Publications by authors named "James Janisse"

77 Publications

Urologists' Perceptions of Active Surveillance and Their Recommendations for Low-risk Prostate Cancer Patients.

Urology 2021 Jan 19. Epub 2021 Jan 19.

Department of Epidemiology, School of Public Health, Emory University, Atlanta, GA.

Objective: To assess practicing urologists' attitudes and perceptions of active surveillance (AS) and other treatment options for low-risk prostate cancer.

Methods: This was a cross-sectional survey of urologists practicing in Michigan and Georgia. Urologists were asked about perceptions and practices pertaining to AS.

Results: Overall, 225 urologists completed the survey; 147 (65%) were from Michigan and 78 (35%) were from Georgia. Most urologists reported they provided (99%), discussed (97%), and offered (61%) AS to all of their low-risk patients. Most believed AS is effective (97%) and underused (90%), while 80% agreed that curative therapy (surgery, radiation) is overused in the United States. Although most (79%) endorse that Black men are more likely to have aggressive low-risk disease, 89% reported feeling comfortable recommending AS to Black men. In multivariable analysis, significant provider-related predictors of AS recommendation were practice location, number of years in practice, beliefs pertaining to survival benefit of prostatectomy and effectiveness of AS, and expectation that patients are not interested in AS. The patient characteristics of race, age, life expectancy, fear of cancer progression, and fear of treatment side effects were also significant predictors of AS recommendations.

Conclusion: Most urologists surveyed stated that AS is effective and underused for low-risk prostate cancer . Overall, urologists are much less likely to recommend AS to younger men and slightly less to Black men. AS recommendations varied by practice location and by years in practice. These findings indicate targeted educational efforts in the US are needed to influence urologists toward greater acceptance of AS.
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http://dx.doi.org/10.1016/j.urology.2020.12.037DOI Listing
January 2021

Personal Protective Equipment and Mental Health Symptoms Among Nurses During the COVID-19 Pandemic.

J Occup Environ Med 2020 Nov;62(11):892-897

Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, Michigan (Dr Arnetz JE, Goetz, Sudan, Dr Arnetz BB); Department of Psychology, Eastern Michigan University, Ypsilanti, Michigan (Dr Arble); Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, Detroit, Michigan (Dr Janisse).

Objective: To determine the association between access to adequate personal protective equipment (PPE) and mental health outcomes among a sample of U.S. nurses.

Methods: An online questionnaire was administered in May 2020 to Michigan nurses via three statewide nursing organizations (n = 695 respondents). Multivariable logistic regression analysis was used to identify factors associated with mental health symptoms.

Results: Nurses lacking access to adequate PPE (24.9%, n = 163) were more likely to report symptoms of depression (OR 1.96, 95% CI 1.31, 2.94; P = 0.001), anxiety (OR 1.64, 95% CI 1.12, 2.40; P = 0.01) and post-traumatic stress disorder (OR 1.83, 95% CI 1.22, 2.74; P = 0.003).

Conclusions: Healthcare organizations should be aware of the magnitude of mental health problems among nurses and vigilant in providing them with adequate PPE as the pandemic continues.
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http://dx.doi.org/10.1097/JOM.0000000000001999DOI Listing
November 2020

Efficacy of enhanced emergency department discharge for chronic hypertension management - Results of a randomized controlled trial.

Contemp Clin Trials Commun 2020 Sep 18;19:100613. Epub 2020 Jul 18.

Cardiovascular Research Institute, School of Medicine, Wayne State University, 421 E Canfield St. Detroit, MI 48201, USA.

Introduction: Achieve is a randomized controlled trial (RCT) of an education intervention for patients with chronic hypertension who have uncontrolled blood pressure (BP) at discharge from an urban emergency department (ED). The study examined efficacy and moderators of an educational intervention in an RCT on BP control at 180-day post-intervention.

Methods: Participants were recruited from a single, urban ED and randomized to receive or not to receive hypertension education. To minimize potential bias, participants were all started on an evidence-based anti-hypertensive regimen and medications were dispensed directly to participants by the study team. Bivariate analysis was performed to examine differences in sociodemographic characteristics between patients achieving BP control and those who did not. Paired -test was used to compare the difference of systolic and diastolic BP between baseline and 180 days post-discharge. Multiple logistic regression analysis examined interaction of covariates and intervention on achieving BP control.

Results: One hundred and thirty-nine participants were randomized into the study. All were African-American with a mean age of 47.6 (SD = 10.8) years; 51% were male, 63% had smoked cigarettes and 15% had diabetes. A total of 66 patients completed the study (47.4%), 44 of whom (67%) achieved BP control. However, there was no difference in BP reduction or control between the two groups. Age and smoking status showed moderation effects on intervention efficacy.

Conclusion: Despite a neutral effect of our intervention, a high level of BP control was achieved overall, suggesting that the ED may be a viable location for efforts aimed at reducing the impact of chronic hypertension in predominantly African American communities.
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http://dx.doi.org/10.1016/j.conctc.2020.100613DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7387778PMC
September 2020

Physical Activity as a Predictor of Changes in Systolic Blood Pressure for African-American Adolescents Seeking Treatment for Obesity.

J Adolesc Health 2019 09 18;65(3):430-432. Epub 2019 Jun 18.

Division of Behavioral Sciences, Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan.

Purpose: The aim of the study was to examine changes in systolic blood pressure (SBP) and whether physical activity and obesity status predicted SBP change for African-American adolescents (n = 181) participating in a behavioral weight control trial.

Methods: Data were collected at baseline, 7 months (end-of-treatment), and 9 months (2-month follow-up).

Results: Nearly half of adolescents achieved clinically significant SBP reductions at 7 and 9 months. Significantly, fewer adolescents had elevated SBP at 7 and 9 months compared with baseline (both p < .001). Changes in percent overweight and moderate-to-vigorous activity predicted changes in SBP over time.

Conclusions: Obesity reduction and increases in moderate-to-vigorous physical activity may predict short-term, clinically meaningful reductions in SBP for African American adolescents with obesity.
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http://dx.doi.org/10.1016/j.jadohealth.2019.04.001DOI Listing
September 2019

Feasibility and Acceptability of e-Screening and Brief Intervention and Tailored Text Messaging for Marijuana Use in Pregnancy.

J Womens Health (Larchmt) 2019 09 18;28(9):1295-1301. Epub 2019 Jan 18.

Department of Psychology, Virginia Commonwealth University, Richmond, Virginia.

