1
|
Marshall GA, Garner JA, Hanson KL, Ammerman AS, Jilcott Pitts SB, Kolodinsky J, Sitaker M, Seguin-Fowler RA. Fruit and Vegetable Preparation Changes During and After Cost-Offset Community-Supported Agriculture Plus Nutrition Education. J Nutr Educ Behav 2023; 55:575-584. [PMID: 37389499 DOI: 10.1016/j.jneb.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 04/27/2023] [Accepted: 05/08/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE Inadequate consumption of fruits and vegetables (FV) can negatively impact health. Cost-offset, or subsidized, community-supported agriculture (CO-CSA) may change FV preparation behaviors among caregivers in low-income households. We assessed changes in FV preparation frequency and methods during and after participation in a CO-CSA plus tailored nutrition education intervention. DESIGN Longitudinal comparison of outcomes at baseline, end of CO-CSA season, and 1 year later. PARTICIPANTS Caregivers of children aged 2-12 years from households with low income in rural areas of 4 US states (n = 148). INTERVENTION Summer season, half-price CO-CSA share plus tailored nutrition education classes. Comparison to a control group not included in this analysis. VARIABLES MEASURED Monthly frequency of preparing 9 FV for children's snacks and 5 vegetables for dinner; use of healthy preparation methods for dinner. ANALYSIS Repeated measures ANCOVA including state with Bonferroni correction and 95% confidence. RESULTS At baseline, caregivers prepared fruit for children's snacks and vegetables for dinner almost daily and vegetables for children's snacks every other day. The frequency of total FV preparation and most vegetable varieties increased during the intervention. Increases in total vegetables for snacks, dinner, and leafy greens were maintained 1 year later (n = 107). CONCLUSIONS AND IMPLICATIONS Community-supported agriculture plus education is a promising approach to sustained increases in vegetable preparation for children's snacks and dinner meals.
Collapse
Affiliation(s)
- Grace A Marshall
- Department of Public and Ecosystem Health, Cornell University, Ithaca, NY.
| | - Jennifer A Garner
- John Glenn College of Public Affairs, The Ohio State University, Columbus, OH; Division of Medical Dietetics, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH
| | - Karla L Hanson
- Department of Public and Ecosystem Health, Cornell University, Ithaca, NY
| | - Alice S Ammerman
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Jane Kolodinsky
- Department of Community Development and Applied Economics, University of Vermont, Burlington, VT
| | - Marilyn Sitaker
- Extension Agriculture and Natural Resources, Washington State University, Olympia, WA
| | - Rebecca A Seguin-Fowler
- Institute for Advancing Health Through Agriculture, Texas A&M University System, College Station, TX
| |
Collapse
|
2
|
Seguin-Fowler RA, Hanson KL, Villarreal D, Rethorst CD, Ayine P, Folta SC, Maddock JE, Patterson MS, Marshall GA, Volpe LC, Eldridge GD, Kershaw M, Luong V, Wang H, Kenkel D. Evaluation of a civic engagement approach to catalyze built environment change and promote healthy eating and physical activity among rural residents: a cluster (community) randomized controlled trial. BMC Public Health 2022; 22:1674. [PMID: 36058913 PMCID: PMC9441047 DOI: 10.1186/s12889-022-13653-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prior studies demonstrate associations between risk factors for obesity and related chronic diseases (e.g., cardiovascular disease) and features of the built environment. This is particularly true for rural populations, who have higher rates of obesity, cancer, and other chronic diseases than urban residents. There is also evidence linking health behaviors and outcomes to social factors such as social support, opposition, and norms. Thus, overlapping social networks that have a high degree of social capital and community cohesion, such as those found in rural communities, may be effective targets for introducing and maintaining healthy behaviors. METHODS This study will evaluate the effectiveness of the Change Club (CC) intervention, a civic engagement intervention for built environment change to improve health behaviors and outcomes for residents of rural communities. The CC intervention provides small groups of community residents (approximately 10-14 people) with nutrition and physical activity lessons and stepwise built environment change planning workshops delivered by trained extension educators via in-person, virtual, or hybrid methods. We will conduct process, multilevel outcome, and cost evaluations of implementation of the CC intervention in a cluster randomized controlled trial in 10 communities across two states using a two-arm parallel design. Change in the primary outcome, American Heart Association's Life's Simple 7 composite cardiovascular health score, will be evaluated among CC members, their friends and family members, and other community residents and compared to comparable samples in control communities. We will also evaluate changes at the social/collective level (e.g., social cohesion, social trust) and examine costs as well as barriers and facilitators to implementation. DISCUSSION Our central hypothesis is the CC intervention will improve health behaviors and outcomes among engaged citizens and their family and friends within 24 months. Furthermore, we hypothesize that positive changes will catalyze critical steps in the pathway to improving longer-term health among community residents through improved healthy eating and physical activity opportunities. This study also represents a unique opportunity to evaluate process and cost-related data, which will provide key insights into the viability of this approach for widespread dissemination. TRIAL REGISTRATION ClinicalTrials.gov: NCT05002660 , Registered 12 August 2021.
