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Sunada GR, Digre KB, Stark LA, Davis F, Mukundente V, Napia E, Sanchez-Birkhead A, Tavake-Pasi OF, Brown H, Alder SC, Gieseker K, Hu N, Wu Y, Simonsen SE. Obesity-Preventive Behaviors and Improvements in Depression among Diverse Utah Women Receiving Coaching from Community Health Workers. J Health Care Poor Underserved 2024; 35:186-208. [PMID: 38661866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
OBJECTIVES This study evaluated how high versus low-intensity community wellness coaching and health behaviors were associated with changes in depression screen results over one year. METHODS This was an analysis of secondary data collected in a 12-month obesity-related community health worker (CHW) program for 485 Utah women of color. Depression screen (Patient Health Questionnaire-2 score ³3) and self-reported fruit/vegetable consumption and physical activity (FV/PA) were recorded quarterly. Associations between FV/PA and changes in depression screen over time were evaluated in multivariable models. RESULTS Positive depression screen prevalence declined over 12 months (21.7% to 9.5%) with no difference between study arms. Overall, FV ³5 times/day (AOR=1.5; 95% CI 1.0-2.2), any PA (AOR=3.1; 95% CI 1.5-6.4), and muscle strengthening activities (AOR=1.13; 95% CI 1.01-1.26) were associated with improved depression screen results over time. CONCLUSION These results indicate value in addressing and evaluating depression in obesity-related interventions in underserved communities.
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Naranjo D, Kimball E, Nelson J, Samore M, Alder SC, Stroupe K, Evans CT, Weaver FM, Ray C, Kale I, Galyean PO, Zickmund S. Differences in perceptions and acceptance of COVID-19 vaccination between vaccine hesitant and non-hesitant persons. PLoS One 2023; 18:e0290540. [PMID: 37682878 PMCID: PMC10490972 DOI: 10.1371/journal.pone.0290540] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 08/10/2023] [Indexed: 09/10/2023] Open
Abstract
Acceptance of the COVID-19 vaccination becomes more critical as new variants continue to evolve and the United States (US) attempts to move from pandemic response to management and control. COVID-19 stands out in the unique way it has polarized patients and generated sustained vaccine hesitancy over time. We sought to understand differences in perceptions and acceptance of COVID-19 vaccination between vaccine hesitant and non-hesitant patients, with the goal of informing communication and implementation strategies to increase uptake of COVID-19 vaccines in Veteran and non-Veteran communities. This qualitative study used interview data from focus groups conducted by the Department of Veterans Affairs (VA) and the University of Utah; all focus groups were conducted using the same script March-July 2021. Groups included forty-six United States Veterans receiving care at 28 VA facilities across the country and 166 non-Veterans across Utah for a total of 36 one-hour focus groups. We identified perceptions and attitudes toward COVID-19 vaccination through qualitative analysis of focus group participant remarks, grouping connections with identified themes within domains developed based on the questions asked in the focus group guide. Responses suggest participant attitudes toward the COVID-19 vaccine were shaped primarily by vaccine attitude changes over time, impacted by perceived vaccine benefits, risks, differing sources of vaccine information and political ideology. Veterans appeared more polarized, being either largely non-hesitant, or hesitant, whereas non-Veterans had a wider range of hesitancy, with more participants identifying minor doubts and concerns about receiving the vaccine, or simply being altogether unsure about receiving it. Development of COVID-19 vaccine communication strategies in Veteran and non-Veteran communities should anticipate incongruous sources of information and explicitly target community differences in perceptions of risks and benefits associated with the vaccine to generate candid discussions and repair individuals' trust. We believe this could accelerate vaccine acceptance over time.
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Affiliation(s)
- Diana Naranjo
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS), VA Salt Lake City Health Care System, Salt Lake City, Utah, United States of America
- Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Elisabeth Kimball
- Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Jeanette Nelson
- Center for Business, Health, and Prosperity, David Eccles School of Business, University of Utah, Salt Lake City, Utah, United States of America
| | - Matthew Samore
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS), VA Salt Lake City Health Care System, Salt Lake City, Utah, United States of America
- Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Stephen C. Alder
- Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- Center for Business, Health, and Prosperity, David Eccles School of Business, University of Utah, Salt Lake City, Utah, United States of America
| | - Kevin Stroupe
- Center of Innovation for Complex Chronic Healthcare (CINCCH) Edward Hines Health Care System, Hines, Illinois, United States of America
| | - Charlesnika T. Evans
- Center of Innovation for Complex Chronic Healthcare (CINCCH) Edward Hines Health Care System, Hines, Illinois, United States of America
- Department of Preventive Medicine (Epidemiology), Northwestern University, Chicago, Illinois, United States of America
| | - Frances M. Weaver
- Center of Innovation for Complex Chronic Healthcare (CINCCH) Edward Hines Health Care System, Hines, Illinois, United States of America
| | - Cara Ray
- Center of Innovation for Complex Chronic Healthcare (CINCCH) Edward Hines Health Care System, Hines, Illinois, United States of America
| | - Ibuola Kale
- Center of Innovation for Complex Chronic Healthcare (CINCCH) Edward Hines Health Care System, Hines, Illinois, United States of America
| | - Patrick O. Galyean
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS), VA Salt Lake City Health Care System, Salt Lake City, Utah, United States of America
- Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Susan Zickmund
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS), VA Salt Lake City Health Care System, Salt Lake City, Utah, United States of America
- Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
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Hartsell JD, Leung DT, Zhang Y, Delgado JC, Alder SC, Samore MH. Sex difference in the discordance between Abbott Architect and EuroImmun serological assays. PeerJ 2023; 11:e15247. [PMID: 37483960 PMCID: PMC10358334 DOI: 10.7717/peerj.15247] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/28/2023] [Indexed: 07/25/2023] Open
Abstract
Background This study evaluated the discordance between Abbott Architect SARS-CoV-2 IgG and EUROIMMUN SARS-COV-2 ELISA in a seroprevalence study. Methods From June 10 to August 15, 2020, 8,246 specimens were dually evaluated by the Abbott Architect SARS-CoV-2 IgG (Abbott) and the EUROIMMUN SARS-CoV-2 ELISA (EI) assays. Sex-stratified phi correlation coefficients were calculated to evaluate the concordance between Abbott and EI assay's quantitative results. Multivariable mixed-effect logistic models were implemented to evaluate the association between assay positivity and sex on a low prevalence sample while controlling for age, race, ethnicity, diabetes, cardiovascular disease, hypertension, immunosuppressive therapy, and autoimmune disease. Results EI positivity among males was 2.1-fold that of females; however, no significant differences in Abbott positivity were observed between sexes. At the manufacturer-recommended threshold, the phi correlation coefficient for the Abbott and EI qualitative results among females (Φ = 0.47) was 34% greater than males (Φ = 0.35). The unadjusted and fully adjusted models yielded a strong association between sex and positive EI result for the low prevalence subgroup (unadjusted OR: 2.24, CI: 1.63, 3.11, adjusted OR: 3.40, CI: 2.15, 5.39). A similar analysis of Abbott positivity in the low prevalence subgroup did not find an association with any of the covariates examined. Significant quantitative and qualitative discordance was observed between Abbott and EI throughout the seroprevalence study. Our results suggest the presence of sex-associated specificity limitations with the EI assay. As these findings may extend to other anti-S assays utilized for SARS-CoV-2 seroprevalence investigations, further investigation is needed to evaluate the generalizability of these findings.
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Affiliation(s)
- Joel D. Hartsell
- Department of Population Health, University of Utah, Salt Lake City, UT, United States of America
- Epi-Vant LLC, Salt Lake City, UT, United States of America
| | - Daniel T. Leung
- Department of Pathology, University of Utah, Salt Lake City, UT, United States of America
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States of America
| | - Yue Zhang
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States of America
| | - Julio C. Delgado
- Department of Pathology, University of Utah, Salt Lake City, UT, United States of America
- ARUP Laboratories, Salt Lake City, UT, United States of America
| | - Stephen C. Alder
- Department of Entrepreneurship and Strategy, University of Utah, Salt Lake City, UT, United States of America
| | - Matthew H. Samore
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States of America
- Veteran Affairs, Salt Lake City, UT, United States of America
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Nelson JR, Ess RH, Dickerson TT, Gren LH, Benson LS, Manortey SO, Alder SC. Strategies to increase rural maternal utilization of skilled health personnel for childbirth delivery in low- and middle-income countries: a narrative review. Glob Health Action 2022; 15:2058170. [PMID: 35506937 PMCID: PMC9090426 DOI: 10.1080/16549716.2022.2058170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Skilled attendance at birth is considered key to accomplishing Sustainable Development Goal (SDG) 3.1 aimed at reducing maternal mortality. Many maternal deaths can be prevented if a woman receives care by skilled health personnel. Maternal utilization of skilled health delivery services in rural areas in low- and middle-income countries is 70% compared to 90% in urban areas. Previous studies have found community-based interventions may increase rural maternal uptake of skilled health delivery services, but evidence is lacking on which strategies are most effective. OBJECTIVE To review the effectiveness of community-based strategies to increase rural maternal utilization of skilled health personnel for childbirth delivery in low-and middle-income countries. METHODS We conducted a narrative review. PubMed, CINAHL, Cochrane Library, and PsycINFO databases were searched for articles from database inception through 13 November 2019. Key search terms were pre-determined. Information was extracted on studies meeting our inclusion criteria: cluster and randomized trials, rural setting, reproductive aged women, community engagement, low- and middle-income countries. Studies were considered effective if statistically significant (p < 0.05). A narrative synthesis was conducted. RESULTS Ten cluster randomized trials out of 5,895 candidate citations met the inclusion criteria. Strategies included home-based visits, women's groups, and combined approaches. Out of the ten articles, only three studies were found to significantly increase maternal uptake of skilled health personnel for delivery, and each used a different strategy. The results are inconclusive as to which strategies are most effective. Limitations of this review include heterogeneity and generalizability of studies. CONCLUSIONS This research suggests that different strategies may be effective at improving maternal utilization of skilled health personnel for delivery in certain rural settings while ineffective in others. More research is warranted to better understand the context in which strategies may be effective and under what conditions.