There are at present no evidence-based interventions for marijuana use during pregnancy, despite it being by far the most commonly used illicit drug during pregnancy. Lack of treatment-seeking, combined with implementation challenges, has limited the extent to which at-risk women receive interventions of any kind. This study sought to evaluate the feasibility and acceptability of two high-reach technology-based interventions: electronic screening and brief intervention (e-SBI) and tailored text messaging, delivered either alone or in combination. In this exploratory feasibility trial, pregnant women seeking prenatal care services and scoring positive for marijuana use risk ( = 45) were randomly assigned to e-SBI, text messaging, or e-SBI plus text messaging. We examined completion rates and acceptability ratings as a function of intervention condition and participant characteristics. All participants assigned to receive the e-SBI ( = 30) were able to complete it during the in-clinic baseline session. Participants assigned to text messaging ( = 30) received a median of 24 text messages before giving birth; 6 of 30 (20%) chose to end text messages before giving birth. Acceptability ratings for the e-SBI were high, with most being above 4.4 on a 5-point scale (., for ease of use, respectfulness, and helpfulness). Acceptability ratings for some aspects of the texting intervention were also high (., for ease of understanding and respectfulness). Participants in the combined e-SBI plus texting condition chose to stop messages at a rate of 13.3% (2 of 15), versus 26.7% (4 of 15) in the texting-only condition ( = 0.37). These two high-reach intervention elements showed strong feasibility and modest to high acceptability. Future efforts evaluating efficacy are warranted, and should specifically examine the possibility that combining text messaging with a brief intervention may promote retention.
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http://dx.doi.org/10.1089/jwh.2018.7169DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6743084PMC
September 2019

Computer-delivered indirect screening and brief intervention for drug use in the perinatal period: A randomized trial.

Drug Alcohol Depend 2018 04 13;185:271-277. Epub 2018 Feb 13.

Department of Obstetrics and Gynecology, Wayne State University School of Medicine, 3990 John R, Detroit, MI 48201, United States.

Background: Under-reporting of drug use in the perinatal period is well-documented, and significantly limits the reach of proactive intervention approaches. The Wayne Indirect Drug Use Screener (WIDUS) focuses on correlates of drug use rather than use itself. This trial tested a computer-delivered, brief intervention designed for use with indirect screen-positive cases, seeking to motivate reductions in drug use without presuming its presence.

Methods: Randomized clinical trial with 500 WIDUS-positive postpartum women recruited between August 14, 2012 and November 19, 2014. Participants were randomly assigned to either a time control condition or a single-session, tailored, indirect brief intervention. The primary outcome was days of drug use over the 6-month follow-up period; secondary outcomes included urine and hair analyses results at 3- and 6-month follow-up. All outcomes were measured by blinded evaluators.

Results: Of the 500 participants (252 intervention and 248 control), 36.1% of participants acknowledged drug use in the 3 months prior to pregnancy, but 89% tested positive at the 6-month follow-up. Participants rated the intervention as easy to use (4.9/5) and helpful (4.4/5). Analyses revealed no between-group differences in drug use (52% in the intervention group, vs. 53% among controls; OR 1.03). Exploratory analyses also showed that intervention effects were not moderated by baseline severity, WIDUS score, or readiness to change.

Conclusions: The present trial showed no evidence of efficacy for an indirect, single-session, computer-delivered, brief intervention designed as a complement to indirect screening. More direct approaches that still do not presume active drug use may be possible and appropriate.
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http://dx.doi.org/10.1016/j.drugalcdep.2017.12.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5889752PMC
April 2018

Willingness to pay and willingness to accept in a patient-centered blood pressure control study.

BMC Health Serv Res 2017 Aug 7;17(1):538. Epub 2017 Aug 7.

Cardiovascular Research Institute, School of Medicine, Wayne State University, 421 E. Canfield St, Detroit, MI, 48201, USA.

Background: Elevated blood pressure is a major risk factor for cardiovascular disease and stroke but patients often discount recommended behavioral changes and prescribed medications. While effective interventions to promote adherence have been developed, cost-effectiveness from the patient's perspective, has not been well studied. The valuation of patient time and out of pocket expenses should be included while performing cost effectiveness evaluation. The Achieve BP study uses the contingent valuation method to assess willingness to accept (WTA) and willingness to pay (WTP) among patients with a history of uncontrolled blood pressure discharged from an urban emergency department and enrolled in a larger randomized controlled trial.

Methods: WTA and WTP were assessed by asking patients a series of questions about time and travel costs and time value related to their study participation. A survey was conducted during the final study visit with patients to investigate the effectiveness of a kiosk-based educational intervention on blood pressure control. All study patients, regardless of study arm, received the same clinical protocol of commonly prescribed antihypertensive medication and met with research clinicians four times as part of the study procedures.

Results: Thirty-eight patients were offered the opportunity to participate in the cost-effectiveness study and all completed the survey. Statistical comparisons revealed these 38 patients were similar in representation to the entire RCT study population. All 38 (100.0%) were African-American, with an average age of 49.1 years; 55.3% were male, 21.1% were married, 78.9% had a high school or higher education, and 44.7% were working. 55.9% did not have a primary care provider and 50.0% did not have health insurance. Time price linear regression analysis was performed to estimate predictors of WTA and WTP.

Conclusions: WTP and WTA may generate different results, and the elasticities were proportional to the estimated coefficients, with WTP about twice as responsive as WTA. An additional feature for health services research was successful piloting in a clinical setting of a brief patient-centered cost effectiveness survey.

Trial Registration: https://clinicaltrials.gov . Registration Number NCT02069015 . Registered February 19, 2014 (Retrospectively registered).
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http://dx.doi.org/10.1186/s12913-017-2451-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5547517PMC
August 2017

Worksite Walkthrough Intervention: Data-driven Prevention of Workplace Violence on Hospital Units.

J Occup Environ Med 2017 09;59(9):875-884

Department of Family Medicine, Michigan State University, East Lansing, Michigan (Drs Hamblin, Judith Arnetz); Detroit Medical Center, Occupational Health Services, Detroit, Michigan (Ms Essenmacher, Mr Russell, Dr Upfal); Institute of Gerontology, Wayne State University, Detroit, Michigan (Dr Luborsky); Department of Neurobiology, Caring Sciences and Society, Karolinska Institutet, Stockholm, Sweden (Dr Luborsky); Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, Michigan (Dr Janisse); Department of Emergency Medicine, Wayne State University, Detroit, Michigan (Dr Upfal), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden (Dr Arnetz); and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (Dr Arnetz).

Objective: The aim of this study was to describe the implementation of a data-driven, unit-based walkthrough intervention shown to be effective in reducing the risk of workplace violence in hospitals.

Methods: A structured worksite walkthrough was conducted on 21 hospital units. Unit-level workplace violence data were reviewed and a checklist of possible prevention strategies and an Action Plan form guided development of unit-specific intervention. Unit supervisor perceptions of the walkthrough and implemented prevention strategies were reported via questionnaires. Prevention strategies were categorized as environmental, behavioral, or administrative.

Results: A majority of units implemented strategies within 12 months' postintervention. Participants found the walkthrough useful, practical, and worthy of continued use.

