Publications by authors named "Scott McIntosh"

164 Publications

Translation and Examination of the Reliability and Validity of the Spanish Version of the Smoking Self-Efficacy Questionnaire Among Latino Smokers.

Tob Use Insights 2021 29;14:1179173X211035366. Epub 2021 Jul 29.

Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA.

The 12-item Smoking Self-Efficacy Questionnaire (SEQ-12) is a valid and reliable instrument to assess confidence in one's ability to refrain from smoking in a variety of different situations. This study evaluated the psychometric properties of the Spanish version of the 12-item Smoking Self-Efficacy Questionnaire (SEQ-12) among a sample of Spanish-speaking Latino smokers engaged in a smoking cessation research study. A forward-backward translation procedure guided the translation of the SEQ-12 into Spanish. The Spanish version of the SEQ-12 showed promising internal consistency reliability and construct validity among Latino smokers, with potential applications in both research and clinical settings.
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http://dx.doi.org/10.1177/1179173X211035366DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8326995PMC
July 2021

Electronic cigarette use intensity measurement challenges and regulatory implications.

Tob Control 2021 May 31. Epub 2021 May 31.

Division of Therapeutics and Medical Consequences, National Institute on Drug Abuse, Bethesda, Maryland, USA.

Assessing tobacco use intensity allows researchers to examine tobacco use in greater detail than assessing ever or current use only. Tobacco use intensity measures have been developed that are specific to tobacco products, such as asking smokers to report number of cigarettes smoked per day. However, consensus on electronic cigarette use intensity measures that can be used for survey research has yet to be established due to electronic cigarette product and user behavior heterogeneity. While some survey measures that attempt to assess electronic cigarette use intensity exist, such as examining number of 'times' using an electronic cigarette per day, number of puffs taken from an electronic cigarette per day, volume of electronic cigarette liquid consumed per day, or nicotine concentration of electronic cigarette liquid, most measures have limitations. Challenges in electronic cigarette measurement often stem from variations across electronic cigarette device and liquid characteristics as well as the difficulty that many electronic cigarette users have regarding answering questions about their electronic cigarette device, liquid, or behavior. The inability for researchers to measure electronic cigarette use intensity accurately has important implications such as failing to detect unintended consequences of regulatory policies. Development of electronic cigarette use intensity measures, though not without its challenges, can improve understanding of electronic cigarette use behaviors and associated health outcomes and inform development of regulatory policies.
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http://dx.doi.org/10.1136/tobaccocontrol-2021-056483DOI Listing
May 2021

Relationship between perceived social support and postpartum care attendance in three Latin American countries: a cross-sectional analytic study.

Glob Health Res Policy 2021 05 7;6(1):16. Epub 2021 May 7.

University of Rochester, School of Medicine and Dentistry, Obstetrics and Gynecology Department Research Division, 601 Elmwood Avenue, Rochester, NY, 14642, USA.

Background: Postpartum Care is a strategy to improve survival of women and newborns, especially in low- and middle-income countries. Early post-partum care can promote healthy behaviors and the identification of risk factors associated with poorer pregnancy-related outcomes. The objective of this study was to assess the association of perceived social support with attendance to post-partum care in women from three Latin-American and Caribbean countries: Costa Rica, Dominican Republic and Honduras.

Methods: Women aged 18+ who completed a pregnancy in the past 5 years were interviewed in local healthcare and community settings in each country. Perceived social support (PSS) was the primary explanatory variable and the primary outcome was self-reported attendance to post-partum care. Odds Ratios (OR) with 95% confidence intervals derived from logistic regression documented the association between variables. Adjusted Odds Ratios (AOR) were calculated, controlling for social and pregnancy-related confounders. Hosmer- Lemeshow's Goodness-of-Fit statistic was computed to assess model fit.

Results: Our cohort of 1199 women across the three Latin-American and Caribbean countries showed relatively high attendance to post-partum care (82.6%, n = 990). However, 51.7% (n = 581) of women reported lower levels of total PSS. Women were more likely to attend postpartum care if they had mean and higher levels of PSS Family subscale (OR: 1.9, 95%CI: 1.4, 2.7), Friends subscale (OR 1.3, 95%CI: 0.9,1.8), Significant Other subscale (OR 1.8, 95%CI: 1.3, 2.4) and the Total PSS (OR 1.8, 95%CI: 1.3, 2.5). All associations were statistically significant at p < 0.05, with exception of the Friends subscale. Women with higher levels of total PSS were more likely to attend to post-partum care (AOR:1.40, 0.97, 1.92) even after controlling for confounders (education, country, and food insecurity).

Conclusions: Women with higher perceived social support levels were more likely to attend to post-partum care. From all countries, women from Dominican Republic had lower perceived social support levels and this may influence attendance at post-partum care for this subgroup. Societal and geographic factors can act as determinants when evaluating perceived social support during pregnancy.
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http://dx.doi.org/10.1186/s41256-021-00196-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8103641PMC
May 2021

CTSA recruitment resources: An inventory of what CTSA hubs are currently offering.

J Clin Transl Sci 2020 May 12;4(6):529-536. Epub 2020 May 12.

University of Rochester, Clinical and Translation Science Institute, Rochester, NY, USA.

Introduction: In order to tackle the challenge of efficiently meeting clinical research accrual goals, many Clinical and Translational Science Award (CTSA) recipients have developed recruitment support mechanisms and resources to help investigators successfully recruit study participants. Disseminating recruitment best practices and developing collaborations between institutions can help strengthen recruitment capabilities and methodologies currently utilized by researchers.

Methods: To discover what recruitment resources and mechanisms CTSAs are using, the CTSA Recruitment and Retention working group developed an electronic survey, which was distributed to CTSAs between May and July 2019. The survey contained over 50 multiple choice and short answer questions, with 40 of the 64 CTSA institutions completing the survey. Institutions reported on registries, feasibility assessment tools, clinical trial listings, experience recruiting special populations, program operations and evaluation, workforce education, social media use, and other recruitment resources.