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Affiliation(s)
- Jeanette R. Nelson
- Center for Business, Health, and Prosperity, David Eccles School of Business, University of Utah, Salt Lake City, Utah, USA,CONTACT Jeanette R. Nelson University of Utah, 1655 E. Campus Center Dr., SFEBB 113, Salt Lake City, UT84112-8939, USA
| | - Rebekah H. Ess
- Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Ty T. Dickerson
- Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA,Department of Paediatrics, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Lisa H. Gren
- Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - L. Scott Benson
- Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA,Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | | | - Stephen C. Alder
- Center for Business, Health, and Prosperity, David Eccles School of Business, University of Utah, Salt Lake City, Utah, USA,Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA,Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA,Ensign Global College, Kpong, Ghana,Department of Obstetrics and Gynecology, School of Medicine; Departments of Health and Kinesiology and Health Promotion & Education, College of Health; Department of Entrepreneurship and Strategy, David Eccles School of Business; University of Utah, Salt Lake City, Utah, USA
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Nelson JR, Gren LH, Dickerson TT, Benson LS, Manortey SO, Ametepey R, Avorgbedor YE, Alder SC. Using the Health Belief Model to explore rural maternal utilisation of skilled health personnel for childbirth delivery: a qualitative study in three districts of the Eastern Region of Ghana. Journal of Global Health Reports 2021. [DOI: 10.29392/001c.29883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
| | - Lisa H Gren
- Family and Preventive Medicine; University of Utah, USA
| | - Ty T Dickerson
- Paediatrics; Family and Preventive Medicine; University of Utah, USA
| | - L Scott Benson
- Family and Preventive Medicine; Internal Medicine; University of Utah, USA
| | | | | | | | - Stephen C Alder
- Center for Business, Health and Prosperity; Family and Preventative Medicine; University of Utah, USA; Ensign Global College, Ghana
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Toth DJA, Beams AB, Keegan LT, Zhang Y, Greene T, Orleans B, Seegert N, Looney A, Alder SC, Samore MH. High variability in transmission of SARS-CoV-2 within households and implications for control. PLoS One 2021; 16:e0259097. [PMID: 34758042 PMCID: PMC8580228 DOI: 10.1371/journal.pone.0259097] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 10/12/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) poses a high risk of transmission in close-contact indoor settings, which may include households. Prior studies have found a wide range of household secondary attack rates and may contain biases due to simplifying assumptions about transmission variability and test accuracy. METHODS We compiled serological SARS-CoV-2 antibody test data and prior SARS-CoV-2 test reporting from members of 9,224 Utah households. We paired these data with a probabilistic model of household importation and transmission. We calculated a maximum likelihood estimate of the importation probability, mean and variability of household transmission probability, and sensitivity and specificity of test data. Given our household transmission estimates, we estimated the threshold of non-household transmission required for epidemic growth in the population. RESULTS We estimated that individuals in our study households had a 0.41% (95% CI 0.32%- 0.51%) chance of acquiring SARS-CoV-2 infection outside their household. Our household secondary attack rate estimate was 36% (27%- 48%), substantially higher than the crude estimate of 16% unadjusted for imperfect serological test specificity and other factors. We found evidence for high variability in individual transmissibility, with higher probability of no transmissions or many transmissions compared to standard models. With household transmission at our estimates, the average number of non-household transmissions per case must be kept below 0.41 (0.33-0.52) to avoid continued growth of the pandemic in Utah. CONCLUSIONS Our findings suggest that crude estimates of household secondary attack rate based on serology data without accounting for false positive tests may underestimate the true average transmissibility, even when test specificity is high. Our finding of potential high variability (overdispersion) in transmissibility of infected individuals is consistent with characterizing SARS-CoV-2 transmission being largely driven by superspreading from a minority of infected individuals. Mitigation efforts targeting large households and other locations where many people congregate indoors might curb continued spread of the virus.
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Affiliation(s)
- Damon J. A. Toth
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- Department of Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah, United States of America
- Department of Mathematics, University of Utah, Salt Lake City, Utah, United States of America
| | - Alexander B. Beams
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- Department of Mathematics, University of Utah, Salt Lake City, Utah, United States of America
| | - Lindsay T. Keegan
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- Department of Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah, United States of America
| | - Yue Zhang
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Tom Greene
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Brian Orleans
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Nathan Seegert
- Department of Finance, University of Utah David Eccles School of Business, Salt Lake City, Utah, United States of America
| | - Adam Looney
- Department of Finance, University of Utah David Eccles School of Business, Salt Lake City, Utah, United States of America
| | - Stephen C. Alder
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Matthew H. Samore
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- Department of Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah, United States of America
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Samore MH, Looney A, Orleans B, Greene T, Seegert N, Delgado JC, Presson A, Zhang C, Ying J, Zhang Y, Shen J, Slev P, Gaulin M, Yang MJ, Pavia AT, Alder SC. Probability-Based Estimates of Severe Acute Respiratory Syndrome Coronavirus 2 Seroprevalence and Detection Fraction, Utah, USA. Emerg Infect Dis 2021; 27:2786-2794. [PMID: 34469285 PMCID: PMC8544980 DOI: 10.3201/eid2711.204435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We aimed to generate an unbiased estimate of the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in 4 urban counties in Utah, USA. We used a multistage sampling design to randomly select community-representative participants >12 years of age. During May 4–June 30, 2020, we collected serum samples and survey responses from 8,108 persons belonging to 5,125 households. We used a qualitative chemiluminescent microparticle immunoassay to detect SARS-CoV-2 IgG in serum samples. We estimated the overall seroprevalence to be 0.8%. The estimated seroprevalence-to-case count ratio was 2.5, corresponding to a detection fraction of 40%. Only 0.2% of participants from whom we collected nasopharyngeal swab samples had SARS-CoV-2–positive reverse transcription PCR results. SARS-CoV-2 antibody prevalence during the study was low, and prevalence of PCR-positive cases was even lower. The comparatively high SARS-CoV-2 detection rate (40%) demonstrates the effectiveness of Utah’s testing strategy and public health response.
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Drits-Esser D, Coulter H, Mannello MC, Sunada G, Alder SC, Davis PFA, Lee D, Mukundente V, Napia E, Ralls B, Rickard S, Tavaké-Pasi F, Stark LA. The Community Faces Model: Community, University and Health Department Partners Thriving Together for Effective Health Education. Collaborations (Coral Gables) 2019; 2:10. [PMID: 33728408 PMCID: PMC7959871 DOI: 10.33596/coll.29] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We use a community based participatory research approach to examine the processes of collaboration and communication, as well as the relational interactions of one community focused health promotion coalition, the Community Faces of Utah (CFU). We assess the evolution, structure, successes, and challenges of the coalition, comprised of five distinct cultural communities, a state health department, and a university. Researchers from the university collaborated with the coalition to find that CFU is an equitable, collaborative partnership of diverse leaders that functions successfully. Shared values and trusting relationships emerged over time, forming the basis for group interaction. A community liaison to facilitate interaction and collaboration was an essential element of the success of this partnership. The experience of CFU can guide other multi-sectoral partnerships in developing functionality consistent with achieving community driven objectives.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ed Napia
- Urban Indian Center of Salt Lake, US
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Park AH, Hughes CW, Jackson A, Hunter L, McGill L, Simonsen SE, Alder SC, Shu XZ, Prestwich GD. Crosslinked hydrogels for tympanic membrane repair. Otolaryngol Head Neck Surg 2016; 135:877-83. [PMID: 17141077 DOI: 10.1016/j.otohns.2006.02.040] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2005] [Accepted: 02/02/2006] [Indexed: 11/19/2022]
Abstract
PROBLEM: To provide a less expensive and more convenient protocol for the treatment of tympanic membrane perforations (TMPs).METHODS: Several materials were prepared and compared for TMP repair including Carbylan-SX, Gelatin-DTPH-PEGDA (GX), Carbylan-S/Gelatin-DTPH (Carbylan-GSX) (injectable and sponge), Gelfoam, Epifilm, and crosslinked thiolated chondroitin sulfate (CS-DTPH-PEGDA [CS-SX]). Hartley pigmented guinea pigs (Elm Hill) underwent bilateral myringotomy with 1 ear left as a control and the other treated with one of the previously mentioned materials.RESULTS: Carbylan-GSX (injectable and sponge), Gelfoam with saline, and CS-SX had the shortest time for TMP closure. Epifilm, Carbylan, and gelatin preparations resulted in closure rates similar to controls. CS-SX showed a marked inflammatory reaction compared with controls and other materials based on neutrophil, lymphocyte, epitheloid counts, and degree of fibrosis.CONCLUSIONS: This study shows the validity of Carbylan-GSX compared with Gelfoam as a material to promote TMP closure in an acute TMP guinea pig model.
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Affiliation(s)
- Albert H Park
- Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah 84132, USA.
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10
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Simonsen SE, Digre KB, Ralls B, Mukundente V, Davis FA, Rickard S, Tavake-Pasi F, Napia EE, Aiono H, Chirpich M, Stark LA, Sunada G, Keen K, Johnston L, Frost CJ, Varner MW, Alder SC. A gender-based approach to developing a healthy lifestyle and healthy weight intervention for diverse Utah women. Eval Program Plann 2015; 51:8-16. [PMID: 25559947 DOI: 10.1016/j.evalprogplan.2014.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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] [Indexed: 05/05/2023]
Abstract
Utah women from some cultural minority groups have higher overweight/obesity rates than the overall population. We utilized a gender-based mixed methods approach to learn about the underlying social, cultural and gender issues that contribute to the increased obesity risk among these women and to inform intervention development. A literature review and analysis of Utah's Behavioral Risk Factor Surveillance System data informed the development of a focus group guide. Focus groups were conducted with five groups of women: African immigrants from Burundi and Rwanda, African Americans, American Indians/Alaskan Natives, Hispanics/Latinas, and Pacific Islanders. Six common themes emerged: (1) health is multidimensional and interventions must address health in this manner; (2) limited resources and time influence health behaviors; (3) norms about healthy weight vary, with certain communities showing more preference to heavier women; (4) women and men have important but different influences on healthy lifestyle practices within households; (5) women have an influential role on the health of families; and (6) opportunities exist within each group to improve health. Seeking insights from these five groups of women helped to identify common and distinct cultural and gender themes related to obesity, which can be used to help elucidate core obesity determinants.
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Affiliation(s)
- Sara E Simonsen
- University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT 84018, United States.
| | - Kathleen B Digre
- University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT 84018, United States.
| | - Brenda Ralls
- Utah Department of Health, PO Box 142107, 288 North 1460 West, Salt Lake City, UT 84114-2107, United States; Community Faces of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, United States.
| | - Valentine Mukundente
- Community Faces of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, United States; Best of Africa, 6379 Thor Way, West Valley City, UT 84128, United States.
| | - France A Davis
- Community Faces of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, United States; Calvary Baptist Church, 1090 South State Street, Salt Lake City, UT 84111, United States.
| | - Sylvia Rickard
- Community Faces of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, United States; Hispanic Health Care Task Force, PO Box 58654, Salt Lake City, UT 84158, United States.
| | - Fahina Tavake-Pasi
- Community Faces of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, United States; National Tongan American Society, 3007 South West Temple, Building H, Salt Lake City, UT 84115, United States.
| | - Eru Ed Napia
- Community Faces of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, United States; Urban Indian Center, 120 West 1300 South, Salt Lake City, UT 84115, United States.
| | - Heather Aiono
- University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT 84018, United States; Community Faces of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, United States.
| | - Meghan Chirpich
- University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT 84018, United States; Community Faces of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, United States.
| | - Louisa A Stark
- University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT 84018, United States; Community Faces of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, United States.
| | - Grant Sunada
- Utah Department of Health, PO Box 142107, 288 North 1460 West, Salt Lake City, UT 84114-2107, United States; Community Faces of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, United States.
| | - Kassy Keen
- University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT 84018, United States.
| | - Leanne Johnston
- University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT 84018, United States.
| | - Caren J Frost
- University of Utah College of Social Work, 395 South 1500 East, Room 101, Salt Lake City, UT 84112, United States.
| | - Michael W Varner
- University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT 84018, United States.
| | - Stephen C Alder
- University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT 84018, United States; Community Faces of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, United States.
