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George CM, Zacher T, Endres K, Richards F, Bear Robe L, Harvey D, Best LG, Red Cloud R, Black Bear A, Skinner L, Cuny C, Rule A, Schwab KJ, Gittelsohn J, Glabonjat RA, Schilling K, O'Leary M, Thomas ED, Umans J, Zhu J, Moulton LH, Navas-Acien A. Effect of an Arsenic Mitigation Program on Arsenic Exposure in American Indian Communities: A Cluster Randomized Controlled Trial of the Community-Led Strong Heart Water Study Program. Environ Health Perspect 2024; 132:37007. [PMID: 38534131 DOI: 10.1289/ehp12548] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND Chronic arsenic exposure has been associated with an increased risk of cardiovascular disease; diabetes; cancers of the lung, pancreas and prostate; and all-cause mortality in American Indian communities in the Strong Heart Study. OBJECTIVE The Strong Heart Water Study (SHWS) designed and evaluated a multilevel, community-led arsenic mitigation program to reduce arsenic exposure among private well users in partnership with Northern Great Plains American Indian Nations. METHODS A cluster randomized controlled trial (cRCT) was conducted to evaluate the effectiveness of the SHWS arsenic mitigation program over a 2-y period on a) urinary arsenic, and b) reported use of arsenic-safe water for drinking and cooking. The cRCT compared the installation of a point-of-use arsenic filter and a mobile Health (mHealth) program (3 phone calls; SHWS mHealth and Filter arm) to a more intensive program, which included this same program plus three home visits (3 phone calls and 3 home visits; SHWS Intensive arm). RESULTS A 47% reduction in urinary arsenic [geometric mean ( GM ) = 13.2 to 7.0 μ g / g creatinine] was observed from baseline to the final follow-up when both study arms were combined. By treatment arm, the reduction in urinary arsenic from baseline to the final follow-up visit was 55% in the mHealth and Filter arm (GM = 14.6 to 6.55 μ g / g creatinine) and 30% in the Intensive arm (GM = 11.2 to 7.82 μ g / g creatinine). There was no significant difference in urinary arsenic levels by treatment arm at the final follow-up visit comparing the Intensive vs. mHealth and Filter arms: GM ratio of 1.21 (95% confidence interval: 0.77, 1.90). In both arms combined, exclusive use of arsenic-safe water from baseline to the final follow-up visit significantly increased for water used for cooking (17% to 53%) and drinking (12% to 46%). DISCUSSION Delivery of the interventions for the community-led SHWS arsenic mitigation program, including the installation of a point-of-use arsenic filter and a mHealth program on the use of arsenic-safe water (calls only, no home visits), resulted in a significant reduction in urinary arsenic and increases in reported use of arsenic-safe water for drinking and cooking during the 2-y study period. These results demonstrate that the installation of an arsenic filter and phone calls from a mHealth program presents a promising approach to reduce water arsenic exposure among private well users. https://doi.org/10.1289/EHP12548.
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Affiliation(s)
- Christine Marie George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tracy Zacher
- Missouri Breaks Industries Research Inc., Eagle Butte, South Dakota, USA
| | - Kelly Endres
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Francine Richards
- Missouri Breaks Industries Research Inc., Eagle Butte, South Dakota, USA
| | - Lisa Bear Robe
- Missouri Breaks Industries Research Inc., Eagle Butte, South Dakota, USA
| | | | - Lyle G Best
- Missouri Breaks Industries Research Inc., Eagle Butte, South Dakota, USA
| | - Reno Red Cloud
- Environmental Resource Department, Oglala Sioux Tribe, Pine Ridge, South Dakota, USA
| | | | - Leslie Skinner
- Missouri Breaks Industries Research Inc., Eagle Butte, South Dakota, USA
| | - Christa Cuny
- Missouri Breaks Industries Research Inc., Eagle Butte, South Dakota, USA
| | - Ana Rule
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kellogg J Schwab
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joel Gittelsohn
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ronald Alexander Glabonjat
- Department of Environmental Health Science, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Kathrin Schilling
- Department of Environmental Health Science, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Marcia O'Leary
- Missouri Breaks Industries Research Inc., Eagle Butte, South Dakota, USA
| | - Elizabeth D Thomas
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jason Umans
- Biomarker, Biochemistry, and Biorepository Core, Medstar Health, Washington, District of Columbia, USA
- Department of Medicine, School of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Jianhui Zhu
- Biomarker, Biochemistry, and Biorepository Core, Medstar Health, Washington, District of Columbia, USA
| | - Lawrence H Moulton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ana Navas-Acien
- Department of Environmental Health Science, Mailman School of Public Health, Columbia University, New York, New York, USA
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McKeown CD, Gautam D, Gaffney G, O'Leary M, Astbury K. Peripartum hysterectomy. Ir Med J 2024; 117:895. [PMID: 38259238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
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Lieberman‐Cribbin W, Li Z, Lewin M, Ruiz P, Jarrett JM, Cole SA, Kupsco A, O'Leary M, Pichler G, Shimbo D, Devereux RB, Umans JG, Navas‐Acien A, Nigra AE. The Contribution of Declines in Blood Lead Levels to Reductions in Blood Pressure Levels: Longitudinal Evidence in the Strong Heart Family Study. J Am Heart Assoc 2024; 13:e031256. [PMID: 38205795 PMCID: PMC10926826 DOI: 10.1161/jaha.123.031256] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 11/21/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Chronic lead exposure is associated with both subclinical and clinical cardiovascular disease. We evaluated whether declines in blood lead were associated with changes in systolic and diastolic blood pressure in adult American Indian participants from the SHFS (Strong Heart Family Study). METHODS AND RESULTS Lead in whole blood was measured in 285 SHFS participants in 1997 to 1999 and 2006 to 2009. Blood pressure and measures of cardiac geometry and function were obtained in 2001 to 2003 and 2006 to 2009. We used generalized estimating equations to evaluate the association of declines in blood lead with changes in blood pressure; cardiac function and geometry measures were considered secondary. Mean blood lead was 2.04 μg/dL at baseline. After ≈10 years, mean decline in blood lead was 0.67 μg/dL. In fully adjusted models, the mean difference in systolic blood pressure comparing the highest to lowest tertile of decline (>0.91 versus <0.27 μg/dL) in blood lead was -7.08 mm Hg (95% CI, -13.16 to -1.00). A significant nonlinear association between declines in blood lead and declines in systolic blood pressure was detected, with significant linear associations where blood lead decline was 0.1 μg/dL or higher. Declines in blood lead were nonsignificantly associated with declines in diastolic blood pressure and significantly associated with declines in interventricular septum thickness. CONCLUSIONS Declines in blood lead levels in American Indian adults, even when small (0.1-1.0 μg/dL), were associated with reductions in systolic blood pressure. These findings suggest the need to further study the cardiovascular impacts of reducing lead exposures and the importance of lead exposure prevention.
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Affiliation(s)
- Wil Lieberman‐Cribbin
- Department of Environmental Health SciencesColumbia University Mailman School of Public HealthNew YorkNYUSA
| | - Zheng Li
- Office of Capacity Development and Applied Prevention Science, Agency for Toxic Substances and Disease RegistryAtlantaGAUSA
| | - Michael Lewin
- Office of Community Health and Hazard Assessment, Agency for Toxic Substances and Disease RegistryAtlantaGAUSA
| | - Patricia Ruiz
- Office of Innovation and Analytics, Agency for Toxic Substances and Disease RegistryAtlantaGAUSA
| | - Jeffery M. Jarrett
- Division for Laboratory SciencesCenters for Disease Control and PreventionAtlantaGAUSA
| | - Shelley A. Cole
- Population Health ProgramTexas Biomedical Research InstituteSan AntonioTXUSA
| | - Allison Kupsco
- Department of Environmental Health SciencesColumbia University Mailman School of Public HealthNew YorkNYUSA
| | - Marcia O'Leary
- Missouri Breaks Research Industries Research, Inc.Eagle ButteSDUSA
| | - Gernot Pichler
- Department of CardiologyKarl Landsteiner Institute for Cardiovascular and Critical Care Research, Clinic FloridsdorfViennaAustria
| | - Daichi Shimbo
- Division of CardiologyColumbia University Irving Medical CenterNew YorkNYUSA
| | | | - Jason G. Umans
- MedStar Health Research InstituteHyattsvilleMDUSA
- Georgetown‐Howard Universities Center for Clinical and Translational ScienceWashingtonDCUSA
| | - Ana Navas‐Acien
- Department of Environmental Health SciencesColumbia University Mailman School of Public HealthNew YorkNYUSA
| | - Anne E. Nigra
- Department of Environmental Health SciencesColumbia University Mailman School of Public HealthNew YorkNYUSA
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Erdei E, O'Donald ER, Luo L, Enright K, O'Leary M, MacKenzie D, Doyle J, Eggers M, Keil D, Lewis J, Henderson JA, Rubin RL. Comparison of circulating and excreted metals and of autoimmunity between two Great Plains Tribal communities. J Autoimmun 2023:103117. [PMID: 37813804 DOI: 10.1016/j.jaut.2023.103117] [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] [Received: 06/30/2023] [Revised: 09/17/2023] [Accepted: 09/19/2023] [Indexed: 10/11/2023]
Abstract
Metals contaminants of the environment from mine waste have been implicated as contributing agents in autoimmune disease. The current study compares metals and autoimmunity in two Tribal communities residing in the Black Hills and the Bighorn Mountains geographical regions that are scattered with extant hard rock mines. With documented drinking water contamination in both communities, in vivo levels of more than half of the measured serum and urine metals differed between the two communities and were substantially different from their national median values. Serum autoantibodies associated with systemic autoimmune disease were rare or at low-level, but antibodies to denatured (single-stranded) DNA and thyroid-specific autoantibodies were commonly elevated, especially in women. A three-tier statistical modeling process was carried out to examine individual metals exposure as predictors of autoantibody levels. For the most part only weak positive associations between individual metals and systemic autoantibodies were found, although univariate quantile regression analysis showed positive statistical associations of serum lead and antimony with anti-chromatin and anti-histone autoantibodies. Using age and gender-adjusted multivariable statistical models, metals did not predict anti-thyroglobulin or -thyroid peroxidase significantly and metals were generally negative predictors of the other autoantibodies. Overall these results suggest that elevated levels of environmental metals and metalloids in these communities may result in suppression of autoantibodies associated with systemic autoimmune disease.