Results: All respondents currently utilize some form of a volunteer registry; over 80% of the CTSAs provide investigators with recruitment consultations, feasibility assessments, study listings, and electronic health record (EHR) utilization; 73% assist with study materials; 47% offer social media assistance. Many institutions reported success in recruiting patients and healthy volunteers, but difficulty in recruiting special populations such as non-English-speaking persons and rural populations. Additional recruitment tools included use of the EHR to facilitate recruitment, use of registries, and use of social media to engage participants.

Conclusions: Areas of opportunity or growth include the development of innovative solutions in the areas of social media advertising, identification of participants from special populations, and research volunteer engagement.
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http://dx.doi.org/10.1017/cts.2020.44DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8057486PMC
May 2020

Immediate impact of the COVID-19 pandemic on CTSA TL1 and KL2 training and career development.

J Clin Transl Sci 2020 Jun 29;4(6):556-561. Epub 2020 Jun 29.

Center for Leading Innovation and Collaboration, Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA.

Clinical and Translational Science Award (CTSA) TL1 trainees and KL2 scholars were surveyed to determine the immediate impact of the COVID-19 pandemic on training and career development. The most negative impact was lack of access to research facilities, clinics, and human subjects, plus for KL2 scholars lack of access to team members and need for homeschooling. TL1 trainees reported having more time to think and write. Common strategies to maintain research productivity involved time management, virtual connections with colleagues, and shifting to research activities not requiring laboratory/clinic settings. Strategies for mitigating the impact of the COVID-19 pandemic on training and career development are described.
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http://dx.doi.org/10.1017/cts.2020.504DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7605410PMC
June 2020

Termination of Solar Cycles and Correlated Tropospheric Variability.

Earth Space Sci 2021 Apr 2;8(4):e2020EA001223. Epub 2021 Apr 2.

National Center for Atmospheric Research High Altitude Observatory Boulder CO USA.

The Sun provides the energy required to sustain life on Earth and drive our planet's atmospheric circulation. However, establishing a solid physical connection between solar and tropospheric variability has posed a considerable challenge. The canon of solar variability is derived from the 400 years of observations that demonstrates the waxing and waning number of sunspots over an 11(-ish) year period. Recent research has demonstrated the significance of the underlying 22 years magnetic polarity cycle in establishing the shorter sunspot cycle. Integral to the manifestation of the latter is the spatiotemporal overlapping and migration of oppositely polarized magnetic bands. We demonstrate the impact of "terminators"-the end of Hale magnetic cycles-on the Sun's radiative output and particulate shielding of our atmosphere through the rapid global reconfiguration of solar magnetism. Using direct observation and proxies of solar activity going back some six decades we can, with high statistical significance, demonstrate a correlation between the occurrence of terminators and the largest swings of Earth's oceanic indices: the transition from El Niño to La Niña states of the central Pacific. This empirical relationship is a potential source of increased predictive skill for the understanding of El Niño climate variations, a high-stakes societal imperative given that El Niño impacts lives, property, and economic activity around the globe. A forecast of the Sun's global behavior places the next solar cycle termination in mid-2020; should a major oceanic swing follow, then the challenge becomes: when does correlation become causation and how does the process work?
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http://dx.doi.org/10.1029/2020EA001223DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8047923PMC
April 2021

Perceptions of Tobacco Product-Specific COVID-19 Risk and Changes in Tobacco Use Behaviors Among Smokers, E-Cigarette Users, and Dual Users.

Nicotine Tob Res 2021 Aug;23(9):1617-1622

Department of Health Behavior, Western New York Center for Research on Flavored Tobacco, Roswell Park Comprehensive Cancer Center, Buffalo, NY.

Introduction: Coronavirus Disease 2019 (COVID-19) is a public health crisis, but its effects on tobacco users remain ill-defined. This report aimed to assess the relationship between tobacco product-specific risk perceptions for COVID-19 and changes in tobacco use since the start of the pandemic.

Methods: A sample (n = 776) of past-30 day exclusive smokers (n = 238), exclusive e-cigarette users (n = 143), and dual users (n = 395) residing in the US and aged 18 or older were collected using Mechanical Turk from April 27 to June 8, 2020. Adjusted associations between tobacco product-specific COVID-19 risk perceptions (ie risk that smokers/vapers are at for COVID-19 relative to non-smokers/non-vapers) and changes in tobacco use since the pandemic began were assessed using partial proportional odds models.

Results: A majority of those who used cigarettes (63.7%) and e-cigarettes (56.1%) felt that the risk of COVID-19 was greater for users of their tobacco product than for non-users. Twenty-four percent of smokers had increased their cigarette use since the start of the pandemic and 28.0% had decreased. Similarly, 27.3% of e-cigarette users had increased their e-cigarette use since the start of the pandemic and 23.8% had decreased. Higher risk perceptions for COVID-19 were associated with reductions in tobacco use since the pandemic began for exclusive e-cigarette users and dual users.

Conclusions: These findings provide the support that tobacco product-specific COVID-19 risk perceptions may be an important correlate of changes in tobacco use during the pandemic. Targeted information to inform tobacco users regarding their risks for COVID-19 is needed during this public health crisis.

Implications: Few published studies have investigated the relationship between tobacco product-specific risk perceptions for COVID-19 and changes in tobacco product use since the pandemic began. This study enhances the current literature by providing evidence that higher tobacco product-specific risk perceptions for COVID-19 are associated with reductions in tobacco use since the pandemic began for exclusive e-cigarette users and dual users of cigarettes and e-cigarettes. Additionally, daily tobacco users may be more likely to have increased their tobacco use than non-daily users. These findings emphasize the importance of disseminating targeted health information to tobacco users regarding COVID-19 risks.
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http://dx.doi.org/10.1093/ntr/ntab053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8083727PMC
August 2021

Cross-Sectional Association Between Exclusive and Concurrent Use of Cigarettes, ENDS, and Cigars, the Three Most Popular Tobacco Products, and Wheezing Symptoms Among U.S. Adults.

Nicotine Tob Res 2020 12;22(Suppl 1):S76-S84

Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, NY.