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11
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Willardson SL, Dickerson TT, Wilson JS, Ansong D, Bueler E, Boakye I, Marfo J, Arhin B, Alder SC. Forming a supplement intervention using a multi-theoretical behavior model. Am J Health Behav 2013; 37:831-40. [PMID: 24001632 DOI: 10.5993/ajhb.37.6.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/12/2022]
Abstract
OBJECTIVES To identify behavior theory-based strategies to improve compliance with daily multiple micronutrient supplementation (MMS) among rural Ghanaian women. METHODS Components of a multi-theoretical framework were investigated in focus groups of reproductive-aged women in 6 communities. RESULTS Participants were generally unaware of MMS' purpose. Perceived benefits included better health and stimulated appetite, which some believe escalates food purchases and financial constraints. Cost, forgetfulness, and unsustainability were also perceived barriers. Facilitators for compliance incorporated initial visual reminders and daily announcements with reinforcement using the 'keeper' system. CONCLUSIONS Application of a tailored health behavioral model can effectively guide the design, implementation and evaluation of community-based MMS interventions.
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Affiliation(s)
- Sarah L Willardson
- Department of Family and Preventive Medicine, Division of Public Health, University of Utah, Salt Lake City, UT, USA.
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Long KNG, Long PM, Pinto S, Crookston BT, Gren LH, Mihalopoulos NL, Dickerson TT, Alder SC. Development and validation of the Indian Adolescent Health Questionnaire. J Trop Pediatr 2013; 59:231-42. [PMID: 23418132 PMCID: PMC3693506 DOI: 10.1093/tropej/fmt006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The period of adolescence is a critical time of development. There is an urgent need to better assess adolescent health worldwide, particularly in India, a country with the world's largest adolescent population. Validated screening tools are needed to evaluate health-related risks and behaviors in this growing demographic. We developed, validated and administered a school-based health assessment, the Indian Adolescent Health Questionnaire, which can be used as a comprehensive health-screening tool among Indian adolescents in secondary school.
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Affiliation(s)
- Katelyn N. G. Long
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
| | - Paul M. Long
- School of Medicine, University of Utah, Salt Lake City, Utah
| | - Snehal Pinto
- Nova Southeastern University, Fort Lauderdale, Florida
| | | | - Lisa H. Gren
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
| | | | - Ty T. Dickerson
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Stephen C. Alder
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
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Park AH, Mann D, Error ME, Miller M, Firpo MA, Wang Y, Alder SC, Schleiss MR. Comparative analysis of detection methods for congenital cytomegalovirus infection in a Guinea pig model. JAMA Otolaryngol Head Neck Surg 2013; 139:82-6. [PMID: 23329096 DOI: 10.1001/jamaoto.2013.1090] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To assess the validity of the guinea pig as a model for congenital cytomegalovirus (CMV) infection by comparing the effectiveness of detecting the virus by real-time polymerase chain reaction (PCR) in blood, urine, and saliva. DESIGN Case-control study. SETTING Academic research. SUBJECTS Eleven pregnant Hartley guinea pigs. MAIN OUTCOME MEASURES Blood, urine, and saliva samples were collected from guinea pig pups delivered from pregnant dams inoculated with guinea pig CMV. These samples were then evaluated for the presence of guinea pig CMV by real-time PCR assuming 100% transmission. RESULTS Thirty-one pups delivered from 9 inoculated pregnant dams and 8 uninfected control pups underwent testing for guinea pig CMV and for auditory brainstem response hearing loss. Repeated-measures analysis of variance demonstrated no statistically significantly lower weight for the infected pups compared with the noninfected control pups. Six infected pups demonstrated auditory brainstem response hearing loss. The sensitivity and specificity of the real-time PCR assay on saliva samples were 74.2% and 100.0%, respectively. The sensitivity of the real-time PCR on blood and urine samples was significantly lower than that on saliva samples. CONCLUSIONS Real-time PCR assays of blood, urine, and saliva revealed that saliva samples show high sensitivity and specificity for detecting congenital CMV infection in guinea pigs. This finding is consistent with recent screening studies in human newborns. The guinea pig may be a good animal model in which to compare different diagnostic assays for congenital CMV infection.
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Affiliation(s)
- Albert H Park
- Divisions of Otolaryngology–Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT 84132, USA.
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Alder SC, Trunnell EP, White GL, Lyon JL, Reading JP, Samore MH, Magill MK. Reducing Parental Demand for Antibiotics by Promoting Communication Skills. American Journal of Health Education 2013. [DOI: 10.1080/19325037.2005.10608174] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Stephen C. Alder
- a Department of Family and Preventive Medicine , University of Utah , 375 Chipeta Way, Suite A, Salt Lake City , Utah , 84108 , USA
| | - Eric P. Trunnell
- b Health Promotion and Education , HPER North, 250 S 1850 East Room 200, Salt Lake City , UT , 84108 , USA
| | - George L. White
- a Department of Family and Preventive Medicine , University of Utah , 375 Chipeta Way, Suite A, Salt Lake City , Utah , 84108 , USA
| | - Joseph L. Lyon
- a Department of Family and Preventive Medicine , University of Utah , 375 Chipeta Way, Suite A, Salt Lake City , Utah , 84108 , USA
| | - James P. Reading
- a Department of Family and Preventive Medicine , University of Utah , 375 Chipeta Way, Suite A, Salt Lake City , Utah , 84108 , USA
| | - Matthew H. Samore
- c Division of Clinical Epidemiology , School of Medicine , 30 N 1900 E RM AC226, USA
| | - Michael K. Magill
- a Department of Family and Preventive Medicine , University of Utah , 375 Chipeta Way, Suite A, Salt Lake City , Utah , 84108 , USA
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Stone MB, Stanford JB, Lyon JL, VanDerslice JA, Alder SC. Childhood thyroid radioiodine exposure and subsequent infertility in the intermountain fallout cohort. Environ Health Perspect 2013; 121:79-84. [PMID: 23099433 PMCID: PMC3553427 DOI: 10.1289/ehp.1104231] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 10/24/2012] [Indexed: 05/15/2023]
Abstract
BACKGROUND Above-ground and underground nuclear weapon detonation at the Nevada Test Site (1951-1992) has resulted in radioiodine exposure for nearby populations. Although the long-term effect of environmental radioiodine exposure on thyroid disease has been well studied, little is known regarding the effect of childhood radioiodine exposure on subsequent fertility. OBJECTIVES We investigated early childhood thyroid radiation exposure from nuclear testing fallout (supplied predominantly by radioactive isotopes of iodine) and self-reported lifetime incidence of male or female infertility or sterility. METHODS Participants were members of the 1965 Intermountain Fallout Cohort, schoolchildren at the time of exposure who were reexamined during two subsequent study phases to collect dietary and reproductive histories. Thyroid radiation exposure was calculated via an updated dosimetry model. We used multivariable logistic regression with robust sandwich estimators to estimate odds ratios for infertility, adjusted for potential confounders and (in separate models) for a medically confirmed history of thyroid disease. RESULTS Of 1,389 participants with dosimetry and known fertility history, 274 were classified as infertile, including 30 classified as sterile. Childhood thyroid radiation dose was possibly associated with infertility [adjusted odds ratio (AOR) = 1.17; 95% CI: 0.82, 1.67 and AOR = 1.35; 95% CI: 0.96, 1.90 for the middle and upper tertiles vs. the first tertile of exposure, respectively]. The odds ratios were attenuated (AOR = 1.08; 95% CI: 0.75, 1.55 and AOR = 1.29; 95% CI: 0.91, 1.83 for the middle and upper tertiles, respectively) after adjusting for thyroid disease. There was no association of childhood radiation dose and sterility. CONCLUSION Our findings suggest that childhood radioiodine exposure from nuclear testing may be related to subsequent adult infertility. Further research is required to confirm this.
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Affiliation(s)
- Mary Bishop Stone
- University of Utah Department of Family and Preventive Medicine, Salt Lake City, Utah 84108, USA
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Rubach MP, Mukemba J, Florence S, John B, Crookston B, Lopansri BK, Yeo TW, Piera KA, Alder SC, Weinberg JB, Anstey NM, Granger DL, Mwaikambo ED. Plasma Plasmodium falciparum histidine-rich protein-2 concentrations are associated with malaria severity and mortality in Tanzanian children. PLoS One 2012; 7:e35985. [PMID: 22586457 PMCID: PMC3346811 DOI: 10.1371/journal.pone.0035985] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 03/29/2012] [Indexed: 11/30/2022] Open
Abstract
Plasma Plasmodium falciparum histidine-rich protein-2 (PfHRP-2) concentrations, a measure of parasite biomass, have been correlated with malaria severity in adults, but not yet in children. We measured plasma PfHRP-2 in Tanzanian children with uncomplicated (n = 61) and cerebral malaria (n = 45; 7 deaths). Median plasma PfHRP-2 concentrations were higher in cerebral malaria (1008 [IQR 342–2572] ng/mL) than in uncomplicated malaria (465 [IQR 36–1426] ng/mL; p = 0.017). In cerebral malaria, natural log plasma PfHRP-2 was associated with coma depth (r = −0.42; p = 0.006) and mortality (OR: 3.0 [95% CI 1.03–8.76]; p = 0.04). In this relatively small cohort study in a mesoendemic transmission area of Africa, plasma PfHRP-2 was associated with pediatric malaria severity and mortality. Further studies among children in areas of Africa with higher malaria transmission and among children with different clinical manifestations of severe malaria will help determine the wider utility of quantitative PfHRP-2 as a measure of parasite biomass and prognosis in sub-Saharan Africa.