Conclusions: Structured worksite walkthroughs provide a feasible method for workplace violence reduction in hospitals. Core elements are standardized yet flexible, promoting fidelity and transferability of this intervention.
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http://dx.doi.org/10.1097/JOM.0000000000001081DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5593762PMC
September 2017

Clinical and metabolic correlates of cerebral calcifications in Sturge-Weber syndrome.

Dev Med Child Neurol 2017 09 11;59(9):952-958. Epub 2017 Apr 11.

Division of Pediatric Neurology, The Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA.

Aim: To evaluate clinical and metabolic correlates of cerebral calcifications in children with Sturge-Weber syndrome (SWS).

Method: Fifteen children (11 females, four males; age range 7mo-9y, mean 4y 1mo) with unilateral SWS underwent baseline and follow-up magnetic resonance imaging (MRI) with susceptibility weighted imaging (SWI), glucose metabolism positron emission tomography (PET), and neurocognitive assessment (mean follow-up 1y 8mo). Calcified brain volumes measured on SWI were correlated with areas of abnormal glucose metabolism, seizure variables, and cognitive function (IQ).

Results: Ten children had brain calcification at baseline and 11 at follow-up. Mean calcified brain volume increased from 1.69 to 2.47cm (p=0.003) in these children; the rate of interval calcified volume increase was associated with early onset of epilepsy (Spearman's rho [r ]=-0.63, p=0.036). Calcified brain regions showed a variable degree of glucose hypometabolism with the metabolic abnormalities often extending to non-calcified cerebral lobes. Larger calcified brain volumes at baseline were associated with longer duration of epilepsy (r =0.69, p=0.004) and lower outcome IQ (r =-0.53, p=0.042).

Interpretation: Brain calcifications are common and progress faster in children with SWS with early epilepsy onset, and are associated with a variable degree of hypometabolism, which is typically more extensive than the calcified area. Higher calcified brain volumes may indicate a risk for poorer neurocognitive outcome.
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http://dx.doi.org/10.1111/dmcn.13433DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5568960PMC
September 2017

Preventing Patient-to-Worker Violence in Hospitals: Outcome of a Randomized Controlled Intervention.

J Occup Environ Med 2017 01;59(1):18-27

Department of Family Medicine, Michigan State University, East Lansing, Michigan (Dr Arnetz); Department of Public Health and Caring Sciences, Uppsala University, Sweden (Dr Arnetz); Departments of Family Medicine and Public Health Sciences (Dr Arnetz, Ms Hamblin, Dr Janisse) and Psychology, Wayne State University (Ms Hamblin); Detroit Medical Center Occupational Health Services (Mr Russell, Dr Upfal, Ms Essenmacher); Department of Emergency Medicine (Dr Upfal); Institute of Gerontology (Dr Luborsky), Wayne State University, Detroit, Michigan; and Department of Neurobiology, Caring Sciences and Society, Karolinska Institutet (Dr Luborsky), Sweden.

Objective: To evaluate the effects of a randomized controlled intervention on the incidence of patient-to-worker (Type II) violence and related injury in hospitals.

Methods: Forty-one units across seven hospitals were randomized into intervention (n = 21) and control (n = 20) groups. Intervention units received unit-level violence data to facilitate development of an action plan for violence prevention; no data were presented to control units. Main outcomes were rates of violent events and injuries across study groups over time.

Results: Six months post-intervention, incident rate ratios of violent events were significantly lower on intervention units compared with controls (incident rate ratio [IRR] 0.48, 95% confidence interval [CI] 0.29 to 0.80). At 24 months, the risk for violence-related injury was lower on intervention units, compared with controls (IRR 0.37, 95% CI 0.17 to 0.83).

Conclusions: This data-driven, worksite-based intervention was effective in decreasing risks of patient-to-worker violence and related injury.
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http://dx.doi.org/10.1097/JOM.0000000000000909DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5214512PMC
January 2017

Patients' Survival Expectations With and Without Their Chosen Treatment for Prostate Cancer.

Ann Fam Med 2016 05;14(3):208-14

Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, Michigan.

Purpose: Overtreatment of screen-detected localized prostate cancer (LPC) is an important public health concern, since the survival benefit of aggressive treatment (surgery or radiation) has not been well established. We investigated the survival expectations of patients who had LPC with and without their chosen treatment.

Methods: A population-based sample of 260 men (132 black, 128 white) 75 years old or younger with newly diagnosed LPC completed a self-administered survey. How long the patients expected to live with their chosen treatment, how long they would expect to live with no treatment, and factors associated with the difference in perceived life expectancy were assessed using multivariable analysis.

Results: Without any treatment, 33% of patients expected that they would live less than 5 years, 41% 5 to 10 years, 21% 10 to 20 years, and 5% more than 20 years. With their chosen treatment, 3% of patients expected to live less than 5 years, 9% 5 to 10 years, 33% 10 to 20 years, and 55% more than 20 years. Treatment chosen, age, general health perception, and perceived cancer seriousness predicted the differences in perceived life expectancy, while race and actual tumor risk did not. After adjustment for other covariates, men who choose surgery or radiation expected greater gain in survival than men who chose watchful waiting or active surveillance.

Conclusions: Most patients with LPC underestimated their life expectancy without treatment and overestimated the gain in life expectancy with surgery or radiation. These unrealistic expectations may compromise patients' ability to make informed treatment decisions and may contribute to overtreatment of LPC. Primary care physicians, when included in the decision process, should focus on helping patients develop realistic expectations and choices that support their treatment goals.
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http://dx.doi.org/10.1370/afm.1926DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4868558PMC
May 2016

Racial Differences in Treatment Decision-Making for Men with Clinically Localized Prostate Cancer: a Population-Based Study.

J Racial Ethn Health Disparities 2016 Mar 5;3(1):35-45. Epub 2015 May 5.

Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI, 48201, USA.

Purpose: Racial differences in prostate cancer treatment patterns have motivated concerns about over- and undertreatment. We surveyed black and white patients with localized prostate cancer (LPC) regarding their treatment decision-making processes to gain a better perspective on factors associated with LPC treatment choice.

Methods: We conducted a population-based, cross-sectional survey of 260 men (132 black, 128 white) aged ≤75 years, with newly diagnosed LPC. Our primary outcome was treatment choice (either surgery, radiation, or watchful waiting/active surveillance (WW/AS)), and our primary predictors were race and tumor risk level.

Results: Overall, treatment choice did not differ by race. As cancer risk increased, both black and white patients were more likely to undergo surgery and less likely to receive radiation. However, the pattern of WW/AS was different between white and black men. White men were less likely to select WW/AS as cancer risk increased, while risk level was unrelated to black men undergoing WW/AS. Urologist's recommendation had the greatest impact on men's treatment choice, followed by tumor risk level, age, and personal preferences.