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Affiliation(s)
- Esther Erdei
- Community Environmental Health Program, Dept. of Pharmaceutical Sciences, College of Pharmacy, University of New Mexico, Health Sciences Center, Albuquerque, NM, USA.
| | - Elena R O'Donald
- Community Environmental Health Program, Dept. of Pharmaceutical Sciences, College of Pharmacy, University of New Mexico, Health Sciences Center, Albuquerque, NM, USA
| | - Li Luo
- Community Environmental Health Program, Dept. of Pharmaceutical Sciences, College of Pharmacy, University of New Mexico, Health Sciences Center, Albuquerque, NM, USA; University of New Mexico, Health Sciences Center UNM Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Kendra Enright
- Missouri Breaks Industries Research Inc. Eagle Butte, SD, USA
| | - Marcia O'Leary
- Missouri Breaks Industries Research Inc. Eagle Butte, SD, USA
| | - Debra MacKenzie
- Community Environmental Health Program, Dept. of Pharmaceutical Sciences, College of Pharmacy, University of New Mexico, Health Sciences Center, Albuquerque, NM, USA
| | - John Doyle
- Crow Environmental Health Steering Committee, Little Big Horn College, Crow Agency, MT, USA
| | - Margaret Eggers
- Crow Environmental Health Steering Committee, Little Big Horn College, Crow Agency, MT, USA; Montana State University, Bozeman, MT, USA
| | | | - Johnnye Lewis
- Community Environmental Health Program, Dept. of Pharmaceutical Sciences, College of Pharmacy, University of New Mexico, Health Sciences Center, Albuquerque, NM, USA
| | | | - Robert L Rubin
- University of New Mexico, Health Sciences Center, School of Medicine, Dept. of Molecular Genetics and Microbiology, Albuquerque, NM, USA
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Hanson JD, Harris A, Gilbertson RJ, Charboneau M, O'Leary M. Feasibility and Acceptability of Using Ecological Momentary Assessment to Evaluate Alcohol Use with American Indian Women. Int J Environ Res Public Health 2023; 20:6071. [PMID: 37372658 DOI: 10.3390/ijerph20126071] [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] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/24/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Ecological momentary assessments (EMA) are one way to collect timely and accurate alcohol use data, as they involve signaling participants via cell phones to report on daily behaviors in real-time and in a participant's natural environment. EMA has never been used with American Indian populations to evaluate alcohol consumption. The purpose of this project was to determine the feasibility and acceptability of EMA for American Indian women. METHODS Eligible participants were American Indian women between the ages of 18 and 44 who were not pregnant and had consumed more than one drink within the past month. All participants received a TracFone and weekly automated messages. Self-reported measures of daily quantity and frequency of alcohol consumption, alcohol type, and context were assessed once per week for four weeks. Baseline measurements also included the Drinking Motives Questionnaire-Revised (DMQ-R) and the Interpersonal Support Evaluation List (ISEL). RESULTS Fifteen participants were enrolled in the study. All but one participant completed all data collection time points, and drinking patterns were consistent across the study period. A total of 420 records were completed across 86 drinking days and 334 non-drinking days. Participants reported drinking an average of 5.7 days over the 30-day period and typically consumed 3.99 drinks per drinking occasion. Sixty-six percent of participants met gender-specific cut-points for heavy episodic drinking, with an average of 2.46 binge drinking occasions across the four week study period. CONCLUSIONS This proof-of-concept project showed that EMA was both feasible and acceptable for collecting alcohol data from American Indian women. Additional studies are necessary to fully implement EMA with American Indian women to better understand the drinking motives, contexts, patterns, and risk factors in this population.
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Affiliation(s)
- Jessica D Hanson
- Department of Applied Human Sciences, University of Minnesota Duluth, 1216 Ordean Court, Duluth, MN 55812, USA
| | - Amy Harris
- Department of Applied Human Sciences, University of Minnesota Duluth, 1216 Ordean Court, Duluth, MN 55812, USA
| | - Rebecca J Gilbertson
- Department of Psychology, University of Minnesota Duluth, 1216 Ordean Court, Duluth, MN 55812, USA
| | - Megan Charboneau
- Missouri Breaks Industries Research Inc, 118 Willow Street, Eagle Butte, SD 57625, USA
| | - Marcia O'Leary
- Missouri Breaks Industries Research Inc, 118 Willow Street, Eagle Butte, SD 57625, USA
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Endres K, Zacher T, Richards F, Bear Robe L, Powers M, Yracheta J, Harvey D, Best LG, Red Cloud R, Black Bear A, Ristau S, Aurand D, Skinner L, Perin J, Cuny C, Gross M, Thomas ED, Rule A, Schwab K, Moulton LH, O'Leary M, Navas-Acien A, George CM. Behavioral determinants of arsenic-safe water use among Great Plains Indian Nation private well users: results from the Community-Led Strong Heart Water Study Arsenic Mitigation Program. Environ Health 2023; 22:42. [PMID: 37183246 PMCID: PMC10183246 DOI: 10.1186/s12940-023-00965-0] [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: 08/04/2022] [Accepted: 01/11/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND The objective of this study was to evaluate the behavioral determinants associated with exclusive use of arsenic-safe water in the community-led Strong Heart Water Study (SHWS) arsenic mitigation program. METHODS The SHWS is a randomized controlled trial of a community-led arsenic mitigation program designed to reduce arsenic exposure among private well users in American Indian Great Plains communities. All households received point-of-use (POU) arsenic filters installed at baseline and were followed for 2 years. Behavioral determinants selected were those targeted during the development of the SHWS program, and were assessed at baseline and follow-up. RESULTS Among participants, exclusive use of arsenic-safe water for drinking and cooking at follow-up was associated with higher self-efficacy for accessing local resources to learn about arsenic (OR: 5.19, 95% CI: 1.48-18.21) and higher self-efficacy to resolve challenges related to arsenic in water using local resources (OR: 3.11, 95% CI: 1.11-8.71). Higher commitment to use the POU arsenic filter faucet at baseline was also a significant predictor of exclusive arsenic-safe water use for drinking (OR: 32.57, 95% CI: 1.42-746.70) and cooking (OR: 15.90, 95% CI: 1.33-189.52) at follow-up. From baseline to follow-up, the SHWS program significantly increased perceived vulnerability to arsenic exposure, self-efficacy, descriptive norms, and injunctive norms. Changing one's arsenic filter cartridge after installation was associated with higher self-efficacy to obtain arsenic-safe water for drinking (OR: 6.22, 95% CI: 1.33-29.07) and cooking (OR: 10.65, 95% CI: 2.48-45.68) and higher perceived vulnerability of personal health effects (OR: 7.79, 95% CI: 1.17-51.98) from drinking arsenic-unsafe water. CONCLUSIONS The community-led SHWS program conducted a theory-driven approach for intervention development and evaluation that allowed for behavioral determinants to be identified that were associated with the use of arsenic safe water and changing one's arsenic filter cartridge. These results demonstrate that theory-driven, context-specific formative research can influence behavior change interventions to reduce water arsenic exposure. The SHWS can serve as a model for the design of theory-driven intervention approaches that engage communities to reduce arsenic exposure. TRIAL REGISTRATION The SHWS is registered with ClinicalTrials.gov (Identifier: NCT03725592).
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Affiliation(s)
- Kelly Endres
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tracy Zacher
- Missouri Breaks Industries Research, Inc., Eagle Butte, SD, USA
| | | | - Lisa Bear Robe
- Missouri Breaks Industries Research, Inc., Eagle Butte, SD, USA
| | - Martha Powers
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joseph Yracheta
- Missouri Breaks Industries Research, Inc., Eagle Butte, SD, USA
| | - David Harvey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Indian Health Service, Rockville, MD, USA
| | - Lyle G Best
- Missouri Breaks Industries Research, Inc., Eagle Butte, SD, USA
| | | | | | - Steve Ristau
- Mid Continent Testing Labs, Inc., Rapid City, SD, USA
| | - Dean Aurand
- Mid Continent Testing Labs, Inc., Rapid City, SD, USA
| | - Leslie Skinner
- Missouri Breaks Industries Research, Inc., Eagle Butte, SD, USA
| | - Jamie Perin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Christa Cuny
- Missouri Breaks Industries Research, Inc., Eagle Butte, SD, USA
| | - Marie Gross
- Missouri Breaks Industries Research, Inc., Eagle Butte, SD, USA
| | - Elizabeth D Thomas
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ana Rule
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kellogg Schwab
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lawrence H Moulton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Marcia O'Leary
- Missouri Breaks Industries Research, Inc., Eagle Butte, SD, USA
| | - Ana Navas-Acien
- Department of Environmental Health Science, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Christine Marie George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Zacher T, Endres K, Richards F, Robe LB, Powers M, Yracheta J, Harvey D, Best LG, Red Cloud R, Black Bear A, Ristau S, Aurand D, Skinner L, Cuny C, Gross M, Thomas E, Rule A, Schwab KJ, O'Leary M, Moulton LH, Navas-Acien A, George CM. Evaluation of a water arsenic filter in a participatory intervention to reduce arsenic exposure in American Indian communities: The Strong Heart Water Study. Sci Total Environ 2023; 862:160217. [PMID: 36410482 PMCID: PMC10373100 DOI: 10.1016/j.scitotenv.2022.160217] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/10/2022] [Accepted: 11/12/2022] [Indexed: 06/16/2023]
Abstract
Many rural populations, including American Indian communities, that use private wells from groundwater for their source of drinking and cooking water are disproportionately exposed to elevated levels of arsenic. However, programs aimed at reducing arsenic in American Indian communities are limited. The Strong Heart Water Study (SHWS) is a randomized controlled trial aimed at reducing arsenic exposure among private well users in American Indian Northern Great Plains communities. The community-led SHWS program installed point-of-use (POU) arsenic filters in the kitchen sink of households, and health promoters delivered arsenic health communication programs. In this study we evaluated the efficacy of these POU arsenic filters in removing arsenic during the two-year installation period. Participants were randomized into two arms. In the first arm households received a POU arsenic filter, and 3 calls promoting filter use (SHWS mobile health (mHealth) & filter arm). The second arm received the same filter and phone calls, and 3 in-person home visits and 3 Facebook messages (SHWS intensive arm) for program delivery. Temporal variability in water arsenic concentrations from the main kitchen faucet was also evaluated. A total of 283 water samples were collected from 50 households with private wells from groundwater (139 filter and 144 kitchen faucet samples). Ninety-three percent of households followed after baseline had filter faucet water arsenic concentrations below the arsenic maximum contaminant level of 10 μg/L at the final visit during our 2 year study period with no difference between study arms (98 % in the intensive arm vs. 94 % in the mHealth & filter arm). No significant temporal variation in kitchen arsenic concentration was observed over the study period (intraclass correlation coefficient = 0.99). This study demonstrates that POU arsenic filters installed for the community participatory SHWS program were effective in reducing water arsenic concentration in study households in both arms, even with delivery of the POU arsenic filter and mHealth program only. Furthermore, we observed limited temporal variability of water arsenic concentrations from kitchen faucet samples collected over time from private wells in our study setting.