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Affiliation(s)
- Matthew P. Rubach
- University of Utah School of Medicine and Veterans Affairs Medical Center, Salt Lake City, Utah, United States of America
| | - Jackson Mukemba
- Hubert Kairuki Memorial University, Dar es Salaam, United Republic of Tanzania
| | - Salvatore Florence
- Hubert Kairuki Memorial University, Dar es Salaam, United Republic of Tanzania
| | - Bernard John
- Hubert Kairuki Memorial University, Dar es Salaam, United Republic of Tanzania
| | - Benjamin Crookston
- University of Utah School of Medicine and Veterans Affairs Medical Center, Salt Lake City, Utah, United States of America
| | - Bert K. Lopansri
- Loyola University Medical Center, Maywood, Illinois, United States of America
| | - Tsin W. Yeo
- Menzies School for Health Research and Charles Darwin University, Darwin, Australia
- Royal Darwin Hospital, Darwin, Australia
| | - Kim A. Piera
- Menzies School for Health Research and Charles Darwin University, Darwin, Australia
| | - Stephen C. Alder
- University of Utah School of Medicine and Veterans Affairs Medical Center, Salt Lake City, Utah, United States of America
| | - J. Brice Weinberg
- VA Medical Centers and Duke University, Durham, North Carolina, United States of America
| | - Nicholas M. Anstey
- Menzies School for Health Research and Charles Darwin University, Darwin, Australia
- Royal Darwin Hospital, Darwin, Australia
| | - Donald L. Granger
- University of Utah School of Medicine and Veterans Affairs Medical Center, Salt Lake City, Utah, United States of America
- * E-mail:
| | - Esther D. Mwaikambo
- Hubert Kairuki Memorial University, Dar es Salaam, United Republic of Tanzania
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Zhang F, Yi C, Feng C, Alder SC, Hale DC, Amy Lee YC. The evaluation of feasibility and expectations of study abroad among Chinese medical students. Med Teach 2012; 34:338. [PMID: 22455706 DOI: 10.3109/0142159x.2012.661895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Rogers CL, Alder SC, Rogers RL, Hopkins SA, Platt ML, Childs LC, Crouch RH, Hansen RS, Hayes JK. High dose brachytherapy as monotherapy for intermediate risk prostate cancer. J Urol 2011; 187:109-16. [PMID: 22088340 DOI: 10.1016/j.juro.2011.09.050] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Indexed: 11/18/2022]
Abstract
PURPOSE We evaluated our retrospective, single institution experience with high dose rate brachytherapy as monotherapy for intermediate risk prostate cancer. MATERIALS AND METHODS Our cohort included 284 patients with intermediate risk prostate cancer, defined as clinical stage T2b/T2c, Gleason score 7 and/or prostate specific antigen 10 to 20 ng/ml, and 1-year minimum followup. Treatment was 2 high dose rate brachytherapy sessions at 3 fractions of 6.5 Gy each for a mean of 19 days. Prostate specific antigen failure was defined as nadir +2 ng/ml. RESULTS Mean followup was 35.1 months (median 31.9). Actuarial 5-year cause specific survival and clinical local control were 100%, distant-metastasis-free survival 98.8% and biochemical disease-free survival 94.4%. Clinical stage predicted biochemical disease-free survival. For stage T2a or less 5-year biochemical disease-free survival was 95.1% vs 100% for stage T2b and 77.4% for T2c (p = 0.012). Percent positive biopsy cores and prostate specific antigen nadir were also predictive. International Prostate Symptom Score results remained stable and potency was maintained in 82.6% of patients at 2 years. Pads were used for the first time after brachytherapy in 22 patients (7.7%), mostly for grade 1 incontinence (occasionally or less per week). Excluding patients with prior transurethral prostatectomy, stroke or tremor 2.5% used pads for the first time after treatment. No patient had urethral stricture. Radiation Therapy Oncology Group grade 1 rectal toxicity developed in 12 patients (4.2%) but not beyond grade 1. CONCLUSIONS High dose rate brachytherapy as monotherapy is safe and effective for patients with intermediate risk prostate cancer. We recommend caution for percent positive biopsy cores exceeding 75% or clinical stage T2c. Excluding such patients the 5-year biochemical disease-free survival rate was 97.5%.
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Coombs JM, Morgan P, Pedersen DM, Koduri S, Alder SC. Factors associated with physician assistant practice in rural and primary care in utah. Int J Family Med 2011; 2011:879036. [PMID: 22295196 PMCID: PMC3263849 DOI: 10.1155/2011/879036] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 04/29/2011] [Accepted: 06/09/2011] [Indexed: 05/31/2023]
Abstract
Physician Assistants (PAs) have become an integral part of the United States (U.S.) health care system since the profession began in the late 1960s. PAs have been suggested as solutions to predicted physician shortages especially in primary care. This study examined the predictors of primary care and rural practice patterns of PAs in Utah. A cross sectional survey design was utilized. The outcome variables were practice specialty and practice location. The predictor variables were age, gender, number of years in practice, location of upbringing, and professional school of graduation. There was a response rate of 67.7%. The Utah Division of Occupational and Professional Licensing (DOPL) provided the list of licensed PAs in the state. Physician assistants who reported being raised in rural communities were 2.29 times more likely to be practicing in rural communities (95% CI 0.89-5.85). Female PAs had lower odds of practicing in a rural area (OR: 0.26; 95% CI: 0.10-0.66). Female PAs had lower odds of practicing in primary care versus their male counterparts (OR: 0.56; 95% CI: 0.33-0.96). Graduation from the Utah PA Program was more likely to result in primary care practice (OR: 2.16; 95% CI: 1.34-3.49).
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Affiliation(s)
- Jennifer M. Coombs
- Physician Assistant Program, The University of Utah, 375 Chipeta Way, Suite A, Salt Lake City, UT 84108, USA
| | - Perri Morgan
- Physician Assistant Program, DUMC 104780, Duke University Medical Center, Durham, NC 27710, USA
| | - Donald M. Pedersen
- Physician Assistant Program, The University of Utah, 375 Chipeta Way, Suite A, Salt Lake City, UT 84108, USA
| | - Sri Koduri
- Utah Medical Education Council, 230 South 500 East, Suite 210, Salt Lake City, UT 84102-2062, USA
| | - Stephen C. Alder
- Division of Public Health, The University of Utah, 375 Chipeta Way, Suite A, Salt Lake City, UT 84108, USA
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Crookston BT, Penny ME, Alder SC, Dickerson TT, Merrill RM, Stanford JB, Porucznik CA, Dearden KA. Children who recover from early stunting and children who are not stunted demonstrate similar levels of cognition. J Nutr 2010; 140:1996-2001. [PMID: 20844188 DOI: 10.3945/jn.109.118927] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Stunting is associated with adverse cognitive development in childhood and adolescence, fewer years of schooling, decreased productivity, and reduced adult stature. Recovery from early stunting is possible; however, few studies explore whether those who demonstrate linear catch-up growth experience long-term cognitive deficits. Using longitudinal data on 1674 Peruvian children from the Young Lives study, we identified factors associated with catch-up growth and assessed whether children who displayed catch-up growth have significantly lower cognition than children who were not stunted during infancy and childhood. Based on anthropometric data for children 6-18 mo of age and again for the same children when they were 4.5-6 y of age, we categorized participants as not stunted, stunted in infancy but not childhood (catch-up), stunted in childhood, and stunted in infancy and childhood. Children who had grandparents in the home, had less severe stunting in infancy, and had taller mothers were more likely to demonstrate catch-up growth by round 2. Children who experienced catch-up growth had verbal vocabulary and quantitative test scores that did not differ from children who were not stunted (P = 0.6 and P = 0.7, respectively). Those stunted in childhood as well as those stunted in infancy and childhood scored significantly lower on both assessments than children who were not stunted. Based on findings from this study, policy makers and program planners should consider redoubling efforts to prevent stunting and promote catch-up growth over the first few years of life as a way of improving children's physical and intellectual development.
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Affiliation(s)
- Benjamin T Crookston
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT 84108, USA.
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Crookston BT, Dearden KA, Alder SC, Porucznik CA, Stanford JB, Merrill RM, Dickerson TT, Penny ME. Impact of early and concurrent stunting on cognition. Matern Child Nutr 2010; 7:397-409. [PMID: 21902807 DOI: 10.1111/j.1740-8709.2010.00255.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Undernutrition is associated with poor cognitive development, late entry into school, decreased years of schooling, reduced productivity and smaller adult stature. We use longitudinal data from 1674 Peruvian children participating in the Young Lives study to assess the relative impact of early stunting (stunted at 6-18 months of age) and concurrent stunting (stunted at 4.5-6 years of age) on cognitive ability. Anthropometric data were longitudinally collected for children at 6-18 months of age and 4.5-6 years of age at which time verbal and quantitative ability were also assessed. We estimate that an increase in concurrent height-for-age z-scores (HAZ) by one standard deviation was associated with an increase in a child's score on the Peabody Picture Vocabulary Test (PPVT) by 2.35 points [confidence interval (CI): 1.55-3.15] and a 0.16 point increase on the cognitive development assessment (CDA) (CI: 0.05-0.27). Furthermore, we report that the estimate for concurrent HAZ and PPVT is significantly higher than the estimate for early stunting and PPVT. We found no significant difference between early and concurrent estimates for HAZ and CDA. Children from older mothers, children whose mothers had higher education levels, children living in urban areas, children who attended pre-school, children with fewer siblings and children from wealthier backgrounds scored higher on both assessments. Cognitive skills of children entering school were associated with early stunting but the strongest association was found with concurrent stunting suggesting that interventions preventing linear growth faltering should not only focus on the under 2s but include children up to 5 years of age.
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Affiliation(s)
- Benjamin T Crookston
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah 84108, USA.
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Crookston BT, Dearden KA, Alder SC, Merrill RM, Dickerson TT, Stanford JB, Porucznik CA, Penny ME. Peruvian children who recover from early stunting and well‐nourished children demonstrate similar cognition. FASEB J 2010. [DOI: 10.1096/fasebj.24.1_supplement.734.6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Kirk A Dearden
- International Health and Center for Global Health and DevelopmentBoston UniversityBostonMA
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Prunuske JP, Crookston BT, Alder SC, Magill MK, Mervis AS, Burt RW. Factors associated with refusal of colonoscopy. Fam Med 2010; 42:161. [PMID: 20204886] [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: 05/28/2023]
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Park AH, Gifford T, Schleiss MR, Dahlstrom L, Chase S, McGill L, Li W, Alder SC. Development of cytomegalovirus-mediated sensorineural hearing loss in a Guinea pig model. ACTA ACUST UNITED AC 2010; 136:48-53. [PMID: 20083778 DOI: 10.1001/archoto.2009.210] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To develop an animal model for cytomegalovirus (CMV)-induced sensorineural hearing loss. DESIGN Guinea pig model. SETTING University of Utah otolaryngology research labs. PARTICIPANTS Thirty-one Hartley guinea pig pups were divided into 4 groups. Group 1 pups were delivered from pregnant dams inoculated with 1 x 10(5) plaque-forming units (PFU) of guinea pig CMV (gpCMV). Group 2 and group 3 pups were delivered from pregnant dams inoculated with higher doses of 2 and 4 x 10(5) PFU of gpCMV, respectively. Group 4 pups, the control group, were delivered from uninoculated dams. MAIN OUTCOME MEASURES All groups underwent weekly auditory brainstem response studies. Six weeks after delivery, the brain, cochlea, salivary glands, lungs, liver, and kidneys were harvested. All tissue except the cochlea was analyzed for histologic evidence of the virus. All tissue underwent polymerase chain reaction (PCR) to detect gpCMV. RESULTS Seven of the 19 (37%) inoculated pups developed a 30-dB hearing loss; none of the animals in the control group had a worse click threshold than 20 dB. Group 1 pups demonstrated statistically significant asymmetric hearing loss. All 3 inoculated groups showed evidence of progressive hearing loss over time. The control group did not demonstrate evidence of progressive threshold worsening. The PCR testing detected gpCMV in the cochleas of group 2 and group 3 animals. CONCLUSIONS We have successfully demonstrated elevated auditory brainstem response click thresholds with characteristics of progressive and asymmetric loss that have been reported in clinical reports of congenital CMV infection. We also detected gpCMV via PCR testing in the cochleas of inoculated pups.
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Affiliation(s)
- Albert H Park
- Division of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Utah, 50 N Medical Dr, Bldg 3C, Ste 120, Salt Lake City, UT 84132, USA.