Collapse
Affiliation(s)
- Rebecca A. Seguin-Fowler
- Institute for Advancing Health Through Agriculture, Texas A&M AgriLife, College Station, TX 77843 USA
| | - Karla L. Hanson
- grid.5386.8000000041936877XDepartment of Public and Ecosystem Health, Cornell University, Ithaca, NY 14853 USA
| | - Deyaun Villarreal
- Institute for Advancing Health Through Agriculture, Texas A&M AgriLife Dallas Center, Dallas, TX 75252 USA
| | - Chad D. Rethorst
- Institute for Advancing Health Through Agriculture, Texas A&M AgriLife Dallas Center, Dallas, TX 75252 USA
| | - Priscilla Ayine
- Institute for Advancing Health Through Agriculture, Texas A&M AgriLife Dallas Center, Dallas, TX 75252 USA
| | - Sara C. Folta
- grid.429997.80000 0004 1936 7531Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02155 USA
| | - Jay E. Maddock
- grid.264756.40000 0004 4687 2082School of Public Health, Texas A&M University, College Station, TX 77843 USA
| | - Megan S. Patterson
- grid.264756.40000 0004 4687 2082School of Public Health, Texas A&M University, College Station, TX 77843 USA
| | - Grace A. Marshall
- grid.5386.8000000041936877XDepartment of Public and Ecosystem Health, Cornell University, Ithaca, NY 14853 USA
| | - Leah C. Volpe
- grid.5386.8000000041936877XDepartment of Public and Ecosystem Health, Cornell University, Ithaca, NY 14853 USA
| | - Galen D. Eldridge
- Institute for Advancing Health Through Agriculture, Texas A&M AgriLife Dallas Center, Dallas, TX 75252 USA
| | - Meghan Kershaw
- Institute for Advancing Health Through Agriculture, Texas A&M AgriLife Dallas Center, Dallas, TX 75252 USA
| | - Vi Luong
- Institute for Advancing Health Through Agriculture, Texas A&M AgriLife Dallas Center, Dallas, TX 75252 USA
| | - Hua Wang
- grid.5386.8000000041936877XJeb E. Brooks School of Public Policy, Cornell University, Ithaca, NY 14853 USA
| | - Don Kenkel
- grid.5386.8000000041936877XJeb E. Brooks School of Public Policy, Cornell University, Ithaca, NY 14853 USA
| |
Collapse
|
3
|
Hanson KL, Xu L, Marshall GA, Sitaker M, Jilcott Pitts SB, Kolodinsky J, Bennett A, Carriker S, Smith D, Ammerman AS, Seguin-Fowler RA. Participation in Cost-offset Community Supported Agriculture by Low-income Households in the U.S. is Associated with Community Characteristics and Operational Practices. Public Health Nutr 2022; 25:1-25. [PMID: 35416140 PMCID: PMC9991818 DOI: 10.1017/s1368980022000908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 01/31/2022] [Accepted: 04/04/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Subsidized or cost-offset community supported agriculture (CO-CSA) connects farms directly to low-income households and can improve fruit and vegetable intake. This analysis identifies factors associated with participation in CO-CSA. DESIGN Farm Fresh Foods for Healthy Kids (F3HK) provided a half-price, summer CO-CSA plus healthy eating classes to low-income households with children. Community characteristics (population, socio-demographics, health statistics) and CO-CSA operational practices (share sizes, pick-up sites, payment options, produce selection) are described and associations with participation levels examined. SETTING Ten communities in New York (NY), North Carolina (NC), Vermont, and Washington states in USA. PARTICIPANTS Caregiver-child dyads enrolled in spring 2016 or 2017. RESULTS Residents of micropolitan communities had more education and less poverty than in small towns. The one rural location (NC2) had the fewest college graduates (10%) and most poverty (23%), and poor health statistics. Most F3HK participants were white, except in NC where 45.2% were African American. CO-CSA participation varied significantly across communities from 33% (NC2) to 89% (NY1) of weeks picked-up. Most CO-CSAs offered multiple share sizes (69.2%) and participation was higher than when not offered (76.8% vs. 57.7% of weeks); whereas 53.8% offered a community pick-up location, and participation in these communities was lower than elsewhere (64.7% vs. 78.2% of weeks). CONCLUSION CO-CSAs should consider offering choice of share size and innovate to address potential barriers such as rural location and limited education and income among residents. Future research is needed to better understand barriers to participation, particularly among participants utilizing community pick-up locations.
Collapse
Affiliation(s)
- Karla L Hanson
- Department of Public and Ecosystem Health, Shurman Hall, Cornell University, Ithaca, NY14853, USA
| | - Lynn Xu
- Department of Public and Ecosystem Health, Shurman Hall, Cornell University, Ithaca, NY14853, USA
| | - Grace A Marshall
- Department of Public and Ecosystem Health, Shurman Hall, Cornell University, Ithaca, NY14853, USA
| | | | | | - Jane Kolodinsky
- Center for Rural Studies, University of Vermont, Burlington, VT, USA
| | - April Bennett
- Cornell Cooperative Extension of Jefferson County, Watertown, NY, USA
| | - Salem Carriker
- University of South Carolina, School of Medicine, Columbia, SC, USA
| | - Diane Smith
- Washington State University, Extension of Skagit County, Burlington, WA, USA
| | - Alice S Ammerman
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | |
Collapse
|
4
|
Dubbelman MA, Sanchez J, Schultz AP, Rentz DM, Amariglio RE, Sikkes SAM, Sperling RA, Johnson KA, Marshall GA. Everyday Functioning and Entorhinal and Inferior Temporal Tau Burden in Cognitively Normal Older Adults. J Prev Alzheimers Dis 2022; 9:801-808. [PMID: 36281685 DOI: 10.14283/jpad.2022.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Performance of cognitively complex "instrumental activities of daily living" (IADL) has previously been related to amyloid deposition in preclinical Alzheimer's disease. OBJECTIVES We aimed to investigate the relationship between IADL performance and cerebral tau accumulation in cognitively normal older adults. DESIGN Cross-sectional. SETTING Data was collected in the Anti-Amyloid Treatment in Asymptomatic Alzheimer's (A4) and Longitudinal Evaluation of Amyloid Risk and Neurodegeneration (LEARN) studies. PARTICIPANTS Participants (n = 447, age 71.9±4.9 years, 57.5% female) who underwent tau positron emission tomography were selected from the A4 and LEARN studies. MEASUREMENTS IADL performance was measured using the self- and study partner-reported versions of the Alzheimer's Disease Cooperative Study Activities of Daily Living - Prevention Instrument (ADCS ADL-PI). We also investigated discordance between participants and their study partners. Cross-sectional associations between entorhinal and inferior temporal tau (independent variables) and ADCS ADL-PI total scores, item-level scores and discordance (dependent variables) were investigated in linear and logistic regressions. Analyses were adjusted for age, sex and education and a tau by amyloid interaction was also included. RESULTS Participants and their study partners reported high levels of IADL performance. Entorhinal and inferior temporal tau were related to study partner but not to self-reported total ADCS ADL-PI scores. The association was not retained after adjustment for global cerebral amyloid burden. At the item level, greater entorhinal tau was associated with study partner-reported difficulties remembering important dates (odds ratio (OR) = 1.24, 95% confidence interval (95%CI) = [1.06, 1.45], p = 0.008) and difficulties remembering the details of TV programs and movies (OR = 1.32, 95%CI = [1.08, 1.61], p = 0.007). Greater inferior temporal tau was associated with self-reported difficulties managing to find personal belongings (OR = 1.23, 95%CI = [1.04, 1.46], p = 0.018) and study partner-reported difficulties remembering the details of TV programs and movies (OR = 1.39, 95%CI = [1.11, 1.75], p = 0.005). Discordance between participant and study partner-report was more likely with greater entorhinal (OR = 1.18, 95%CI = [1.05, 1.33], p = 0.005) and inferior temporal tau burden (OR = 1.29, 95%CI = [1.10, 1.51], p = 0.002). DISCUSSION We found a cross-sectional relationship between study partner-reported everyday functioning and tau in cognitively normal older adults. Participants were more likely to self-report difficulties differently from their study partners when tau burden was higher. This may hint at an altered early-disease awareness of functional changes and underscores the importance of self-report of IADL functioning in addition to collateral report by a study partner.
