Medicine and Health Sciences Commons^™

Our Collective Law Abiding Mental Illness, Gregory J. Brock

Gregory J. Brock

No abstract provided.

Accelerated Resolution Therapy For Treatment Of Pain Secondary To Symptoms Of Combat-Related Posttraumatic Stress Disorder, Kevin E. Kip, Laney Rosenzweig, Diego F. Hernandez, Amy Shuman, David M. Diamond, Sue Ann Girling, Kelly L. Sullivan, Trudy R. Wittenberg, Ann M. Witt, Cecile A. Lengacher, Brian Anderson, Susan C. Mcmillan

Kelly L. Sullivan

Background: As many as 70% of veterans with chronic pain treated within the US Veterans Administration (VA) system may have posttraumatic stress disorder (PTSD), and conversely, up to 80% of those with PTSD may have pain. We describe pain experienced by US service members and veterans with symptoms of PTSD, and report on the effect of Accelerated Resolution Therapy (ART), a new, brief exposure-based therapy, on acute pain reduction secondary to treatment of symptoms of PTSD.
Methods: A randomized controlled trial of ART versus an attention control (AC) regimen was conducted among 45 US service members/veterans with symptoms of combat-related …

Treatment Of Neurodegenerative Ataxias With Intravenous Immune Globulin, Theresa A. Zesiewicz, Seok Hun Kim, Kelly L. Sullivan, Jeannie Stephenson, Israt Jahan, Susan L. Perlman, Jessica D. Shaw, Tuan Vu, Clifton L. Gooch

Kelly L. Sullivan

Background: Neurodegenerative ataxias, including spinocerebellar ataxias (SCAs), are progressive diseases without effective treatment. There is preclinical evidence that inflammation may contribute to neuronal injury in several neurodegenerative ataxias. Intravenous immune globulin (IVIG) is a therapeutic modality that is used as treatment of several autoimmune and inflammatory disorders.
Methods: The primary objective of this open-label pilot study was to assess the effect of IVIG on neurodegenerative ataxias as measured by total scale for the assessment and rating of ataxia (SARA) score. Three patients received IVIG (2 g/kg of body weight, divided over 5 days) once monthly for 3 months, and were …

Premorbid Personality And The Risk Of Parkinson's Disease, Kelly L. Sullivan, James A. Mortimer, Wei Wang, Theresa A. Zesiewicz, James H. Brownlee Jr., Amy R. Borenstein

Kelly L. Sullivan

Background: Previous studies support the hypothesis that premorbid personality characteristics may be associated with the risk of Parkinson’s disease (PD). However, most of these relied upon subjective reports of premorbid personality earlier in life, which may be subject to recall bias. The objective of the current study was to evaluate the association of PD with risk-taking, routinization, smoking and alcohol consumption in early-adult life as indicators of premorbid personality.
Methods: In-person interviews were conducted with 89 PD patients and 99 controls from a university-based medical center. Associations between indicators of early-adult personality and risk of PD were examined using logistic …

Lung Flute Improves Symptoms And Health Status In Copd With Chronic Bronchitis: A 26 Week Randomized Controlled Trial, Sanjay Sethi, Jingjing Yin, Pamela K. Anderson

Jingjing Yin

Background: Chronic obstructive pulmonary disease (COPD) is characterized by mucus hypersecretion that contributes to disease related morbidity and is associated with increased mortality. The Lung Flute® is a new respiratory device that produces a low frequency acoustic wave with moderately vigorous exhalation to increase mucus clearance. We hypothesized that the Lung Flute, used on a twice daily basis will provide clinical benefit to patients with COPD with chronic bronchitis.

Methods: We performed a 26 week randomized, non-intervention controlled, single center, open label trial in 69 patients with COPD and Chronic Bronchitis. The primary endpoint was change in respiratory …

Modeling The Effect Of Water, Sanitation, And Hygiene And Oral Cholera Vaccine Implementation In Haiti, Isaac Chun-Hai Fung, David L. Fitter, Rebekah H. Borse, Martin I. Meltzer, Jordan W. Tappero

Isaac Chun-Hai Fung

In 2010, toxigenic Vibrio cholerae was newly introduced to Haiti. Because resources are limited, decisionmakers need to understand the effect of different preventive interventions. We built a static model to estimate the potential number of cholera cases averted through improvements in coverage in water, sanitation and hygiene (WASH) (i.e., latrines, point-of-use chlorination, and piped water), oral cholera vaccine (OCV), or a combination of both. We allowed indirect effects and non-linear relationships between effect and population coverage. Because there are limited incidence data for endemic cholera in Haiti, we estimated the incidence of cholera over 20 years in Haiti by using …