Conclusions: Although there were no overall racial differences in treatment choice, when stratified by tumor risk level, the pattern of WW/AS was different between white and black patients, suggesting that over- and undertreatment is a larger concern for black than white men. A risk-stratified approach to understand racial disparities in LPC treatment and better strategies to aid black men in their treatment decision-making are needed to reduce racial disparities in prostate cancer outcomes.
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http://dx.doi.org/10.1007/s40615-015-0109-8DOI Listing
March 2016

Parental Support, Mental Health, and Alcohol and Marijuana Use in National and High-Risk African-American Adolescent Samples.

Subst Abuse 2015 11;9(Suppl 1):11-20. Epub 2016 Jan 11.

Department of Pediatrics, Wayne State University, Detroit, MI, USA.

African-American adolescents experience disproportionate rates of negative consequences of substance use despite using substances at average or below-average rates. Due to underrepresentation of African-American adolescents in etiological literature, risk and protective processes associated with their substance use require further study. This study examines the role of parental support in adolescents' conduct problems (CPs), depressive symptoms (DSs), and alcohol and marijuana use in a national sample and a high-risk sample of African-American adolescents. In both samples, parental support was inversely related to adolescent CPs, DSs, and alcohol and marijuana use. CPs, but not DSs, partially mediated the relation of parental support to substance use. Results were consistent across the national and high-risk samples, suggesting that the protective effect of parental support applies to African-American adolescents from a range of demographic backgrounds.
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http://dx.doi.org/10.4137/SART.S22441DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4736548PMC
February 2016

Efficacy of Low-Dose Buspirone for Restricted and Repetitive Behavior in Young Children with Autism Spectrum Disorder: A Randomized Trial.

J Pediatr 2016 Mar 30;170:45-53.e1-4. Epub 2015 Dec 30.

National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD.

Objectives: To determine safety and efficacy of the 5HT1A serotonin partial agonist buspirone on core autism and associated features in children with autism spectrum disorder (ASD).

Study Design: Children 2-6 years of age with ASD (N = 166) were randomized to receive placebo or 2.5 or 5.0 mg of buspirone twice daily. The primary objective was to evaluate the effects of 24 weeks of buspirone on the Autism Diagnostic Observation Schedule (ADOS) Composite Total Score. Secondary objectives included evaluating the effects of buspirone on social competence, repetitive behaviors, language, sensory dysfunction, and anxiety and to assess side effects. Positron emission tomography measures of tryptophan metabolism and blood serotonin concentrations were assessed as predictors of buspirone efficacy.

Results: There was no difference in the ADOS Composite Total Score between baseline and 24 weeks among the 3 treatment groups (P = .400); however, the ADOS Restricted and Repetitive Behavior score showed a time-by-treatment effect (P = .006); the 2.5-mg buspirone group showed significant improvement (P = .003), whereas placebo and 5.0-mg buspirone groups showed no change. Children in the 2.5-mg buspirone group were more likely to improve if they had fewer foci of increased brain tryptophan metabolism on positron emission tomography (P = .018) or if they showed normal levels of blood serotonin (P = .044). Adverse events did not differ significantly among treatment groups.

Conclusions: Treatment with 2.5 mg of buspirone in young children with ASD might be a useful adjunct therapy to target restrictive and repetitive behaviors in conjunction with behavioral interventions.

Trial Registration: ClinicalTrials.gov: NCT00873509.
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http://dx.doi.org/10.1016/j.jpeds.2015.11.033DOI Listing
March 2016

Post-Discharge Adverse Events Among Urban and Rural Patients of an Urban Community Hospital: A Prospective Cohort Study.

J Gen Intern Med 2015 Aug 31;30(8):1164-71. Epub 2015 Mar 31.

Department of Family Medicine & Public Health Sciences, Wayne State University School of Medicine, Detroit, MI, 48201, USA,

Background: There has been little research to examine post-discharge adverse events (AEs) in rural patients discharged from community hospitals.

Objective: We aimed to determine the rate of post-discharge AEs, classify the types of post-discharge AEs, and identify risk factors for post-discharge AEs in urban and rural patients.

Design: This was a prospective cohort study of patients at risk for post-discharge adverse events from December 2011 through October 2012.

Patients: Six hundred and eighty-four patients who were under the care of hospitalist physicians and were being discharged home, spoke English, and could be contacted after discharge, were admitted to the medical service. Patients were stratified as urban/rural using zip code of residence. Rural patients were oversampled to ensure equal enrollment of urban and rural patients.

Main Measures: The main outcome of the study was post-discharge AEs based on structured telephone interviews, health record review, and adjudication by two blinded, trained physicians using a previously established methodology.

Results: Over 28% of 684 patients experienced post-discharge AEs, most of which were either preventable or ameliorable. There was no difference in the incidence of post-discharge AEs in urban versus rural patients (ARR 1.04 95% CI 0.82-1.32 ), but post-discharge AEs were associated with hypertension, type 2 diabetes mellitus, and number of secondary discharge diagnoses only in urban patients.

Conclusions: Post-discharge AEs were common in both urban and rural patients and many were preventable or ameliorable. Potentially different risk factors for AEs in urban versus rural patients suggests the need for further research into the underlying causes. Different interventions may be required in urban versus rural patients to improve patient safety during transitions in care.
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http://dx.doi.org/10.1007/s11606-015-3260-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4510218PMC
August 2015

Prenatal alcohol exposure selectively enhances young adult perceived pleasantness of alcohol odors.

Physiol Behav 2015 Sep 17;148:71-7. Epub 2015 Jan 17.

Carman and Ann Adams Department of Pediatrics, Wayne State University, Detroit, MI, United States.

Prenatal alcohol exposure (PAE) can lead to life-long neurobehavioral and social problems that can include a greater likelihood of early use and/or abuse of alcohol compared to older teens and young adults without PAE. Basic research in animals demonstrates that PAE influences later postnatal responses to chemosensory cues (i.e., odor & taste) associated with alcohol. We hypothesized that PAE would be related to poorer abilities to identify odors of alcohol-containing beverages, and would alter perceived alcohol odor intensity and pleasantness. To address this hypothesis we examined responses to alcohol and other odors in a small sample of young adults with detailed prenatal histories of exposure to alcohol and other drugs. The key finding from our controlled analyses is that higher levels of PAE were related to higher relative ratings of pleasantness for alcohol odors. As far as we are aware, this is the first published study to report the influence of PAE on responses to alcohol beverage odors in young adults. These findings are consistent with the hypothesis that positive associations (i.e., "pleasantness") to the chemosensory properties of alcohol (i.e., odor) are acquired prenatally and are retained for many years despite myriad interceding postnatal experiences. Alternate hypotheses may also be supported by the results. There are potential implications of altered alcohol odor responses for understanding individual differences in initiation of drinking, and alcohol seeking and high-risk alcohol-related behaviors in young adults.
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http://dx.doi.org/10.1016/j.physbeh.2015.01.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4591746PMC
September 2015

Alluvial and riparian soils as major sources of lead exposure in young children in the Philippines: the role of floods.