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Affiliation(s)
- Tracy Zacher
- Missouri Breaks Industries Research Inc., Eagle Butte, SD, USA
| | - Kelly Endres
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Lisa Bear Robe
- Missouri Breaks Industries Research Inc., Eagle Butte, SD, USA
| | - Martha Powers
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joseph Yracheta
- Missouri Breaks Industries Research Inc., Eagle Butte, SD, USA
| | - David Harvey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Indian Health Services, Rockville, MD, USA
| | - Lyle G Best
- Missouri Breaks Industries Research Inc., Eagle Butte, SD, USA
| | - Reno Red Cloud
- Environmental Resource Department, Oglala Sioux Tribe, USA
| | | | - Steve Ristau
- Mid Continent Testing Labs, Inc, Rapid City, SD, USA
| | - Dean Aurand
- Mid Continent Testing Labs, Inc, Rapid City, SD, USA
| | - Leslie Skinner
- Missouri Breaks Industries Research Inc., Eagle Butte, SD, USA
| | - Christa Cuny
- Missouri Breaks Industries Research Inc., Eagle Butte, SD, USA
| | - Marie Gross
- Missouri Breaks Industries Research Inc., Eagle Butte, SD, USA
| | - Elizabeth Thomas
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ana Rule
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kellogg J Schwab
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Marcia O'Leary
- Missouri Breaks Industries Research Inc., Eagle Butte, SD, USA
| | - Lawrence H Moulton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ana Navas-Acien
- Department of Environmental Health Science, Mailman School of Public Health, Columbia University, NY, New York, USA
| | - Christine Marie George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Best LG, O'Leary M, O'Leary R, Lawrence W, Torgerson DG. Return of Participants' Incidental Genetic Research Findings: Experience from a Case-Control Study of Asthma in an American Indian Community. Res Sq 2023:rs.3.rs-2485539. [PMID: 36711525 PMCID: PMC9882662 DOI: 10.21203/rs.3.rs-2485539/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE The proper communication of clinically actionable findings to participants of genetic research entails important ethical considerations, but has been challenging for a variety of reasons. We document an instance of return of individual genetic results in the context of a very rural American Indian community, in hopes of providing insight to other investigators about potentially superior or inferior courses of action. METHODS The original study was a case/control study of asthma among 324 pediatric participants. The study utilized a genotyping microarray assessing over 2 million variants, including one conferring risk for hypertrophic cardiomyopathy for which the American College of Medical Genetics recommends return of results to participants. The study investigators engaged in extensive consultation with the IRB, the Tribal government and local clinicians to better inform our approach. RESULTS With some difficulty we were able to notify the 2 participants heterozygous for this variant. One participant welcomed this information and proceeded to obtain further clinical work-up; the other participant declined further follow-up. CONCLUSION While demanding of considerable time and effort, the return of clinically actionable genetic results is important from both an ethical perspective and to provide an improved trust relationship with the community of research participants.
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Affiliation(s)
| | | | - Rae O'Leary
- Missouri Breaks Industries Research Inc, Eagle Butte
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Li Z, Lewin M, Ruiz P, Nigra AE, Henderson NB, Jarrett JM, Ward C, Zhu J, Umans JG, O'Leary M, Zhang Y, Ragin-Wilson A, Navas-Acien A. Blood cadmium, lead, manganese, mercury, and selenium levels in American Indian populations: The Strong Heart Study. Environ Res 2022; 215:114101. [PMID: 35977585 PMCID: PMC9644284 DOI: 10.1016/j.envres.2022.114101] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 05/15/2023]
Abstract
BACKGROUND Many American Indian (AI) communities are in areas affected by environmental contamination, such as toxic metals. However, studies assessing exposures in AI communities are limited. We measured blood metals in AI communities to assess historical exposure and identify participant characteristics associated with these levels in the Strong Heart Study (SHS) cohort. METHOD Archived blood specimens collected from participants (n = 2014, all participants were 50 years of age and older) in Arizona, Oklahoma, and North and South Dakota during SHS Phase-III (1998-1999) were analyzed for cadmium, lead, manganese, mercury, and selenium using inductively coupled plasma triple quadrupole mass spectrometry. We conducted descriptive analyses for the entire cohort and stratified by selected subgroups, including selected demographics, health behaviors, income, waist circumference, and body mass index. Bivariate associations were conducted to examine associations between blood metal levels and selected socio-demographic and behavioral covariates. Finally, multivariate regression models were used to assess the best model fit that predicted blood metal levels. FINDINGS All elements were detected in 100% of study participants, with the exception of mercury (detected in 73% of participants). The SHS population had higher levels of blood cadmium and manganese than the general U.S. population 50 years and older. The median blood mercury in the SHS cohort was at about 30% of the U.S. reference population, potentially due to low fish consumption. Participants in North Dakota and South Dakota had the highest blood cadmium, lead, manganese, and selenium, and the lowest total mercury levels, even after adjusting for covariates. In addition, each of the blood metals was associated with selected demographic, behavioral, income, and/or weight-related factors in multivariate models. These findings will help guide the tribes to develop education, outreach, and strategies to reduce harmful exposures and increase beneficial nutrient intake in these AI communities.
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Affiliation(s)
- Zheng Li
- Office of Community Health and Hazard Assessment, Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Michael Lewin
- Office of Community Health and Hazard Assessment, Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Patricia Ruiz
- Office of Innovation and Analytics, Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Anne E Nigra
- Department of Environmental Health Sciences, School of Public Health, Columbia University, New York City, NY, USA
| | - Noelle B Henderson
- Office of Community Health and Hazard Assessment, Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jeffery M Jarrett
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cynthia Ward
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jianhui Zhu
- MedStar Health Research Institute, Hyattsville, MD, USA
| | - Jason G Umans
- MedStar Health Research Institute, Hyattsville, MD, USA; Georgetown-Howard Universities Center for Clinical and Translational Science, Washington DC, USA
| | - Marcia O'Leary
- Missouri Breaks Industries and Research, Inc., Eagle Butte, SD, USA
| | - Ying Zhang
- Center for American Indian Health Research, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Angela Ragin-Wilson
- Office of Associate Director, Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, School of Public Health, Columbia University, New York City, NY, USA
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10
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O'Leary M, Secter M, Sanders A. Laparoscopic-Assisted Myomectomy during the Second Trimester of Pregnancy. J Minim Invasive Gynecol 2022. [DOI: 10.1016/j.jmig.2022.09.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Donkervoort S, Mohassel P, O'Leary M, Hartley T, Mozaffar T, Saporta M, Dyment D, Austin-Tse C, Verma S, Hurth K, Warman-Chardon J, O'Donnell-Luria A, Bönnemann C. P.155 Recurring homozygous ACTN2 variant (p.Arg506Gly) cause a recessive, adult-onset myofibrillar myopathy. Neuromuscul Disord 2022. [DOI: 10.1016/j.nmd.2022.07.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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12
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Neff Warner LR, Littman AJ, O'Leary M, Sarche M, Nelson LA, Gray JS, Fretts AM. Diet Quality and Depression in a Cohort of American Indians: The Strong Heart Family Study. Am Indian Alsk Native Ment Health Res 2022; 29:90-121. [PMID: 36178749 DOI: 10.5820/aian.2903.2022.90] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Diet quality has been shown to be inversely associated with depression, but this has not been studied in American Indians (AIs). We examined the prospective association of diet quality and probable depression in a family-based cohort of rural AIs. Using data from the Strong Heart Family Study, we included 1,100 AIs ≥14 years old who were free of probable depression at baseline. We defined probable depression as the presence of moderate or severe depressive symptoms on the Center for Epidemiologic Studies Depression Scale or current use of antidepressant medications. We calculated baseline diet quality from food frequency questionnaires using the Alternative Healthy Eating Index-2010 (AHEI). We used GEE-based multivariate logistic regression to estimate the odds ratio of probable depression at follow up associated with a 10-point higher AHEI score at baseline, adjusted for demographic, psychosocial, and health factors. At follow up, 19% (n = 207) of the sample reported probable depression. Diet quality was not associated with report of probable depression at follow up (OR = 1.16, 95% CI [0.96, 1.39]). Research is needed to examine other temporal dimensions of this relationship and unique aspects of rural AI diets and psychosocial factors that may influence depression.
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13
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Hanson JD, Oziel K, Harris A, Sarche M, O'Leary M, Buchwald D. Adaptations of an RCT during COVID: Case Study in one Rural American Indian Community. Collaborations: A Journal of Community-Based Research and Practice 2022; 5. [PMID: 35519790 PMCID: PMC9070515 DOI: 10.33596/coll.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The COVID-19 pandemic is global in nature but especially threatens American Indian and Alaska Native (AI/AN) communities due to pre-existing conditions and social determinants of health. Because of the higher risk to AI/AN communities, many tribal nations have been proactive in their policies to keep the virus at bay, including travel restrictions and lockdowns. This affected tribal programs as well as collaborative research projects. One project impacted is the Native CHOICES project, an ongoing randomized controlled trial with an AI/AN community that is focused on the prevention of alcohol-exposed pregnancies. Originally designed to be conducted via in-person motivational interviewing sessions, COVID-19 restrictions precluded the intervention from being delivered in-person as it was designed. The study team received valuable input from the project’s Community Advisory Board (CAB) and community-based staff to establish a feasible and acceptable way of conducting the intervention while respecting tribally-enacted COVID-19 restrictions. The goal of this brief report is to outline not just the process to adapting to COVID-19 but also to provide recommendations for future public health programs, including the ongoing need to consider gaps in access affecting resource-poor settings.
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14
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Sobel M, Sanchez TR, Zacher T, Mailloux B, Powers M, Yracheta J, Harvey D, Best LG, Bear AB, Hasan K, Thomas E, Morgan C, Aurand D, Ristau S, Olmedo P, Chen R, Rule A, O'Leary M, Navas-Acien A, George CM, Bostick B. Spatial relationship between well water arsenic and uranium in Northern Plains native lands. Environ Pollut 2021; 287:117655. [PMID: 34426377 PMCID: PMC8434972 DOI: 10.1016/j.envpol.2021.117655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/15/2021] [Accepted: 06/22/2021] [Indexed: 05/09/2023]
Abstract
Arsenic and uranium in unregulated private wells affect many rural populations across the US. The distribution of these contaminants in the private wells of most American Indian communities is poorly characterized, and seldom studied together. Here, we evaluate the association between drinking water arsenic and uranium levels in wells (n = 441) from three tribal regions in North Dakota and South Dakota participating in the Strong Heart Water Study. Groundwater contamination was extensive; 29% and 7% of wells exceeded maximum contaminant levels for arsenic and uranium respectively. 81% of wells had both arsenic and uranium concentrations at one-tenth of their human-health benchmark (arsenic, 1 μg/L; uranium 3 μg/L). Well arsenic and uranium concentrations were uncorrelated (rs = 0.06); however, there appeared to be a spatial correlation of wells co-contaminated by arsenic and uranium associated with flow along a geologic contact. These findings indicate the importance of measuring multiple metals in well water, and to understand underlying hydrogeological conditions. The underlying mechanisms for the prevalence of arsenic and uranium across Northern Plains Tribal Lands in the US, and in particular the occurrence of both elevated arsenic and uranium in drinking water wells in this region, demands further study.
