria). RESULTS From 10% to 62% of practitioners were 'surgically invasive' at baseline, depending on the clinical scenario. Stated treatment approach was significantly less invasive at follow-up for four of six items. Change was greater among full participants and those with a more-invasive approach at baseline, with an overall pattern of movement away from the extremes. CONCLUSIONS These results are consistent with a preliminary conclusion that network participation fostered movement of scientific evidence into routine practice. PBRNs may foster movement of evidence into everyday practice as practitioners become engaged in the scientific process.
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Affiliation(s)
- Gregg H Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL 35294-0007, USA.
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Tang MJ, Worley D, Sanicola M, Dressler GR. The RET-glial cell-derived neurotrophic factor (GDNF) pathway stimulates migration and chemoattraction of epithelial cells. J Biophys Biochem Cytol 1998; 142:1337-45. [PMID: 9732293 PMCID: PMC2149344 DOI: 10.1083/jcb.142.5.1337] [Citation(s) in RCA: 104] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Embryonic development requires cell migration in response to positional cues. Yet, how groups of cells recognize and translate positional information into morphogenetic movement remains poorly understood. In the developing kidney, the ureteric bud epithelium grows from the nephric duct towards a group of posterior intermediate mesodermal cells, the metanephric mesenchyme, and induces the formation of the adult kidney. The secreted protein GDNF and its receptor RET are required for ureteric bud outgrowth and subsequent branching. However, it is unclear whether the GDNF-RET pathway regulates cell migration, proliferation, survival, or chemotaxis. In this report, we have used the MDCK renal epithelial cell line to show that activation of the RET pathway results in increased cell motility, dissociation of cell adhesion, and the migration towards a localized source of GDNF. Cellular responses to RET activation include the formation of lamellipodia, filopodia, and reorganization of the actin cytoskeleton. These data demonstrate that GDNF is a chemoattractant for RET-expressing epithelial cells and thus account for the developmental defects observed in RET and GDNF mutant mice. Furthermore, the RET-transfected MDCK cells described in this report are a promising model for delineating RET signaling pathways in the renal epithelial cell lineage.
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Affiliation(s)
- M J Tang
- Department of Pathology and Howard Hughes Medical Institute, University of Michigan, Ann Arbor, Michigan 48109, USA
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Hamric AB, Worley D, Lindebak S, Jaubert S. Outcomes associated with advanced nursing practice prescriptive authority. J Am Acad Nurse Pract 1998; 10:113-8. [PMID: 9644410] [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] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Thirty-three advanced practice nurses (APNs) in 25 different primary care sites in one state participated in a study of the safety and effectiveness of APN prescriptive authority. Data were analyzed on 1,708 patients seen during a 2-month period. Outcomes of care were studied using three different measures as well as patient satisfaction. Evaluation of patient outcome by APN and physician indicated that in 76% of the cases, the patient's condition stabilized or improved. Patients evaluated their own outcomes positively. Participating physicians were unanimous in their evaluation of APN prescriptive authority as beneficial to their patients.
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Affiliation(s)
- A B Hamric
- Graduate Nursing Program, Louisiana State University Medical Center, New Orleans 70112-2262, USA
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Affiliation(s)
- S Hohler
- St Francis Medical Center, Cape Girardeau, MO, USA
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10
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Sanicola M, Hession C, Worley D, Carmillo P, Ehrenfels C, Walus L, Robinson S, Jaworski G, Wei H, Tizard R, Whitty A, Pepinsky RB, Cate RL. Glial cell line-derived neurotrophic factor-dependent RET activation can be mediated by two different cell-surface accessory proteins. Proc Natl Acad Sci U S A 1997; 94:6238-43. [PMID: 9177201 PMCID: PMC21033 DOI: 10.1073/pnas.94.12.6238] [Citation(s) in RCA: 231] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Glial cell line-derived neurotrophic factor (GDNF)-dependent activation of the tyrosine kinase receptor RET is necessary for kidney and enteric neuron development, and mutations in RET are associated with human diseases. Activation of RET by GDNF has been shown to require an accessory component, GDNFR-alpha (RETL1). We report the isolation and characterization of rat and human cDNAs for a novel cell-surface associated accessory protein, RETL2, that shares 49% identity with RETL1. Both RETL1 and RETL2 can mediate GDNF dependent phosphorylation of RET, but they exhibit different patterns of expression in fetal and adult tissues. The most striking differences in expression observed were in the adult central and peripheral nervous systems. In addition, the mechanisms by which the two accessory proteins facilitate the activation of RET by GDNF are quite distinct. In vitro binding experiments with soluble forms of RET, RETL1 and RETL2 demonstrate that while RETL1 binds GDNF tightly to form a membrane-associated complex which can then interact with RET, RETL2 only forms a high affinity complex with GDNF in the presence of RET. This strong RET dependence of the binding of RETL2 to GDNF was confirmed by FACS analysis on RETL1 and RETL2 expressing cells. Together with the recent discovery of a GDNF related protein, neurturin, these data raise the possibility that RETL1 and RETL2 have distinctive roles during development and in the nervous system of the adult. RETL1 and RETL2 represent new candidate susceptibility genes and/or modifier loci for RET-associated diseases.