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Abstract
The objective of this study was to compare initial use of the open abdomen using the vacuum-pack technique followed by delayed abdominal closure with standard primary abdominal closure in the treatment of ruptured abdominal aortic aneurysm (rAAA) repair. A retrospective review identified 122 rAAA cases, which were divided into two management eras: era 1 (primarily closed) and era 2 (47% open abdomen).One hundred three patients were included in this review: 58 in era 1 and 45 in era 2. Evidence of one of three ischemia-reperfusion (IR) criteria, preoperative hypotension, estimated blood loss > or = 6 L, or intraoperative resuscitation with > or = 12 L, predicted mortality. These criteria were also used as surrogate clinical markers for abdominal compartment syndrome. The in-hospital mortality was higher in those with at least one IR criterion: 43% versus 10% (p = .0003). In those with at least one IR criterion, the initial 24-hour mortality was 21% for era 1 versus 0% for era 2 (p = .03), and the 30-day mortality was 40% for era 1 and 32% for era 2 (p = .77).Three IR criteria were identified and were associated with increased mortality. Patients with these risk factors who were treated with delayed abdominal closure had an improved acute survival rate and a trend for improved long-term survival.
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Crookston BT, Alder SC, Boakye I, Merrill RM, Amuasi JH, Porucznik CA, Stanford JB, Dickerson TT, Dearden KA, Hale DC, Sylverken J, Snow BS, Osei-Akoto A, Ansong D. Exploring the relationship between chronic undernutrition and asymptomatic malaria in Ghanaian children. Malar J 2010; 9:39. [PMID: 20122258 PMCID: PMC2837055 DOI: 10.1186/1475-2875-9-39] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Accepted: 02/02/2010] [Indexed: 11/15/2022] Open
Abstract
Background A moderate association has been found between asymptomatic parasitaemia and undernutrition. However, additional investigation using the gold standard for asymptomatic parasitaemia confirmation, polymerase chain reaction (PCR), is needed to validate this association. Anthropometric measurements and blood samples from children less than five years of age in a rural Ghanaian community were used to determine if an association exists between chronic undernutrition and PCR-confirmed cases of asymptomatic malaria. Methods This was a descriptive cross-sectional study of 214 children less than five years of age from a community near Kumasi, Ghana. Blood samples and anthropometric measurements from these children were collected during physical examinations conducted in January 2007 by partners of the Barekuma Collaborative Community Development Programme. Results Findings from the logistic model predicting the odds of asymptomatic malaria indicate that children who experienced mild, moderate or severe stunting were not more likely to have asymptomatic malaria than children who were not stunted. Children experiencing anaemia had an increased likelihood (OR = 4.15; 95% CI: 1.92, 8.98) of asymptomatic malaria. Similarly, increased spleen size, which was measured by ultrasound, was also associated with asymptomatic malaria (OR = 2.17; 95% CI: 1.44, 3.28). Fast breathing, sex of the child, and age of the child were not significantly associated with the asymptomatic malaria. Conclusions No significant association between chronic undernutrition and presence of asymptomatic malaria was found. Children who experience anaemia and children who have splenomegaly are more likely to present asymptomatic malaria. Programmes aimed at addressing malaria should continue to include nutritional components, especially components that address anaemia.
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Affiliation(s)
- Benjamin T Crookston
- Department of Family and Preventive Medicine, University of Utah, 375 Chipeta Way, Salt Lake City, UT 84108, USA.
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Elsherif AM, Park AH, Alder SC, Smith ME, Muntz HR, Grimmer F. Indicators of a more complicated clinical course for pediatric patients with retropharyngeal abscess. Int J Pediatr Otorhinolaryngol 2010; 74:198-201. [PMID: 19963280 DOI: 10.1016/j.ijporl.2009.11.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Revised: 11/05/2009] [Accepted: 11/09/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Determine clinical signs or symptoms associated with a more complicated clinical course in patients with retropharyngeal abscesses (RPAs). DESIGN Retrospective chart review at a tertiary care level Children's hospital. Main Outcome Measures Age, presenting signs and symptoms, laboratory tests, imaging results, antibiotic therapy, surgical approach, pathogens isolated, and duration of hospitalization were evaluated to determine any factors associated with a more complicated clinical course (CCC). RESULTS Fifteen of one hundred thirty pediatric patients with RPA were identified with a complicated clinical course (CCC). Eight of the fifteen required more than one procedure before the abscess resolved. Patients with multiple abscess sites had a statistically significantly greater chance of requiring multiple procedures to clear the infections (p<0.001). Another seven presented with airway obstruction requiring an admission into the Pediatric Intensive Care (PICU) and/or intubation. All the patients requiring admission to the PICU presented with signs or symptoms of airway obstruction compared to ten of the one hundred fifteen patients (8.7%) with a smooth clinical course (SCC) (p<0.001). Five patients from the CCC group required a bronchoscopy to secure the airway; seven patients required intubation following incision and drainage of the abscess for an average of 5+/-3 days. There was no statistically significant difference between the two groups with respect to pathogens isolated, or antibiotics used. CONCLUSION Our study suggests that patients with a CCC are more likely to present with airway obstruction or multiple abscess sites than patients with SCC.
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Affiliation(s)
- Abdelaziz M Elsherif
- Division of Otolaryngology/Head and Neck Surgery, University of Utah, 50 North Medical Drive, 3C 120, Salt Lake City, UT 84132, United States
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Yorgason JG, Park AH, Sturgill N, Grimmer JF, Alder SC. The Role of Intraoperative Auditory Brainstem Response Testing for Infants and Difficult-To-Test Children. Otolaryngol Head Neck Surg 2010; 142:36-40. [DOI: 10.1016/j.otohns.2009.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 09/10/2009] [Accepted: 09/14/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVE: To assess the validity of intraoperative auditory brainstem response in infants and difficult-to-treat older children. STUDY DESIGN: Case series with chart review. SETTING: Tertiary-level children's hospital. SUBJECTS AND METHODS: Twenty-six patients were identified (mean age, 20 ± 18 months) who underwent both intraoperative auditory brainstem response (ioABR) testing and a follow-up hearing evaluation at five (standard deviation 4) months. Ears were analyzed separately for mean threshold change, and a sub-analysis was performed accounting for the presence or absence of fluid at the time of surgery. RESULTS: A paired t test analysis indicated a statistically significant difference at 1 kHz. There was not a statistically significant difference between the two groups with click or 4-kHz testing. Fifteen ears (58%) at 1 kHz and 17 ears (49%) at 4 kHz frequencies, however, improved by 10 dB or more; 67 percent and 65 percent of these ears, respectively, had middle ear fluid intraoperatively. Eight ears (35%) in the click ABR group had a similar improvement, four of which had fluid at the time of surgery. Four ears in the 1-kHz (11.5%), in the 4-kHz (11.4%), and in the click ABR group (17.4%) demonstrated a 10-dB or worse threshold. The range of the discrepancy varied from a worsening in thresholds up to 20 dB and improvement in thresholds up to 45 dB. CONCLUSIONS: We observed a significant discrepancy between ioABR and follow-up hearing thresholds. If ioABR indicates a hearing loss, audiologic testing should be performed at least several weeks later to confirm the results.
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Affiliation(s)
- Joshua G. Yorgason
- Division of Otolaryngology–Head and Neck Surgery (Drs Yorgason, Park, and Grimmer), University of Utah, Salt Lake City, UT
| | - Albert H. Park
- Division of Otolaryngology–Head and Neck Surgery (Drs Yorgason, Park, and Grimmer), University of Utah, Salt Lake City, UT
| | - Nanette Sturgill
- Audiology, Primary Children's Medical Center (N. Sturgill), Salt Lake City, UT
| | - Johannes Fredrik Grimmer
- Division of Otolaryngology–Head and Neck Surgery (Drs Yorgason, Park, and Grimmer), University of Utah, Salt Lake City, UT
| | - Stephen C. Alder
- Family and Preventive Medicine (Dr Alder), University of Utah, Salt Lake City, UT
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Kimball EJ, Baraghoshi GK, Mone MC, Hansen HJ, Adams DM, Alder SC, Jackson P, Cannon P, Horn J, Wolfe TR. A Comparison of Infusion Volumes in the Measurement of Intra-Abdominal Pressure. J Intensive Care Med 2009; 24:261-8. [DOI: 10.1177/0885066609335730] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Bladder pressure measurement through a foley catheter is the current standard in monitoring for intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS). Accurate pressure transduction requires a continuous fluid column with a small volume of transducing medium at the tip of the catheter. Infusing excessive fluid volume can falsely elevate the measured intra-abdominal pressure (IAP) due to bladder overdistention and can lead to intrinsic muscular contraction. This effect can be seen with volumes as low as 60 mL. Recent expert consensus has recommended 25 mL as the maximal infusion volume; however, 50 mL is the most commonly cited volume of infusion in the literature. The purpose of this analysis was to determine the variance between IAP values using a range of volume infusions between 10 and 60 mL. Eighteen adult, surgical intensive care unit (SICU) patients who were undergoing IAP measurement for IAH or clinically indicated monitoring were enrolled in a prospective, nontreatment study. Intra-abdominal pressure measurements were obtained with stepwise increases of injectate volume from 10 to 60 mL (in 10 mL increments). Bland-Altman analyses and receiver operating characteristic (ROC) curves were used for analysis. After analysis accounting for data correlation within patients, means and standard deviations were generated for differences between 50 mL and 10, 20, 30, 40, and 60 mL bladder infusion volumes. Bland-Altman analyses showed good agreement between measurements and no significant difference in variance (mean ≤1.35 mm Hg) between volume comparisons. The ROC curve generated for each test volume using a diagnostic pressure value for IAH (!12 mm Hg) showed that a value between 11 and 12 mm Hg gave the best combination of sensitivity and specificity for all test volumes. In SICU patients, with a clinical indication for IAP monitoring, bladder infusion volumes between 10 mL and 60 mL provide consistent IAP measurements.
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Affiliation(s)
- Edward J. Kimball
- Department of Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah,
| | | | - Mary C. Mone
- Department of Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Heidi J. Hansen
- Department of Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Danielle M. Adams
- Department of Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Stephen C. Alder
- Department of Family & Preventive Medicine, Salt Lake City, Utah
| | - Peter Jackson
- Department of Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Philip Cannon
- Department of Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Jeffrey Horn
- Department of Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Timothy R. Wolfe
- Department of Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah
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Morton DA, Bradshaw WS, Alder SC, Foreman KB, Bell JD. Improving analytical reasoning skills in the gross anatomy classroom. FASEB J 2009. [DOI: 10.1096/fasebj.23.1_supplement.lb5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | - John D Bell
- Physiology and Developmental BiologyBrigham Young UniversityProvoUT
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Feldkamp ML, Alder SC, Carey JC. A case control population-based study investigating smoking as a risk factor for gastroschisis in Utah, 1997-2005. ACTA ACUST UNITED AC 2009; 82:768-75. [PMID: 18985693 DOI: 10.1002/bdra.20519] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Smoking in pregnancy increases the risk for many different adverse pregnancy outcomes, including birth defects. Gastroschisis, a birth defect most commonly associated with young maternal age has been associated with smoking, but findings are inconsistent. We assessed whether smoking increases the risk for gastroschisis using population-based data from Utah. METHODS Gastroschisis cases (n = 189) were identified from the Utah Birth Defect Network and all live births without birth defects (n = 423,499) occurring in Utah from January 1, 1997 through December 31, 2005 served as controls. Exposure data were derived from birth certificates and fetal death certificates and, for terminated pregnancies, the Utah Birth Defect Network. RESULTS Women who smoked during the first trimester of pregnancy had an increased risk of gastroschisis (OR 1.6; 95% CI: 1.1, 2.3) after adjusting for maternal age and preconception BMI. Discordance between birth certificate data and data from structured interviews increased exposure prevalence from 16.9 to 22.2% for case mothers and 7.4 to 13.2% for control mothers. Accounting for this misclassification, the crude OR decreased by 24%, 1.9 (1.3, 2.7). CONCLUSIONS Though first trimester cigarette smoking was reported on birth certificates by more mothers of gastroschisis cases than controls, adjustment for confounders (maternal age and preconception BMI) and smoking misclassification suggests the association is weak. Despite a decrease in smoking prevalence among all women of childbearing years in Utah between 1997 and 2005, the prevalence of gastroschisis has not followed a similar trend.