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Affiliation(s)
- Marisa Sobel
- Department of Environmental Health Science, Mailman School of Public Health, Columbia University, USA.
| | - Tiffany R Sanchez
- Department of Environmental Health Science, Mailman School of Public Health, Columbia University, USA.
| | | | | | - Martha Powers
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, USA; Department of Health Sciences, Northeastern University, USA.
| | - Joseph Yracheta
- Missouri Breaks Industries Research, Inc., USA; Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, USA.
| | | | - Lyle G Best
- Missouri Breaks Industries Research, Inc., USA.
| | | | - Khaled Hasan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, USA.
| | - Elizabeth Thomas
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, USA.
| | - Camille Morgan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, USA.
| | | | | | - Pablo Olmedo
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, USA; Department of Toxicology, University of Granada, Spain.
| | - Rui Chen
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, USA.
| | - Ana Rule
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, USA.
| | | | - Ana Navas-Acien
- Department of Environmental Health Science, Mailman School of Public Health, Columbia University, USA.
| | - Christine Marie George
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, USA.
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15
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Hawley CN, Huber CM, Best LG, Howard BV, Umans J, Beresford SAA, McKnight B, Hager A, O'Leary M, Thorndike AN, Ornelas IJ, Brown MC, Fretts AM. Cooking for Health: a healthy food budgeting, purchasing, and cooking skills randomized controlled trial to improve diet among American Indians with type 2 diabetes. BMC Public Health 2021; 21:356. [PMID: 33588808 PMCID: PMC7883757 DOI: 10.1186/s12889-021-10308-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 01/15/2023] Open
Abstract
Background The prevalence of poor diet quality and type 2 diabetes are exceedingly high in many rural American Indian (AI) communities. Because of limited resources and infrastructure in some communities, implementation of interventions to promote a healthy diet is challenging—which may exacerbate health disparities by region (urban/rural) and ethnicity (AIs/other populations). It is critical to adapt existing evidence-based healthy food budgeting, purchasing, and cooking programs to be relevant to underserved populations with a high burden of diabetes and related complications. The Cooking for Health Study will work in partnership with an AI community in South Dakota to develop a culturally-adapted 12-month distance-learning-based healthy food budgeting, purchasing, and cooking intervention to improve diet among AI adults with type 2 diabetes. Methods The study will enroll 165 AIs with physician-diagnosed type 2 diabetes who reside on the reservation. Participants will be randomized to an intervention or control arm. The intervention arm will receive a 12-month distance-learning curriculum adapted from Cooking Matters® that focuses on healthy food budgeting, purchasing, and cooking skills. In-person assessments at baseline, month 6 and month 12 will include completion of the Nutrition Assessment Shared Resources Food Frequency Questionnaire and a survey to assess frequency of healthy and unhealthy food purchases. Primary outcomes of interest are: (1) change in self-reported intake of sugar-sweetened beverages (SSBs); and (2) change in the frequency of healthy and unhealthy food purchases. Secondary outcomes include: (1) change in self-reported food budgeting skills; (2) change in self-reported cooking skills; and (3) a mixed-methods process evaluation to assess intervention reach, fidelity, satisfaction, and dose delivered/received. Discussion Targeted and sustainable interventions are needed to promote optimal health in rural AI communities. If effective, this intervention will reduce intake of SSBs and the purchase of unhealthy foods; increase the purchase of healthy foods; and improve healthy food budgeting and cooking skills among AIs with type 2 diabetes – a population at high risk of poor health outcomes. This work will help inform future health promotion efforts in resource-limited settings. Trial registration This study was registered on ClinicalTrials.gov on October 9, 2018 with Identifier NCT03699709. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10308-8.
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Affiliation(s)
- Caitlin N Hawley
- Department of Medicine, University of Washington, 1410 NE Campus Parkway, Seattle, WA, 98195, USA
| | - Corrine M Huber
- Missouri Breaks Industries Research Inc, 118 S Willow St, Eagle Butte, SD, 57625, USA
| | - Lyle G Best
- Missouri Breaks Industries Research Inc, 118 S Willow St, Eagle Butte, SD, 57625, USA
| | - Barbara V Howard
- Medstar Health Research Institute, 6525 Belcrest Rd #700c, Hyattsville, MD, 20785, USA.,Georgetown and Howard Universities Center for Clinical and Translational Science, 4000 Reservoir Road NW, Washington, DC, 20007, USA
| | - Jason Umans
- Medstar Health Research Institute, 6525 Belcrest Rd #700c, Hyattsville, MD, 20785, USA
| | - Shirley A A Beresford
- Department of Epidemiology, University of Washington, 1410 NE Campus Parkway, Seattle, WA, 98195, USA
| | - Barbara McKnight
- Department of Biostatistics, University of Washington, 1410 NE Campus Parkway, Seattle, WA, 98195, USA
| | - Arlette Hager
- Cheyenne River Sioux Tribe Adult Diabetes Program, 24276 Airport Rd, Eagle Butte, SD, 57625, USA
| | - Marcia O'Leary
- Missouri Breaks Industries Research Inc, 118 S Willow St, Eagle Butte, SD, 57625, USA
| | - Anne N Thorndike
- Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - India J Ornelas
- Department of Health Services, 1410 NE Campus Parkway, Seattle, WA, 98195, USA
| | - Meagan C Brown
- Department of Epidemiology, University of Washington, 1410 NE Campus Parkway, Seattle, WA, 98195, USA
| | - Amanda M Fretts
- Department of Epidemiology, University of Washington, 1410 NE Campus Parkway, Seattle, WA, 98195, USA.
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16
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Hanson J, Mohawk C, Shrestha U, Gross M, O'Leary M, Sarche M. The Importance of Understanding Social Context in the Reduction of AEP Risk among Native Women. Alcohol Clin Exp Res 2020; 44:2154-2157. [PMID: 32981143 DOI: 10.1111/acer.14470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/10/2020] [Accepted: 09/17/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Jessica Hanson
- From the, Department of Applied Human Sciences, (JH, CM), University of Minnesota Duluth, Duluth, Minnesota, USA
| | - Cassaundra Mohawk
- From the, Department of Applied Human Sciences, (JH, CM), University of Minnesota Duluth, Duluth, Minnesota, USA
| | - Umit Shrestha
- Colorado School of Public Health, Centers for American Indian and Alaska Native Health, (US, MS), University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Marie Gross
- Missouri Breaks Industries Research Inc., (MG, MO), Eagle Butte, South Dakota, USA
| | - Marcia O'Leary
- Missouri Breaks Industries Research Inc., (MG, MO), Eagle Butte, South Dakota, USA
| | - Michelle Sarche
- Colorado School of Public Health, Centers for American Indian and Alaska Native Health, (US, MS), University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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17
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Chen J, O'Leary M, Burbank L, Zheng Z, Deng X. Whole Genome Sequence of Xylella fastidiosa ATCC 35879 T and Detection of Genome Rearrangements Within Subsp. fastidiosa. Curr Microbiol 2020; 77:1858-1863. [PMID: 32179972 DOI: 10.1007/s00284-020-01937-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 02/24/2020] [Indexed: 10/24/2022]
Abstract
Xylella fastidiosa is a Gram-negative and nutritionally fastidious bacterial pathogen causing Pierce's disease (PD) of grapevine and other plant diseases. X. fastidiosa strain ATCC 35879T which originated from Florida is the designated type strain for the species and for subsp. fastidiosa. In bacterial taxonomy, type strains preserve the characters of the original descriptions. Whole genome sequence of a type strain not only provides a standard reference for bacterial taxonomy, but also facilitates research in other fields such as population diversity and genome evolution. In this study, the whole genome sequence of strain ATCC 35879T was determined using PacBio RSII format. The ATCC 35879T genome has a circular chromosome of 2,565,504 bp with 2,904 predicted protein coding genes and 55 RNA genes, and a circular plasmid of 41,753 bp. The chromosomal sequence of strain ATCC 35879T was compared to that of X. fastidosa subsp. fastidiosa strain M23 from California which causes both PD and almond leaf scorch disease. Genome rearrangements involving a ~ 1,200 K bp region were detected. Genome annotations showed clusters of phage-related genes around the rearrangement junctions, suggesting the likely involvement of phage activities. This is the first report on genome structure variations within strains of X. fastidiosa subsp. fastidiosa.
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Affiliation(s)
- J Chen
- Agricultural Research Service, United States Department of Agriculture, San Joaquin Valley Agricultural Sciences Center, Parlier, CA, USA.
| | - M O'Leary
- Agricultural Research Service, United States Department of Agriculture, San Joaquin Valley Agricultural Sciences Center, Parlier, CA, USA
| | - L Burbank
- Agricultural Research Service, United States Department of Agriculture, San Joaquin Valley Agricultural Sciences Center, Parlier, CA, USA
| | - Z Zheng
- Department of Plant Pathology, South China Agricultural University, Guangzhou, People's Republic of China
| | - X Deng
- Department of Plant Pathology, South China Agricultural University, Guangzhou, People's Republic of China
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18
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Nigra AE, Olmedo P, Grau-Perez M, O'Leary R, O'Leary M, Fretts AM, Umans JG, Best LG, Francesconi KA, Goessler W, Cole SA, Navas-Acien A. Dietary determinants of inorganic arsenic exposure in the Strong Heart Family Study. Environ Res 2019; 177:108616. [PMID: 31442790 PMCID: PMC6748659 DOI: 10.1016/j.envres.2019.108616] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/08/2019] [Accepted: 07/26/2019] [Indexed: 05/19/2023]
Abstract
BACKGROUND Chronic exposure to inorganic arsenic (iAs) in the US occurs mainly through drinking water and diet. Although American Indian (AI) populations have elevated urinary arsenic concentrations compared to the general US population, dietary sources of arsenic exposure in AI populations are not well characterized. METHODS We evaluated food frequency questionnaires to determine the major dietary sources of urinary arsenic concentrations (measured as the sum of arsenite, arsenate, monomethylarsonate, and dimethylarsinate, ΣAs) for 1727 AI participants in the Strong Heart Family Study (SHFS). We compared geometric mean ratios (GMRs) of urinary ΣAs for an interquartile range (IQR) increase in reported food group consumption. Exploratory analyses were stratified by gender and study center. RESULTS In fully adjusted generalized estimating equation models, the percent increase (95% confidence interval) of urinary ΣAs per increase in reported food consumption corresponding to the IQR was 13% (5%, 21%) for organ meat, 8% (4%, 13%) for rice, 7% (2%, 13%) for processed meat, and 4% (1%, 7%) for non-alcoholic drinks. In analyses stratified by study center, the association with organ meat was only observed in North/South Dakota. Consumption of red meat [percent increase -7% (-11%, -3%)] and fries and chips [-6% (-10%, -2%)] was inversely associated with urinary ΣAs. CONCLUSIONS Organ meat, processed meat, rice, and non-alcoholic drinks contribute to ΣAs exposure in the SHFS population. Organ meat is a unique source of ΣAs exposure for North and South Dakota participants and may reflect local food consumption. Further studies should comprehensively evaluate drinking water arsenic in SHFS communities and determine the relative contribution of diet and drinking water to total arsenic exposure.