Environ Sci Pollut Res Int 2015 Apr 12;22(7):5082-91. Epub 2014 Dec 12.

Department of Pediatrics, Hutzel Women's Hospital, the Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, 3980 John R, Detroit, MI, 48201, USA,

The objective of this paper was to determine the prevalence and sources of high lead (Pb) exposure among children in Bulacan, Philippines. A total of 150 children (6-7 years old) and their caregivers were studied. Lead was analyzed in children hair and deciduous teeth. Sources of lead exposure were determined by caregiver interview and Pb analysis of house soil, drinking faucet water, air, and water from seven Bulacan rivers. Lead was positive in 91.3% of children's hair (MC or median concentration = 8.9 μg/g; range = 0-38.29), in 46.2% of the teeth (MC = 0.000 μg/mg in positive samples; range = 0.00-0.020), in 100% of soil (MC = 27.06 mg/kg; range = 3.05-1155.80), in 21.1% of air (MC = 0 μg/Ncm; range = 0-0.10), in 4% of house, faucet water (MC = 0.0 ppm; range = 0-40). There was a significant correlation (Spearman's rho) between Pb in children's hair and soil (r = 0.195; p = 0.017) and between Pb in house water and outdoor air (r = 0.616; p = 0.005). There is no significant correlation between Pb in children's hair and teeth. None of the potential sources of Pb from interview were related to lead exposure in the children. Water from seven Bulacan rivers was 100% positive for lead (MC = 70.00 ppb; range = 30-90). Widespread flooding with river overflow occurred in Bulacan in 2009 which likely caused lead contamination of the soil. There was no significant difference in the lead concentration of the soil whether near or far from the river (p = 0.205, Mann-Whitney U test). High lead exposure in children in Bulacan is likely from soil contaminated by lead-polluted rivers during flooding. In areas where flooding is common, alluvial and riparian soils from polluted rivers are important sources of lead exposure in children.
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http://dx.doi.org/10.1007/s11356-014-3908-2DOI Listing
April 2015

Increased cut-point of the TACER-3 screen reduces false positives without losing sensitivity in predicting risk alcohol drinking in pregnancy.

Alcohol Clin Exp Res 2014 May 21;38(5):1401-8. Epub 2014 Mar 21.

College of Nursing, Wayne State University, Detroit, Michigan.

Background: Detection of in-pregnancy maternal risk alcohol drinking is an essential first step in preventing fetal alcohol spectrum disorders, and the widely used T-ACE screen was developed for that purpose. We recently reported that increasing the total T-ACE score cut-point from 2 to 3 doubled specificity of detecting risk drinking in pregnancy and identified 4-year-old children with neurobehavioral effects associated with prenatal alcohol exposure.

Methods: In this study, the TACER-3 was further validated in another prospectively identified high-risk urban cohort. Women were categorized as follows: (i) Not At-Risk Group (negative on T-ACE and TACER-3); (ii) At-Risk Group (positive on T-ACE and TACER-3); and (iii) Change Risk Group (positive on T-ACE but negative on TACER-3).

Results: The TACER-3 total score cut-point of 3 yielded fewer "false positives" than the T-ACE cut-point of 2. Based on relative risk scores, women in the TACER-3-positive At-Risk Group were more likely to drink alcohol during pregnancy than women in the Change Risk Group. In contrast, women in the Not At-Risk Group were largely not different in their drinking from women in the Change Risk Group. The largest increases in relative risk of the At-Risk Group compared to the Change Risk Group were for the amount of drinking per day across pregnancy (RR = 11.4) and for the amount of drinking per drinking day at the first prenatal visit (RR = 12.7). For both of these measures, the relative risk of at-risk alcohol consumption in the At-Risk Group was over >10 times that of the Change Risk Group.

Conclusions: Thus, the TACER-3 was more effective at selectively identifying women drinking at fetal risk levels than the original T-ACE. The TACER-3 allows for more efficient use of healthcare provider time in directing targeted clinical interventions with pregnant women identified as drinking at fetal risk levels.
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http://dx.doi.org/10.1111/acer.12368DOI Listing
May 2014

Trends in long term exposure to propoxur and pyrethroids in young children in the Philippines.

Environ Res 2014 May 15;131:13-6. Epub 2014 Mar 15.

Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI 48201, USA.

Background/aim: Pesticides are neurotoxic and can adversely affect children's neurobehavioral outcome. Ongoing pesticide exposure has to be monitored in the study of long term outcome of pesticide adverse effects since changes in the type and amount of exposure can influence outcome. The aim of this paper is to describe the trend in long term pesticide exposure in children through the analysis of pesticides in their hair.

Patients And Methods: As part of an NIH study on the long term effects of pesticide exposure in young children, ongoing exposure to pesticides was determined by the analysis of children's hair for propoxur and pyrethroids by gas chromatography/mass spectrometry at 2, 4 and 6 years of age.

Results: There were significant changes in the prevalence and concentration of propoxur and pyrethroids in children's hair at 2, 4 and 6 years of age. At ages 2 and 4 years, the prevalence of propoxur exposure increased from 12.4% to 24.1% (p<0.001) but dramatically decreased to 1.7% at 6 years (p<0.001). For bioallethrin, the prevalence of exposure steadily increased from 2 years (0.7%, p<0.001) to 4 years (12.4%, p<0.001) and to 6 years (18.4% p<0.001). Exposure to transfluthrin significantly increased from 4 years (1.0%) to 6 years (9.2%, p<0.001). There were also significantly higher median concentrations of bioallethrin at 2 compared to 4 years and for propoxur at 2 years compared to 6 years. Between 4 and 6 years, there was a higher median concentration of propoxur at 4 compared to 6 years and for transfluthrin and bioallethrin, at 6 compared to 4 years.

Conclusion: Changes in the prevalence and concentration of exposure to propoxur and pyrethroids in children at 2, 4 and 6 years of age are related to the progress in ambulation of young children and to changes in the formulation of home spray pesticides. Thus, periodic monitoring of pesticide exposure is necessary when studying the long term effects of pesticide exposure in the neurodevelopment of young children.
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http://dx.doi.org/10.1016/j.envres.2014.01.003DOI Listing
May 2014

Alcohol, tobacco, cocaine, and marijuana use: relative contributions to preterm delivery and fetal growth restriction.

Subst Abus 2014 ;35(1):60-7

a Department of Family Medicine and Public Health Sciences, School of Medicine , Wayne State University , Detroit , Michigan , USA.

Background: Pregnancy substance use is linked to low birth weight. However, less is known about relative contributions of various substances and whether effects are due to decreased gestational duration, restriction of fetal growth, or both. The study goal was to use causal modeling to evaluate the individual impact of alcohol, tobacco, cocaine, and marijuana on gestational duration and fetal growth.

