Publications by authors named "Paula F Rosenbaum"

32 Publications

A comparison of passive surveillance and active cluster-based surveillance for dengue fever in southern coastal Ecuador.

BMC Public Health 2020 Jul 6;20(1):1065. Epub 2020 Jul 6.

Institute for Global Health and Translational Science, SUNY Upstate Medical University, 505 Irving Avenue Suite 4200, Syracuse, NY, USA.

Background: Dengue is a major emerging infectious disease, endemic throughout the tropics and subtropics, with approximately 2.5 billion people at risk globally. Active (AS) and passive surveillance (PS), when combined, can improve our understanding of dengue's complex disease dynamics to guide effective, targeted public health interventions. The objective of this study was to compare findings from the Ministry of Health (MoH) PS to a prospective AS arbovirus research study in Machala, Ecuador in 2014 and 2015.

Methods: Dengue cases in the PS system were compared to laboratory confirmed acute dengue illness cases that entered the AS study during the study period. Variables of interest included age class and sex. Outbreak detection curves by epidemiologic week, overall cumulative incidence and age-specific incidence proportions were calculated. Descriptive statistics were tabulated for all variables of interest. Chi-square tests were performed to compare demographic characteristics between the AS and PS data sets in 2014 and 2015.

Results: 177 and 245 cases were identified from 1/1/2014 to 12/31/2015 by PS and AS, respectively; nine cases appeared in both systems. AS identified a greater number of laboratory-confirmed cases in 2014, accounting for more than 60% of dengue cases in the study area. In 2015, the opposite trend was observed with PS identifying 60% of the dengue cases in the study area. Peak transmission time in laboratory confirmed dengue illness, as noted by AS and PS was similar in 2014, whereas earlier detection (7 weeks) was observed by AS in 2015. Younger patients were more frequently identified by PS, while older patients were identified more frequently by AS. The cumulative incidence proportion for laboratory confirmed dengue illness reported via PS to the MoH was 4.12 cases per 10,000 residents in 2014, and 2.21 cases per 10,000 residents in 2015.

Conclusions: Each surveillance system captured distinct demographic subgroups within the Machala population, possibly due to differences in healthcare seeking behaviors, access to care, emerging threats of other viruses transmitted by the same mosquito vector and/or differences in clinical presentation. Integrating AS with pre-existing PS can aid in identifying additional cases in previously underdiagnosed subpopulations, improving our understanding of disease dynamics, and facilitating the implementation of timely public health interventions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12889-020-09168-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7336448PMC
July 2020

Outcomes Following Stereotactic Body Radiotherapy with Intensity-Modulated Therapy versus Three-Dimensional Conformal Radiotherapy in Early Stage Non-Small Cell Lung Cancer.

Lung Cancer (Auckl) 2019 20;10:151-159. Epub 2019 Dec 20.

Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA.

Introduction: The treatment techniques used for stereotactic body radiation therapy (SBRT) for early-stage lung cancer continue to evolve. In this study, clinical outcomes following SBRT were evaluated according to the use of either 3D conformal radiotherapy (3DCRT) or intensity-modulated radiation therapy (IMRT).

Patients And Methods: Patients with stage I NSCLC who received SBRT from 2007 to 2015 were retrospectively reviewed. Disease control and survival were assessed using Kaplan-Meier estimates. Dosimetric analyses for target dose heterogeneity and coverage were performed.

Results: A total of 297 patients with 351 lesions were included. 3DCRT was used in 52% and IMRT in 48%. IMRT was utilized at a higher rate in more recent years. The most common regimens were 48 Gy in 4 fractions and 54-60 Gy in 3 fractions. With a median follow up of 22.7 months, there were 17 local failures for a crude relapse rate of 5.7%. Local failure did not differ in patients treated with 3DCRT and IMRT (4.9% vs 6.5%, p=0.573). Mean dose to gross tumor volume (GTV) as a percent of prescription dose was higher with 3DCRT compared with IMRT (107.7% vs 103.6%, p < 0.0001). Tumor stage, histology, and SBRT regimen did not correlate with local tumor control. Overall survival for the entire population approximated 72% at 2 years. Treatment was well tolerated with 6 documented grade 3+ events.

Conclusion: In this single-institution cohort of SBRT for early-stage NSCLC, there was no discernible difference in clinical outcomes between those treated with 3DCRT and IMRT.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2147/LCTT.S235713DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6929968PMC
December 2019

Hypertension in Relation to Dioxins and Polychlorinated Biphenyls from the Anniston Community Health Survey Follow-Up.

Environ Health Perspect 2019 12 20;127(12):127007. Epub 2019 Dec 20.

National Cancer Institute at National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH), Research Triangle Park, North Carolina, USA.

Background: In 2014, we conducted a longitudinal study [Anniston Community Health Survey (ACHS II)] 8 y after the baseline (ACHS I).

Objectives: We investigated the relationship between persistent chlorinated compounds and hypertension in residents living around the former polychlorinated biphenyl (PCB) production plant in Anniston, Alabama. We also examined the potential role of inflammatory cytokines in those with hypertension.

Methods: A total of 338 participants had their blood pressure measured and medications recorded, gave a blood sample, and completed a questionnaire. Prevalent hypertension was defined as taking antihypertensive medication or having systolic blood pressure and/or diastolic pressure ; incident hypertension used similar criteria in those who developed hypertension since the baseline in 2005-2007. PCB congeners were categorized into structure-activity groups, and toxic equivalencies (TEQs) were calculated for dioxin-like compounds. Descriptive statistics, logistic and linear regressions, as well as Cox proportional hazard models, were used to analyze the associations between exposures and hypertension.

Results: Prevalent hypertension (78%) in ACHS II showed statistically significant adjusted odds ratios (ORs) for PCBs 74, 99, 138, 153, 167, 177, 183, and 187, ranging from 2.18 [95% confidence interval (CI): 1.10, 4.33] to 2.76 (95% CI: 1.14, 6.73), as well as for two estrogenic-like PCB groups, and the thyroid-like group [ORs ranging from 2.25 (95% CI: 1.07, 4.75) to 2.54 (95% CI: 1.13, 5.74)]. Furthermore, analysis of quartiles demonstrated a monotonic relationship for dioxin-like non-ortho (non-)-PCB TEQs [fourth vs. first quartile: 3.66 (95% CI: 1.40, 9.56)]. Longitudinal analyses of incident hypertension supported those positive associations. The results were strongest for the di--PCBs [ (95% CI: 0.93, 4.00)] and estrogenic II PCB group [ (95% CI: 0.96, 3.78)] but were weaker for the dioxin TEQs.