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Affiliation(s)
- Marcia L Feldkamp
- Department of Medical Genetics, University of Utah Health Sciences Center, Salt Lake City, Utah 84132, USA.
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Abstract
BACKGROUND Giant cell arteritis (GCA) is a systemic vasculitis of elderly individuals associated with significant morbidity, including blindness, stroke, and myocardial infarction. Previous studies have investigated whether GCA is associated with increased mortality, with conflicting results. The objective of this study is to determine whether GCA, is associated with increased mortality. METHODS Forty-four cases with GCA were identified from the University of Utah Health Sciences Center, the major tertiary care center for the Intermountain West. The Utah Population Database, a unique biomedical information resource, selected cases and age- and gender-matched controls. Cases were defined as patients with a temporal artery biopsy-proven diagnosis of GCA (international classification of diseases [ICD]-9 code 446.5) between 1991 and 2005. Exclusion criteria included a negative biopsy, alternative diagnoses, or insufficient clinical data. For each of the 44 cases, 100 controls were identified; thus, 4,400 controls were included in the data analysis. Median survival time and 5-year cumulative survival were measured for cases and controls. RESULTS The median survival time for the 44 GCA cases was 1,357 days (3.71 years) after diagnosis compared with 3,044 days (8.34 years) for the 4,400 controls (p = 0.04). Five-year cumulative survival was 67% for the control group versus 35% for the cases (p < .001). Survival rates for cases and controls converged at approximately 11.12 years. CONCLUSIONS Patients with GCA were more likely than age- and gender-matched controls to die within the first 5 years following diagnosis.
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Affiliation(s)
- R Wade Crow
- Department of Ophthalmology and Visual Sciences, University of Utah Health Sciences Center, Salt Lake City, UT 84132, USA
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Tuteja AK, Talley NJ, Gelman SS, Alder SC, Adler SC, Thompson C, Tolman K, Hale DC. Development of functional diarrhea, constipation, irritable bowel syndrome, and dyspepsia during and after traveling outside the USA. Dig Dis Sci 2008; 53:271-6. [PMID: 17549631 DOI: 10.1007/s10620-007-9853-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [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] [Received: 02/26/2007] [Accepted: 04/20/2007] [Indexed: 12/09/2022]
Abstract
BACKGROUND Persistent gastrointestinal (GI) symptoms after travel abroad may be common. It remains unclear how often subjects who developed new GI symptoms while abroad have persistent symptoms on return. The objective of this retrospective study was to evaluate the prevalence of persistent GI symptoms in a healthy cohort of travelers. METHODS One hundred and eight consecutive patients, mostly returned missionaries, attending the University of Utah International Travel Clinic for any reason (but mostly GI symptoms) had data recorded about their bowel habits before, during, and after travel abroad. All subjects had standard hematological, biochemical, and microbiological tests to exclude known causes of their symptoms. Endoscopic procedures were performed when considered necessary by the treating physician. Diarrhea, constipation, irritable bowel syndrome (IBS), bloating, and dyspepsia were defined according to the Rome II Criteria. RESULTS Eighty three (82% men and 18% women, median age 21 years) completed the survey with 68 subjects completing the questionnaire about bowel habits before and during travel. Among the respondents, 55 (82.1%) did not have any symptoms before travel. During travel, 41 (63%) developed new onset diarrhea; 6 (9%) developed constipation; 16 (24%) IBS, 29 (45%) bloating; and 11 (16%) dyspepsia. Of those who developed symptoms during travel, 27 (68%) had persistent diarrhea, 3 (50%) had persistent constipation, 10 (63%) had persistent IBS, 12 (43%) had persistent bloating and 8 (73%) had persistent dyspepsia. The presence of bowel symptoms during and after travel was not associated with age, gender, travel destination, or duration of travel. CONCLUSIONS This study suggests that new onset of diarrhea, IBS, constipation, and dyspepsia are common among subjects traveling abroad. Gastrointestinal symptoms that develop during travel abroad usually persist on return.
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Affiliation(s)
- Ashok K Tuteja
- George E Wahlen VA Medical Center, Salt Lake City, UT, USA.
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Abstract
Trends in invasive meningococcal disease in Utah during 1995–2005 have differed substantially from US trends in incidence rate and serogroup and age distributions. Regional surveillance is essential to identify high-risk populations that might benefit from targeted immunization efforts.
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Affiliation(s)
- Rachelle B Boulton
- Department of Health, Division of Epidemiology and Laboratory Services, University of Utah, Salt Lake City, Utah 84114, USA.
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Alder SC, Simonsen SE, Duncan M, Shaver J, Dewitt J, Crookston B. Perspectives on efforts to address HIV/AIDS of religious clergy serving African American and Hispanic communities in Utah. Open AIDS J 2007; 1:1-4. [PMID: 18923690 PMCID: PMC2556193 DOI: 10.2174/1874613600701010001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Revised: 09/14/2007] [Accepted: 09/17/2007] [Indexed: 11/22/2022] Open
Abstract
Introduction The HIV/AIDS epidemic in America is rapidly progressing in certain subpopulations, including African-American and Hispanic communities. Churches may provide a means for reaching high-risk minority populations with effective HIV/AIDS prevention. We report on a series of focus group interviews conducted with Utah clergy who primarily serve African American and Hispanic congregations. Methods A total of three focus groups (two with Catholic clergy serving Hispanic congregations and one with protestant clergy serving African American congregations) were conducted with eleven participants, lasting approximately two hours each. Each focus group was audio-recorded and transcribed for analysis. Analysis of the data was conducted using a modified grounded theory approach. Results There were remarkable similarities in the attitudes and beliefs among all clergy participating in this study regarding HIV/AIDS and church-based prevention programs. All groups expressed concern about the diseases as a global epidemic and reported that the disease is highly preventable. Also, participants indicated a sense of responsibility to address the issues surrounding HIV/AIDS-related prevention, testing and care within their theological framework. Conclusion HIV/AIDS prevention and care for the infected are seen as falling within the scope of religious organizations. Openness to expanding efforts in this regard was shared by clergy participating in this study. Approaching religious leaders with tailored approaches that respect the values and practices of their particular religions will be more effective than attempting to impose approaches that do not achieve this standard.
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Affiliation(s)
- Stephen C Alder
- University of Utah, Department of Family and Preventive Medicine, 375 Chipeta Way, Suite A, Salt Lake City, Utah 84105, USA.
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Abstract
OBJECTIVE To study whether a cue-based clinical pathway for oral feeding initiation and advancement of premature infants would result in earlier achievement of full oral feeding. STUDY DESIGN Age of achievement of full oral intake was compared for two groups of preterm infants; a prospective study group vs historic cohort controls. Study infants had oral feedings managed by nurses using a clinical pathway that relied on infant behavioral readiness signs to initiate and advance oral feedings. Controls had oral feedings managed by physician orders. RESULT Fifty-one infants (n=28 study and n=23 control) were studied. Gender distribution, gestational age, birth weight and ventilator days were not different between groups. Study infants reached full oral feedings 6 days earlier than controls (36+/-1 3/7 weeks of postmenstrual age (PMA) vs 36 6/7+/-1 4/7 weeks of PMA, P=0.02). CONCLUSION The cue-based clinical pathway for oral feeding initiation and advancement of premature infants resulted in earlier achievement of full oral feeding.
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Affiliation(s)
- A T Kirk
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT 84108, USA.
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Kimball EJ, Mone MC, Wolfe TR, Baraghoshi GK, Alder SC. Reproducibility of bladder pressure measurements in critically ill patients. Intensive Care Med 2007; 33:1195-1198. [PMID: 17468849 DOI: 10.1007/s00134-007-0641-z] [Citation(s) in RCA: 20] [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] [Received: 11/22/2006] [Accepted: 03/26/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Intra-abdominal hypertension is an independent cause of multiorgan failure and directly effects other physiological measurements, making it an important factor in the management of critically ill patients, but no clinical studies have investigated the reproducibility of intra-abdominal pressure (IAP) measurement to ensure diagnostic accuracy. This study evaluated the intraobserver and interobserver variability of bladder pressure measurements. DESIGN AND SETTING Prospective, observational study in a university-based adult surgical intensive care unit. PATIENTS Critically ill patients undergoing intra-abdominal pressure readings, measured by nursing staff. MEASUREMENTS AND RESULTS The study compared patient IAP measurements obtained by the same nurse (intraobserver variation) and between two different nurses (interobserver variation) in critical care patients with clinical indications for IAP monitoring. Data related to the nursing technique and performance were observed and collected for each IAP measurement obtained. Good correlation of bladder pressure measurements between the same and different individuals was found. Intraobserver and interobserver Pearson's correlations for measured IAP were 0.934 and 0.950, respectively. A unit protocol for IAP measurement standardization was modified based on observational data collected. CONCLUSIONS Intra-abdominal pressure can be accurately and reliably measured in critically ill patients by utilizing a standardized measurement device combined with a standardized clinical protocol.