Collapse
Affiliation(s)
- M A Dubbelman
- Gad A. Marshall, MD, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, 60 Fenwood Road, 9016P, Boston, MA 02115, P: 617-732-8085, F: 617-264-6831, E:
| | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Reynolds GO, Manning L, Kirn D, Klein H, Hampton O, Burke O, Buckley R, Rentz D, Sperling R, Marshall GA, Amariglio RE. Subjective Cognitive Decline in a Registry Sample: Relation to Psychiatric History, Loneliness, and Personality. J Prev Alzheimers Dis 2022; 9:435-440. [PMID: 35841244 PMCID: PMC8940594 DOI: 10.14283/jpad.2022.31] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND With the increasing focus on prevention of Alzheimer's disease, there is need for characterization of preclinical populations. Local participant registries offer an opportunity to facilitate research engagement via remote data collection, inform recruitment, and characterize preclinical samples, including individuals with subjective cognitive decline. OBJECTIVES We sought to characterize subjective cognitive decline in a registry sample, as related to psychiatric history and related variables, including personality and loneliness, quality of life, and factors related to dementia risk (e.g., family history of dementia). DESIGN, SETTING, PARTICIPANTS Participants were 366 individuals (mean age=67.2 (range 50-88), 65% female, 94% white, 97% non-Hispanic or Latino, 82% with at least a bachelor's degree) with no reported history of mild cognitive impairment or dementia. All participants had expressed interest in research, primarily via community outreach events and prior research involvement. Data was collected via electronic surveys, distributed using REDCap. Electronic questionnaires included questions on demographic variables, subjective cognitive decline, quality of life, loneliness, and personality. RESULTS There was a high prevalence of risk factors for dementia in the registry sample (68% with family history of dementia, 31% with subjective cognitive decline). Subjective cognitive decline was more common in women and associated with history of depression, but not with family history of dementia. Subjective cognitive decline was also associated with lower conscientiousness and lower emotional stability, as well as higher loneliness and lower quality of life. Among participants who endorsed a psychiatric history, most reported onset more than 10 years prior, rather than within the last 10 years. CONCLUSIONS Subjective cognitive decline in a registry sample may be more strongly associated with longstanding psychiatric and personality variables, rather than family history of dementia, adding to the literature on characterization of subjective cognitive decline across different settings. These findings highlight the acceptability of remote data collection and the potential of registries to inform recruitment by characterizing registrants, which may help to stratify dementia risk and match participants to eligible trials.
Collapse
Affiliation(s)
- G O Reynolds
- Gretchen Reynolds PhD, 60 Fenwood Road, Boston MA 02115, USA,
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Amariglio RE, Sikkes SAM, Marshall GA, Buckley RF, Gatchel JR, Johnson KA, Rentz DM, Donohue MC, Raman R, Sun CK, Yaari R, Holdridge KC, Sims JR, Grill JD, Aisen PS, Sperling RA. Item-Level Investigation of Participant and Study Partner Report on the Cognitive Function Index from the A4 Study Screening Data. J Prev Alzheimers Dis 2021; 8:257-262. [PMID: 34101781 PMCID: PMC8240963 DOI: 10.14283/jpad.2021.8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Greater subjective cognitive changes on the Cognitive Function Index (CFI) was previously found to be associated with elevated amyloid (Aß) status in participants screening for the A4 Study, reported by study partners and the participants themselves. While the total score on the CFI related to amyloid for both sources respectively, potential differences in the specific types of cognitive changes reported by either participants or their study partners was not investigated. OBJECTIVES To determine the specific types of subjective cognitive changes endorsed by participants and their study partners that are associated with amyloid status in individuals screening for an AD prevention trial. DESIGN, SETTING, PARTICIPANTS Four thousand four hundred and eighty-six cognitively unimpaired (CDR=0; MMSE 25-30) participants (ages 65-85) screening for the A4 Study completed florbetapir (Aß) Positron Emission Tomography (PET) imaging. Participants were classified as elevated amyloid (Aß+; n=1323) or non-elevated amyloid (Aß-; n=3163). MEASUREMENTS Prior to amyloid PET imaging, subjective report of changes in cognitive functioning were measured using the CFI (15 item questionnaire; Yes/Maybe/No response options) and administered separately to both participants and their study partners (i.e., a family member or friend in regular contact with the participant). The impact of demographic factors on CFI report was investigated. For each item of the CFI, the relationship between Aß and CFI response was investigated using an ordinal mixed effects model for participant and study partner report. RESULTS Independent of Aß status, participants were more likely to report 'Yes' or 'Maybe' compared to the study partners for nearly all CFI items. Older age (r= 0.06, p<0.001) and lower education (r=-0.08, p<0.001) of the participant were associated with higher CFI. Highest coincident odds ratios related to Aß+ for both respondents included items assessing whether 'a substantial decline in memory' had occurred in the last year (ORsp= 1.35 [95% CI 1.11, 1.63]; ORp= 1.55 [95% CI 1.34, 1.79]) and whether the participant had 'seen a doctor about memory' (ORsp= 1.56 [95% CI 1.25, 1.95]; ORp =1.71 [95% CI 1.37, 2.12]). For two items, associations were significant for only study partner report; whether the participant 'Repeats questions' (ORsp = 1.30 [95% CI 1.07, 1.57]) and has 'trouble following the news' (ORsp= 1.46[95% CI 1.12, 1.91]). One question was significant only for participant report; 'trouble driving' (ORp= 1.25 [95% CI 1.04, 1.49]). CONCLUSIONS Elevated Aβ is associated with greater reporting of subjective cognitive changes as measured by the CFI in this cognitively unimpaired population. While participants were more likely than study partners to endorse change on most CFI items, unique CFI items were associated with elevated Aß for participants and their study partners, supporting the value of both sources of information in clinical trials.