Introduction: This study assessed the association of exclusive and concurrent use of cigarettes, electronic nicotine delivery systems (ENDS), and cigars with ever and past 12-month wheezing symptoms among a nationally representative sample of US adult current tobacco users.

Methods: Cross-sectional data from the Population Assessment of Tobacco and Health (PATH) Study Wave 3 (W3) were used. The weighted prevalence of self-reported ever and past 12-month wheezing symptoms for noncurrent users compared with users of cigarettes, ENDS, cigars, and any combination of these products (polytobacco use of these tobacco products) were presented for 28 082 adults. The cross-sectional association of tobacco use with self-reported wheezing symptoms was assessed using weighted multivariable and ordinal logistic regression with consideration of complex sampling design.

Results: Significantly higher odds of ever had wheezing or whistling in the chest at any time in the past were observed among current cigarette (adjusted odds ratio: 2.62, 95% confidence intervals [CI]: 2.35, 2.91), ENDS (1.49, 95% CI: 1.14, 1.95), and polytobacco users (2.67, 95% CI: 2.26, 3.16) compared with noncurrent users. No associations were seen for cigar use. Polytobacco use was associated with a higher odds of ever wheezing when compared with exclusive ENDS (1.61, 95% CI: 1.19, 2.17) and exclusive cigar use (2.87, 95% CI: 1.93, 4.26), but not exclusive use of cigarettes.

Conclusions: Ever wheezing is associated with the use of cigarettes, ENDS, and polytobacco use of cigarettes, ENDS, and/or cigars, but not cigar use. The association of polytobacco use and wheezing appears to be driven by cigarette use.

Implications: Cross-sectional associations with ever and past 12-month wheezing symptoms were found to be the strongest among cigarette users, exclusively or in combination. Future longitudinal research is needed to better understand how cigarette use interacts with other tobacco and nicotine products and contributes to respiratory symptoms.
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http://dx.doi.org/10.1093/ntr/ntaa199DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8224835PMC
December 2020

Flavor Inconsistencies between Flavored Tobacco Products among US Adults.

Am J Health Behav 2020 09;44(5):617-630

Professor, Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY.

Banning flavors in some tobacco products, while allowing them in others, may shift consumer preferences towards products in which flavors are still allowed. In this study, we examine flavor popularity and inconsistencies in flavor preference across non-cigarette tobacco products among US adults. We used data from the Population Assessment of Tobacco and Health Study Wave 3 to assess the prevalence of flavor preference for users of non-cigarette tobacco products (N = 9037), as well as flavor inconsistencies between products among polyusers (N = 3183). Most users of flavored tobacco products reported using one flavor category per product. Fruit and tobacco were among the most commonly used flavor categories of ENDS, hookah, traditional cigars, and cigarillo/filtered cigars. Menthol/mint was the most common flavor among snus/smokeless users. Polyusers of ENDS and traditional cigars had the largest inconsistency, where about 68%-76% used different flavors across products. Conversely, polyusers of traditional cigars and cigarillos/filtered cigars had the lowest inconsistency (25%-28%). Flavor preferences differed according to product, suggesting that consumers are not likely to switch across products to maintain a flavor preference. Future research should assess flavor preferences prospectively to improve understanding of the potential benefits of flavor bans.
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http://dx.doi.org/10.5993/AJHB.44.5.6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7751059PMC
September 2020

Association of flavored electronic nicotine delivery system (ENDS) use with self-reported chronic obstructive pulmonary disease (COPD): Results from the Population Assessment of Tobacco and Health (PATH) study, Wave 4.

Tob Induc Dis 2020 1;18:82. Epub 2020 Oct 1.

Department of Clinical and Translational Research, University of Rochester Medical Center, Rochester, United States.

Introduction: Flavors other than tobacco flavor have been identified as a major reason for electronic nicotine delivery system (ENDS) initiation in youth and are thought to contribute to the continued use of ENDS in users of all ages. Our previous research showed a significant association between overall ENDS use and COPD. This study aims to identify the association of ENDS flavor categories with self-reported COPD.

Methods: The data analysis included 4909 adults from Population Assessment of Tobacco and Health (PATH) Wave 4 data who were ever established ENDS users and responded to an item about diagnosis of COPD. Weighted multivariable logistic regression models were used to examine the association between different ENDS flavors and self-reported COPD considering complex sampling design.

Results: Among 4909 ever established ENDS users, 418 adults (weighted percentage 9.8%) had self-reported COPD. Self-reported COPD prevalence differed between different ENDS flavor categories, with the highest (weighted percentage 19.9%) occurring among tobacco flavor users. Compared to non-tobacco flavor categories, tobacco flavor category showed significantly higher association with self-reported COPD (AOR=2.05; 95% CI: 1.20-3.53), after adjusting for potential confounding variables. No significant associations with self-reported COPD were found for other examined ENDS flavor categories including menthol/mint, fruit, candy/ desserts/other-sweets, and other flavors, compared to their corresponding non-users.

Conclusions: Tobacco flavored ENDS use was significantly associated with self-reported COPD. Future studies are needed to confirm the biological and epidemiological association of flavored ENDS use with COPD.
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http://dx.doi.org/10.18332/tid/127238DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7549379PMC
October 2020

Global maps of the magnetic field in the solar corona.

Science 2020 08;369(6504):694-697

School of Earth and Space Sciences, Peking University, Beijing 100871, People's Republic of China.

Understanding many physical processes in the solar atmosphere requires determination of the magnetic field in each atmospheric layer. However, direct measurements of the magnetic field in the Sun's corona are difficult to obtain. Using observations with the Coronal Multi-channel Polarimeter, we have determined the spatial distribution of the plasma density in the corona and the phase speed of the prevailing transverse magnetohydrodynamic waves within the plasma. We combined these measurements to map the plane-of-sky component of the global coronal magnetic field. The derived field strengths in the corona, from 1.05 to 1.35 solar radii, are mostly 1 to 4 gauss. Our results demonstrate the capability of imaging spectroscopy in coronal magnetic field diagnostics.
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http://dx.doi.org/10.1126/science.abb4462DOI Listing
August 2020

Home smoking and vaping policies among US adults: results from the Population Assessment of Tobacco and Health (PATH) study, wave 3.