Discussion: Findings supportive of positive associations were reported for dioxin-like mono-- and non--PCBs as well as for nondioxin-like estrogenic and thyroid-like congeners with prevalent and incident hypertension, suggesting that multiple pathways may be involved in hypertension development. https://doi.org/10.1289/EHP5272.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1289/EHP5272DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6957279PMC
December 2019

The Effects of Timing of Soft Tissue Coverage on Outcomes After Reconstruction of Type IIIB Open Tibia Fractures.

Orthopedics 2019 Sep 29;42(5):260-266. Epub 2019 Jul 29.

High-energy open fractures of the tibia are frequently associated with tissue loss, wound contamination, and compromised vascularity that often result in amputation. The management of these severe injuries remains a challenge for orthopedic reconstructive surgeons. Studies have compared the timing of soft tissue coverage of Gustilo type IIIB open tibia fractures with associated outcomes such as rate of deep infection, primary union, length of hospitalization, flap failure, and eventual secondary amputation. These studies often highlight better outcomes with specific time domains that are not always attainable at a large tertiary hospital with multi-system trauma patients. Many studies do not account for delayed patient transfers after initial open fracture management elsewhere. This retrospective analysis of the limb salvage outcomes included 140 consecutive patients with Gustilo type IIIB open tibia fractures who presented to the authors' level I trauma center between 2001 and 2014. The authors included patients who required delayed coverage or who were transferred from outside institutions. The majority (77%) were male, and the mean age was 39.4 years. Motor vehicle accidents were the most common cause of injury, and 83% of patients obtained full weight-bearing status with successful limb salvage. Twenty patients had a secondary amputation, with the cause being refractory osteomyelitis in 52%. This study provides guidance on treating a heterogeneous patient population with severe open tibia fractures typically seen in a large tertiary hospital orthopedic trauma service. [Orthopedics. 2019; 42(5):260-266.].
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3928/01477447-20190723-01DOI Listing
September 2019

Clinical outcomes following advanced respiratory motion management (respiratory gating or dynamic tumor tracking) with stereotactic body radiation therapy for stage I non-small-cell lung cancer.

Lung Cancer (Auckl) 2018 5;9:103-110. Epub 2018 Nov 5.

Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA,

Purpose: To report the outcomes of stereotactic body radiation therapy (SBRT) for stage I non-small-cell lung cancer (NSCLC) according to respiratory motion management method.

Methods: Patients with stage I NSCLC who received SBRT from 2007 to 2015 were reviewed. Computed tomography (CT) simulation with four-dimensional CT was performed for respiratory motion assessment. Tumor motion >1 cm in the craniocaudal direction was selectively treated with advanced respiratory management: either respiratory gating to a pre-specified portion of the respiratory cycle or dynamic tracking of an implanted fiducial marker. Comparisons were made with internal target volume approach, which treated all phases of respiratory motion.

Results: Of 297 patients treated with SBRT at our institution, 51 underwent advanced respiratory management (48 with respiratory gating and three with tumor tracking) and 246 underwent all-phase treatment. Groups were similarly balanced with regard to mean age (=0.242), tumor size (=0.315), and histology (=0.715). Tumor location in the lower lung lobes, as compared to middle or upper lobes, was more common in those treated with advanced respiratory management (78.4%) compared to all-phase treatment (25.6%, <.0001). There were 17 local recurrences in the treated lesions. Kaplan-Meier analyses showed that there were no differences with regard to mean time to local failure (91.5 vs 98.8 months, =0.56), mean time to any failure (73.2 vs 78.7 months, =0.73), or median overall survival (43.3 vs 45.5 months, =0.56) between patients who underwent advanced respiratory motion management and all-phase treatment.

Conclusion: SBRT with advanced respiratory management (the majority with respiratory gating) showed similar efficacy to all-phase treatment approach for stage I NSCLC.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2147/LCTT.S175168DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6223331PMC
November 2018

Perceived Importance of Wellness Features at a Cancer Center: Patient and Staff Perspectives.

HERD 2018 07 28;11(3):80-93. Epub 2018 Feb 28.

2 Department of Public Health and Preventive Medicine, State University of New York Upstate Medical University, Syracuse, NY, USA.

Objectives: Determine the relative impact of 11 building wellness features on preference and on the ability to deliver/receive quality care for two groups: patients and caregivers.

Background: The impact of building features that promote wellness is of increasing interest to the building owners, designers, and occupants.

Methods: This study performed a postoccupancy evaluation of two user groups at a healthcare facility with specific wellness features. Seventy-six staff and 62 patients of a cancer center were polled separately to determine their preferences in 11 categories.

Results: Results showed that all wellness features were viewed favorably by the two groups, with natural lighting, views of nature, and thermal comfort as top categories for both. The t-test comparisons were performed, and significant differences ( p < .05) between the two groups were found for three of the features (views of nature, art and murals, and indoor plants). Discussion of these differences and the interaction of competing design goals (thermal comfort, views of nature, natural light, and desire for privacy) are included.

Conclusions: Designers and owners will want to consider the preferred use of roof gardens, art and murals, and indoor plants for patient spaces, where their relative value is greater. Access to private and quiet spaces is the top need for caregivers. Ease of movement, thermal comfort, and natural light were top needs for patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1937586718758446DOI Listing
July 2018

Polychlorinated biphenyls, indicators of thyroid function and thyroid autoantibodies in the Anniston Community Health Survey I (ACHS-I).

Chemosphere 2018 Mar 9;195:156-165. Epub 2017 Dec 9.

Agency for Toxic Substances and Disease Registry (ATSDR), Atlanta, GA, USA.

In this study, we examined associations between serum concentrations of 35 polychlorinated biphenyl (PCB) congeners, pesticides, and indicators of thyroid function in participants of the Anniston Community Health Survey (ACHS). Study subjects lived in the vicinity of a former PCB production facility and had PCB concentrations 2 to 3 times higher than similar age and race groups from the general population. We investigated associations among serum levels of thyroid hormones (thyroxin [T4], free thyroxin [fT4], triiodothyronine [T3], thyroid stimulation hormone [TSH]) and auto-antibodies (thyroglobulin antibody [TgAb] or thyroperoxidase antibody [TPOAb]) and combined indicators of thyroid function with the sum of PCBs, varying PCB groups, individual PCB congeners, and 8 pesticides. Logistic and linear regression models were adjusted for log10 transformed total lipids, age, sex, ethnicity, BMI, smoking, and family history of thyroid disease. We also performed analyses stratified by ethnicity and sex. Linear regression showed inverse associations between TT3 and thyroid-like PCBs (sum of PCBs 28, 52, 74, 101, 105, and 118; p = .0004), two pesticides (hexachlorobenzene, and pp'-DDE), and individual congeners (PCBs 74, 105). Null associations were observed between PCBs, pesticides, TSH, TT4, and fT4. Logistic regression analyses did not provide support for TT3 findings and found no association with other thyroid hormones, antibodies, or combined indicator of thyroid function. These results suggest there is little evidence that these chemicals have any major clinical effect on thyroid function in this highly PCB exposed population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.chemosphere.2017.12.050DOI Listing
March 2018

Metabolic syndrome is associated with exposure to organochlorine pesticides in Anniston, AL, United States.