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Affiliation(s)
- Anne E Nigra
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Pablo Olmedo
- Department of Legal Medicine and Toxicology, School of Medicine, University of Granada, Granada, Spain
| | - Maria Grau-Perez
- Area of Cardiometabolic and Renal Risk, Biomedical Research Institute Hospital Clinic of Valencia, Valencia, Spain
| | - Rae O'Leary
- Missouri Breaks Industries Research Inc, Eagle Butte, SD, USA
| | - Marcia O'Leary
- Missouri Breaks Industries Research Inc, Eagle Butte, SD, USA
| | - Amanda M Fretts
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Jason G Umans
- MedStar Health Research Institute; Washington, DC, USA
| | - Lyle G Best
- Missouri Breaks Industries Research Inc, Eagle Butte, SD, USA
| | | | | | - Shelley A Cole
- Texas Biomedical Research Institute, Hyattsville, MD, USA
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
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19
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Sienna J, O'Leary M, Farrokhyar F, Salehi A, Eiriksson L, Kong I. Adjuvant Radiation for Endometrioid Adenocarcinoma Stage II (AREAS2): A Canadian Cohort. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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20
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O'Donald ER, Miller CP, O'Leary R, Ong J, Pacheco B, Foos K, Enright K, O'Leary M, Nez Henderson P, Lewis J, Erdei E, Henderson JA. Active smoking, secondhand smoke exposure and serum cotinine levels among Cheyenne River Sioux communities in context of a Tribal Public Health Policy. Tob Control 2019; 29:570-576. [PMID: 31462578 DOI: 10.1136/tobaccocontrol-2019-055056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 03/08/2019] [Revised: 06/18/2019] [Accepted: 06/26/2019] [Indexed: 11/03/2022]
Abstract
INTRODUCTION American Indians and Alaska Natives face disproportionately high rates of smoking and secondhand smoke (SHS) exposure. The Cheyenne River Sioux Tribe (CRST) is among the few Tribal Nations controlling commercial tobacco exposures in public and work places. We had an opportunity to explore effects of the new commercial tobacco-free policy (implemented in 2015) in an environmental health study (2014-2016) that collected information about commercial tobacco use and SHS prevalence and examined predictor variables of serum cotinine concentrations. METHODS Self-reported survey data were used in quantile regression statistical modelling to explore changes in cotinine levels, based on smoking status, smokeless tobacco consumption and SHS exposure. RESULTS From enrolled 225 adults, 51% (N=114) were current smokers. Among 88 non-tobacco users, 35 (40%) reported current SHS exposure. Significant differences in cotinine median concentrations were found among participants with and without current SHS exposure. Extremely high cotinine concentrations (~100 times larger than the median) were detected in some non-tobacco users. After implementing the new smoke-free air Tribal policy, cotinine decreased in participants with intermediate (3-15 ng/mL, non-tobacco users with SHS exposure) and high (>15 ng/mL, mainly tobacco users) cotinine levels showing association with an abatement of opportunities for SHS exposure. Significant predictors of cotinine levels were sampling year, current smoking and tobacco chewing. No gender differences were observed in cotinine. CONCLUSIONS Our results show decrease in cotinine concentrations in CRST participants since implementation of their 'Smoke-Free Clean Air Act' in 2015.
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Affiliation(s)
- Elena R O'Donald
- Pharmaceutical Sciences, Community Environmental Health Program, University of New Mexico Health Sciences Center College of Pharmacy, Albuquerque, New Mexico, USA
| | - Curtis P Miller
- Pharmaceutical Sciences, Community Environmental Health Program, University of New Mexico Health Sciences Center College of Pharmacy, Albuquerque, New Mexico, USA
| | - Rae O'Leary
- Missouri Breaks Industries Research Inc, Eagle Butte, South Dakota, USA
| | - Jennifer Ong
- Pharmaceutical Sciences, Community Environmental Health Program, University of New Mexico Health Sciences Center College of Pharmacy, Albuquerque, New Mexico, USA
| | - Bernadette Pacheco
- Pharmaceutical Sciences, Community Environmental Health Program, University of New Mexico Health Sciences Center College of Pharmacy, Albuquerque, New Mexico, USA
| | - Kathryne Foos
- Pharmaceutical Sciences, Community Environmental Health Program, University of New Mexico Health Sciences Center College of Pharmacy, Albuquerque, New Mexico, USA
| | - Kendra Enright
- Missouri Breaks Industries Research Inc, Eagle Butte, South Dakota, USA
| | - Marcia O'Leary
- Missouri Breaks Industries Research Inc, Eagle Butte, South Dakota, USA
| | | | - Johnnye Lewis
- Pharmaceutical Sciences, Community Environmental Health Program, University of New Mexico Health Sciences Center College of Pharmacy, Albuquerque, New Mexico, USA
| | - Esther Erdei
- Pharmaceutical Sciences, Community Environmental Health Program, University of New Mexico Health Sciences Center College of Pharmacy, Albuquerque, New Mexico, USA
| | - Jeffrey A Henderson
- Black Hills Center for American Indian Health, Rapid City, South Dakota, USA
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21
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Thomas ED, Gittelsohn J, Yracheta J, Powers M, O'Leary M, Harvey DE, Red Cloud R, Best LG, Black Bear A, Navas-Acien A, George CM. The Strong Heart Water Study: Informing and designing a multi-level intervention to reduce arsenic exposure among private well users in Great Plains Indian Nations. Sci Total Environ 2019; 650:3120-3133. [PMID: 30373089 PMCID: PMC10472338 DOI: 10.1016/j.scitotenv.2018.09.204] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/11/2018] [Accepted: 09/16/2018] [Indexed: 05/18/2023]
Abstract
Elevated arsenic exposure from drinking water is associated with an increased risk of cardiovascular disease, diabetes, kidney disease, and skin, lung, and bladder cancer. Arsenic contamination in groundwater supplies disproportionately affects rural populations using private wells. Arsenic mitigation programs for American Indian communities are limited. There is an urgent need for targeted approaches to reduce arsenic exposure for at-risk communities using private wells. Formative research was conducted to inform and design a community-based arsenic mitigation intervention for Lakota and Dakota Nations in the Great Plains Area of the United States, where, in some communities, one-quarter of private wells are estimated to have elevated arsenic. Formative research included semi-structured interviews, a community workshop, intervention-planning workshops, and a pilot study of the developed intervention. Community members prioritize aesthetic qualities of water (e.g. taste, color), safety, and other situational factors (e.g. cost) when considering their drinking and cooking water. Although water safety is a concern, awareness and concern for arsenic vary substantially within communities. To reduce arsenic exposure, community members recommended communication of water test results, home visits for intervention delivery, and reminders to use arsenic-safe water. Findings informed the development of an intervention to prevent arsenic exposure through drinking water and cooking, including health promotion messages and household items to facilitate use of an arsenic removal device (e.g. tankards to store filtered water). The pilot study indicated promising acceptability and operability of the developed intervention. This research provides a model for the development of environmental health interventions in partnership with American Indian and other private well-using communities.
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Affiliation(s)
- Elizabeth D Thomas
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
| | - Joel Gittelsohn
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
| | - Joseph Yracheta
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA; Missouri Breaks Industries Research, Inc., 118 South Willow Street, P.O. Box 1824, Eagle Butte, SD 57625, USA.
| | - Martha Powers
- Missouri Breaks Industries Research, Inc., 118 South Willow Street, P.O. Box 1824, Eagle Butte, SD 57625, USA.
| | - Marcia O'Leary
- Missouri Breaks Industries Research, Inc., 118 South Willow Street, P.O. Box 1824, Eagle Butte, SD 57625, USA.
| | - David E Harvey
- The Indian Health Service, 5600 Fishers Ln, Rockville, MD 20857, USA.
| | | | - Lyle G Best
- Missouri Breaks Industries Research, Inc., 118 South Willow Street, P.O. Box 1824, Eagle Butte, SD 57625, USA.
| | - Annabelle Black Bear
- Missouri Breaks Industries Research, Inc., 209 West Main Street, Martin, SD 57551, USA.
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032, USA.
| | - Christine Marie George
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
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Powers M, Yracheta J, Harvey D, O'Leary M, Best LG, Black Bear A, MacDonald L, Susan J, Hasan K, Thomas E, Morgan C, Olmedo P, Chen R, Rule A, Schwab K, Navas-Acien A, George CM. Arsenic in groundwater in private wells in rural North Dakota and South Dakota: Water quality assessment for an intervention trial. Environ Res 2019; 168:41-47. [PMID: 30261340 PMCID: PMC6296218 DOI: 10.1016/j.envres.2018.09.016] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/11/2018] [Accepted: 09/15/2018] [Indexed: 05/25/2023]
Abstract
Elevated exposure to arsenic disproportionately affects populations relying on private well water in the United States (US). This includes many American Indian (AI) communities where naturally occurring arsenic is often above 10 µg/L, the current US Environmental Protection Agency safety standard. The Strong Heart Water Study is a randomized controlled trial aiming to reduce arsenic exposure to private well water users in AI communities in North Dakota and South Dakota. In preparation for this intervention, 371 households were included in a community water arsenic testing program to identify households with arsenic ≥10 µg/L by inductively coupled plasma mass spectrometry (ICP-MS). Arsenic ≥10 µg/L was found in 97/371 (26.1%) households; median water arsenic concentration was 6.3 µg/L, ranging from <1-198 µg/L. Silica was identified as a water quality parameter that could impact the efficacy of arsenic removal devices to be installed. A low-range field rapid arsenic testing kit evaluated in a small number of households was found to have low accuracy; therefore, not an option for the screening of affected households in this setting. In a pilot study of the effectiveness of a point-of-use adsorptive media water filtration device for arsenic removal, all devices installed removed arsenic below 1 µg/L at both installation and 9 months post-installation. This study identified a relatively high burden of arsenic in AI study communities as well as an effective water filtration device to reduce arsenic in these communities. The long-term efficacy of a community based arsenic mitigation program in reducing arsenic exposure and preventing arsenic related disease is being tested as part of the Strong Heart Water Study.