Prev Med 2020 10 18;139:106215. Epub 2020 Jul 18.

Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd, Rochester, NY, USA. Electronic address:

We examined the prevalence of home smoking and vaping restrictions among US adults, and compared home policy differences for smoking and vaping among vapers, smokers, and dual users. Secondary data from the Population Assessment of Tobacco and Health (PATH) Study Wave 3 (2015-2016) with 28,148 adults were analyzed using weighted multivariable logistic regression models that account for complex sampling design to compare differences in home policies among non-users, vapers only, smokers only, and dual users. Compared to never-users, current vapers who were ex-smokers and dual users were more likely to allow home vaping (aOR = 11.06, 95% CI: 8.04-15.21; aOR = 6.44, 95% CI: 5.01-8.28) and smoking (aOR = 1.62, 95% CI: 1.19-2.22; aOR = 3.58, 95% CI: 2.88-4.45). Current smokers were more likely to allow vaping (aOR = 3.53, 95% CI: 3.06-4.06) and smoking (aOR = 4.27, 95% CI: 3.73-4.89) inside the home than never-users. Current vapers who never smoked were more likely to allow vaping inside the home than never-users (aOR = 2.45, 95% CI: 1.53-3.93). Vapers reported much lower rates of vape-free home policies relative to both their smoke-free home policies and to vape-free home policies among smokers. Vapers may be using e-cigarettes in hopes of harm reduction, but interpreting "harm reduction" as safe, thus exposing non-users in their homes to second- and thirdhand aerosols. This underscores the need to healthcare providers to extend intervention with vapers to include implementing vape-free home policies.
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http://dx.doi.org/10.1016/j.ypmed.2020.106215DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7494576PMC
October 2020

Using formalin embalmed cadavers to teach fracture identification with ultrasound.

BMC Med Educ 2020 Jul 18;20(1):227. Epub 2020 Jul 18.

Rocky Vista University College of Osteopathic Medicine - Southern Utah, 255 East Center Street, Ivins, UT, 84738, USA.

Background: Ultrasound is being utilized more frequently to diagnose fractures in bone and track fracture reduction quickly, and without radiation exposure in the ED. Realistic and practical methods of teaching sonographic fracture identification to medical trainees are needed. The objective of this study is to determine the feasibility of using formalin-embalmed human cadavers in teaching medical trainees to use ultrasound to identify synthetic fractures in tibia, radius, and metacarpal bones.

Methods: First-year medical students attended an orientation presentation and a 15-min scanning workshop, to evaluate fractures in cadaver bones with an instructor. Next participants independently scanned bones to determine if a fracture was present. Questionnaires were given that assessed participant self-confidence and ability to evaluate still ultrasound images for fracture and differentiate between tissue layers before, after, and 5 months following training.

Results: Participants were collectively able to scan and differentiate between fractured and unfractured bone in 75% of 186 total bone scanning attempts (tibia: 81% correct, metacarpal: 68% correct, radius: 76% correct). When evaluating still ultrasound images for fracture, participants' scores rose significantly following training from an average score of 77.4 to 91.1% (p = 0.001). Five months post-training, scores fell slightly, to an average of 89.8% (p = 0.325).

Conclusions: Ultrasound images of formalin-embalmed cadaveric fractures are of sufficient quality to use in teaching fracture identification to medical trainees. With only 15 minutes of scanning experience, medical trainees can learn to independently scan and significantly increase their ability to identify fractures in still ultrasound images.
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http://dx.doi.org/10.1186/s12909-020-02148-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7368716PMC
July 2020

A Rapid Assessment Procedure to Develop A Non-Communicable Disease Prevention Pilot Health Communications Project Using E- and M-Health Communications in Pohnpei State, Federated States of Micronesia.

Hawaii J Health Soc Welf 2020 06;79(6 Suppl 2):58-63

Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY (JM,TD).

Pohnpei State of the Federated States of Micronesia, located in the Northwestern Pacific Ocean, has limited health research infrastructure; chronic non-communicable diseases (NCD) such as diabetes, heart disease, and cancer are a concern. Over 73% of Pohnpei's population is overweight or obese. E- and m- (mobile) health interventions are becoming more popular in low and middle income countries. A Rapid Assessment Procedure was conducted for formative research to identify the enabling factors and challenges related to health communication and technology in Pohnpei to address NCD prevention. Thirty-seven local stakeholders were identified through snowball sampling for interviews and group discussions about e-health readiness and NCD priorities, held in local settings. Interviews were audio recorded, with field notes taken. Data were iteratively coded using DEDOOSE. Diabetes emerged as the most serious NCD issue because both the health system and local community are having to deal with the complications and consequences. Stakeholders recommended that prevention should be integrated with diabetes treatment. Local health workers' teaching evidence-based diabetes prevention and other health promotion education were through handheld (mobile devices) was identified. The ability to readily access evidence-based health education materials and modules is compatible with community approaches providing tailored, individual and small group education and social support. This approach may serve as a key component of local NCD prevention communications initiatives integral to prevent diabetes and its complications as remote Small Island Nations face burgeoning NCD epidemics and dramatic shifts in diet and activity.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7311940PMC
June 2020

An Assessment of E-health Resources and Readiness in the Republic of the Marshall Islands: Implications for Non-communicable Disease Intervention Development.

Hawaii J Health Soc Welf 2020 06;79(6 Suppl 2):52-57

Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, NY (MD, TD).