Environ Int 2017 11 2;108:11-21. Epub 2017 Aug 2.

Agency for Toxic Substances and Disease Registry, Atlanta, GA, United States.

The Anniston Community Health Survey, a cross-sectional study, was undertaken in 2005-2007 to study environmental exposure to polychlorinated biphenyl (PCB) and organochlorine (OC) pesticides and health outcomes among residents of Anniston, AL, United States. The examination of potential risks between these pollutants and metabolic syndrome, a cluster of cardiovascular risk factors (i.e., hypertension, central obesity, dyslipidemia and dysglycemia) was the focus of this analysis. Participants were 548 adults who completed the survey and a clinic visit, were free of diabetes, and had a serum sample for clinical laboratory parameters as well as PCB and OC pesticide concentrations. Associations between summed concentrations of 35 PCB congeners and 9 individual pesticides and metabolic syndrome were examined using generalized linear modeling and logistic regression; odds ratios (OR) and 95% confidence intervals (CI) are reported. Pollutants were evaluated as quintiles and as log transformations of continuous serum concentrations. Participants were mostly female (68%) with a mean age (SD) of 53.6 (16.2) years. The racial distribution was 56% white and 44% African American; 49% met the criteria for metabolic syndrome. In unadjusted logistic regression, statistically significant and positive associations across the majority of quintiles were noted for seven individually modeled pesticides (p,p'-DDT, p,p'-DDE, HCB, β-HCCH, oxychlor, tNONA, Mirex). Following adjustment for covariables (i.e., age, sex, race, education, marital status, current smoking, alcohol consumption, positive family history of diabetes or cardiovascular disease, liver disease, BMI), significant elevations in risk were noted for p,p'-DDT across multiple quintiles (range of ORs 1.61 to 2.36), for tNONA (range of ORs 1.62-2.80) and for p,p'-DDE [OR (95% CI)] of 2.73 (1.09-6.88) in the highest quintile relative to the first. Significant trends were observed in adjusted logistic models for log HCB [OR=6.15 (1.66-22.88)], log oxychlor [OR=2.09 (1.07-4.07)] and log tNONA [3.19 (1.45-7.00)]. Summed PCB concentrations were significantly and positively associated with metabolic syndrome only in unadjusted models; adjustment resulted in attenuation of the ORs in both the quintile and log-transformed models. In conclusion, several OC pesticides were found to have significant associations with metabolic syndrome in the Anniston study population while no association was observed for PCBs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.envint.2017.07.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5627356PMC
November 2017

Cross-Calibrated Dual-Energy X-Ray Absorptiometry Scanners Demonstrate Systematic Bias in Pediatric and Young Adult Females.

J Clin Densitom 2018 Apr - Jun;21(2):281-294. Epub 2017 Feb 28.

Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, NY, USA; Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI, USA.

Consistency of dual-energy X-ray absorptiometry (DXA) scan results is critical for data integrity. For pediatric subjects, the extent to which cross-calibration of DXA scanners alleviates model-to-model scanner differences is unclear. In the current study, DXA bone outcomes were compared for same-day measurements performed using different scanners, cross-calibrated to alleviate discrepancies (Hologic; Discovery A [DISCO] and QDR 4500W [QDR]). Interscanner differences were evaluated in approximately 130 females aged 8-24 yr. Scans were performed in a single session on both QDR and DISCO scanners to compare projected area, bone mineral content, and areal bone mineral density (BMD) outputs for the whole body (total, subhead, head, arm, and leg), forearm (1/3 and ultradistal radius), lumbar spine (vertebra L3 and L1-L4), and proximal femur (femoral neck). Paired t tests evaluated interscanner differences; concordance correlation coefficients (CCCs) evaluated interscanner correlations. Root mean square error coefficients of variation were compared to same-day duplicate DISCO scan root mean square error coefficients of variation for approximately 30 adult females. Deming regression equations were generated for conversion of QDR to DISCO results and vice versa. Interscanner correlations were very high (95% confidence interval for CCC > 0.90), for all outcomes except for femoral neck area and subhead area (95% confidence interval for CCC = 0.83-0.94, 0.57-073). However, QDR values were systematically lower than Discovery values (p < 0.05), except for head area, head bone mineral content, head BMD, ultradistal BMD (QDR > Discovery, p ≤ 0.05) and L1-L4 area, L3 area, and femoral neck BMD (no differences). Most Bland-Altman and Deming regression plots indicated good interscanner agreement, with little systematic variation based on bone or body size. In pediatric and young adult females, subtle but systematic differences were noted between scans obtained on DISCO and QDR scanners, despite cross-calibration, such that most outcomes are systematically higher for DISCO than for QDR. The use of conversion equations is warranted.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jocd.2017.01.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573641PMC
November 2019

Rapid Weight Gain in Pediatric Refugees after US Immigration.

J Immigr Minor Health 2017 04;19(2):263-266

Department of Pediatrics, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY, 13210, USA.

Prior studies of immigrants to the United States show significant weight gain after 10 years of US residence. Pediatric refugees are a vulnerable population whose post-immigration weight trajectory has not been studied. We examined the longitudinal weight trajectory of 1067 pediatric refugees seen in a single university based refugee health program between the dates of September 3, 2012 and September 3, 2014 to determine how quickly significant weight gain occurs post-arrival. The most recent BMI was abstracted from the electronic health record and charts reviewed to obtain serial BMI measurements in 3 year increments after the date of US arrival. The mean arrival BMI percentile for all refugees was 47th percentile. This increased significantly to the 63rd percentile within 3 years of US arrival (p < 0.01). This rapid increase was largely attributable to African and South and Southeast Asian refugees. The overall prevalence of age and sex adjusted obesity rose from 7.4 % at arrival to 18.3 % within 9 years of US immigration exceeding the pediatric US national obesity prevalence of 16.9 %. Pediatric refugees are at increased risk of rapid weight gain after US immigration. Targeted interventions focused on prevention of weight gain in specific populations are warranted.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10903-016-0461-8DOI Listing
April 2017

Indicators of airborne fungal concentrations in urban homes: understanding the conditions that affect indoor fungal exposures.