Collapse
Affiliation(s)
- R E Amariglio
- R.E. Amariglio, Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, 02115, USA,
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Seguin-Fowler RA, Hanson KL, Jilcott Pitts SB, Kolodinsky J, Sitaker M, Ammerman AS, Marshall GA, Belarmino EH, Garner JA, Wang W. Community supported agriculture plus nutrition education improves skills, self-efficacy, and eating behaviors among low-income caregivers but not their children: a randomized controlled trial. Int J Behav Nutr Phys Act 2021; 18:112. [PMID: 34461931 PMCID: PMC8406558 DOI: 10.1186/s12966-021-01168-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 07/05/2021] [Indexed: 12/03/2022] Open
Abstract
Background Adults and children in the U.S. consume inadequate quantities of fruit and vegetables (FV), in part, due to poor access among households with lower socioeconomic status. One approach to improving access to FV is community supported agriculture (CSA) in which households purchase a ‘share’ of local farm produce throughout the growing season. This study examined the effects of cost-offset (half-price) CSA plus tailored nutrition education for low-income households with children. Methods The Farm Fresh Foods for Healthy Kids (F3HK) randomized controlled trial in New York, North Carolina, Vermont, and Washington (2016–2018) assigned caregiver-child dyads (n = 305) into cost-offset CSA plus education intervention or control (delayed intervention) groups. Following one growing season of CSA participation, changes in children’s diet quality, body mass index (BMI), and physical activity; caregivers’ nutrition knowledge, attitudes, behaviors, and diet quality; and household food access and security were examined using multiple linear or logistic regression, with adjustment for baseline value within an intent-to-treat (ITT) framework in which missing data were multiply imputed. Results No significant net effects on children’s dietary intake, BMI, or physical activity were observed. Statistically significant net improvements were observed after one growing season for caregivers’ cooking attitudes, skills, and self-efficacy; FV intake and skin carotenoid levels; and household food security. Changes in attitudes and self-efficacy remained one-year after baseline, but improvements in caregiver diet and household food security did not. The number of weeks that participants picked up a CSA share (but not number of education sessions attended) was associated with improvements in caregiver FV intake and household food security. Conclusions Cost-offset CSA plus tailored nutrition education for low-income households improved important caregiver and household outcomes within just one season of participation; most notably, both self-reported and objectively measured caregiver FV intake and household food security improved. Households that picked up more shares also reported larger improvements. However, these changes were not maintained after the CSA season ended. These results suggest that cost-offset CSA is a viable approach to improving adult, but not child, FV intake and household food security for low-income families, but the seasonality of most CSAs may limit their potential to improve year-round dietary behavior and food security. Trial registration ClinicalTrials.gov. NCT02770196. Registered 5 April 2016. Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-021-01168-x.
Collapse
Affiliation(s)
- Rebecca A Seguin-Fowler
- Texas A&M AgriLife Research, 600 John Kimbrough Boulevard, Suite 512, College Station, TX, 77843, USA.
| | - Karla L Hanson
- Department of Population Medicine and Diagnostic Sciences, Master of Public Health Program, Cornell University, S2064 Schurman Hall, Ithaca, NY, 14853, USA
| | - Stephanie B Jilcott Pitts
- Department of Public Health, East Carolina University, 600 Moye Blvd, Lakeside Annex Modular 7, Greenville, NC, 27834, USA
| | - Jane Kolodinsky
- Department of Community Development and Applied Economics, University of Vermont, 202 Morrill Hall, Burlington, VT, 05405, USA
| | - Marilyn Sitaker
- Ecological Agriculture and Food Systems, The Evergreen State College, 2700 Evergreen Parkway NW, Olympia, WA, 98505, USA
| | - Alice S Ammerman
- Department of Nutrition, Gillings School of Global Public Health, Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin Luther King Boulevard, CB#7426, Chapel Hill, NC, 27599, USA
| | - Grace A Marshall
- Master of Public Health Program, Cornell University, S2074 Schurman Hall, Ithaca, NY, 14853, USA
| | - Emily H Belarmino
- Department of Nutrition and Food Sciences, University of Vermont, 225 B Marsh Life Science, Burlington, VT, 05405, USA
| | - Jennifer A Garner
- School of Health and Rehabilitation Sciences, College of Medicine, John Glenn College of Public Affairs, The Ohio State University, 210N Page Hall, Columbus, OH, 43210, USA
| | - Weiwei Wang
- Center for Rural Studies, University of Vermont, 206 Morrill Hall, 146 University Place, Burlington, VT, 05405, USA
| |
Collapse
|
8
|
Seguin-Fowler RA, Hanson KL, Marshall GA, Belarmino EH, Jilcott Pitts SB, Kolodinsky J, Sitaker M, Ammerman A. Fruit and Vegetable Intake Assessed by Repeat 24 h Recalls, but Not by A Dietary Screener, Is Associated with Skin Carotenoid Measurements in Children. Nutrients 2021; 13:nu13030980. [PMID: 33803576 PMCID: PMC8003042 DOI: 10.3390/nu13030980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/11/2021] [Accepted: 03/16/2021] [Indexed: 01/09/2023] Open
Abstract
Accurate measurement of fruit and vegetable (FV) intake is important for nutrition surveillance and evaluation of dietary interventions. We compared two tools for reporting FV intake to objective measurement of skin carotenoids among children. FV cups/day was assessed by repeated 24 h dietary recalls (24H FV) and the National Cancer Institute’s All-Day Fruit and Vegetable Screener (NCI FV). Skin carotenoids were measured by repeated resonance Raman spectroscopy (RRS) of the palm. FV cups were regressed on RRS scores in unadjusted, field-based, and research-setting models with covariates feasible in each scenario. Data were baseline values from children aged 2–12 years in low-income households enrolled in a healthy eating randomized trial in four U.S. states (n = 177). Twenty-four-hour FV cups were associated with skin carotenoids in all models (p < 0.001) but NCI FV cups were not. Predicted RRS scores for discrete 24H FV cups provide a guide to interpretation of RRS in children (2 cups FV intake ~36,000 RRS units), with the research-setting scenario generally providing the narrowest prediction range (+/−1924). When self-reported data are required, 24 h recalls are more accurate than NCI FV screener data; and, when limited time, resources, or literacy must be considered, RRS scores can be quickly obtained and easily interpreted.