Methods: Participants were 3164 urban black women recruited at entry to prenatal care and followed to delivery, with all gestational dating ultrasound supported. Pregnancy substance use was assessed via self-report (alcohol, tobacco, cocaine, and marijuana).

Results: Alcohol, cigarette, and cocaine use were all individually and negatively related to gestational age at delivery. However, only alcohol, cigarette, and marijuana use predicted fetal growth, with effects for alcohol and cigarette greater and more discrepant for older women. Overall, heavy cigarette smoking had the greatest individual impact on birth weight (up to 431 g). Heavy levels of use of all 4 substances by older women decreased birth weight by 26% (806 g).

Conclusions: For perhaps the first time, reduced birth weight is apportioned both by type of substance and mechanism of effect. The use of alcohol and/or cigarettes was clearly more harmful to fetal growth than cocaine use. Findings demonstrate the need for continued emphasis on intervention efforts to address legal and illicit pregnancy substance use.
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http://dx.doi.org/10.1080/08897077.2013.804483DOI Listing
April 2015

Maternal endotoxin exposure results in abnormal neuronal architecture in the newborn rabbit.

Dev Neurosci 2013 27;35(5):396-405. Epub 2013 Aug 27.

Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Md., USA.

Maternal intrauterine inflammation/infection is a potential risk factor for the development of neurologic disorders such as cerebral palsy (CP) in preterm and term infants. CP is associated with white matter and grey matter injury. In the current study, we used a rabbit model of CP in which pregnant rabbits are administered intrauterine injections of the endotoxin lipopolysaccharide. We then investigated the extent of neuronal damage in the newborn kit brain. We observed an overall decrease in the number of MAP2-stained neurons and an increase in Fluoro-Jade C-stained cells in the anterior thalamus of 1-day-old rabbit brain. We also observed an overall decrease in the number of branching points and spine density in the retrosplenial cortex, a major output region of the anterior thalamus that is involved in cognition and memory. The loss of spines and dendritic atrophy in the retrosplenial cortex may be caused by loss of presynaptic input from the thalamus. Our study indicates that the cognitive impairments seen in patients with CP may be related to the degeneration of neurons and abnormal arborization of the thalamic and cortical neurons.
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http://dx.doi.org/10.1159/000353156DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3918000PMC
June 2014

15O PET measurement of blood flow and oxygen consumption in cold-activated human brown fat.

J Nucl Med 2013 Apr 29;54(4):523-31. Epub 2013 Jan 29.

Department of Pediatrics, Wayne State University, Detroit, MI 48201, USA.

Unlabelled: Although it has been believed that brown adipose tissue (BAT) depots disappear shortly after the perinatal period in humans, PET imaging using the glucose analog (18)F-FDG has shown unequivocally the existence of functional BAT in adult humans, suggesting that many humans retain some functional BAT past infancy. The objective of this study was to determine to what extent BAT thermogenesis is activated in adults during cold stress and to establish the relationship between BAT oxidative metabolism and (18)F-FDG tracer uptake.

Methods: Twenty-five healthy adults (15 women and 10 men; mean age ± SD, 30 ± 7 y) underwent triple-oxygen scans (H2(15)O, C(15)O, and (15)O2) as well as measurements of daily energy expenditure (DEE; kcal/d) both at rest and after exposure to mild cold (15.5°C [60°F]) using indirect calorimetry. The subjects were divided into 2 groups (high BAT and low BAT) based on the presence or absence of (18)F-FDG tracer uptake (standardized uptake value [SUV] > 2) in cervical-supraclavicular BAT. Blood flow and oxygen extraction fraction (OEF) were calculated from dynamic PET scans at the location of BAT, muscle, and white adipose tissue. Regional blood oxygen saturation was determined by near-infrared spectroscopy. The total energy expenditure during rest and mild cold stress was measured by indirect calorimetry. Tissue-level metabolic rate of oxygen (MRO2) in BAT was determined and used to calculate the contribution of activated BAT to DEE.

Results: The mass of activated BAT was 59.1 ± 17.5 g (range, 32-85 g) in the high-BAT group (8 women and 1 man; mean age, 29.6 ± 5.5 y) and 2.2 ± 3.6 g (range, 0-9.3 g) in the low-BAT group (9 men and 7 women; mean age, 31.4 ± 10 y). Corresponding maximal SUVs were significantly higher in the high-BAT group than in the low-BAT group (10.7 ± 3.9 vs. 2.1 ± 0.7, P = 0.01). Blood flow values were significantly higher in the high-BAT group than in the low-BAT group for BAT (12.9 ± 4.1 vs. 5.9 ± 2.2 mL/100 g/min, P = 0.03) and white adipose tissue (7.2 ± 3.4 vs. 5.7 ± 2.3 mL/100 g/min, P = 0.03) but were similar for muscle (4.4 ± 1.9 vs. 3.9 ± 1.7 mL/100 g/min). Moreover, OEF in BAT was similar in the 2 groups (0.51 ± 0.17 in high-BAT group vs. 0.47 ± 0.18 in low-BAT group, P = 0.39). During mild cold stress, calculated MRO2 values in BAT increased from 0.97 ± 0.53 to 1.42 ± 0.68 mL/100 g/min (P = 0.04) in the high-BAT group and were significantly higher than those determined in the low-BAT group (0.40 ± 0.28 vs. 0.51 ± 0.23, P = 0.67). The increase in DEE associated with BAT oxidative metabolism was highly variable in the high-BAT group, with an average of 3.2 ± 2.4 kcal/d (range, 1.9-4.6 kcal/d) at rest, and increased to 6.3 ± 3.5 kcal/d (range, 4.0-9.9 kcal/d) during exposure to mild cold. Although BAT accounted for only a small fraction of the cold-induced increase in DEE, such increases were not observed in subjects lacking BAT.

Conclusion: Mild cold-induced thermogenesis in BAT accounts for 15-25 kcal/d in subjects with relatively large BAT depots. Thus, although the presence of active BAT is correlated with cold-induced energy expenditure, direct measurement of MRO2 indicates that BAT is a minor source of thermogenesis in humans.
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http://dx.doi.org/10.2967/jnumed.112.111336DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3883579PMC
April 2013

Where does work stress come from? A generalizability analysis of stress in police officers.

Psychol Health 2012 22;27(12):1426-47. Epub 2012 May 22.

Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, USA.