Sci Total Environ 2015 Jun 25;517:113-24. Epub 2015 Feb 25.

Department of Pathology, SUNY Upstate Medical University, 750 E. Adams Street, Syracuse, NY 13210, United States. Electronic address:

Indoor fungal exposure can compromise respiratory health. Low-income urban areas are of concern because of high asthma and allergy rates and housing disrepair. Understanding the conditions that affect indoor fungal exposures is important for assessing health risks and for developing mitigation strategies. We examined the types and concentrations of airborne fungi inside and outside of homes in low-income areas of Syracuse, NY as well as the effect of snow cover on fungal levels. At 103 homes, air samples for viable fungi were collected, occupants were interviewed and homes were inspected for visible mold, musty odors, water problems and other factors. Multivariable logistic regression was used to relate high fungal levels to home conditions. Predominant indoor fungi included Cladosporium, Penicillium, Aspergillus, Alternaria and hyaline unknowns. Basidiomycetes and an uncommon genus Acrodontium were also found frequently due to analysis methods developed for this project. With snow cover, outdoor total fungal levels were depressed and indoor concentrations were three times higher than outdoor on average with a maximum of 29 times higher. Visible mold was related to elevated levels of Penicillium (OR 4.11 95% CI 1.37-14.0) and bacteria (OR 3.79 95% CI 1.41-11.2). Musty, moldy odors were associated with elevated concentrations of total fungi (OR 3.48 95% CI 1.13-11.6) and basidiomycetes. Cockroaches, an indicator of moisture, were associated with elevated levels of Penicillium (OR 3.66 95% CI 1.16-13.1) and Aspergillus (OR 4.36 95% CI 1.60-13.4). Increasing relative humidity was associated with higher concentrations of Penicillium, yeasts and basidiomycetes. Visible mold, musty odors, indoor humidity and cockroaches are modifiable factors that were important determinants of indoor fungal exposures. Indoor air investigators should interpret indoor:outdoor fungal ratios cautiously when snow cover is present.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.scitotenv.2015.02.060DOI Listing
June 2015

Influenza vaccine hesitancy in a low-income community in central New York State.

Hum Vaccin Immunother 2014 ;10(7):2098-103

a Department of Pediatrics; State University of New York; Upstate Medical University; Syracuse, NY USA.

Objective: Influenza vaccine (IV) coverage rates remain suboptimal among US adults. Socioeconomic disparities exist in IV coverage. We describe influenza vaccine attitudes among a low-income community in central New York.

Methods: Adults attending a Salvation Army function during December 2012 were surveyed regarding IV including their intention to be immunized. On-site IV was offered to eligible participants.

Results: The 1041 participants included Whites (non-Hispanics), African Americans, Hispanics, Native Americans, and multi-racial ethnicities. At time of enrollment, 386 (37%) participants had already received 2012-13 IV. Of the 655 unimmunized participants, 299 (46%) stated intent to receive IV, evenly distributed by age, gender, and ethnicity. Of the 312 participants who declined IV, 46% did so because of IV misperceptions. Of the 299 participants who intended to receive vaccine but had not yet done so, 284 (95%) stated the reason for delay was difficult access to vaccine. Intent to receive vaccine was strongly associated with the belief that IV is safe and/or effective (P < 0.05).

Conclusion: IV misperceptions regarding IV efficacy and safety result in suboptimal vaccine uptake in this low-income community, regardless of age, gender, or ethnicity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4161/hv.28803DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4186041PMC
February 2016

The Influence of Organized Physical Activity (Including Gymnastics) on Young Adult Skeletal Traits: Is Maturity Phase Important?

Pediatr Exerc Sci 2015 May 10;27(2):285-96. Epub 2014 Nov 10.

School of Medicine &Public Health, University of Wisconsin, Madison, WI.

We prospectively evaluated adolescent organized physical activity (PA) as a factor in adult female bone traits. Annual DXA scans accompanied semiannual records of anthropometry, maturity, and PA for 42 participants in this preliminary analysis (criteria: appropriately timed DXA scans at ~1 year premenarche [predictor] and ~5 years postmenarche [dependent variable]). Regression analysis evaluated total adolescent interscan PA and PA over 3 maturity subphases as predictors of young adult bone outcomes: 1) bone mineral content (BMC), geometry, and strength indices at nondominant distal radius and femoral neck; 2) subhead BMC; 3) lumbar spine BMC. Analyses accounted for baseline gynecological age (years pre- or postmenarche), baseline bone status, adult body size and interscan body size change. Gymnastics training was evaluated as a potentially independent predictor, but did not improve models for any outcomes (p > .07). Premenarcheal bone traits were strong predictors of most adult outcomes (semipartial r2 = .21-0.59, p ≤ .001). Adult 1/3 radius and subhead BMC were predicted by both total PA and PA 1-3 years postmenarche (p < .03). PA 3-5 years postmenarche predicted femoral narrow neck width, endosteal diameter, and buckling ratio (p < .05). Thus, participation in organized physical activity programs throughout middle and high school may reduce lifetime fracture risk in females.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1123/pes.2014-0051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4428999PMC
May 2015

Poor air quality in homes of Medicare recipients with diabetes.

Home Healthc Nurse 2014 Jun;32(6):354-61

Philip C. Morin, MS, is a Project Manager, Department of Medicine, Upstate Medical University, Syracuse, New York. Paula F. Rosenbaum, PhD, is an Associate Professor, Department of Public Health and Preventive Medicine, Upstate Medical University, Syracuse, New York. Jerrold L. Abraham, MD, is a Professor, Department of Pathology, Upstate Medical University, Syracuse, New York. Ruth S. Weinstock, MD, PhD, is a SUNY Distinguished Service Professor, Department of Medicine, Upstate Medical University, Syracuse, New York.

Poor air quality has been associated with chronic illness such as diabetes. This can be of particular importance for older adults with diabetes and other chronic conditions who spend most of their time indoors. The purpose of this study was to assess home air quality and residents' awareness and concerns about air quality in rural underserved areas of upstate New York. Implications for home care clinicians are discussed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/NHH.0000000000000094DOI Listing
June 2014

Muscle function, dynamic loading, and femoral neck structure in pediatric females.