Collapse
Affiliation(s)
- Rebecca A. Seguin-Fowler
- Texas A&M AgriLife Research and the Department of Nutrition, Texas A&M University System, College Station, TX 77843, USA
- Correspondence: ; Tel.: +1-(979)-845-8486
| | - Karla L. Hanson
- Master of Public Health Program and the Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY 14853, USA; (K.L.H.); (G.A.M.)
| | - Grace A. Marshall
- Master of Public Health Program and the Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY 14853, USA; (K.L.H.); (G.A.M.)
| | - Emily H. Belarmino
- Department of Nutrition and Food Science, University of Vermont, Burlington, VT 05405, USA;
| | | | - Jane Kolodinsky
- Community Development and Applied Economics Department, University of Vermont, Burlington, VT 05405, USA;
| | | | - Alice Ammerman
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| |
Collapse
|
9
|
Seguin-Fowler RA, Strogatz D, Graham ML, Eldridge GD, Marshall GA, Folta SC, Pullyblank K, Nelson ME, Paul L. The Strong Hearts, Healthy Communities Program 2.0: An RCT Examining Effects on Simple 7. Am J Prev Med 2020; 59:32-40. [PMID: 32389532 PMCID: PMC7311302 DOI: 10.1016/j.amepre.2020.01.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 01/26/2020] [Accepted: 01/27/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Rural women have higher rates of cardiovascular disease than their nonrural counterparts, partially because of their social and environmental contexts. The study objective is to test a refined version of the multilevel Strong Hearts, Healthy Communities intervention, which used extensive process and outcome evaluation data from the original randomized trial to optimize effectiveness as measured by improved Simple 7 score, a composite measure of cardiovascular disease risk. STUDY DESIGN The intervention was implemented in a 6-month, delayed intervention, community-randomized trial; control participants received the program following 24-week outcome assessment. The study was conducted in 2017-2018; data analysis occurred in 2018-2019. SETTING/PARTICIPANTS The study was conducted in 11 rural, medically underserved towns in New York. Participants were women aged ≥40 years who were either (1) obese or (2) overweight and sedentary. INTERVENTION The intervention group received 24 weeks of hour-long, twice-weekly classes including strength training, aerobic exercise, and skill-based nutrition- and health-related education, as well as civic engagement activities focused on healthy food and physical activity environments. MAIN OUTCOME MEASURES Measures included weight and height; blood pressure; blood cholesterol; blood glucose; and self-reported smoking, diet, and physical activity behaviors. Individual Simple 7 components were examined, and mixed linear regression analyses were used to examine change in Simple 7 score. RESULTS A total of 182 participants were randomized. Compared with control participants, the intervention group had greater improvements in Simple 7 score (difference=1.03, 95% CI=0.44, 1.61, p<0.001) and 3 of the Simple 7 components (physical activity, healthy diet score, and BMI). CONCLUSIONS These findings highlight the importance of rigorously evaluating programs in real-world community settings and, when appropriate, revising and retesting interventions to optimize dissemination potential. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT03059472.
Collapse
Affiliation(s)
- Rebecca A Seguin-Fowler
- Texas A&M AgriLife Research, Texas A&M University System, College Station, Texas; Department of Nutrition, Texas A&M University, College Station, Texas.
| | - David Strogatz
- Center for Rural Community Health, Bassett Research Institute, Cooperstown, New York
| | - Meredith L Graham
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Galen D Eldridge
- Texas A&M AgriLife Research, Texas A&M University System, College Station, Texas
| | - Grace A Marshall
- Master of Public Health Program, Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, New York
| | - Sara C Folta
- Friedman School of Nutrition, Tufts University, Boston, Massachusetts
| | - Kristin Pullyblank
- Center for Rural Community Health, Bassett Research Institute, Cooperstown, New York
| | - Miriam E Nelson
- Friedman School of Nutrition, Tufts University, Boston, Massachusetts
| | - Lynn Paul
- Montana State University Extension, Bozeman, Montana
| |
Collapse
|
10
|
Morgan EH, Graham ML, Marshall GA, Hanson KL, Seguin-Fowler RA. Serum carotenoids are strongly associated with dermal carotenoids but not self-reported fruit and vegetable intake among overweight and obese women. Int J Behav Nutr Phys Act 2019; 16:104. [PMID: 31718657 PMCID: PMC6852957 DOI: 10.1186/s12966-019-0869-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 10/22/2019] [Indexed: 11/29/2022] Open
Abstract
Background Accurate assessment of fruit and vegetable intake (FVI) is essential for public health nutrition research and surveillance. Blood carotenoid concentrations are robust biomarkers of FVI, but collecting blood samples typically is not feasible in population-based studies. Understanding how well non-invasive measures compare to blood estimates is important for advancing surveillance and evaluation. The objective of this study was to examine the associations between serum carotenoids and four non-invasive measures of FVI in overweight and obese women. Methods This study utilized baseline data from 157 overweight or obese women (95.5% white, mean age 58.56 years ± 9.49 years) enrolled in the Strong Hearts, Healthy Communities randomized trial, including two direct measures of carotenoids and three self-reported measures of FVI. Participants completed a fasting blood draw, dermal carotenoid scans using resonance Raman spectroscopy (RRS), a two-item FVI screener modeled after the American Heart Association’s Life’s Simple 7 “My Life Check” tool (modified AHA tool), the National Cancer Institute’s All-Day Fruit and Vegetable Screener (FVS), multiple 24-h dietary recalls, physical measurements, and demographic and health behavior questions. We analyzed blood for total carotenoids and derived total FVI estimates from self-report tools. We used multivariate linear regression models to examine associations between each non-invasive tool and serum carotenoids under four scenarios analogous to different research contexts in which varying breadths of participant data are available. We also calculated adjusted Pearson’s correlations between serum carotenoids, dermal carotenoids, and the self-reported measures. Results Dermal carotenoids were strongly correlated with serum carotenoids (0.71, P < 0.00067) and associated with serum carotenoids in all regression models (0.42–0.43, P < 0.002). None of the self-reported FVI measures were significantly associated with serum or dermal carotenoids in adjusted regression models or correlation analyses. Conclusions Compared to self-reported FVI, we found dermal carotenoids measured by RRS to be a superior method to approximate serum carotenoids among overweight and obese women. More research is needed to investigate these assessment methods in diverse populations. Trial registration ClinicalTrials.gov Identifier: NCT02499731, registered July 16, 2015.