The prevalence of non-communicable diseases (NCDs) is rapidly increasing in low and middle income countries (LMIC). The Republic of the Marshall Islands is an island country in the Pacific located near the equator and has the third highest prevalence of diabetes in the world, high rates of complications, and early mortality with limited or no resources for tertiary care of these complications. Given the limited resources of the country, there is a need for strategies which emphasize NCD prevention. E-health interventions are becoming more popular in LMICs. A rapid qualitative assessment, involving focus groups, site visits, and key informant interviews, was performed to ascertain community perceptions about the causes of NCDs including diabetes and potential solutions. An assessment of the technology infrastructure was conducted to assess capacity for potential e-health interventions. Thirty local participants were interviewed. Participants identified diabetes as the highest priority NCD with dietary shifts toward imported, processed foods and decrease in physical activity as the major causes. Text messaging and Facebook were found to be widely utilized for personal and public communication. Given the low-tech, low-cost communication mechanisms and widespread use of Facebook, a social media intervention could help support local NCD prevention communications initiatives.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7311931PMC
June 2020

Effect of Calcium-Channel Blockade on the Cold-Induced Vasodilation Response.

Wilderness Environ Med 2020 Sep 29;31(3):312-316. Epub 2020 May 29.

University of Utah, Division of Emergency Medicine, Salt Lake City, UT.

Introduction: Cold-induced vasodilation (CIVD) is seen in the extremities during exposure to cold. A strong vasodilation response has been associated with a decreased risk of cold injury. Increasing CIVD might further decrease this risk. The calcium-channel blocker nifedipine causes vasodilation and is used to treat Raynaud's syndrome and chilblains. Nifedipine is also used for high altitude pulmonary edema and could potentially serve a dual purpose in preventing frostbite. The effects of nifedipine on CIVD have not been studied.

Methods: A double-blind crossover study comparing nifedipine (30 mg SR (sustained release) orally twice daily) to placebo was designed using 2 sessions of 4 finger immersion in 5°C water, with 24 h of medication pretreatment before each session. Finger temperatures were measured via nailbed thermocouples. The primary outcome was mean finger temperature; secondary outcomes were mean apex and nadir temperatures, first apex and nadir temperatures, subjective pain ranking, and time of vasodilation onset (all presented as mean±SD).

Results: Twelve volunteers (age 29±3 [24-34] y) completed the study. No significant difference in finger temperature (9.2±1.1°C nifedipine vs 9.0±0.7°C placebo, P=0.38) or any secondary outcome was found. Pain levels were similar (2.8±1.6 nifedipine vs 3.0±1.5 placebo, P=0.32). The most common adverse event was headache (32% of nifedipine trials vs 8% placebo).

Conclusions: Pretreatment with 30 mg of oral nifedipine twice daily does not affect the CIVD response in healthy individuals under cold stress.
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http://dx.doi.org/10.1016/j.wem.2020.03.002DOI Listing
September 2020

Building capacity for collaborative research on opioid and other substance use disorders through the Clinical and Translational Science Award Program.

J Clin Transl Sci 2020 Apr 25;4(2):81-89. Epub 2019 Nov 25.

Medical University of South Carolina, Charleston, SC, USA.

The opioid crisis in the USA requires immediate action through clinical and translational research. Already built network infrastructure through funding by the National Institute on Drug Abuse (NIDA) and National Center for Advancing Translational Sciences (NCATS) provides a major advantage to implement opioid-focused research which together could address this crisis. NIDA supports training grants and clinical trial networks; NCATS funds the Clinical and Translational Science Award (CTSA) Program with over 50 NCATS academic research hubs for regional clinical and translational research. Together, there is unique capacity for clinical research, bioinformatics, data science, community engagement, regulatory science, institutional partnerships, training and career development, and other key translational elements. The CTSA hubs provide unprecedented and timely response to local, regional, and national health crises to address research gaps [Clinical and Translational Science Awards Program, Center for Leading Innovation and Collaboration, ]. This paper describes opportunities for collaborative opioid research at CTSA hubs and NIDA-NCATS opportunities that build capacity for best practices as this crisis evolves. Results of a Landscape Survey (among 63 hubs) are provided with descriptions of best practices and ideas for collaborations, with research conducted by hubs also involved in premier NIDA initiatives. Such collaborations could provide a rapid response to the opioid epidemic while advancing science in multiple disciplinary areas.
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http://dx.doi.org/10.1017/cts.2019.441DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7159806PMC
April 2020

COVID-19 Lung Injury is Not High Altitude Pulmonary Edema.

High Alt Med Biol 2020 06 13;21(2):192-193. Epub 2020 Apr 13.

Altitude Research Center, Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.

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http://dx.doi.org/10.1089/ham.2020.0055DOI Listing
June 2020

Reply to: Reconsidering the air pocket around mouth and nose as a positive outcome predictor in completely buried avalanche victims.

Resuscitation 2020 07 28;152:210-211. Epub 2020 Mar 28.

Intermountain Medical Center, 5121 S Cottonwood St, Murray, UT 84107, United States.

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http://dx.doi.org/10.1016/j.resuscitation.2020.03.015DOI Listing
July 2020

Symptom burden among individuals with Parkinson disease: A national survey.

Neurol Clin Pract 2020 Feb 18;10(1):65-72. Epub 2019 Nov 18.

Department of Neurology (CGT, GAZ, RGH), University of Rochester Medical Center, NY; Center for Health + Technology (CGT, PA, ERD), University of Rochester Medical Center, NY; Department of Public Health Sciences (SM), University of Rochester Medical Center, NY; Department of Internal Medicine (RKH), Palliative Care Division, University of Rochester Medical Center, NY; and Department of Neurology (BMK), University of Colorado Anschutz Medical Campus, Aurora.

Objective: To explore disease burden in Parkinson disease (PD) by evaluating the prevalence of symptoms and key disease milestones (critical events, e.g., hospitalization or frequent falls) and their association with quality of life (QOL) in those with PD.

Methods: We created and pretested an online needs assessment survey to evaluate the clinical characteristics, QOL, symptom prevalence, and critical event frequency among those with PD. We recruited individuals with self-reported Hoehn and Yahr stage II-V PD through online postings and email through the Davis Phinney Foundation. We used logistic regression to evaluate the association between a large number of uncontrolled symptoms and events on QOL.