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Affiliation(s)
- M Sanicola
- Biogen, Inc., 14 Cambridge Center, Cambridge, MA 02142, USA
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Rhyan JC, Aune K, Ewalt DR, Marquardt J, Mertins JW, Payeur JB, Saari DA, Schladweiler P, Sheehan EJ, Worley D. Survey of free-ranging elk from Wyoming and Montana for selected pathogens. J Wildl Dis 1997; 33:290-8. [PMID: 9131561 DOI: 10.7589/0090-3558-33.2.290] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
From December 1991 through January 1995, a disease survey was conducted on herds of free-ranging, hunter-killed elk (Cervus elaphus nelsoni) from three areas in proximity to Yellowstone National Park (YNP), Wyoming (USA), after tuberculosis caused by Mycobacterium bovis was discovered in a captive herd of elk in the area. Complete or partial sets of specimens from 289 elk collected between December 1991 and January 1993 were examined histologically; no mycobacterial lesions were observed. Lesions of tuberculosis were not detected in tonsils or lymph nodes of the head from an additional 99 hunter-killed, adult elk from one area (area 2) collected in January 1995. Neither M. bovis nor M. paratuberculosis were isolated from any of the specimens cultured. Antibodies to Brucella abortus were detected in serum samples from 0%, 1%, and 1% of elk from three areas sampled (areas 1, 2 and 3), respectively. Brucella abortus biovar 1 was isolated from multiple tissues from one seropositive animal from area 3. Larvae with morphology consistent with Dictyocaulus sp. were found in 12%, 14%, and 0% of fecal specimens tested from areas 1, 2, and 3, respectively. Pasteurella multocida and Actinomyces pyogenes were isolated from a lung with purulent bronchopneumonia and abscesses.
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Affiliation(s)
- J C Rhyan
- U.S. Department of Agriculture, Animal and Plant Health Inspection Service, National Veterinary Services Laboratories, Ames, Iowa 50010, USA
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Lonzer MD, Imrie R, Rogers D, Worley D, Licata A, Secic M. Effects of heredity, age, weight, puberty, activity, and calcium intake on bone mineral density in children. Clin Pediatr (Phila) 1996; 35:185-9. [PMID: 8665751 DOI: 10.1177/000992289603500402] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Osteoporosis is a disease that plagues older individuals, particularly women. At the usual age of diagnosis, limited therapy is available. By further delineating the factors that influence bone mineral acquisition before peak bone density is achieved, individuals at risk may be identified at an earlier age when therapies may be more effective. This was a study of 16 family units, 16 mothers, eight fathers, and their 28 children between the ages of 5 and 20 years. The evaluation consisted of a focused history, Tanner staging of adolescents, anthropometric data (height, weight), and spinal bone mineral density (BMD) by DEXA (dual-energy x-ray absorptiometry). Bone mineral density in the children was compared with multiple environmental factors. Bone mineral density Z-scores were then compared between children and their parents. Variables found to be positively correlated with children's BMDs were: age (r = 0.94, P < 0.001), Tanner stage (r = 0.90, P < 0.001), weight (r = 0.88, P < 0.001), height (r = 0.81, P < 0.001), and body mass index (r = 0.77, P < 0.001). No association was found between calcium intake and BMD, owing possibly to increased calcium intake among children with a family history of osteoporosis. Activity was not significantly associated with BMD. Significant correlations were noted between the children's BMD and that of their father's (r = 0.83, P = 0.01), premenopausal mother's (r = 0.58, P = 0.03), and midparental (the mean value of both parents' BMDs) (r = 0.86, P = 0.01). These data suggest that children who have parents affected by low BMD may be at risk for low BMD themselves.
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Affiliation(s)
- M D Lonzer
- Department of Endocrinology, Cleveland Clinic Foundation, OH 44195, USA
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