Differences among workers and workplace stressors both contribute to perceiving work as stressful. However, the relative importance of these sources to work stress is not well delineated. Moreover, the extent to which work stress additionally reflects unique matches between specific workers and particular job stressors is also unclear. In this study, we use generalizability theory to specify and compare sources of variance in stress associated with police work. US police officers (N = 115) provided ratings of 60 stressors commonly associated with policing duties. Primary and secondary stress appraisal ratings reflected differences among officers in tendencies to generally perceive work stressors as stressful (14-15% officer effect), and also agreement among officers in viewing some stressors as more stressful than others (18-19% stressor effect). However, ratings especially reflected distinct pairings of officers and stressors (38-41% interaction effect). Additional analyses revealed individual differences and stressor characteristics associated with each variance component, including an officer × stressor interaction - compared to officers low in neuroticism, highly neurotic officers provided lower primary appraisal ratings of stressors generally seen as not serious, and also higher primary appraisal ratings of stressors that were seen as serious. We discuss implications of the current approach for the continued study of stress at work.
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http://dx.doi.org/10.1080/08870446.2012.687738DOI Listing
May 2013

Dendrimer-based postnatal therapy for neuroinflammation and cerebral palsy in a rabbit model.

Sci Transl Med 2012 Apr;4(130):130ra46

Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Detroit, MI 48201, USA.

Cerebral palsy (CP) is a chronic childhood disorder with no effective cure. Neuroinflammation, caused by activated microglia and astrocytes, plays a key role in the pathogenesis of CP and disorders such as Alzheimer's disease and multiple sclerosis. Targeting neuroinflammation can be a potent therapeutic strategy. However, delivering drugs across the blood-brain barrier to the target cells for treating diffuse brain injury is a major challenge. We show that systemically administered polyamidoamine dendrimers localize in activated microglia and astrocytes in the brain of newborn rabbits with CP, but not healthy controls. We further demonstrate that dendrimer-based N-acetyl-l-cysteine (NAC) therapy for brain injury suppresses neuroinflammation and leads to a marked improvement in motor function in the CP kits. The well-known and safe clinical profile for NAC, when combined with dendrimer-based targeting, provides opportunities for clinical translation in the treatment of neuroinflammatory disorders in humans. The effectiveness of the dendrimer-NAC treatment, administered in the postnatal period for a prenatal insult, suggests a window of opportunity for treatment of CP in humans after birth.
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http://dx.doi.org/10.1126/scitranslmed.3003162DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3492056PMC
April 2012

Recognized spontaneous abortion in mid-pregnancy and patterns of pregnancy alcohol use.

Alcohol 2012 May 21;46(3):261-7. Epub 2012 Mar 21.

College of Nursing, Wayne State University, Detroit, MI 48202, USA.

Alcohol consumption during pregnancy is one potential risk factor for spontaneous abortion (SAb). Prior research suggested that heavy drinking during pregnancy was associated with significantly increased rates of SAb, but results for lower levels of drinking have been inconsistent. We examined the association between different levels and patterns of prenatal alcohol consumption and SAb in a high-risk inner-city sample. We hypothesized that higher levels, binge patterns, and more frequent drinking would be associated with increased rates of SAb. The quantity and frequency of self-reported peri-conceptional and repeated in-pregnancy maternal drinking volumes per beverage type were assessed with semi-structured interviews in a prospective subsample of 302 African-American mothers. Relations between various measures of prenatal alcohol exposure and SAb were assessed using logistic regression. After controlling for various potential confounders, there was a significant positive relation between average absolute alcohol use per day across pregnancy and SAb. Greater frequency of drinking episodes also predicted SAb: an average of even one day of drinking per week across pregnancy was associated with an increase in the incidence of SAb. However, contrary to our hypothesis, neither the amount of alcohol drunk per drinking day nor a measure of binge drinking was significantly related to SAb after controlling for confounders. Differences in when women who drank at risk levels initiated antenatal care may have under-estimated the impact of alcohol on SAb in this low-SES urban African-American sample. Some drinking measures averaged across pregnancy may have under-estimated consumption and overestimated risk of SAb, but other risk drinking measures that avoid this limitation show similar relations to SAb. Identifying fetal risk drinking in pregnant women is critical to increasing the effectiveness of interventions that reduce risk level alcohol consumption and protect from pregnancy loss.
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http://dx.doi.org/10.1016/j.alcohol.2011.11.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3354912PMC
May 2012

Fetal exposure to propoxur and abnormal child neurodevelopment at 2 years of age.

Neurotoxicology 2012 Aug 1;33(4):669-75. Epub 2011 Dec 1.

Department of Pediatrics, Hutzel Women's Hospital, the Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, MI, United States.

Objective: Our aim was to determine the effects of fetal exposure to propoxur and pyrethroids, on child neurodevelopment at 2 years of age.

Patients And Methods: Mothers were prospectively recruited during mid-pregnancy in Bulacan, Philippines where multiple pesticides including propoxur, cyfluthrin, chlorpyrifos, cypermethrin, pretilachlor, bioallethrin, malathion, diazinon and transfluthrin are used. To detect prenatal exposure to these pesticides, maternal hair and blood, infant's hair, cord blood, and meconium were analyzed for the pesticides by gas chromatography/mass spectrometry. Infants were examined at 2 years of age with 95.1% follow up rate and their neurodevelopment outcome was assessed by the Griffiths mental developmental scale (N=754).

Results: Meconium analysis was the most sensitive method to detect fetal exposure to pesticides and exposure was highest for propoxur (21.3%) and the grouped pyrethroids (2.5% - bioallethrin, transfluthrin, cyfluthrin and cypermethrin). Path analysis modeling was performed to determine the effects of fetal exposure to propoxur and pyrethroids on the child's neurodevelopment at 24 months of age while controlling for confounders. Only singletons and those with complete data for the path analysis were included (N=696). Using a path analysis model, there was a significant negative (β=-0.14, p<0.001) relationship between prenatal pesticide exposure to propoxur and motor development at 2 years of age after controlling for confounders, e.g., infant gender, socioeconomic status, maternal intelligence, home stimulation (HOME), postnatal exposure to propoxur and blood lead level at 2 years of age.

Conclusion: At 2 years of age, prenatal exposure to propoxur was associated with poorer motor development in children.
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http://dx.doi.org/10.1016/j.neuro.2011.11.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3509383PMC
August 2012

Analysis of House Dust and Children's Hair for Pesticides: A Comparison of Markers of Ongoing Pesticide Exposure in Children.

J Bioanal Biomed 2011 Nov;4

Department of Pediatrics, Hutzel Women's Hospital, the Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA.

Background/aim: The long term study of the adverse effects of pesticides on child neuro development requires monitoring not only of initial, but ongoing pesticide exposure. Our aim was to compare house dust and children's hair as environmental and biological markers of ongoing pesticide exposure in children.

Design/methods: In a continuing NIH study on the adverse effects of prenatal pesticide exposure on child neurodevelopment, ongoing pesticide exposure after birth was measured in swept house dust and hair in the children at 4 years of age for propoxur and pyrethroids (transfluthrin, bioallethrin, cyfluthrin and cypermethrin) by gas chromatography/mass spectrometry. The prevalence and concentration of pesticides in the two matrices were compared.