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Affiliation(s)
- Martha Powers
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205, USA.
| | - Joseph Yracheta
- Missouri Breaks Industries Research, Inc., 118 S. Willow St, Eagle Butte, SD 57625, USA.
| | - David Harvey
- Division of Sanitation Facilities Construction, Indian Health Service, Rockville, MD 20857, USA.
| | - Marcia O'Leary
- Missouri Breaks Industries Research, Inc., 118 S. Willow St, Eagle Butte, SD 57625, USA.
| | - Lyle G Best
- Missouri Breaks Industries Research, Inc., 118 S. Willow St, Eagle Butte, SD 57625, USA.
| | - Annabelle Black Bear
- Missouri Breaks Industries Research, Inc., 118 S. Willow St, Eagle Butte, SD 57625, USA.
| | - Luke MacDonald
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205, USA.
| | - Jolie Susan
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205, USA.
| | - Khaled Hasan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205, USA.
| | - Elizabeth Thomas
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205, USA.
| | - Camille Morgan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205, USA.
| | - Pablo Olmedo
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205, USA.
| | - Rui Chen
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205, USA.
| | - Ana Rule
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205, USA.
| | - Kellogg Schwab
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205, USA.
| | - Ana Navas-Acien
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205, USA; Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY 10032, USA.
| | - Christine Marie George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205, USA.
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Fretts AM, Huber C, Best LG, O'Leary M, LeBeau L, Howard BV, Siscovick DS, Beresford SA. Availability and Cost of Healthy Foods in a Large American Indian Community in the North-Central United States. Prev Chronic Dis 2018; 15:E03. [PMID: 29300694 PMCID: PMC5757381 DOI: 10.5888/pcd15.170302] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
To understand the local food environment in a rural American Indian community, we assessed the availability and price of healthy foods offered at all stores (n = 27) within a 90-mile radius of the town center of a large American Indian reservation. Stores were classified by type, and availability and cost of foods were measured using the Nutrition Environment Measures Survey in Stores (January–February 2016). Healthy foods were available at most grocery stores (>97%), although the price of foods varied considerably among stores. Having quantified the availability and cost of food, efforts must focus on understanding other structural and contextual factors that influence diet in this community.
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Affiliation(s)
- Amanda M Fretts
- Department of Epidemiology, University of Washington, University of Washington Cardiovascular Health Research Unit, 1730 Minor Ave, Ste 1360, Seattle, WA 98101.
| | - Corrine Huber
- Missouri Breaks Industries Research Inc, Eagle Butte, South Dakota
| | - Lyle G Best
- Missouri Breaks Industries Research Inc, Eagle Butte, South Dakota
| | - Marcia O'Leary
- Missouri Breaks Industries Research Inc, Eagle Butte, South Dakota
| | - Laurel LeBeau
- Missouri Breaks Industries Research Inc, Eagle Butte, South Dakota
| | - Barbara V Howard
- MedStar Health Research Institute and Georgetown and Howard Universities Center for Translational Sciences, Washington, District of Columbia
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Nesoff ED, Brownstein JN, Veazie M, O'Leary M, Brody EA. Time-to-Treatment for Myocardial Infarction: Barriers and Facilitators Perceived by American Indians in Three Regions. J Community Health 2018; 42:129-138. [PMID: 27613739 DOI: 10.1007/s10900-016-0239-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 11/24/2022]
Abstract
Early recognition of acute myocardial infarction (MI), followed by prompt emergency care, improves patient outcomes. Among rural American Indian (AI) populations there are disparities in access to care for MI and processes of care, resulting in poor MI-related health outcomes compared to the general population. We sought to gain an understanding of barriers related to MI time-to-treatment delays using a qualitative approach. We conducted semi-structured interviews and focus groups with AI key informants and community members in three Indian Health Service regions. Major barriers to care included long travel distance to care and lack of supporting infrastructure; distrust of the health care system; low overall literacy and basic health literacy; priority of family care-giving; and lack of specialized medical facilities and specialists. Findings suggest that improved time-to-treatment facilitators include educating the local community about the causes and consequences of MI and culturally-sensitive health communication, as well as addressing the quality of local systems of care and the community's perception of these systems. Pursuing these strategies may improve quality of care and reduce MI-related morbidity and mortality in rural AI populations.
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Affiliation(s)
- Elizabeth D Nesoff
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA.
| | - J Nell Brownstein
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop F-72, Atlanta, GA, 30341-3717, USA
| | - Mark Veazie
- Indian Health Service, 1215 N. Beaver Street, Suite #201, Flagstaff, AZ, 86001, USA
| | - Marcia O'Leary
- Missouri Breaks Industries Research, HCR 64 Box 52, Timber Lake, SD, 57656, USA
| | - Eric A Brody
- Native American Cardiology and Medical Service Program, University of Arizona Medical Center, 1501 North, Campbell Ave., PO Box 245202, Tucson, AZ, 85724, USA
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Suchy-Dicey AM, Shibata D, Best LG, Verney SP, Longstreth WT, Lee ET, Okin PM, Devereux R, O'Leary M, Ali T, Jensen PN, Muller C, Nelson LA, Rhoades E, Madhyastha T, Grabowski TJ, Beauchamp N, Umans JG, Buchwald D. Cranial Magnetic Resonance Imaging in Elderly American Indians: Design, Methods, and Implementation of the Cerebrovascular Disease and Its Consequences in American Indians Study. Neuroepidemiology 2016; 47:67-75. [PMID: 27603047 DOI: 10.1159/000443277] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 05/09/2016] [Indexed: 12/17/2022] Open
Abstract
The Cerebrovascular Disease and its Consequences in American Indians (CDCAI) Study recruited surviving members of a 20-year, longitudinal, population-based cohort of American Indians focused on cardiovascular disease, its risk factors, and its consequences. The goal of the CDCAI Study is to characterize the burden, risk factors, and manifestations of vascular brain injury identified on cranial MRI. The CDCAI Study investigators enrolled 1,033 participants aged 60 and older from 11 American Indian communities and tribes in the Northern Plains, Southern Plains, and Southwestern United States. In addition to cranial MRI performed according to standardized protocols, participants underwent extensive medical interview, clinical examination, neurocognitive testing, physical function evaluation, electrocardiogram, and provided blood and urine specimens. Participants also self-administered questionnaires covering demographics, quality of life, and medical history. This report describes the design, implementation, and some of the unique challenges of this study and data collection.
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Affiliation(s)
- Astrid M Suchy-Dicey
- Partnerships for Native Health, Elson S. Floyd College of Medicine, Washington State University, Seattle, Wash., USA
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26
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Sullivan EA, Koro S, Tabrizi S, Kaldor J, Poumerol G, Chen S, O'Leary M, Garland SM. Prevalence of sexually transmitted diseases and human immunodeficiency virus among women attending prenatal services in Apia, Samoa. Int J STD AIDS 2016; 15:116-9. [PMID: 15006074 DOI: 10.1258/095646204322764316] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 11/18/2022]
Abstract
There is no routine prenatal screening for sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV) in pregnancy in Samoa. Testing for chlamydial infection is not available. To gather information on pregnant women, a prevalence survey was conducted in Apia, Samoa, utilizing two prenatal hospital clinics. Pregnant ( n = 427) women were tested for Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis using polymerase chain reaction (PCR), and for syphilis ( n = 441) by rapid plasmid reagin (RPR) and HIV ( n = 441) by enzyme-linked immunosorbent assay (ELISA). Results were: chlamydia 30.9% (132); trichomoniasis 20.8%; gonorrhoea 3.3%; syphilis 0.5%; and HIV 0%. Overall 42.7% had at least 1 STD. Young women aged <25 years were three times more likely to have a STD than older women (odds ratio = 3.0, 95% confidence intervals 2.0, 4.5). The lack of inexpensive, reliable field diagnostics remain a barrier to sustainable STD control programmes for pregnant women living in developing countries.
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Affiliation(s)
- E A Sullivan
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia.
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27
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O'Leary JL, Smith JM, Inukai J, O'Leary M. The inferior olive as a source of climbing fibers in the rat. Bibl Psychiatr 2015; 143:128-37. [PMID: 5411696 DOI: 10.1159/000385824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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28
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Punekar YS, Roberts G, Ismaila A, O'Leary M. Cost Effectiveness of Umeclidinium/Vilanterol (UMEC/VI) Combination Therapy Among Symptomatic COPD Patients. Value Health 2014; 17:A595. [PMID: 27202045 DOI: 10.1016/j.jval.2014.08.2053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | | | - A Ismaila
- GlaxoSmithKline, Research Triangle Park, NC, USA
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29
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Ismaila A, Roberts G, Punekar YS, O'Leary M. Cost-Effectiveness Analysis of Umeclidinium Bromide Compared to Tiotropium Bromide for Symptomatic Patients with COPD in the UK. Value Health 2014; 17:A595. [PMID: 27202044 DOI: 10.1016/j.jval.2014.08.2052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- A Ismaila
- GlaxoSmithKline, Research Triangle Park, NC, USA
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30
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Hart AJ, Hodgson WC, O'Leary M, Isbister GK. Pharmacokinetics and pharmacodynamics of the myotoxic venom of Pseudechis australis (mulga snake) in the anesthetised rat. Clin Toxicol (Phila) 2014; 52:604-10. [PMID: 24940643 DOI: 10.3109/15563650.2014.914526] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [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: 11/13/2022]
Abstract
CONTEXT Myotoxicity is a common clinical effect of snake envenoming and results from either local or systemic myotoxins in snake venoms. Although numerous myotoxins have been isolated from snake venoms, there has been limited study on the relationship between the time course of venom concentrations (pharmacokinetics) and the time course of muscle injury measured as a rise in creatine kinase (CK) (pharmacodynamics). OBJECTIVE The aim of this study was to develop an in vivo model of myotoxicity to investigate the time course of myotoxicity and the effect of antivenom. MATERIALS AND METHODS Anesthetised rats were administered Pseudechis australis (mulga snake) venom either through i.v., i.m. or s.d. route, including a range of doses (5-100 μg/kg). Serial blood samples were collected for measurement of venom using enzyme immunoassay and measurement of CK and creatinine. Antivenom was administered before, 1 and 6 h after venom administration to investigate its effect on muscle injury. Plots of venom and CK versus time were made and the area under the curve (AUC) was calculated. RESULTS There was a significant dose-dependent increase in CK concentration after administration of P. australis venom, which was greatest for i.v. administration. Timed measurement of venom concentrations showed a rapid absorption through s.d. and i.m. routes and a delayed rise in CK concentrations following any route. Antivenom prevented myotoxicity shown by a decrease in the CK AUC, which was most effective if given earliest. There was a rise in creatinine following i.v. venom administration. CONCLUSION The study shows the delayed relationship between venom absorption and the rise in CK, consistent with the delayed onset of myotoxicity in human envenoming. Antivenom prevented myotoxicity more effectively if given earlier.