Results: A total of 612 individuals (mean age 70.1 years, 49.8% women) completed the survey. Among respondents, 13.6% reported poor QOL. Nearly 20% of respondents reported >3 falls, and 15% of respondents had been hospitalized over the previous 6 months. Participants had an average of 5.1 uncontrolled symptoms, with 86.1% of respondents reporting at least 1 uncontrolled symptom; more than 10% of respondents reported >10 uncontrolled symptoms. Depression, confusion, pain, and bothersome hallucinations were associated with poor QOL among the cohort.

Conclusions: In this national survey of individuals with PD, we identified poor QOL, frequent critical events, and numerous uncontrolled symptoms among a substantial proportion of respondents. Although motor symptoms were common, only nonmotor symptoms were associated with poor QOL. Many of these symptoms and events are treatable or preventable, highlighting the need for better identification and management to improve QOL among those with PD.
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http://dx.doi.org/10.1212/CPJ.0000000000000746DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7057075PMC
February 2020

Evaluating the implementation of cervical cancer screening programs in low-resource settings globally: a systematized review.

Cancer Causes Control 2020 May 17;31(5):417-429. Epub 2020 Mar 17.

University of Rochester Department of Obstetrics and Gynecology, Rochester, NY, USA.

Purpose: Cervical cancer disproportionately burdens low-resource populations where access to quality screening services is limited. A greater understanding of sustainable approaches to implement cervical cancer screening services is needed.

Methods: We conducted a systematized literature review of evaluations from cervical cancer screening programs implemented in resource-limited settings globally that included a formal evaluation and intention of program sustainment over time. We categorized the included studies using the continuum of implementation research framework which categorizes studies progressively from "implementation light" to more implementation intensive.

Results: Fifty-one of 13,330 initially identified papers were reviewed with most study sites in low-resource settings of middle-income countries (94.1%) ,while 9.8% were in low-income countries. Across all studies, visual inspection of the cervix with acetic acid (58.8%) was the most prevalent screening method followed by cytology testing (39.2%). Demand-side (client and community) considerations were reported in 86.3% of the articles, while 68.6% focused scientific inquiry on the supply side (health service). Eighteen articles (35.3%) were categorized as "Informing Scale-up" along the continuum of implementation research.

Conclusions: The number of cervical cancer screening implementation reports is limited globally, especially in low-income countries. The 18 papers we classified as Informing Scale-up provide critical insights for developing programs relevant to implementation outcomes. We recommend that program managers report lessons learnt to build collective implementation knowledge for cervical cancer screening services, globally.
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http://dx.doi.org/10.1007/s10552-020-01290-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7105425PMC
May 2020

Predictors of current tobacco smoking by adolescents in Nigeria: Interaction between school location and socioeconomic status.

Tob Induc Dis 2020 3;18:13. Epub 2020 Mar 3.

Institute of Maternal and Child Health, University of Nigeria, Enugu, Nigeria.

Introduction: Tobacco smoking is the largest preventable cause of global mortality, with its prevalence increasing in Sub-Saharan Africa, particularly among adolescents. We sought to determine the factors associated with tobacco smoking among Nigerian school adolescents and investigate the interaction between school location and socioeconomic status (SES).

Methods: Using a cross-sectional study design, 4332 eighth to tenth grade students in rural and urban secondary schools in Enugu State, Nigeria, were selected by stratified two-stage cluster sampling. We collected data using a modified Global Youth Tobacco Survey (GYTS) Core Questionnaire. Outcome measures were current smoking of cigarettes and other smoked tobacco. Multilevel mixed effects logistic regression models were used to determine factors associated with current tobacco smoking and were considered statistically significant at p<0.05.

Results: Prevalences of current smoking of cigarettes and other smoked tobacco were 13.3% (95% CI: 11.3-15.7) and 5.8% (95% CI: 4.6-7.2), respectively. Possession of higher weekly allowance, exposure to secondhand smoke or tobacco advertisements, having smoking parents, friends or classmates who smoke, and sale of cigarettes near school, were positively associated with current smoking of tobacco. Female sex, having both parents employed and being exposed to tobacco teaching in school were negatively associated with current cigarette smoking while increasing age and high father's SES were negatively associated with current smoking of other tobacco products. There was an interaction between school location and father's SES in the association with cigarette smoking. The higher odds of smoking in rural versus urban schools were much higher for students with fathers of high SES compared to low SES. In rural schools, high SES was associated with higher odds of smoking, but in urban schools low SES was associated with higher odds of smoking. Environmental factors are associated with adolescent tobacco smoking. Tobacco control programs should use targeted strategies that vary depending on the local context.
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http://dx.doi.org/10.18332/tid/117959DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7067232PMC
March 2020

Inflammatory biomarkers and growth factors in saliva and gingival crevicular fluid of e-cigarette users, cigarette smokers, and dual smokers: A pilot study.

J Periodontol 2020 10 16;91(10):1274-1283. Epub 2020 Mar 16.

Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY.

Background: Cigarette smoking remains one of the leading public health threats worldwide. Electronic cigarettes (e-cigs) provide an alternative to conventional cigarette smoking; however, the evidence base of risks and benefits of e-cig use is new and growing. In this cross-sectional pilot study, the effect of e-cig use on biological profiles in saliva and gingival crevicular fluid (GCF) was assessed and compared with the profiles of cigarette smokers (CS), dual users, and non-users. The systemic inflammatory mediators between e-cig users (EC) and these other groups were also assessed.

Methods: This pilot cross-sectional study recruited volunteer participants consisting of four groups, non-smokers (NS), CS, EC, and dual EC and cigarette smokers (DS). Saliva and GCF samples were collected and analyzed for biomarkers of inflammation, oxidative stress, anti-inflammatory lipid mediators, tissue injury and repair, and growth factors with immunoassay (enzyme-linked immunosorbent assay and Luminex).