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Affiliation(s)
- Edward J Kimball
- Department of Surgery, School of Medicine, University of Utah, 30 North 1900 East, 84132, Salt Lake City, UT, USA.
| | - Mary C Mone
- Department of Surgery, School of Medicine, University of Utah, 30 North 1900 East, 84132, Salt Lake City, UT, USA
| | - Timothy R Wolfe
- Department of Surgery, School of Medicine, University of Utah, 30 North 1900 East, 84132, Salt Lake City, UT, USA
| | - Gabriele K Baraghoshi
- Department of Surgery, School of Medicine, University of Utah, 30 North 1900 East, 84132, Salt Lake City, UT, USA
| | - Stephen C Alder
- Department of Family and Preventive Medicine, School of Medicine, University of Utah, 30 North 1900 East, 84132, Salt Lake City, UT, USA
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Christensen RD, Alder SC, Richards SC, Lambert DK, Schmutz N, Wiedmeier SE, Burnett J, Baer VL, Horn JT, Richards M, Barraza J. D-Penicillamine administration and the incidence of retinopathy of prematurity. J Perinatol 2007; 27:103-11. [PMID: 17262043 DOI: 10.1038/sj.jp.7211653] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [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: 11/08/2022]
Abstract
OBJECTIVE We compared the development of retinopathy of prematurity (ROP) among 49 preterm neonates:; 15 who were treated during the first 2 weeks of life with D-penicillamine and 34 who were not. METHODS During a 15-month period beginning 1 March, 2005, 15 preterm neonates <1000 g birth weight or < or =29 weeks gestation enterally received a 14-day course of D-penicillamine, and 34 did not, in an open-label non-randomized trial. We compared the outcomes of developing 'ROP any stage' and 'ROP requiring surgery' in the recipients vs the non-recipients. Potential toxicities of the D-penicillamine were examined by comparing specific laboratory tests, growth velocities, transfusion requirements, discharge hemoglobin concentrations and supplemental O(2) at discharge. RESULTS The 34 non-treated and the 15 D-penicillamine treated patients were of similar gestational age (26.5+/-1.8 vs 26.6+/-2.2 weeks, mean+/-s.d.) and birth weight (887+/-222 vs 849+/-187 g). Four of the 34 non-recipients died. Eighteen of the 30 survivors (60%) developed ROP and seven of the 30 (23%) had ROP surgery. One of the 15 D-penicillamine recipients died. Three of the 14 survivors (21%) developed ROP (P=0.01 vs non-recipients) and all three had ROP laser surgery. No increase in elevated creatinine, direct or indirect bilirubin, thrombocytopenia or neutropenia was apparent in those treated with D-penicillamine. The D-penicillamine recipients did not receive more transfusions and did not have lower hemoglobin concentrations at discharge. They did not have lower velocities of weight gain at 14, 28 and 56 days, and were not discharged on supplemental O(2) at a rate exceeding that of the non-recipients. CONCLUSIONS In this non-randomized, single-centered comparison analysis, a 14-day course of D-penicillamine resulted in no apparent short-term toxicity. The treatment was associated with elimination of Stage I and Stage II ROP, decreasing the overall odds of developing ROP from 60 to 21%. However, this approach did not reduce the odds of ROP surgery. Perhaps higher doses of D-penicillamine or longer treatment periods or other prophylactic approaches will be required to reduce ROP surgery among the most immature neonates.
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Affiliation(s)
- R D Christensen
- Department of Women and Newborns, Intermountain Healthcare, McKay-Dee Hospital Center, Ogden, UT 84403, USA.
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Street JL, Montgomery D, Alder SC, Lambert DK, Gerstmann DR, Christensen RD. Implementing feeding guidelines for NICU patients<2000 g results in less variability in nutrition outcomes. JPEN J Parenter Enteral Nutr 2007; 30:515-8. [PMID: 17047177 DOI: 10.1177/0148607106030006515] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [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: 11/15/2022]
Abstract
BACKGROUND We devised a consistent approach to instituting and advancing enteral nutrition among neonatal intensive care unit (NICU) patients<2000 g birth weight. We then assessed variability in feeding-related outcomes during a period before (period 1) vs after (period 2) implementing these guidelines. METHODS Using data from period 1 vs period 2, we statistically compared the equivalence of variance, focusing on certain feeding-related outcomes. Specific outcomes we chose to examine were (1) day of life when the first enteral feedings were given, (2) number of days during the entire hospitalization when no feedings were given, (3) number of days parenteral nutrition (PN) was administered, and (4) day of life when feedings of 80 mL/k/d and 100 kcal/k/d enteral were achieved. RESULTS Fifty-eight patients<2000 g were admitted to the NICU in period 1, of which 56 survived to discharge home. In period 2, 68 patients<2000 g were admitted and 66 survived to discharge. Demographic features of the patients in periods 1 and 2 did not differ. In both periods, feedings were begun on a median of day 1. However, in period 1 the range was from day 0 to day 24, and in period 2, the range was from day 0 to day 6 (equivalence of variance p<.001). After feedings were initiated, they were withheld for a median of 2 days (range, 0-23) during the remainder of the hospitalization in period 1 vs a median of 1 day (range, 0-12) in period 2 (p<.001). During period 1, PN was used for a median of 10 days (range, 0-72) vs 7 (range, 0-47) in period 2 (p=.001). During period 1, more variability occurred in the day of life when 80 mL/k/d and 100 kcal/k/d were achieved (both p<.001). No differences were seen in necrotizing enterocolitis, intestinal perforation, mortality, or length of hospital stay. CONCLUSIONS Implementing feeding guidelines was associated with significantly less variability in feeding-related outcomes. We speculate that this is a reflection of better feeding tolerance, which resulted from a more consistent approach to initiating and advancing enteral feedings.
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Affiliation(s)
- Jennifer L Street
- Intermountain Healthcare Neonatology Research, McKay-Dee Hospital Center, Ogden 84403, and Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, USA
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Barney CK, Lambert DK, Alder SC, Scoffield SH, Schmutz N, Christensen RD. Treating feeding intolerance with an enteral solution patterned after human amniotic fluid: a randomized, controlled, masked trial. J Perinatol 2007; 27:28-31. [PMID: 17180128 DOI: 10.1038/sj.jp.7211609] [Citation(s) in RCA: 21] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Feeding intolerance is a common problem in the neonatal intensive care unit (NICU) and some cases might be causally related to atrophic changes in the small bowel mucosa. We speculated that for such patients, feeding tolerance might improve after oral administration of enterocyte growth factors in a sterile, isotonic solution patterned after amniotic fluid. STUDY DESIGN Twenty neonates meeting criteria for feeding intolerance were eligible for this trial. They were randomized to either Group 1 (test solution) or Group 2 (control). Group 1 received 2.5 ml of test solution/kg every 3 h by oral-gastric or nasal-gastric (OG/NG) tube. This was begun when the patient was NPO because of feeding intolerance and continued until 80 ml/k/day of milk feedings were tolerated, or for a maximum of 7 days. Group 2 received a sham OG/NG administration every 3 h, until 80 ml/k/day of milk feedings were tolerated, or for a maximum of 7 days. Only the bedside nurse and the NICU pharmacist were aware which patients received the test solution and which received the sham administrations. The volumes of milk feedings were increased by order of the attending neonatologist and nurse practitioner. The study outcome was enteral calories/kg/day during and for 7 days after the cessation of the treatments. RESULTS Eleven patients were randomized to receive the test solution and nine to receive sham administrations. At study entry, the two groups were not different in gestational age, postnatal age, signs of feeding intolerance or cal/k/day taken enterally during the previous 3 days. The study doses were given for an average of just under 6 days (range, 2 to 7 days). During the week following the administrations, the test solution recipients trended toward more enteral calories. Specifically, they had an increase averaging 78+/-20.8 cal/k/day more than before the study, whereas the sham recipients had an increase averaging 55.9+/-33 cal/k/day more than before the study (P=0.05 for a one-sided test and P=0.10 for a two-sided test). The test solution recipients also had a trend toward fewer formula changes than did the sham recipients (P=0.10). In this small, randomized, controlled, masked trial, the administration of a sterile, non-caloric, growth factor containing solution patterned after human amniotic fluid was associated with trends that we interpret as reflecting better tolerance of milk feedings. On this basis, we suggest that a phase III efficacy trial should be accomplished, using the present data for sample size calculations.
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Affiliation(s)
- C K Barney
- Intermountain Healthcare Neonatology Clinical Research Group and McKay-Dee Hospital, Ogden, UT 84033, USA
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Stone MB, Lyon JL, Simonsen SE, White GL, Alder SC. An internet-based method of selecting control populations for epidemiologic studies. Am J Epidemiol 2007; 165:109-12. [PMID: 17041132 DOI: 10.1093/aje/kwj351] [Citation(s) in RCA: 4] [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: 11/15/2022] Open
Abstract
Identifying control subjects for epidemiologic studies continues to increase in difficulty because of changes in telephone technology such as answering services and machines, caller identification, and cell phones. An Internet-based method for obtaining study subjects that may increase response rates has been developed and is described. This method uses information from two websites that, when combined, provide accurate and complete lists of names, addresses, and listed phone numbers. This method was developed by use of randomly selected streets in a suburb of Salt Lake City, Utah, in June 2005.
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Affiliation(s)
- Mary Bishop Stone
- Public Health Program, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT 84108, USA.
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Abstract
OBJECTIVE To develop an ideal supportive packing material for ossiculoplasty, tympanoplasty, or other otologic procedures. MATERIALS AND METHODS Several materials, namely, Carbylan-SX (P-C; Sentrx Surgical, Inc., Salt Lake City, UT), Gelfoam (P-GF; Pharmacia & Upjohn, Kalamazoo, MI), and Merogel (P-MG; Medtronics, Inc., Minneapolis, MN), were prepared and then placed into a Hartley guinea pig's (Elm Hill, Chelmsford, MA) middle ear cavities through a large myringotomy incision. The contralateral ear underwent a large myringotomy without packing material being placed. Preoperative and posteroperative auditory brainstem response studies were performed using Intelligent Hearing system software. The animals were examined weekly. Two weeks after packing placement, the animals were killed, and the temporal bones were harvested. Whole temporal bone sectioning was performed to analyze the presence of implant, surrounding inflammation, presence of osteoneogenesis and fibrosis, or adhesions. RESULTS All the materials, except the P-MG, were easy to place into the middle ear cavity. The P-MG contains woven strands that are difficult to trim into the small sizes needed for placement. The P-MG group had a smaller average amount of implant present compared with the other groups at 2 weeks. The degree of osteoneogenesis was similar among the P-GF, P-C, and P-MG groups. The P-MG and P-C groups contained the lowest amount of fibrosis between the implant and surrounding middle ear structures. CONCLUSION This study demonstrates promising results with P-C as a potential supportive packing material for otologic procedures. P-C compares favorably with P-MG and P-GF in a guinea pig model with respect to ease of placement and amount of fibrosis.
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Affiliation(s)
- Albert H Park
- Division of Otolaryngology-Head and Neck Surgery, University of Utah, School of Medicine, Salt Lake City, Utah 84132, USA.
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Lyon JL, Alder SC, Stone MB, Scholl A, Reading JC, Holubkov R, Sheng X, White GL, Hegmann KT, Anspaugh L, Hoffman FO, Simon SL, Thomas B, Carroll R, Meikle AW. Thyroid Disease Associated With Exposure to the Nevada Nuclear Weapons Test Site Radiation. Epidemiology 2006; 17:604-14. [PMID: 17028502 DOI: 10.1097/01.ede.0000240540.79983.7f] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A study was begun in 1965 to 1966 to determine whether children exposed to radioactive iodine from nuclear weapons testing at the Nevada Test Site from 1951 through 1962 were at higher risk of thyroid disease. In 1993, we reported that among those examined in 1985 to 1986 (Phase II) there was an association between radiation from the Nevada Test Site and thyroid neoplasms. METHODS We reevaluated the relationship between exposure to Nevada Test Site fallout and thyroid disease using newly corrected dose estimates and disease outcomes from the Phase II study. A prospective cohort of school children 12 to 18 years old living in Utah, Nevada, and Arizona was first examined for thyroid disease in 1965 to 1966 and reexamined in 1985 to 1986. In the Phase II report, 2497 subjects formed the basis for this analysis. Thyroid disease, including thyroid neoplasms and thyroiditis, was expressed as cumulative incidence and risk ratios (RRs) with a dose-response expressed as excess risk ratio (ERR/Gy). RESULTS The RR between thyroid radiation dose in the highest dose group and thyroid neoplasms increased from 3.4 (in the earlier analysis) to 7.5. The RR for thyroiditis increased from 1.1 to 2.7 with an ERR/Gy of 4.9 (95% confidence interval = 2.0 to 10.0). There were too few malignant thyroid neoplasms to estimate risk. CONCLUSIONS Persons exposed to radioactive iodine as children have an increased risk of thyroid neoplasms and autoimmune thyroiditis up to 30 years after exposure.