Results: Prevalence of propoxur was higher in hair compared to house dust (p<0.001) whereas prevalence of the pyrethroids was higher (p<0.001) in house dust. The overall concentrations of the pyrethroids were also higher (p<0.007) in house dust compared to hair. There was a significant (p<0.001) correlation between dust and hair for bioallethrin and cypermethrin.

Conclusions: Ongoing exposure of children to environmental pesticides is sensitively detected by analysis of children's hair and house dust. However, prevalence of propoxur was higher in hair compared to swept house dust, but the opposite was found for the pyrethroids. Thus, both matrices should be analyzed. There was a significant (p<0.001) correlation between house dust and hair for bioallethrin and cypermethrin.
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http://dx.doi.org/10.4172/1948-593X.1000057DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3840167PMC
November 2011

Brain damage and IQ in unilateral Sturge-Weber syndrome: support for a "fresh start" hypothesis.

Epilepsy Behav 2011 Oct;22(2):352-7

Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, MI 48201, USA.

We tested the hypothesis that extent of severe hypometabolism measured by fluorodeoxyglucose PET has a U-shaped (nonlinear) relationship to IQ in children with unilateral Sturge-Weber syndrome. Thirty-five consecutive children (age range: 30-153 months) with Sturge-Weber syndrome and unilateral brain involvement were enrolled in the study. Participants underwent cognitive assessment and interictal fluorodeoxyglucose PET scans. Regression analyses tested whether a quadratic model best accounted for the relationship between extent of severe cortical hypometabolism and IQ, controlling for seizure variables. A significant quadratic relationship was found between IQ and extent of severe (but not total) hypometabolism. Seizure variables also contributed significant variance to cognitive functions. Results suggest that intermediate size of severe hemispheric hypometabolism is associated with the worst cognitive outcomes, and small or absent lesions, with the best cognitive outcomes. Children in whom a very large extent of the hemisphere is severely affected are likely to have relatively preserved cognitive function.
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http://dx.doi.org/10.1016/j.yebeh.2011.07.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3185171PMC
October 2011

Magnitude of [(11)C]PK11195 binding is related to severity of motor deficits in a rabbit model of cerebral palsy induced by intrauterine endotoxin exposure.

Dev Neurosci 2011 28;33(3-4):231-40. Epub 2011 Jul 28.

Department of Pediatrics, Wayne State University, Detroit, MI, USA.

Intrauterine inflammation is known to be a risk factor for the development of periventricular leukomalacia (PVL) and cerebral palsy. In recent years, activated microglial cells have been implicated in the pathogenesis of PVL and in the development of white matter injury. Clinical studies have shown the increased presence of activated microglial cells diffusely throughout the white matter in brains of patients with PVL. In vitro studies have reported that activated microglial cells induce oligodendrocyte damage and white matter injury by release of inflammatory cytokines, reactive nitrogen and oxygen species and the production of excitotoxic metabolites. PK11195 [1-(2-chlorophenyl)-N-methyl-N-(1-methylpropyl)-3-isoquinoline carboxamide] is a ligand that is selective for the 18-kDa translocator protein expressed on the outer mitochondrial membrane of activated microglia and macrophages. When labeled with carbon-11, [(11)C]PK11195 can effectively be used as a ligand in positron emission tomography (PET) studies for the detection of activated microglial cells in various neuroinflammatory and neurodegenerative conditions. In this study, we hypothesized that the magnitude of [(11)C]-(R)-PK11195 uptake in the newborn rabbit brain, as measured using a small-animal PET scanner, would match the severity of motor deficits resulting from intrauterine inflammation-induced perinatal brain injury. Pregnant New Zealand white rabbits were intrauterinely injected with endotoxin or saline at 28 days of gestation. Kits were born spontaneously at 31 days and underwent neurobehavioral testing and PET imaging following intravenous injection of the tracer [(11)C]-(R)-PK11195 on the day of birth. The neurobehavioral scores were compared with the change in [(11)C]PK11195 uptake over the time of scanning, for each of the kits. Upon analysis using receiver operating characteristic curves, an optimal combined sensitivity and specificity for detecting abnormal neurobehavioral scores suggestive of cerebral palsy in the neonatal rabbit was noted for a positive change in [(11)C]PK11195 uptake in the brain over time on PET imaging (sensitivity of 100% and area under the curve of >0.82 for all parameters tested). The strongest agreements were noted between a positive uptake slope - indicating increased [(11)C]PK11195 uptake over time - and worsening scores for measures of locomotion (indicated by hindlimb movement, forelimb movement, circular motion and straight- line motion; Cohen's κ >0.75 for each) and feeding (indicated by ability to suck and swallow and turn the head during feeding; Cohen's κ >0.85 for each). This was also associated with increased numbers of activated microglia (mean ratio ± SD of activated to total microglia: 0.96 ± 0.16 in the endotoxin group vs. 0.13 ± 0.08 in controls; p < 0.001) in the internal capsule and corona radiata. Our findings indicate that the magnitude of [(11)C]PK11195 binding measured in vivo by PET imaging matches the severity of motor deficits in the neonatal rabbit. Molecular imaging of ongoing neuroinflammation in the neonatal period may be helpful as a screening biomarker for detecting patients at risk of developing cerebral palsy due to a perinatal insult.
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http://dx.doi.org/10.1159/000328125DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3225246PMC
March 2012

Do household smoking behaviors constitute a risk factor for hookah use?

Nicotine Tob Res 2011 May 31;13(5):384-8. Epub 2011 Jan 31.

Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI, USA.

Introduction: Much research has focused on the role played by families in cigarette smoking behavior. However, there is a lack of such research for hookah (waterpipe) smoking. This study focuses on the role of family members' hookah smoking behaviors as a possible risk factor for hookah smoking.

Methods: Eight hundred and one adults in southeast Michigan responded to an anonymous self-administered survey regarding personal and family members' hookah smoking behavior and perceptions of health risks related to hookah smoking. Multinomial logistic regression modeling was used to examine risk factors for hookah use.

Results: The prevalence of current hookah smoking in the study population was 26%. The odds ratio for an individual to smoke hookah were 9.5 (95% CI = 2.37-38.47, p < .01), 8.6 (95% CI = 3.92-19.02, p < .001), and 1.2 (95% CI = 1.14-1.41, p < .05) if the father, mother, or sibling, respectively, smoked hookah at home. Male gender and younger age were also significantly associated with hookah smoking. Household hookah smoking behaviors were also significant risk factors among former hookah smokers compared with nonsmokers, but there were no significant risk factors when comparing former hookah smokers with current hookah smokers.

Conclusions: Having a father, mother, or sibling smoking hookah at home, male gender and younger age are significant risk factors for current hookah smoking.
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http://dx.doi.org/10.1093/ntr/ntq249DOI Listing
May 2011