Results: Smoking status was confirmed via salivary cotinine. Prostaglandin E2 level was significantly increased in CS compared with EC and DS, but not significantly different in EC and DS groups compared with non-smokers (NS). Statistically significant differences were observed between groups of EC and NS (myeloperoxidase [MPO], matrix metalloproteinase-9) as well as between DS and EC for biomarkers of inflammatory mediators (receptor for advanced glycation end products [RAGE], MPO, uteroglobin/CC-10); between groups of DS and NS for extracellular newly identified RAGE binding protein and between CS and NS for MPO. No statistically significant differences in biomarkers of immunity (S100A8, S100A9, galectin-3), tissue injury and repair (Serpine1/PAI-1) and growth factors (brain-derived neurotrophic factor, fibroblast growth factors, platelet-derived growth factor-AA, vascular endothelial growth factor, and others) were found between any of groups.

Conclusion: Statistically significant differences in measurable health outcomes were found between different smoking status groups, suggesting that smoking/vaping produces differential effects on oral health.
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http://dx.doi.org/10.1002/JPER.19-0457DOI Listing
October 2020

Flavor Preference and Systemic Immunoglobulin Responses in E-Cigarette Users and Waterpipe and Tobacco Smokers: A Pilot Study.

Int J Environ Res Public Health 2020 01 19;17(2). Epub 2020 Jan 19.

Department of Environmental Medicine and Public Health Sciences, University of Rochester Medical Center, School of Medicine & Dentistry, Rochester, NY 14642, USA.

Electronic cigarette (e-cigarette) use has had an exponential increase in popularity since the product was released to the public. Currently, there is a lack of human studies that assess different biomarker levels. This pilot study attempts to link e-cigarette and other tobacco product usage with clinical respiratory symptoms and immunoglobulin response. Subjects completed surveys in order to collect self-reported data on tobacco product flavor preferences. Along with this, plasma samples were collected to test for immunoglobulin G (IgG) and E (IgE) levels. Our pilot study's cohort had a 47.9% flavor preference towards fruit flavors and a 63.1% preference to more sweet flavors. E-cigarette and traditional cigarette smokers were the two subject groups to report the most clinical symptoms. E-cigarette users also had a significant increase in plasma IgE levels compared to non-tobacco users 1, and dual users had a significant increase in plasma IgG compared to non-tobacco users 2, cigarette smokers, and waterpipe smokers. Our pilot study showed that users have a preference toward fruit and more sweet flavors and that e-cigarette and dual use resulted in an augmented systemic immune response.
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http://dx.doi.org/10.3390/ijerph17020640DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7013586PMC
January 2020

Systemic biomarkers in electronic cigarette users: implications for noninvasive assessment of vaping-associated pulmonary injuries.

ERJ Open Res 2019 Oct 23;5(4). Epub 2019 Dec 23.

Dept of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA.

Background: Electronic cigarettes (e-cigs) were introduced as electronic nicotine delivery systems, and have become very popular in the USA and globally. There is a paucity of data on systemic injury biomarkers of vaping in e-cig users that can be used as a noninvasive assessment of vaping-associated lung injuries. We hypothesised that characterisation of systemic biomarkers of inflammation, anti-inflammatory, oxidative stress, vascular and lipid mediators, growth factors, and extracellular matrix breakdown may provide information regarding the toxicity of vaping in e-cig users.

Methods: We collected various biological fluids, plasma, urine, saliva and exhaled breath condensate (EBC), measured pulmonary function and vaping characteristics, and assessed various biomarkers in e-cig users and nonusers.

Results: The plasma samples of e-cig users showed a significant increase in biomarkers of inflammation (interleukin (IL)-1β, IL-6, IL-8, IL-13, interferon (IFN)-γ, matrix metalloproteinase-9, intercellular cell adhesion molecule-1) and extracellular matrix breakdown (desmosine), and decreased pro-resolving lipid mediators (resolvin D and resolvin D). There was a significant increase in growth factor (endothelial growth factor, vascular endothelial growth factor, β-nerve growth factor, platelet-derived growth factor-AA, stem cell factor, hepatocyte growth factor and placental growth factor) levels in plasma of e-cig users nonusers. E-cig users showed a significant increase in levels of inflammatory biomarker IFN-γ, oxidative stress biomarker 8-isoprostane and oxidative DNA damage biomarker 8-oxo-dG in urine samples, and of inflammatory biomarker IL-1β in saliva samples. EBC showed a slight increase in levels of triglycerides and 8-isoprostane in e-cig users compared with normal nonusers.

Conclusion: E-cig users have increased levels of biomarkers of inflammation and oxidative stress, reduced pro-resolving anti-inflammatory mediators, and endothelial dysfunction, which may act as risk factors for increasing susceptibility to systemic diseases. The identified noninvasive biomarkers can be used for determining e-cig vaping-associated lung injuries, and for regulatory and diagnostic aspects of vaping in humans.
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http://dx.doi.org/10.1183/23120541.00182-2019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6926365PMC
October 2019

Qualitative Assessment of Environmental Health Risk Perceptions and Community Challenges in a Puerto Rican Community: Change and Continuity in Response to Hurricanes Irma and María.

Behav Med 2020 Jul-Sep;46(3-4):231-244. Epub 2019 Dec 20.

Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry.

Culebra, a geographically isolated island located 17 miles from the eastern coast of Puerto Rico's main island, suffers from an amalgam of significant environmental health risk and associated social determinants of health that are affecting the community. In 2017, two major Hurricanes (Irma and María) impacted Culebra, resulting in an increase of preexisting environmental health risk. The present study's primary aim was to explore community attitudes, beliefs, and perceptions of environmental health risk, and to describe the social priorities of in relation to these risks and challenges. Semi-structured interview guide and Rapid Qualitative Inquiry (RQI) focused on topics of environmental health risk was followed. Qualitative focus groups and individual interviews were conducted among community members in Culebra before and shortly after Hurricanes Irma and María affected the island. Environmental health factors identified included: presence of mosquitoes, trash disposal, water quality and tourism. Additionally, a strong sentiment of island pride was found potentially generating a sense of community that could facilitate solutions to the existing environmental health challenges. Preexisting environmental health risk magnified after the pass of Hurricanes Irma and María. Sustainable and community engagement approaches are needed to develop strategies that can assist in the mitigation and resolution of the identified environmental health risk and challenges, including factors associated with threats such as disasters and pollution.
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http://dx.doi.org/10.1080/08964289.2019.1700894DOI Listing
December 2019

Avalanche airbag post-burial active deflation - The ability to create an air pocket to delay asphyxiation and prolong survival.