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Affiliation(s)
- Joseph L Lyon
- Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, UT 84108, USA.
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Balbierz JM, Petajan JH, Alder SC, Vlach SA. Differences in Pain Perception in Women Using Concentric and Monopolar Needles. Arch Phys Med Rehabil 2006; 87:1403-6. [PMID: 17023253 DOI: 10.1016/j.apmr.2006.06.017] [Citation(s) in RCA: 4] [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] [Received: 05/19/2006] [Accepted: 06/30/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine pain perception using concentric needle electrodes and monopolar needle electrodes in an all-female study group without underlying hand or arm pain complaints, using study subjects as their own controls. DESIGN Prospective randomized study. Two muscles--the biceps and abductor pollicis brevis (APB)--were examined using both a concentric needle electrode and a monopolar needle electrode. SETTING University community. PARTICIPANTS Eighty healthy female employees at the University of Utah and Primary Children's Hospital were enrolled. All completed the study. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Pain scores. Posttest verbal analog pain scale (0-10) measures were obtained after each muscle was studied. A subset of subjects (n=51) was asked to identify needle preference after completion of the study. RESULTS There was no significant difference in mean pain scores between the concentric needle electrode and the monopolar needle electrode (3.06 and 3.10, respectively; P=.803). The APB muscle was significantly more painful than the biceps muscle with both needle types (mean pain scores, 3.92 and 2.24, respectively; P<.001). In the subset of subjects asked to identify needle preference after completion of the study, 21 chose a concentric needle electrode and 30 a monopolar needle electrode. This difference was not statistically significant. However, verbal analog pain scores were lower with the needle preferred by each subject (P<.20). CONCLUSIONS There is no significant difference in mean pain scores reported between a concentric needle electrode and a monopolar needle electrode. Subjects were clear on the needle they preferred, and the pain scores reported for the less painful needle were lower than those for the other needle.
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Park AH, Warner J, Sturgill N, Alder SC. A survey of parental views regarding their child's hearing loss: a pilot study. Otolaryngol Head Neck Surg 2006; 134:794-800. [PMID: 16647537 DOI: 10.1016/j.otohns.2006.01.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2005] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Assess parental perceptions of their child's sensorineural hearing loss care. METHODS Families of pediatric patients diagnosed with a sensorineural hearing loss from 2000 to 2004 were sent a survey asking about their experiences with their child's hearing loss. RESULTS One hundred eight of 389 families surveyed were studied. Thirteen percent did not know the results of the newborn screening. Twenty-two percent of the primary care physicians were not involved in the child's hearing evaluation. Forty percent of the patients underwent 4 or more audiologic tests before a diagnosis. The most common reason for delayed diagnosis was difficulty in obtaining an appointment with an audiologist. Sixty-two percent of families had difficulties obtaining hearing aids, and 58% noted difficulties obtaining cochlear implants. CONCLUSIONS Families reported multiple obstacles to obtain timely diagnosis and treatment. Otolaryngologists may need to be more involved in the evaluation and treatment of these patients. EBM RATING C-4.
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Affiliation(s)
- Albert H Park
- Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah 84132, USA.
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Abstract
The evidence base for the efficacy of the ketogenic diet was assessed among pediatric epileptic patients by application of a rigorous statistical meta-analysis. Nineteen studies from 392 abstracts met the inclusion criteria. The sample size was 1084 patients (mean age at initiation 5.78 +/- 3.43 years). The pooled odds ratio, using a random effects model, of treatment success (> 50% seizure reduction) among patients staying on the diet relative to those discontinuing the diet was 2.25 (95% confidence interval = 1.69-2.98). The reasons for diet discontinuation included < 50% seizure reduction (47.0%), diet restrictiveness (16.4%), and incurrent illness or diet side effects (13.2%). The results indicate that children with generalized seizures and patients who respond with > 50% seizure reduction within 3 months tend to remain on the diet longer. Although no class I or II studies have been published regarding the efficacy of the ketogenic diet, this meta-analysis shows that current observational studies reporting on the therapeutic effect of the ketogenic diet contain valuable statistical data. Future observational studies should aim for long-term follow-up, patient dropout analysis, and improved seizure type characterization.
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Affiliation(s)
- C Beth Henderson
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, USA
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Snow M, White GL, Alder SC, Stanford JB. Mentor's hand hygiene practices influence student's hand hygiene rates. Am J Infect Control 2006; 34:18-24. [PMID: 16443088 DOI: 10.1016/j.ajic.2005.05.009] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2005] [Revised: 05/11/2005] [Accepted: 05/11/2005] [Indexed: 11/16/2022]
Abstract
BACKGROUND There were 3 objectives for this prospective quasiexperimental study. The first was to determine the effect of mentor's hand hygiene practices on student's hand hygiene rates during clinical rotations. The second was to assess the difference in hand hygiene rates for students with and without prior medical experience. The third was to assess the student's opinion and beliefs regarding hand hygiene. METHODS Sixty students enrolled in a certified nursing program were selected to participate in the study. Each study group was observed twice during the 30-day span. The first observational period was conducted on day 1 of clinical rotation. The second observational period was conducted on day 30 of clinical rotation. Students were observed for hand hygiene. Also assessed were medical experience, sex, gloving, age, and mentor's hand hygiene practices. After observational period 2, a brief questionnaire was given to students to determine their opinion and beliefs regarding hand hygiene. The questionnaire was divided into 5 sections: student's commitment to hand hygiene, their perception of hand hygiene inconvenience, the necessity of hand hygiene, the student's ability to perform hand hygiene, and their opinion on the frequency of medical staff's hand hygiene. RESULTS The mentor's practice of hand hygiene was the strongest predictor of the student's rate of hand hygiene for both observational periods (P < .01). Furthermore, students without prior medical experience had a significant increase in hand hygiene rates when comparing observational period 1 to observational period 2 (P < .01). Glove usage was associated with increased hand hygiene rates by 50% during observational period 1 (P = .01) and 44% during observational period 2 (P < .01). Male students during observational period 1 practiced hand hygiene 30% less often than female students (P < .01); however, during observational period 2, there was no significant difference between hand hygiene rates for males and females (P = .82). Questionnaires were completed by 47 students, who reported a strong commitment to hand hygiene, belief in its necessity, and ability to perform hand hygiene (with scores in the high 90s on a 10 to 100 rating scale). CONCLUSION Mentor's use of hand hygiene and glove usage was associated with increased hand hygiene among students. Even though students reported strongly positive attitudes toward hand hygiene, students had a low overall rate of hand hygiene.
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Affiliation(s)
- Michelle Snow
- Department of Family and Preventive Medicine, University of Utah, USA.
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Christensen RD, Alder SC, Richards SC, Horn JT, Lambert DK, Baer VL. A pilot trial testing the feasibility of administering D-penicillamine to extremely low birth weight neonates. J Perinatol 2006; 26:120-4. [PMID: 16407960 DOI: 10.1038/sj.jp.7211440] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [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: 11/08/2022]
Abstract
OBJECTIVE We enterally administered a 14-day course of 3-mercapto-D-valine (D-penicillamine) to five extremely low birth weight (ELBW) neonates, as a step toward assessing this therapy as a means of reducing the incidence or severity of retinopathy of prematurity (ROP). METHODS The study drug (100 mg/ml) was given by nasogastric tube at a dose of 100 mg/k every 8 h for three days, and then 50 mg/k once per day for 11 additional days. Logbooks were maintained by the bedside nurses to record signs of possible immediate intolerance. Laboratory tests assessed hepatic, renal, and hematologic toxicity. ROP was scored according to the ICROP guidelines. Comparisons were with a cohort of 139 consecutive recent neonates of the same birth weight and gestational age range. RESULTS Five neonates were enrolled in the study, and all received the full course of study drug as planned. Signs of immediate intolerance of the study drug were not observed in any. The study patients did not have a higher incidence, than that of the cohort group, in creatinine elevation, thrombocytopenia, neutropenia, hyperbilirubinemia, or abnormal liver function test. Four of the five had no ROP and one developed transient stage 1, compared with a 54% occurrence of ROP in the cohort. CONCLUSIONS It is feasible to enterally administer a 14-day course of 3-mercapto-D-valine to ELBW neonates and the suspension appears to be well tolerated. These results suggest that phase II safety and preliminary efficacy trials can be undertaken.
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Affiliation(s)
- R D Christensen
- Department of Women and Newborn, Intermountain Health Care and the McKay-Dee Hospital Center, Ogden, UT 84403, USA.
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Samore MH, Lipsitch M, Alder SC, Haddadin B, Stoddard G, Williamson J, Sebastian K, Carroll K, Ergonul O, Carmeli Y, Sande MA. Mechanisms by which antibiotics promote dissemination of resistant pneumococci in human populations. Am J Epidemiol 2006; 163:160-70. [PMID: 16319292 DOI: 10.1093/aje/kwj021] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Mechanisms by which antimicrobials contribute to dissemination of pneumococcal resistance are incompletely characterized. A serial cross-sectional study of nasopharyngeal pneumococcal carriage in healthy, home-living children <or=6 years of age was conducted in four rural communities-two in Utah (1998-2003) and two in Idaho (2002-2003). Prevalence odds ratios for carriage of resistant pneumococci (OR(res)) and of susceptible pneumococci (OR(sus)) were estimated. Dynamic transmission models were developed to facilitate a mechanistic interpretation of OR(res) and OR(sus) and to compare the population impact of distinct antimicrobial classes. A total of 5,667 cultures were obtained; 25% of the cultures were positive, and 29% of isolates exhibited reduced susceptibility to penicillin. The adjusted OR(res) for recent individual and sibling cephalosporin use was 2.2 (95% confidence interval: 1.4, 3.4) and 1.8 (95% confidence interval: 1.0, 3.3), respectively. Neither individual nor sibling penicillin use was associated with increased OR(res). Rather, recent use of penicillins was associated with decreased carriage of susceptible pneumococci (OR(sus) = 0.2, 95% confidence interval: 0.1, 0.3). In simulations, both types of effects promoted dissemination of resistant pneumococci at the population level. Findings show that oral cephalosporins enhance the risk of acquiring resistant pneumococci. Penicillins accelerate clearance of susceptible strains. The effect of penicillins in increasing resistance is shared equally by treated and untreated members of the population.
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Affiliation(s)
- Matthew H Samore
- Division of Clinical Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT 84132, USA.
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