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Affiliation(s)
- A J Hart
- Department of Pharmacology, Monash Venom Group, Monash University , Victoria , Australia
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31
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Cummings C, Foreman R, Killoran T, Krane J, O'Leary M. Testicular Infarction After Angioembolization of an Ipsilateral Renal Angiomyolipoma. Urology 2013; 82:995-7. [DOI: 10.1016/j.urology.2013.04.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 04/09/2013] [Accepted: 04/20/2013] [Indexed: 11/25/2022]
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32
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Gately RP, Concannon ES, Hogan A, Ryan RS, O'Leary M, Barry K. Recurrent femoral hernia and associated ovarian pathology. BMJ Case Rep 2012; 2012:bcr-2012-006442. [PMID: 22927276 DOI: 10.1136/bcr-2012-006442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The following case describes an ovarian tumour presenting in a highly unusual manner-in the form of a recurrent femoral hernia. Recurrent femoral herniae are unusual and should prompt awareness of underlying pathology causing increased intra-abdominal pressure.
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Affiliation(s)
- Ryan Patrick Gately
- Department of General Surgery, Mayo General Hospital, Castlebar, County Mayo, Ireland
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33
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Mather M, Blake R, Koland J, Schrock H, Russell P, O'Brien T, Hager LP, Gennis RB, O'Leary M. Escherichia coli pyruvate oxidase: interaction of a peripheral membrane protein with lipids. Biophys J 2010; 37:87-8. [PMID: 19431517 DOI: 10.1016/s0006-3495(82)84613-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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34
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Loughrey A, Rooney P, O'Leary M, McCalmont M, Warner M, Karisik E, Donaghy P, Smyth B, Woodford N, Livermore D. P1348 Prevalence of an epidemic ESBL-producing Escherichia coli strain in LTCFs in Belfast. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)71188-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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35
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Sayers G, McCarthy T, O'Connell M, O'Leary M, O'Brien D, Cafferkey M, McNamara E. Haemolytic uraemic syndrome associated with interfamilial spread of E. coli O26:H11. Epidemiol Infect 2006; 134:724-8. [PMID: 16371176 PMCID: PMC2870445 DOI: 10.1017/s0950268805005455] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2005] [Indexed: 11/06/2022] Open
Abstract
In September 2000, haemolytic uraemic syndrome (HUS) was diagnosed in a 10-month-old child with a prodromal history of vomiting and diarrhoea (non-bloody). Investigation revealed that a self-limiting gastrointestinal illness (mean duration 48 h) had occurred among immediate and extended family in the 2 weeks prior to the child's admission. The epidemiology of the illness suggested person-to-person spread. Five children (close family contacts) had E. coli O26 verocytotoxin (VT1 and VT2) isolated from stools. Stool culture and serology from the index case were negative for shiga toxin-producing E. coli (STEC) organisms. Control measures in accordance with the Public Health Laboratory Service (PHLS), verocytotoxogenic organisms (VTEC) guidelines were applied to prevent further spread among the extended family and contacts. Despite detailed food and environmental exposure histories, the source of the illness was not identified. This incident highlights the importance of investigation of cases of post-diarrhoeal HUS, for potential shiga toxin E. coli aetiology.
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Affiliation(s)
- G Sayers
- Department of Public Health, Health Service Executive Eastern Region, Dublin.
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36
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Abed Z, O'Leary M, Hand K, Flannelly G, Lenehan P, Murphy J, Foley M. Cervical screening history in patients with early stage carcinoma of the cervix. Ir Med J 2006; 99:140-2. [PMID: 16892918] [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: 05/11/2023]
Abstract
This study aimed to examine whether a decade of heightened publicity on issues relating to cervical screening has changed the screening profile of women presenting with cervical cancer at the National Maternity Hospital. The screening history of 100 women diagnosed with early/surgically treated cervical cancer between 1998 and 2002 was compared with a similar study conducted in 1982 /1990. The percentage of women never screened was similar - 24 %( 2002) and 23% (1990). The interval between last recorded smear and diagnosis of disease was greater than 5 years in 45.6% and 41.7% respectively. Overall 60% of women in the recent period had either failed to avail of screening or were not screened within 5 years of diagnosis compared with 64% in 1990. Multiparous women comprised 90% of the study group and 50% of those inadequately screened were attending their general practitioner on a regular basis - therefore affording a potential for opportunistic screening The current method of screening has failed in this group and has not improved in 10 years despite of increased population awareness and greater opportunities for screening than ever before and would support an argument for a National Screening Program.
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Affiliation(s)
- Z Abed
- Dept of Obstetrics and Gynaecology, National Maternity Hospital, Dublin
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37
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O'Connor R, O'Leary M, Ballot J, Collins CD, Kinsella P, Mager DE, Arnold RD, O'Driscoll L, Larkin A, Kennedy S, Fennelly D, Clynes M, Crown J. A phase I clinical and pharmacokinetic study of the multi-drug resistance protein-1 (MRP-1) inhibitor sulindac, in combination with epirubicin in patients with advanced cancer. Cancer Chemother Pharmacol 2006; 59:79-87. [PMID: 16642371 DOI: 10.1007/s00280-006-0240-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2006] [Accepted: 03/20/2006] [Indexed: 12/16/2022]
Abstract
PURPOSE Multi-drug resistance mediated by ATP-binding cassette trans-membrane protein pumps is an important cause of cancer treatment failure. Sulindac has been shown to be a competitive substrate for the clinically important resistance protein, multi-drug resistance protein-1 (MRP-1), and thus might enhance the anti-cancer activity of substrate chemotherapeutic agents, e.g. anthracyclines. METHODS We conducted a dose-escalating, single arm, prospective, open label, non-randomised phase I trial of epirubicin (75 mg/m(2)) in combination with escalating oral doses of sulindac (0-800 mg) in patients with advanced cancer to identify an appropriate dose of sulindac to use in future resistance studies. Anthracycline and sulindac pharmacokinetics were studied in cycles 1 and 3. RESULTS Seventeen patients (8 breast, 3 lung, 2 bowel, 1 melanoma, 1 renal, 1 ovarian and 1 of unknown primary origin, 16/17 having had prior chemotherapy) were enrolled. Eight patients received a full six cycles of treatment; 14 patients received three or more cycles. Dose-limiting toxicity was observed in two patients at 800 mg sulindac (1 renal impairment, 1 fatal haemoptysis in a patient with advanced lung cancer), and sulindac 600 mg was deemed to be the maximum tolerated dose. Sulindac had no effect on epirubicin pharmacokinetics. Among 15 patients with evaluable tumour, two partial responses were seen (malignant melanoma and breast cancer). Four others had prolonged stable disease. CONCLUSION Epirubicin 75 mg/m(2) and sulindac 600 mg are the recommended doses for phase II studies for these agents in combination.
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MESH Headings
- ATP Binding Cassette Transporter, Subfamily B, Member 1/antagonists & inhibitors
- ATP Binding Cassette Transporter, Subfamily B, Member 1/metabolism
- Adult
- Aged
- Anti-Inflammatory Agents, Non-Steroidal/adverse effects
- Anti-Inflammatory Agents, Non-Steroidal/pharmacokinetics
- Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
- Antibiotics, Antineoplastic/adverse effects
- Antibiotics, Antineoplastic/therapeutic use
- Chemotherapy, Adjuvant
- Creatinine/blood
- Dose-Response Relationship, Drug
- Drug Resistance, Multiple/drug effects
- Drug Resistance, Neoplasm/drug effects
- Epirubicin/adverse effects
- Epirubicin/therapeutic use
- Female
- Humans
- Immunohistochemistry
- Male
- Middle Aged
- Myocardium/metabolism
- Neoplasms/drug therapy
- Neoplasms/metabolism
- Neoplasms/pathology
- Platelet Count
- Prospective Studies
- Sulindac/adverse effects
- Sulindac/pharmacokinetics
- Sulindac/therapeutic use
- Troponin/metabolism
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Affiliation(s)
- R O'Connor
- The National Institute for Cellular Biotechnology, Dublin City University, Dublin, 9, Ireland.
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Lowe FC, Batista J, Berges R, Chartier-Kastler E, Conti G, Desgrandchamps F, Dreikorn K, O'Leary M, Perez M, Speakman M, Trachtenberg J, Tubaro A, Meesen B, Smets L, Stoevelaar H. Risk factors for disease progression in patients with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH): a systematic analysis of expert opinion. Prostate Cancer Prostatic Dis 2005; 8:206-9. [PMID: 15953934 DOI: 10.1038/sj.pcan.4500806] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [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: 11/09/2022]
Abstract
Disease progression has become an important issue for the management of lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH). Although several risk factors have been identified, no specific patient risk profiles have been established that can be useful in the day-to-day management of LUTS/BPH. In this study, an international panel of urologists developed a risk classification based on the attribution of a risk score to 243 unique patient profiles. From the perspective of clinical decision making, it was concluded that postvoid residual, symptom severity and maximum flow rate are the most relevant determinants of the risk of disease progression.
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Affiliation(s)
- F C Lowe
- 1St Luke's-Roosevelt Hospital Center, New York, NY 10019, USA.