Collapse
Affiliation(s)
- Emily H Morgan
- Department of Nutrition and Food Sciences, University of Vermont, Burlington, VT, 05405, USA
| | - Meredith L Graham
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, 14853, USA
| | - Grace A Marshall
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, 14853, USA
| | - Karla L Hanson
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, 14853, USA
| | - Rebecca A Seguin-Fowler
- Texas A&M AgriLife Research and Department of Nutrition and Food Science, Texas A&M University, Agriculture and Life Sciences Building, 600 John Kimbrough Boulevard, Suite 512, College Station, TX, 77843-2142, USA.
| |
Collapse
|
11
|
Pullyblank K, Strogatz D, Folta SC, Paul L, Nelson ME, Graham M, Marshall GA, Eldridge G, Parry SA, Mebust S, Seguin RA. Effects of the Strong Hearts, Healthy Communities Intervention on Functional Fitness of Rural Women. J Rural Health 2019; 36:104-110. [PMID: 30865324 DOI: 10.1111/jrh.12361] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE The purposes of these analyses were to determine whether Strong Hearts, Healthy Communities (SHHC), a multilevel, cardiovascular disease risk reduction program for overweight, sedentary rural women aged 40 or older, led to improved functional fitness, and if changes in fitness accounted for weight loss associated with program participation. METHODS Sixteen rural communities were randomized to receive the SHHC intervention or a control program. Both programs involved groups of 12-16 participants. The SHHC program met 1 hour twice a week for 24 weeks where participants engaged in aerobic exercise and progressive strength training. Program content addressed diet and social and environmental influences on heart-healthy behavior. The control group met 1 hour each month for 6 months, covering current dietary and physical activity recommendations. Objective measures of functional fitness included the 30-second arm curl, 30-second chair stand, and 2-minute step test. Self-reported functional fitness was measured by the Physical Functioning Subscale of the MOS Short Form-36 (SF-36 PF). FINDINGS The SHHC program was associated with increased strength and endurance, as represented by greater improvement in the chair stand and step test; and with increased physical function, as represented by the SF-36 PF. Adjustment for change in aerobic endurance, as measured by the step test, accounted for two-thirds of the intervention effect on weight loss at the end of the intervention. CONCLUSIONS SHHC participants experienced improved performance on objective measures of functional fitness and self-reported measures of physical function, and changes in weight were partially accounted for by changes in aerobic fitness.
Collapse
Affiliation(s)
| | | | | | - Lynn Paul
- Montana State University, Bozeman, Montana
| | | | | | | | | | | | - Sean Mebust
- Bassett Research Institute, Cooperstown, New York
| | | |
Collapse
|
12
|
Affiliation(s)
- G A Marshall
- Department of Chemical Pathology, Pathology Queensland, Royal Brisbane Hospital, Herston QLD 4029, Australia
| | - C J Pretorius
- Department of Chemical Pathology, Pathology Queensland, Royal Brisbane Hospital, Herston QLD 4029, Australia
| | - J P J Ungerer
- Department of Chemical Pathology, Pathology Queensland, Royal Brisbane Hospital, Herston QLD 4029, Australia
| |
Collapse
|
13
|
Passmore PR, Kailis SG, Marshall GA. Identifying prediction factors for unplanned hospitalisation of an elderly population using classification and regression tree (CART) analysis. International Journal of Pharmacy Practice 2011. [DOI: 10.1111/j.2042-7174.1993.tb00728.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Abstract
Accurate prediction of those elderly people who are at a high risk of unplanned hospitalisation may assist pharmacists and other health care providers to target health care initiatives more specifically. A prospective study of 84 elderly persons, suffering from either ischaemic heart disease or obstructive airways disease, or both, was conducted to identify health-related factors that may be used to predict unplanned hospitalisation. Non-invasive factors, including the sickness impact profile (SIP) health status measure scores, drug consumption, demographic data, smoking history and disease/symptoms experience were determined. For hospitalised patients the overall SIP score was significantly higher (18.93) than for those non-hospitalised (10.54). The physical dimension score (20.76) and the psychosocial dimension score (16.74) were also both significantly higher in the hospitalised than the non-hospitalised group (10.85 and 9.44, respectively). The number of medicines used was higher (8.2) in the hospitalised group than in the non-hospitalised group (6.3). Logistic regression determined that the overall SIP score was highly predictive (P<0.01) of unplanned hospitalisation. Classification and regression tree (CART) analysis was used to determine the mix of health-related factors that could best classify subjects as being at either a high or low risk for unplanned hospitalisation within the six month prospective study period. A selected CART-generated decision protocol determined that the health-related parameters that enabled a useful prediction for unplanned hospitalisation were overall SIP score, the person's age, whether the person lived alone and smoking history. Seventy-nine per cent of those hospitalised and 91 per cent of those non-hospitalised had been correctly predicted. The results of this study show that it is possible to predict unplanned hospitalisation of elderly people in a retirement village setting by using previously measured non-invasive health related parameters in a decision protocol to determine their category of risk.
Collapse
Affiliation(s)
- P R Passmore
- School of Pharmacy, Curtin University of Technology, GPO Box U 1987, Perth 6001, Western Australia
| | - S G Kailis
- School of Pharmacy, Curtin University of Technology, GPO Box U 1987, Perth 6001, Western Australia
| | - G A Marshall
- School of Pharmacy, Curtin University of Technology, GPO Box U 1987, Perth 6001, Western Australia
| |
Collapse
|
14
|
Marshall GA, McMahon SK, Nicholls W, Pretorius CJ, Ungerer JPJ. Gonadotrophin-independent precocious puberty in an eight-year-old boy due to ectopic human chorionic gonadotrophin from the central nervous system. Ann Clin Biochem 2010; 47:271-4. [DOI: 10.1258/acb.2010.009267] [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: 12/27/2022]
Abstract
We present the case of an eight-year-old boy with advanced isosexual precocity associated with an elevated serum total-beta human chorionic gonadotrophin (HCG) and markedly elevated serum total testosterone. Radiological investigation discovered a lesion in the left thalamus and no peripheral tumour. Serum:cerebrospinal fluid (CSF) HCG ratio was approximately 1:1, consistent with a central nervous system source of HCG, with thalamic germinoma strongly suspected. Consent was not obtained for biopsy of the lesion. The patient underwent multiagent chemotherapy with return of serum HCG to normal. We discuss mechanisms of HCG-mediated sexual precocity in both boys and girls and the importance of CSF HCG.