Med Sci Sports Exerc 2014 ;46(5):911-9

1Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, NY; 2Department of Exercise Science, Syracuse University, Syracuse, NY; 3Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY; 4Vitality Program, College of Health Professions, SUNY Upstate Medical University, Syracuse, NY; and 5Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI.

Purpose: Muscle forces influence the development of bone mass and structure, but dynamic loading via impact exercise is considered particularly osteogenic. We hypothesized that indices of local muscle function and physical activity exposure would predict femoral neck (FN) structure in premenarcheal females.

Methods: We tested this hypothesis in 76 healthy, premenarcheal girls (46 gymnasts and 30 nongymnasts). Height, weight, Tanner breast stage, and prior year nonaquatic, organized physical activity level (PAL) were recorded semiannually. Hologic dual-energy x-ray absorptiometry scans (whole body, left FN) yielded total body nonbone lean mass and bone outcomes, including narrow neck (NN) hip structural analysis data. Dynamometers assessed nondominant hand grip and left hip flexion/extension indices. Parsimonious regression models tested the following as predictors of bone outcomes: local muscle function, PAL, gymnast status, and lean mass, accounting for Tanner breast stage and height, as appropriate.

Results: Hip flexion indices were significantly correlated with indices of FN mass, density, structure, and strength (P < 0.05). However, the entry of PAL, gymnast status, and lean mass into regression models supplanted local muscle function explanatory value. In contrast, for many variables, the significant association of gymnast status persisted after accounting for physical maturity, body size/lean mass, and PAL. For all skeletal indices except FNArea, NNwidth, NN endosteal diameter, and NN buckling ratio, gymnast status was more strongly associated with bone outcomes than PAL.

Conclusions: Greater activity doses and exposure to extreme dynamic loading provide independent benefits to FN structure during growth. Furthermore, weight-bearing activity and high-impact exercise exposure appear superior to local muscle force measures for prediction of FN structure.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1249/MSS.0000000000000191DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3992432PMC
November 2014

Molecular Characterization of Invasive Staphylococcus aureus Infection in Central New York Children: Importance of Two Clonal Groups and Inconsistent Presence of Selected Virulence Determinants.

J Pediatric Infect Dis Soc 2013 Mar 18;2(1):30-9. Epub 2012 Sep 18.

Department of Pediatrics, State University of New York Upstate Medical University, Syracuse, New York.

Background: The genetic makeup of circulating Staphylococcus aureus (SA) populations varies by region. The extent to which SA virulence determinants contribute to the severity of pediatric infections is poorly understood. The study objective was to describe the genetic population of invasive SA (ISA) isolates from children in the Central New York (CNY) area and the prevalence of selected virulence genes.

Methods: Clinical and demographic information for hospitalized children <19 years of age with community-onset or community-associated ISA infections, determined from clinical microbiology records, was extracted from medical records from Upstate Golisano Children's Hospital in CNY. Antibiotic susceptibility was assessed, and available isolates were genotyped and tested for the presence of selected virulence determinants. Associations between clinical and laboratory findings were evaluated using standard statistical techniques.

Results: Ninety patients with ISA disease diagnosed between 2007 and 2010 were included in the study; 74% were due to methicillin-susceptible SA (MSSA). The most common clinical diagnosis was bacteremia. Fifty-seven of 90 isolates were available for further testing. The SA pulsed-field gel electrophoresis type, agr type, and clonal complexes most commonly isolated were USA300 (n = 25, 44%), agr1 (n = 30, 52%), and CC8 (n = 25, 44%), respectively. USA300 strains were more likely to be associated with deep abscesses (P = .007), whereas non-USA300 strains were associated with medical device infections (P = .018). Isolates from patients with deep abscesses and pneumonia were more likely to carry luk-PV genes (P = .023 and P = .051, respectively).

Conclusions: MSSA remains an important problem of pediatric ISA infection in our region and results from genetically diverse SA populations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/jpids/pis087DOI Listing
March 2013

Improved body composition assessment using biceps skinfold and physical activity score in premenarcheal girls: a DXA-based validation study.

Int J Body Compos Res 2013;11(2):35-42

SUNY Upstate Medical University, USA ; Syracuse University, USA.

Objective: Age-specific body mass index (BMI) is commonly employed as an index of adiposity for pediatric clinical and research purposes. However, BMI fails to discriminate between fat and lean mass, making it an imperfect monitor for obesity. We hypothesized that simple anthropometry and organized non-aquatic physical activity assessment (PA) would provide superior explanatory value for pediatric body composition outcomes.

Research Methods And Procedures: In a cross-sectional analysis, whole body DXA assessed body composition in 120 pre-menarcheal girls. Questionnaires were used to record and generate annual means for PA. Age, Tanner breast self-stage, height, weight, BMI, skinfold thicknesses, girths and PA were examined as potential predictors of body composition outcomes, using backward stepwise multiple linear regression. A parsimonious regression model was developed in 75% and cross-validated in 25% of the total sample; models were rerun with the total sample.

Results: Subject means were as follows: age = 10.4±1.2 y; lean soft tissue (LST) = 24.4±4.2 kg; fat mass (FM) = 8.1±4.1 kg; BMI = 17.6±2.5 kg/m; PA = 6.8±5.0 h/wk; Tanner breast self-stage ranged from 1 to 3. BMI for age Z scores ranged from -2 to 2.1. Age and BMI alone yielded adjusted model r=0.44 to 0.78. The final model, including age, height, weight, biceps skinfold and PA, yielded adjusted r=0.61 to 0.92, <0.001. Prediction of LST and FM increased from r=0.64 and 0.76 to r=0.92 and 0.91, respectively.

Discussion: Compared to BMI and age alone, models including biceps skinfold, PA, height, weight and age had superior explanatory value for clinically-relevant body composition outcomes, and are feasible for clinical use.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4562384PMC
January 2013

High fecal hand contamination among wilderness hikers.

Am J Infect Control 2012 Nov 14;40(9):893-5. Epub 2012 Mar 14.

Department of Pediatrics, Upstate Medical University, Syracuse, NY 13210, USA.

Information about hand hygiene and fecal hand contamination among the general public is limited. Hands are an important vector in transmission of various pathogenic bacteria. We found high (31%) prevalence of fecal hand contamination among healthy adults engaged in hiking.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajic.2011.11.009DOI Listing
November 2012

Tibial component fixation with a peri-apatite coating: evaluation by radiostereometric analysis in a canine total knee arthroplasty model.

J Arthroplasty 2012 Jun 22;27(6):1138-48. Epub 2012 Feb 22.

Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio 43210, USA.

Cementless fixation for the tibial component in total knee arthroplasty (TKA) remains problematic. Peri-Apatite (PA), a solution-deposited hydroxyapatite, is under investigation as an option for improving the fixation of cementless tibial components. In this study, radiostereometric analysis was used to document implant migration in 48 dogs that underwent TKA with cementless, PA-coated, or cemented tibial components. Migration at 12 weeks was similar in the 2 groups. At 12 months, there was greater migration in the PA-coated group, but the difference between the 2 groups was below the threshold considered clinically significant. In this canine TKA model, cementless fixation with PA performed less well than did cemented fixation, but not to a degree that would make a clinical difference in the short term.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arth.2011.12.029DOI Listing
June 2012

Site-specific advantages in skeletal geometry and strength at the proximal femur and forearm in young female gymnasts.

Bone 2012 May 9;50(5):1173-83. Epub 2012 Feb 9.

Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, NY 13210, USA.

Purpose: We evaluated site-specific skeletal adaptation to loading during growth, comparing radius (RAD) and femoral neck (FN) DXA scans in young female gymnasts (GYM) and non-gymnasts (NON).

Methods: Subjects from an ongoing longitudinal study (8-26yr old) underwent annual DXA scans (proximal femur, forearm, total body) and anthropometry, completing maturity and physical activity questionnaires. This cross-sectional analysis used the most recent data meeting the following criteria: gynecological age ≤2.5yr post-menarche; and GYM annual mean gymnastic exposure ≥5.0h/wk in the prior year. Bone geometric and strength indices were derived from scans for 173 subjects (8-17yr old) via hip structural analysis (femoral narrow neck, NN) and similar radius formulae (1/3 and Ultradistal (UD)). Maturity was coded as M1 (Tanner I breast), M2 (pre-menarche, ≥Tanner II breast) or M3 (post-menarche). ANOVA and chi square compared descriptive data. Two factor ANCOVA adjusted for age, height, total body non-bone lean mass and percent body fat; significance was tested for main effects and interactions between gymnastic exposure and maturity.

Results: At the distal radius, GYM means were significantly greater than NON means for all variables (p<0.05). At the proximal femur, GYM exhibited narrower periosteal and endosteal dimensions, but greater indices of cortical thickness, BMC, aBMD and section modulus, with lower buckling ratio (p<0.05). However, significant interactions between maturity and loading were detected for the following: 1) FN bone mineral content (BMC) and NN buckling ratio (GYM BMC advantages only in M1 and M3; for BMC and buckling ratio, M1 advantages were greatest); 2) 1/3 radius BMC, width, endosteal diameter, cortical cross-sectional area, and section modulus (GYM advantages primarily post-menarche); and 3) UD radius BMC and axial compressive strength (GYM advantages were larger with greater maturity, greatest post-menarche).

Conclusions: Maturity-specific comparisons suggested site-specific skeletal adaptation to loading during growth, with greater advantages at the radius versus the proximal femur. At the radius, GYM advantages included greater bone width, cortical cross-sectional area and cortical thickness; in contrast, at the femoral neck, GYM bone tissue cross-sectional area and cortical thickness were greater, but bone width was narrower than in NON. Future longitudinal analyses will evaluate putative maturity-specific differences.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.bone.2012.01.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3340420PMC
May 2012

Polychlorinated biphenyl (PCB) exposure and diabetes: results from the Anniston Community Health Survey.

Environ Health Perspect 2012 May 14;120(5):727-32. Epub 2012 Feb 14.

State University of New York Upstate Medical University, Syracuse, New York 13210, USA.

Background: Polychlorinated biphenyls (PCBs) manufactured in Anniston, Alabama, from 1929 to 1971 caused significant environmental contamination. The Anniston population remains one of the most highly exposed in the world.

Objectives: Reports of increased diabetes in PCB-exposed populations led us to examine possible associations in Anniston residents.

Methods: Volunteers (n = 774) from a cross-sectional study of randomly selected households and adults who completed the Anniston Community Health Survey also underwent measurements of height, weight, fasting glucose, lipid, and PCB congener levels and verification of medications. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to assess the relationships between PCBs and diabetes, adjusting for diabetes risk factors. Participants with prediabetes were excluded from the logistic regression analyses.

Results: Participants were 47% African American, 70% female, with a mean age of 54.8 years. The prevalence of diabetes was 27% in the study population, corresponding to an estimated prevalence of 16% for Anniston overall; the PCB body burden of 35 major congeners ranged from 0.11 to 170.42 ppb, wet weight. The adjusted OR comparing the prevalence of diabetes in the fifth versus first quintile of serum PCB was 2.78 (95% CI: 1.00, 7.73), with similar associations estimated for second through fourth quintiles. In participants < 55 years of age, the adjusted OR for diabetes for the highest versus lowest quintile was 4.78 (95% CI: 1.11, 20.6), whereas in those ≥ 55 years of age, we observed no significant associations with PCBs. Elevated diabetes prevalence was observed with a 1 SD increase in log PCB levels in women (OR = 1.52; 95% CI: 1.01, 2.28); a decreased prevalence was observed in men (OR = 0.68; 95% CI: 0.33, 1.41).

Conclusions: We observed significant associations between elevated PCB levels and diabetes mostly due to associations in women and in individuals < 55 years of age.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1289/ehp.1104247DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3346783PMC
May 2012

Mechanical loading during growth is associated with plane-specific differences in vertebral geometry: A cross-sectional analysis comparing artistic gymnasts vs. non-gymnasts.

Bone 2011 Nov 3;49(5):1046-54. Epub 2011 Aug 3.

Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, NY, USA.