Resuscitation 2020 01 5;146:155-160. Epub 2019 Dec 5.

Intermountain Medical Center, 5121 S Cottonwood St, Murray, UT 84107, United States.

Aim: The primary purpose of an avalanche airbag is to prevent burial during an avalanche. Approximately twenty percent of avalanche victims deploying airbags become critically buried, however. One avalanche airbag actively deflates three minutes after deployment, potentially creating an air pocket. Our objective was to evaluate this air pocket and its potential to prevent asphyxiation.

Methods: Twelve participants were fitted with an airbag and placed prone on the snow. Participants deployed the airbag and were buried in 1.5 m of snow for 60 min with vital signs including oxygen saturation (SpO2) and end-tidal CO2 (ETCO2) measured every minute. Participants completed a post-burial survey to determine head movement within the air pocket.

Results: Eleven of the 12 participants (92%) completed 60 min of burial. Preburial baseline SpO2 measurements did not change significantly over burial time (P > 0.05). Preburial baseline ETCO2 measurements increased over the burial time (P < 0.02); only one ETCO2 value was outside of the normal ETCO2 range (35-45 mmHg). Participants reported they could move their head forward 11.2 cm (SD 4.8 cm) and backward 6.6 cm (SD 5.1 cm) with the majority of participants stated that they had enough head movement to separate the oral cavity from opposing snow if necessary. Visual examination during extrication revealed a well-defined air pocket in all burials.

Conclusion: The avalanche airbag under study creates an air pocket that appears to delay asphyxia, which could allow extra time for rescue and improve overall survival of avalanche victims.
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http://dx.doi.org/10.1016/j.resuscitation.2019.11.023DOI Listing
January 2020

Wilderness Medical Society Clinical Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia: 2019 Update.

Wilderness Environ Med 2019 Dec 15;30(4S):S47-S69. Epub 2019 Nov 15.

Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center and the University of Utah, Salt Lake City, UT.

To provide guidance to clinicians, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for the out-of-hospital evaluation and treatment of victims of accidental hypothermia. The guidelines present the main diagnostic and therapeutic modalities and provide recommendations for the management of hypothermic patients. The panel graded the recommendations based on the quality of supporting evidence and a balance between benefits and risks/burdens according to the criteria published by the American College of Chest Physicians. The guidelines also provide suggested general approaches to the evaluation and treatment of accidental hypothermia that incorporate specific recommendations. This is the 2019 update of the Wilderness Medical Society Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia: 2014 Update.
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http://dx.doi.org/10.1016/j.wem.2019.10.002DOI Listing
December 2019

Improvised vs Standard Cervical Collar to Restrict Spine Movement in the Backcountry Environment.

Wilderness Environ Med 2019 Dec 6;30(4):412-416. Epub 2019 Nov 6.

Division of Emergency Medicine, University of Utah, Salt Lake City, UT. Electronic address:

Introduction: To compare the effectiveness of a molded fleece jacket with that of a standard cervical collar at limiting movement of the cervical spine in 3 different directions.

Methods: This is a prospective study using 24 healthy volunteers to measure cervical flexion/extension, rotation, and lateral flexion with both the fleece collar and the standard cervical collar. A hand-held goniometer was used for measurements. The results were then analyzed for the 3 independent movements using a noninferiority test.

Results: The fleece collar was determined to be noninferior at limiting the designated motions. Comfort was greater while wearing the improvised fleece collar.

Conclusions: Our small study demonstrated that mountain travelers and rescuers may be able to use an improvised fleece jacket collar in place of a standard collar if spine trauma is suspected after a backcountry accident. Further research should examine different types of improvised collars, their ability to remain in place over extended evacuations, and when to apply collars to backcountry patients.
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http://dx.doi.org/10.1016/j.wem.2019.07.002DOI Listing
December 2019

Tobacco use and chemosensory impairments among current adult tobacco users in the US: Data from NHANES 2013-2014.

Tob Induc Dis 2018 18;16:43. Epub 2018 Sep 18.

Roswell Park Cancer Institute, Buffalo, United States.

Introduction: Among US adults 40 years and older, about 23% report problems with their ability to smell, and 19% report problems with their ability to taste. Chemosenses are a first line of defence against environmental hazards (e.g. fires and leaking gas). A potential risk factor of chemosensory disorders includes nicotine product use, such as cigarette use. This study aims to assess the relationship of taste and smell alterations with type of recent nicotine product use (e.g. inhaled versus smokeless), recent cigarette use, and mentholation status based on data from NHANES 2013-2014.

Methods: A total of 3186 men and women, 40 years and older, from NHANES 2013-2014 were assessed for smell and taste impairment, according to their recent nicotine product use. Taste impairment was identified as inability to identify quinine as bitter in the whole-mouth taste test. Impairment of smell was defined as failing to identify six or more of eight specific odors. Logistic regression models were adjusted for age, gender, and race/ethnicity.

Results: Approximately 13% of participants failed the smell examination. No significant association between smell examination outcome and recent nicotine product use was found, though recent cigarette use showed a trend toward positive association (OR=1.66, 95% CI: 0.76-3.63) and mentholation status showed a trend toward negative association (OR=0.57, 95% CI: 0.22-1.49) on smell examination results. About 17% of participants failed the taste examination, and trends toward positive association were seen between taste examination outcomes and both recent nicotine product use (OR=1.28, 95% CI: 0.99-1.65) and recent cigarette use (OR=1.30, 95% CI: 0.50-3.40).

Conclusions: Findings indicate that recent use of nicotine products has an inconsistent relationship to dysfunctions in taste and smell. However, limiting the use of inhaled nicotine products, such as from cigarette use, could prove beneficial to a person's taste and smell ability.
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http://dx.doi.org/10.18332/tid/94202DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6659548PMC
September 2018
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