Collapse
Affiliation(s)
- G A Marshall
- Department of Chemical Pathology, Pathology Queensland
| | | | - W Nicholls
- Department of Paediatric Oncology, Royal Children's Hospital, Brisbane, QLD, 4029, Australia
| | - C J Pretorius
- Department of Chemical Pathology, Pathology Queensland
| | - J P J Ungerer
- Department of Chemical Pathology, Pathology Queensland
| |
Collapse
|
15
|
Marshall GA, Shchelchkov E, Kaufer DI, Ivanco LS, Bohnen NI. White matter hyperintensities and cortical acetylcholinesterase activity in parkinsonian dementia. Acta Neurol Scand 2006; 113:87-91. [PMID: 16411968 DOI: 10.1111/j.1600-0404.2005.00553.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the relationship between the severity of white matter hyperintensities (WMH) and cortical acetylcholinesterase (AChE) activity in parkinsonian dementia (PDem). METHODS PDem (n = 11) and control subjects (n = 14) underwent [11C]methyl-4-piperidinyl propionate (11C-PMP) AChE brain positron emission tomography and magnetic resonance (MR) imaging. Presence of WMH on proton density and T2 MR images was scored using a modified version of the semi-quantitative rating scale by Scheltens et al. [J Neurol Sci114 (1993)]. RESULTS Analysis demonstrated significantly lower mean cortical (11)C-PMP k3 hydrolysis rates in PDem (-19.9%) when compared with control subjects (P < 0.0001). PDem subjects had higher mean severity of WMH (+20.1%) when compared with control subjects (P < 0.05). When WMH severity was entered into the analysis of variance model, there was no significant co-variate effect on cortical AChE activity (F = 0.24, ns). CONCLUSIONS The concomitant presence of mild to moderate WMH in patients with PDem does not have a significant effect on cortical AChE activity.
Collapse
Affiliation(s)
- G A Marshall
- Department of Neurology, University of Pittsburgh and Veterans Affairs Medical Center, Pittsburgh, PA, USA
| | | | | | | | | |
Collapse
|
16
|
Marshall GA, Kaufer DI, Lopez OL, Rao GR, Hamilton RL, DeKosky ST. Right prosubiculum amyloid plaque density correlates with anosognosia in Alzheimer's disease. J Neurol Neurosurg Psychiatry 2004; 75:1396-400. [PMID: 15377684 PMCID: PMC1738763 DOI: 10.1136/jnnp.2003.030007] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Anosognosia is a common manifestation of Alzheimer's disease. There is an association between impaired awareness and frontal-executive cognitive deficits. Anosognosia is also correlated with decreased metabolism in the right hemisphere, particularly in frontal lobe regions. OBJECTIVE To investigate pathological correlates of anosognosia in Alzheimer's disease. DESIGN 41 subjects followed longitudinally in the University of Pittsburgh memory disorders clinic and with necropsy verified Alzheimer's disease were divided into two groups, based on previous clinical assessment: +Aware (n = 23) and -Aware (n = 18). A subset analysis matching subjects for dementia severity using mini-mental state examination scores was also carried out (13 +Aware; 13 -Aware). Histopathological data from necropsy brain tissue consisted of senile plaque (SP) and neurofibrillary tangle (NFT) counts (regional density) from four different brain regions in the right and left hemispheres: superior and middle frontal gyri (SMF), superior temporal isocortex (ST), the prosubiculum of the hippocampus (PRO), and the entorhinal cortex (EC). RESULTS SP density was greater in the right PRO region of -Aware subjects (F = 6.54, p = 0.015) than +Aware subjects. Significant differences between SP or NFT density were not observed in any other regions. In the subset analysis matching for dementia severity, SP density was again greater in the right PRO region of -Aware subjects than in the other regions (F = 12.72, p = 0.002). CONCLUSIONS Increased SP density in the right PRO region suggests that selective pathological involvement of this area contributes to awareness deficits in Alzheimer's disease. The putative role of the PRO in self appraisal may reflect its interconnections with other medial temporal and prefrontal regions.
Collapse
Affiliation(s)
- G A Marshall
- Department of Neurology, University of Pittsburgh, Pennsylvania, USA
| | | | | | | | | | | |
Collapse
|
17
|
Cook RF, Bernstein AD, Arrington TL, Andrews CM, Marshall GA. Methods for assessing drug use prevalence in the workplace: a comparison of self-report, urinalysis, and hair analysis. Int J Addict 1995; 30:403-26. [PMID: 7607776 DOI: 10.3109/10826089509048734] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A random sample of 1,200 employees of a steel manufacturing plant were randomly assigned to four different self-report methods of assessing illicit drug use: 1) Individual interview in the workplace, 2) group-administered questionnaire in the workplace, 3) telephone interview, and 4) individual interview off the worksite. Urine specimens were collected and analyzed on all 928 subjects participating in the study, and hair analysis was conducted on 307 of the subjects. Although self-reports produced the highest drug use prevalence rate, analyses combining the results of the three assessment methods showed that the actual prevalence rate was approximately 50% higher than the estimate produced by self-reports. The group-administered questionnaire condition produced prevalence rates that were roughly half those of the other self-report methods. The findings cast doubt on the validity of self-reports as a means of estimating drug use prevalence and suggest the need for multiple assessment methods.
Collapse
Affiliation(s)
- R F Cook
- ISA Associates, Alexandria, Virginia 22314, USA
| | | | | | | | | |
Collapse
|
18
|
Abstract
OBJECTIVE To investigate the phenomenon of spontaneous erections in patients on long-term intracavernous injection therapy. METHODS We undertook an objective assessment of the penile circulation of 35 patients; 21 used prostaglandin E1 (PGE1) alone and 14 used a combination of papaverine, phentolamine, and PGE1. All underwent duplex ultrasonography before initiation of home self-injection and again after a mean of thirty-one months of treatment (most patients performed injections once or twice a week). RESULTS The diameter of the cavernosal arteries did not change significantly after treatment. However, the mean peak flow velocity increased highly significantly (P < 0.001): 17.9 cm/second in the right cavernous artery and 21.2 cm/second on the left before treatment; 24 cm/second on the right and 29 cm/second on the left after treatment. More than one third (13 of 35 patients [35%]) achieved functional erection without injection at least some of the time, giving clinical support to the sonographic findings. CONCLUSIONS We suggest that the combination of vasodilatory drugs and sexual stimulation may act to improve sinusoidal and penile arteriolar smooth muscle function.