Lumbar spine geometry, density and indices of bone strength were assessed relative to menarche status, using artistic gymnastics exposure during growth as a model of mechanical loading. Paired posteroanterior (pa) and supine lateral (lat) DXA scans of L3 for 114 females (60 ex/gymnasts and 54 non-gymnasts) yielded output for comparison of paired (palat) versus standard pa and lat outcomes. BMC, areal BMD, vertebral body dimensions, bone mineral apparent density (BMAD), axial compressive strength (IBS) and a fracture risk index were evaluated, modeling vertebral body geometry as an ellipsoid cylinder. Two-factor ANCOVA tested statistical effects of gymnastic exposure, menarche status and their interaction, adjusting for age and height as appropriate. Compared to non-gymnasts, ex/gymnasts exhibited greater paBMD, paBMC, paWidth, pa Cross-sectional area (CSA), paVolume, latBMD, latBMAD, palatCSA and palatIBS (p<0.05). Non-gymnasts exhibited greater latDepth/paWidth, latBMC/paBMC, latVHeight, latArea and Fracture Risk Index. Using ellipsoid vertebral geometric models, no significant differences were detected for pa or palat BMAD. In contrast, cuboid model results (Carter et al., 1992) suggested erroneous ex/gymnast paBMAD advantages, resulting from invalid assumptions of proportional variation in linear skeletal dimensions. Gymnastic exposure was associated with shorter, wider vertebral bodies, yielding greater axial compressive strength and lower fracture risk, despite no BMAD advantage. Our results suggest the importance of plane-specific vertebral geometric adaptation to mechanical loading during growth. Paired scan output provides a more accurate assessment of this adaptation than pa or lat plane scans alone.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.bone.2011.07.033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3200503PMC
November 2011

Vitamin D and pelvic floor disorders in women: results from the National Health and Nutrition Examination Survey.

Obstet Gynecol 2010 Apr;115(4):795-803

From the Department of Obstetrics and Gynecology, SUNY Upstate Medical University, and Gynecology and Urogynecology Center, St. Joseph's Hospital Health Center, Syracuse, New York; Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, New York.

Objective: To estimate the prevalence of vitamin D deficiency in women with pelvic floor disorders and to evaluate possible associations between vitamin D levels and pelvic floor disorders.

Methods: Using 2005-2006 National Health and Nutrition Examination Survey data, we performed a cross-sectional analysis of nonpregnant women older than 20 years of age with data on both pelvic floor disorders and vitamin D measurements (n=1,881). Vitamin D levels lower than 30 ng/mL were considered insufficient. The prevalence of demographic factors, pelvic floor disorders, and vitamin D levels were determined, accounting for the multi-stage sampling design; odds ratios (OR) and 95% confidence intervals (CI) were calculated to evaluate associations between vitamin D levels and pelvic floor disorders with control for known risk factors.

Results: One or more pelvic floor disorders were reported by 23% of women. Mean vitamin D levels were significantly lower for women reporting at least one pelvic floor disorder and for those with urinary incontinence, irrespective of age. In adjusted logistic regression models, we observed significantly decreased risks of one or more pelvic floor disorders with increasing vitamin D levels in all women aged 20 or older (OR, 0.94; 95% CI, 0.88-0.99) and in the subset of women 50 years and older (OR, 0.92; 95% CI, 0.85-0.99). Additionally, the likelihood of urinary incontinence was significantly reduced in women 50 and older with vitamin D levels 30 ng/mL or higher (OR, 0.55; 95% CI, 0.34-0.91).

Conclusion: Higher vitamin D levels are associated with a decreased risk of pelvic floor disorders in women.

Level Of Evidence: III.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/AOG.0b013e3181d34806DOI Listing
April 2010

Incidence of invasive community-onset Staphylococcus aureus infections in children in Central New York.

J Pediatr 2010 Jan;156(1):152-154.e1

Department of Pediatrics, Upstate Medical University, Syracuse, NY, USA.

We determined the incidence of invasive community-onset Staphylococcus aureus infections, clinical characteristics, and antibiotic susceptibilities in 128 hospitalized children in central New York. The prevalence of invasive S aureus infections in our institution remained <1% between 1996 and 2006, although the proportion of methicillin-resistant S aureus infections significantly increased.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpeds.2009.07.020DOI Listing
January 2010

Indoor airborne fungi and wheeze in the first year of life among a cohort of infants at risk for asthma.

J Expo Sci Environ Epidemiol 2010 Sep 17;20(6):503-15. Epub 2009 Jun 17.

Department of Public Health & Preventive Medicine, State University of New York Upstate Medical University, Syracuse, USA.

In studies worldwide, respiratory outcomes such as cough, wheeze and asthma have been consistently linked to mold exposure. Young children spend most of their time indoors and may be particularly vulnerable. We evaluated the associations between exposure to airborne fungal levels and episodes of wheezing in a cohort of 103 infants at risk for asthma (due to maternal history of asthma), living primarily in low-income urban settings. Using a new protocol that facilitates identification of rare and slow-growing fungi, we measured the type and concentration of cultured fungi in home air samples taken early in the infant's first year of life. We also inspected the homes for visible mold, water damage and other housing and environmental conditions. All homes had measurable indoor airborne fungi and 73%, had some sign of mold, water damage, dampness or a musty odor. One or more episodes of wheeze during the first year of life were observed in 38% of infants. Multiple logistic regression showed high indoor levels of Penicillium were a significant risk factor for wheeze (OR 6.18; 95% CI: 1.34-28.46) in the first year of life after controlling for season of sampling, smoking, endotoxin levels, day care attendance and confounders. Acrodontium, a rarely reported fungal genus, was detected in 18% of study homes, and was associated with wheeze in unadjusted models (OR 2.75; 95% CI 0.99-7.61), but not after adjustment for confounders. Total fungal levels, visually observed mold, dampness, water damage or musty odors were not significantly associated with wheeze.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/jes.2009.27DOI Listing
September 2010

Knee medial compartment contact pressure increases with release of the type I anterior intermeniscal ligament.

Am J Sports Med 2009 Jul 13;37(7):1412-6. Epub 2009 Mar 13.

Department of Orthopedic Surgery, State University of New York Upstate Medical University, Syracuse, New York 13210, USA.

Background: The anterior intermeniscal ligament of the knee is at risk during knee arthroscopy, anterior cruciate ligament reconstruction, and tibial nail insertion.

Hypothesis: Release of the anterior intermeniscal ligament, in knees with type I ligaments, will result in altered contact pressures in the medial compartment.

Study Design: Controlled laboratory study.

Methods: Five fresh-frozen human cadaveric knees with intact type I anterior intermeniscal ligaments were chosen for testing in a modified MTS machine from 0 degrees to 60 degrees of flexion under 2 conditions: (1) intact and (2) after sharp sectioning of the anterior intermeniscal ligament. Measurements were made using inframeniscal contact pressure sensors covering the medial compartment. Poststudy analysis was done in 10 degrees increments between 0 degrees and 60 degrees of flexion, looking at peak contact pressure and the amount of contact area seeing pressure.

Results: Sectioning of the anterior intermeniscal ligament caused a statistically significant increase in the peak pressure at 20 degrees , 30 degrees , 40 degrees , and 50 degrees of knee flexion. The largest change occurred at 40 degrees of knee flexion, when the peak pressure increased by 27.5% (3.68 MPa to 4.69 MPa). Contact area decreased, although this difference was not statistically significant.