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Gendy S, O'Leary M, Colreavy M, Rowley H, O'Dwyer T, Blayney A. Tonsillectomy--cold dissection vs. hot dissection: a prospective study. Ir Med J 2005; 98:243-4. [PMID: 16445144] [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: 05/06/2023]
Abstract
Throughout the years, investigators and surgeons have developed new techniques for tonsillectomy aiming to lessen the postoperative morbidity and complications of tonsillectomy. It is generally accepted that the ideal method should decrease operative time, blood loss, postoperative haemorrhage and morbidity. To compare the technique and post-operative morbidity of two different tonsillectomy methods: cold dissection and bipolar electrodissection. A prospective study including a total of 545 children (Age: 3-16 yrs) undergoing tonsillectomy at The Children's University Hospital in Dublin, Ireland, from January 2003 to December 2003. The incidence of primary, secondary haemorrhage and postoperative pain was compared between both techniques. The overall rate of haemorrhage was 3.6% (20 patients) this included primary haemorrhage in 0.3% (2 patients) and secondary haemorrhage in 3.3% (18 patents). Primary haemorrhage occurred only in the electrodissection technique. As regards to secondary haemorrhage it was higher in the electrodissection technique 2.3% (12 patients) compared to 1% (6 patients) of the cold dissection technique. Patients rated pain to be more severe in the electrodissection technique compared to the cold dissection technique. Cold dissection tonsillectomy technique is still considered to be a safe and effective method with less posoperative morbidity complications as evidenced from our study.
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Affiliation(s)
- S Gendy
- Department of Otolaryngology, The Children's University Hospital, Dublin 1.
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Speakman M, Batista J, Berges R, Chartier-Kastler E, Conti G, Desgrandchamps F, Dreikorn K, Lowe F, O'Leary M, Perez M, Trachtenberg J, Tubaro A, Meesen B, Smets L, Stoevelaar H. Integrating risk profiles for disease progression in the treatment choice for patients with lower urinary tract symptoms/benign prostatic hyperplasia: a combined analysis of external evidence and clinical expertise. Prostate Cancer Prostatic Dis 2005; 8:369-74. [PMID: 16130013 DOI: 10.1038/sj.pcan.4500827] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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: 11/10/2022]
Abstract
The RAND appropriateness method was used to explore the relevance of risk factors for disease progression in the treatment choice for patients with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH). A total of, 12 international experts assessed the appropriateness of various treatments for 243 risk profiles. Highest appropriateness rates were found for alpha1-adrenoceptor antagonists (68% of profiles) and combination therapy (46%). A large prostate volume was the dominant argument in favour of 5alpha-reductase inhibitors and combination therapy, but was irrelevant for the choice of surgery. Considerable postvoid residual, severe symptoms and poor maximum flow rate were the most important factors in favour of surgery.
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Affiliation(s)
- M Speakman
- Taunton & Somerset Hospital, Taunton, UK.
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Cullen W, O'Leary M, Langton D, Stanley J, Kelly Y, Bury G. Guidelines for the management of hepatitis C in general practice: a semi-qualitative interview survey of GPs’ views regarding content and implementation. Ir J Med Sci 2005; 174:32-7. [PMID: 16285336 DOI: 10.1007/bf03169145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 11/28/2022]
Abstract
BACKGROUND Hepatitis C is a common infection among people who attend GPs for methadone maintenance treatment. AIM To determine the views of GPs towards clinical guidelines for the management of hepatitis C among current or former injecting drug users in advance of their implementation. METHODS A purposive sample of 14 GPs (10% of the total prescribing methadone at the time the guidelines were developed) was invited to review a pre-publication draft of the guidelines and interviewed regarding content, presentation, perceived barriers to implementation and suggested interventions to facilitate effective implementation of the guidelines. RESULTS GPs indicated the guidelines were useful but suggested aspects of presentation should be clarified. Organisational issues were identified as the principal barriers to effective implementation, with the provision of additional nursing support the principal intervention suggested to facilitate implementation. CONCLUSIONS Interviewing intended recipients may be an important step in ensuring clinical practice guidelines are effectively implemented.
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Affiliation(s)
- W Cullen
- UCD, Dept of General Practice, Coombe Healthcare Centre, Dublin.
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Saxena M, O'Leary M, Jacques T. Intensive insulin therapy and the bath insulin protocol. Anaesth Intensive Care 2005; 33:141; author reply 141-2. [PMID: 15957706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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Affiliation(s)
- A M Murphy
- Department of Urology, Columbia University Medical Center, New York 10032, USA.
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Ward M, Hutton J, Mc Donnell R, Bachir N, Scallan E, O'Leary M, Hoey J, Doyle A, Delany V, Sayers G. Folic acid supplements to prevent neural tube defects: trends in East of Ireland 1996-2002. Ir Med J 2004; 97:274-6. [PMID: 15568585] [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: 05/01/2023]
Abstract
Promotion of folic acid to prevent neural Tube Defects (NTD) has been ongoing for ten years in Ireland, without a concomitant reduction in the total birth prevalence of NTD. The effectiveness of folic acid promotion as the sole means of primary prevention of NTD is therefore questionable. We examined trends in folic acid knowledge and peri-conceptional use from 1996-2002 with the aim of assessing the value of this approach. From 1996-2002, 300 women attending ante-natal clinics in Dublin hospitals annually were surveyed regarding their knowledge and use of folic acid. During the period the proportion who had heard of folic acid rose from 54% to 94% between 1996 and 2002 (c2 test for trend: p<0.001). Knowledge that folic acid can prevent NTD also rose from 21% to 66% (c2 test for trend: p<0.001). Although the proportion who took folic acid during pregnancy increased from 14% to 83% from 1996 to 2002 (c2 test for trend: p<0.001), peri-conceptional intake did not rise above 24% in any year. There is a high awareness of folic acid and its relation to NTD, which is not matched by peri-conceptional uptake. The main barrier to peri-conceptional uptake is the lack of pregnancy planning. To date promotional campaigns appear to have been ineffective in reducing the prevalence of NTD in Ireland. Consequently, fortification of staple foodstuffs is the only practical and reliable means of primary prevention of NTD.
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Affiliation(s)
- M Ward
- Department of Public Health, Eastern Regional Health Authority, Dr. Steeven's Hospital, Dublin 8, Republic of Ireland
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Affiliation(s)
- M O'Leary
- UCD Department of Obstetrics and Gynaecology, National Maternity Hospital, Dublin, Republic of Ireland
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Abstract
BACKGROUND A new diabetes shared care service was introduced in North Dublin. It was designed as a randomized controlled trial with a complex intervention comprising education of participating practitioners, the introduction of a community-based diabetes nurse specialist, local agreement on clinical protocols and structured communication across the primary-secondary care interface. OBJECTIVES Our aim was to assess the feasibility and effectiveness of a structured diabetes shared care service in a mixed health care system and to analyse the impact on total patient care. METHODS A Cluster randomized controlled trial lasting 18 months was carried out in 183 patients with type 2 diabetes from 30 general practices in North Dublin. Biophysical outcomes (HbA1c, blood pressure, body mass index), psychosocial measures (smoking status and Diabetes Clinic Treatment Satisfaction and Diabetes Well-being scores) and process outcomes were collected. RESULTS There were significant improvements in diabetes care delivery and in psychosocial outcomes, but no significant improvements in biomedical outcomes. Process data collection revealed a significant increase in diabetes care-related activity for participating patients with an increase in structured annual reviews and fewer patients defaulting from care. There were also significant improvements in information exchange between primary and secondary care. CONCLUSION Structured diabetes shared care, in a mixed health care system, can produce significant improvements in diabetes care delivery and in psychosocial outcomes for patients, with improved information exchange across the primary-secondary care interface.
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Affiliation(s)
- S Smith
- Department of General Practice, UCD, Beaumont Hospital, Dublin, Ireland.
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Smith SM, O'Leary M, Bury G, Shannon W, Tynan A, Staines A, Thompson C. A qualitative investigation of the views and health beliefs of patients with Type 2 diabetes following the introduction of a diabetes shared care service. Diabet Med 2003; 20:853-7. [PMID: 14510868 DOI: 10.1046/j.1464-5491.2003.01071.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [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: 11/20/2022]
Abstract
AIMS A qualitative research approach was adopted in order to explore the views and health beliefs of patients with Type 2 diabetes who had experienced a new structured diabetes shared care service. METHODS Patients from 15 general practices were randomly selected and invited to attend three focus groups. Two independent researchers adopted the "Framework" technique to analyse the transcribed data and identify key themes expressed by patients. RESULTS Themes relating to diabetes included frustration, victimization and powerlessness in relation to living with diabetes, controlling blood sugar, medication and economic barriers to care. Differences in emphases between patients and healthcare providers emerged. Patients were generally positive about shared care and largely identified it with the nurses involved. CONCLUSION This research highlights the importance of an in-depth exploration of patients' views during changes in diabetes care delivery to identify service delivery failures and gaps in patient knowledge such as lack of awareness of the extent of macrovascular risk.
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Affiliation(s)
- S M Smith
- Department of General Practice, UCD, Dublin, Ireland.
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Lucey MA, Patil V, Girling K, Jacques T, O'Leary M. Does neostigmine increase gastric emptying in the critically ill?--results of a pilot study. CRIT CARE RESUSC 2003; 5:14-9. [PMID: 16573452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2002] [Accepted: 01/08/2003] [Indexed: 05/08/2023]
Abstract
OBJECTIVE Based on the successful use of neostigmine for the treatment of acute colonic pseudo-obstruction, we hypothesised that neostigmine would increase gastric emptying and improve tolerance to enteral feeding in the critically ill patient. METHODS Eleven patients intolerant of enteral feeds due to high gastric aspirates, were randomised to receive a 'study infusion' consisting of either neostigmine (0.4 mg/hr) or 0.9% saline. If, after 12 hours the patient was deemed intolerant of the nasogastric feed, the rate of the 'study infusion' was doubled. Those who remained intolerant after 24 hours of the 'study infusion' were 'crossed-over' and continued on the other infusion for a further 24 hours. Gastric emptying was assessed in each group before and after the infusion by measuring the hourly rates of feed "absorption" [(delivery rate + returned aspirates) - total aspirates] and paracetamol absorption using the area under a time-concentration curve at 120 minutes (AUC120). Differences within and between groups were analysed using Students t test and one-way analysis of variance. RESULTS Six patients received neostigmine first and 5 received the placebo first. Four of the 6 patients receiving the neostigmine first compared with all of those receiving placebo first required to be 'crossed-over' to the other infusion. While the hourly rates of feed "absorption" were greater for patients receiving neostigmine than for placebo, these differences did not achieve statistical significance. The mean paracetamol AUC120 for all patients who received neostigmine was 3996 mg/min/L while that for placebo was 1929 mg/min/L (p = 0.21). CONCLUSIONS These data suggest that while neostigmine may have a positive effect on gastric emptying and enteral feed absorption in critically ill patients, the results did not reach statistical significance and an adequately powered study will be required to confirm this effect.
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Affiliation(s)
- M A Lucey
- Intensive Care Unit, The St. George Hospital, Sydney, New South Wales
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