Collapse
Affiliation(s)
- G A Marshall
- Department of Urology, University of California School of Medicine, San Francisco
| | | | | |
Collapse
|
19
|
Abstract
Because prostaglandin E1 causes erection by smooth muscle relaxation in a receptor-dependent manner, one would expect increasing dosages to cause a progressively greater response and that, at receptor saturation, further increases would not be beneficial. To test this hypothesis a single-blind, placebo-controlled study of increasing dosages of prostaglandin E1 injected intracavernously was done. In 16 men with vasculogenic impotence erections were monitored by the RigiScan device in real time for 2 hours after injection, and rigidity, tumescence and duration of erection were measured. Summary parameters to characterize erection with each dosage were developed: maximal rigidity, maximal rigidity sustained for 30 minutes and duration of greater than 60% rigidity. The dose-response curve was similar for all 3 parameters. The initial response to escalating doses of prostaglandin E1 from 2.5 to 20 micrograms. demonstrated a steep dose-dependent increase; at greater than 20 micrograms. a plateau was reached, indicating a nonlinear response. More than 80% of the patients attained the maximal response at doses of 20 micrograms. or less and less than 20% benefited from a further increase. Based on these results, the effects of prostaglandin E1 appear to be receptor-dependent and prostaglandin E1 monotherapy for impotence could be limited to 20 micrograms. or less, since larger amounts offer little additional benefit.
Collapse
Affiliation(s)
- B von Heyden
- Department of Urology, University of California School of Medicine, San Francisco
| | | | | | | | | |
Collapse
|
20
|
Abstract
Spontaneous rupture of the normal bladder associated with alcohol abuse is rare, with only 20 cases reported in the English literature to which we add 2 cases. Heavy alcohol ingestion predisposes the bladder to rupture by the large volume of fluid intake, its diuretic effect and the mental obtusion it produces, clouding sensory cues to void. alpha-Sympathomimetic drugs, such as cocaine and methamphetamine, increase the resistance at the urethral sphincter and exacerbate the effects of alcohol. Cystography will be diagnostic, and prompt operative repair of intraperitoneal rupture is mandatory. Complete evaluation of the bladder, including urodynamic study, is important to eliminate underlying bladder pathological conditions. Substance abuse-related rupture demonstrates a typical constellation of clinical features that necessitate considering it a syndrome separate from other causes of spontaneous bladder rupture.
Collapse
Affiliation(s)
- G A Marshall
- Department of Urology, University of California School of Medicine, San Francisco 94143-0738
| | | | | |
Collapse
|
21
|
Morris JA, Auerbach PS, Marshall GA, Bluth RF, Johnson LG, Trunkey DD. The Trauma Score as a triage tool in the prehospital setting. JAMA 1986; 256:1319-25. [PMID: 3747045] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Implementation of a regional trauma care system requires a field triage tool that identifies the severely injured patient and transports him to a trauma center, while preserving the flow of minimally injured patients to community hospitals. We prospectively tested the Trauma Score (TS) as a field triage tool and evaluated its accuracy against that of the Injury Severity Score (ISS), calculated after the patients' injuries were fully defined. During an 18-month period, 1106 patients admitted to the trauma center at San Francisco General Hospital had a TS determined in the field (TS1) and on arrival at the emergency department. A TS1 of 14 or less defined a subgroup of 222 patients in whom 93% of the deaths occurred. Using an ISS of 20 or more as an indicator of life-threatening injury, we determined the predictive value of TS1. There were 66 false-negatives (ISS, greater than or equal to 20; TS1, 15 or 16) and 107 false-positives (ISS, less than 20; TS1, less than or equal to 14). Using a prehospital TS of 14 or less as an indicator of serious injury, only 20% of a major urban trauma population would qualify for diversion to a trauma center.
Collapse
|
22
|
Abstract
Sections of aorta, coronary artery, basilar artery and vena cava were collected at autopsy. Macroscopically normal intimal specimens were removed by stripping. Intimal collagen was measured as hydroxyproline. Intimal film embrittlement was measured in vitro by a bursting volume distensibility test developed in our laboratory. There was an average increase of over 100% in the collagen content of apparently lesion-free human arterial intima on aging over a fifty-year period. This includes an increase of 113% for aortic intima, 49% increase for coronary artery intima, and an increase of 158% in collagen in basilar artery intima. In contrast the collagen level in the vena caval intima decreases on aging, by 42% in fifty years. The large increase in collagen in arterial intima is accompanied by a large increase in intimal embrittlement. The decreasing collagen content of the venous intima on aging results in increased distensibility. Increased aortic intimal film embrittlement (lower distensibility) correlates with age (R = 0.699), but even better with intimal collagen (R = 0.911), suggesting that aortic intimal collagen level is a more important determinant of intimal embrittlement than age. Men, older than 55, have significantly higher aortic intimal collagen levels than women. Embrittlement of arterial intima should make it more susceptible to injury under the pulsatile pressure of the blood. Decreased venous intimal collagen and greater distensibility on aging could be factors in the development of venous valvular insufficiency and varicose veins. However, our study of veins was performed primarily as a control in this instance. Fundamental elements in the atherogenic process are increased intimal collagen, increased intimal brittleness, endothelial injury, followed by intimal cell proliferation. In the vena caval intima on aging there is decreased collagen, increased intimal distensibility, no injury due to increased pulse or blood pressure, and, therefore, no cell proliferation and no intimal lesion.
Collapse
|
23
|
Abstract
We studied prospectively 359 consecutive patients with blunt (306) or penetrating (53) renal trauma to refine the indications for radiographic evaluation. Various factors, including the degree of hematuria, presence of shock and associated injuries easily assessable at the time of initial evaluation, were correlated with the severity of renal injury to determine whether any combination of parameters will separate patients with renal contusions from those with significant renal injuries (minor and major lacerations, and vascular injuries). We identified 3 groups: group 1-85 patients with gross hematuria or microscopic hematuria and shock after blunt trauma (including all 23 with significant renal injuries), group 2-221 patients with microscopic hematuria but no shock after blunt trauma (all with renal contusions) and group 3-53 patients with penetrating trauma. No combination of parameters was able to predict a severe injury in group 3. Our data support radiographic evaluation in groups 1 and 3. However, because all patients in group 2 had renal contusions and experienced no complications from nonoperative management we believe that excretory urography, which is time-consuming and costly, can be avoided in patients with microscopic hematuria but no shock after blunt renal trauma.
Collapse
|
24
|
Marshall GA. Query/response. Productivity. Health Care Strateg Manage 1984; 2:36-7. [PMID: 10266897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
|
25
|
Gale MD, Law CN, Marshall GA, Worland AJ. The genetic control of gibberellic acid insensitivity and coleoptile length in a “dwarf” wheat. Heredity (Edinb) 1975. [DOI: 10.1038/hdy.1975.48] [Citation(s) in RCA: 43] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
26
|
Marshall GA. Selection theory and its alternatives. Eugen Rev 1927; 19:203-213. [PMID: 21259859 PMCID: PMC2984704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
|