Conclusion: Release of the anterior intermeniscal ligament results in increased peak contact pressures in the medial compartment of the knee.

Clinical Relevance: Care should be taken to avoid sacrifice of this ligament during surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0363546509331418DOI Listing
July 2009

Identifying scapholunate ligamentous injury.

J Orthop Res 2009 Mar;27(3):394-9

Department of Orthopedic Surgery, SUNY Upstate Medical University, 3214 Institute for Human Performance, 505 Irving Avenue, Syracuse, NY 13210, USA.

The first purpose of this study was to develop a noninvasive clinical tool that could predict whether the scapholunate interosseous ligament and other secondary stabilizing ligaments are injured in the presence of suspected scapholunate instability. The second purpose of this study was to determine which of those ligaments or ligament groups have been injured. Kinematic and three-dimensional (3D) meaurements from 62 cadaver wrists moved in a wrist joint motion simulator were used to develop various neural network predictive models. One group of models was based on angular changes in scaphoid and lunate motion before and after ligament sectioning (representing scapholunate instability). A second group of models was based on changes in the minimum distance between the scaphoid and lunate as well as other 3D gap measurements. The models, based on the scaphoid and lunate angular data, could predict with a 93% accuracy rate whether the wrist ligaments were intact. These models could also predict whether it was the dorsal ligaments or the volar ligaments that were sectioned 84% of the time. The models worked best using data with the wrist in 10 to 30 degrees of wrist flexion. The viability of a CT-based predictive model has been demonstrated by obtaining high prediction rates, sensitivity, specificity, and kappa statistic values.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/jor.20749DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4532271PMC
March 2009

Worksite e-mail health promotion trial: Early lessons.

Eval Program Plann 2006 Nov 10;29(4):405-12. Epub 2006 Oct 10.

Department of Orthopedics, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA 01655, USA.

In preparation for an electronic mail (e-mail) and web-based health promotion intervention across multiple worksites, secure, regulatory-compliant, user-friendly e-mail and Internet applications were used to recruit potential participants across worksites, to enroll participants, and to collect baseline health assessment data. Specific hardware and software information technology environments were required of the 19 participating worksites. Sequential e-mails introduced the study and invited participation. Twenty-four percent of all employees (1106 of approximately 4600) provided consent. E-mail delivered a web link for the baseline study assessment, and reminder e-mails were sent to prompt completion. Of those who consented, 888 (80%) completed baseline health and behavior data surveys. An HTML-native web survey software was more stable across computing environments. Using e-mail and web assessment, this research recruited, enrolled, and collected data from more than 850 participants. Technical and operational challenges emerged at each step. Solutions and recommendations are discussed. Overall, this experience suggests that the use of e-mail and web software can facilitate recruitment, enrollment, and data acquisition through direct contact with study participants. This experience yields a series of lessons learned for using e-mail and the Internet to support multi-site trials.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.evalprogplan.2006.08.010DOI Listing
November 2006

Competencies, essential training, and resources viewed by designated institutional officials as important to the position in graduate medical education.

Acad Med 2006 May;81(5):426-31

Medical Education Research and Outcomes, Academic Affairs, Christiana Care Health System, Newark, Delaware, USA.

Purpose: In 1998, the Accreditation Council for Graduate Medical Education (ACGME) added the stipulation that each institution providing graduate medical education (GME) have a Designated Institutional Official (DIO). The authors conducted this study via a cross-sectional survey designed to provide descriptive data on the beliefs held by DIOs regarding required competencies, training and experience, and desired resources for the position.

Method: The authors collected data between January 2004 and May 2004 using a multistep process that included a prenotice letter; a survey, cover letter, and stamped return envelope; a thank you/reminder postcard; and a replacement survey with new cover letter and stamped return envelope. Data were summarized using descriptive statistics.

Results: Completed surveys were received from 243 of 363 DIOs (66.9%). Eighty-two percent indicated that DIOs should have specified minimum experience or training requirements. Ten competency items were viewed as essential by greater than 50% of respondents, with five items endorsed by over 95% of respondents: professionalism, verbal communication skills, interpersonal skills, leadership skills, and written communications skills. The percentage of responding DIOs who indicated they would be very likely to use resources were as follows: templates for GME policies, contracts, and affiliation agreements (83.1%); DIO-specific training (58.0%); data on DIO demographics (53.9%); DIO job description templates (46.9%); a clear description of DIO versus program director responsibilities (46.1%); and a DIO certification program (32.1%).

Conclusions: Designated Institutional Officials supported the idea that there should be minimum experience and requirements and demonstrated remarkable consistency in endorsing essential competencies for the position. DIOs, their respective institutions, the ACGME, and other GME organizations and associations may use the data from this study to develop the role further.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/01.ACM.0000222279.28824.f5DOI Listing
May 2006

Using sequential e-mail messages to promote health behaviors: evidence of feasibility and reach in a worksite sample.

J Med Internet Res 2006 Mar 30;8(1):e3. Epub 2006 Mar 30.

Department of Orthopedics, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA.

Background: US adults report suboptimal physical activity and fruit and vegetable intake. Innovative strategies to promote healthy behaviors are needed. Employee health promotion programs have been associated with reductions in health risks but are labor-intensive and costly to implement. E-mail and Web-based worksite programs have the potential to reach a broad adult population and to provide a cost-effective approach to employee wellness programming.

Objective: To assess the feasibility of using sequential e-mail messages to promote physical activity and increase fruit and vegetable intake among employed adults.

Methods: Employees at one worksite of a large insurance company in New York State were invited to participate. Interested workers provided written consent. After completing a baseline survey, participants received daily e-mails, Monday through Friday, for 26 weeks. The e-mails provided (a) succinct strategies to encourage physical activity or increase fruit and vegetable intake and (b) links to detailed Web-based information and tools. Program reach was assessed by the number of e-mails opened, measures of sustained participation over 6 months, and the number of health-related Web-links clicked.

Results: Of 960 employees, 388 (40%) consented to participate; of these, 345 (89%) completed the baseline health survey. After 6 months, 70% of the 345 participants had opened 50% or more of the daily e-mails. In addition, 75% of participants continued to open at least one e-mail a week through week 26 of the study. E-mail opening rates did not vary by gender, age, income, education, ethnicity, or baseline health behavior.

Conclusions: The rate of enrollment and sustained participation document the feasibility, broad reach, employee acceptance, and potential value of using electronic communications for health promotion in the workplace.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/jmir.8.1.e3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1550693PMC
March 2006