Brief Treatment Of Co-Occurring Post-Traumatic Stress And Depressive Symptoms By Use Of Accelerated Resolution Therapy®, Kevin E. Kip, Kelly L. Sullivan, Cecile A. Lengacher, Laney Rosenzweig, Diego F. Hernandez, Rejendra P. Kadel, Frank A. Kozel, Amy Shuman, Sue Ann Girling, Marian J. Hardwick, David M. Diamond

Kelly L. Sullivan

This uncontrolled prospective cohort study evaluated the use of accelerated resolution therapy (ART) for treatment of comorbid symptoms of post-traumatic stress disorder (PTSD) and major depressive disorder. Twenty-eight adult subjects, mean age of 41 years (79% female, 36% Hispanic), received a mean of 3.7 ± 1.1 ART treatment sessions (range 1-5). ART is a new exposure-based psychotherapy that makes use of eye movements. Subjects completed a range of self-report psychological measures before and after treatment with ART including the 17-item PCL-C checklist (symptoms of PTSD) and 20-item Center for Epidemiologic Studies Depression Scale (CES-D). For the PCL-C, the pre-ART mean …

Endurance Tests Are The Most Reliable Core Stability Related Measurements, Andy Waldhelm, Li Li

Li Li

Purpose: To determine the intra-tester reliability of clinical measurements that assess five components related to core stability: strength, endurance, flexibility, motor control, and function.
Methods: Participants were 15 college-aged males who had not suffered any orthopedic injury in the past year. Core strength measurements included eight isometric tests and a sit-up test. The four core endurance tests were the trunk flexor test, trunk extensor test, and bilateral side bridge tests. Flexibility tests included the sit-and-reach test and active range of the trunk and hip joint motions. Proprioception via passive reposition tests of the hips and a single limb balance test …

How To Minimize The Attack Rate During Multiple Influenza Outbreaks In A Heterogeneous Population, Isaac Chun-Hai Fung, Rustom Antia, Andreas Handel

Isaac Chun-Hai Fung

Background: If repeated interventions against multiple outbreaks are not feasible, there is an optimal level of control during the first outbreak. Any control measures above that optimal level will lead to an outcome that may be as sub-optimal as that achieved by an intervention that is too weak. We studied this scenario in more detail.
Method: An age-stratified ordinary-differential-equation model was constructed to study infectious disease outbreaks and control in a population made up of two groups, adults and children. The model was parameterized using influenza as an example. This model was used to simulate two consecutive outbreaks of the …

Muscular Activity Characteristics Associated With Preparation For Gait Transition, Li Li, Lorna L. Ogden

Li Li

Purpose: The purpose of this study was to investigate lower extremity neuromuscular activity patterns during gait transitions with continuously changing locomotion speeds.
Methods: Muscular activities related to gait transitions (walk to run and run to walk) induced by changing treadmill speed were compared to muscular activities during walk and run at constant speeds. All transition and constant speed conditions were conducted in similar speed range. Surface electromyographic activities of gluteus maximus (GM), rectus femoris (RF), vastus lateralis (VL), biceps femoris long head (BFL), tibialis anterior (TA), gastrocnemius (GA), and soleus (SL) were collected and analyzed. The influences of speed and …

Sustained Medication Reduction Following Unilateral Vim Thalamic Stimulation For Essential Tremor, Andrew S. Resnick, Michael S. Okun, Teresita Malapira, Donald A. Smith, Fernando L. Vale, Kelly L. Sullivan, Amber M. Miller, Israt Jahan, Theresa A. Zesiewicz

Kelly L. Sullivan

Background: Deep brain stimulation (DBS) is an increasingly utilized therapeutic modality for the management of medication refractory essential tremor (ET). The aim of this study was to determine whether DBS allowed for anti-tremor medication reduction within the year after the procedure was performed.
Methods: We conducted a retrospective chart review and telephone interviews on 34 consecutive patients who had been diagnosed with ET, and who had undergone unilateral DBS surgery.
Results: Of the 34 patients in our cohort, 31 patients (91%) completely stopped all anti-tremor medications either before surgery (21 patients, 62%) or in the year following DBS surgery (10 …

Beta Interferon-Mediated Activation Of Signal Transducer And Activator Of Transcription Protein 1 Interferes With Rickettsia Conorii Replication In Human Endothelial Cells, Punsiri M. Colonne, Marina Eremeeva, Sanjeev K. Sahni

Marina E. Eremeeva

Infection of the endothelial cell lining of blood vessels with Rickettsia conorii, the causative agent of Mediterranean spotted fever, results in endothelial activation. We investigated the effects of R. conorii infection on the status of the Janus kinase (JAK)-signal transducer and activator of transcription protein (STAT) signaling pathway in human microvascular endothelial cells (HMECs), the most relevant host cell type, in light of rickettsial tropism for microvascular endothelium in vivo. R. conoriiinfection induced phosphorylation of STAT1 on tyrosine 701 and serine 727 at 24, 48, and 72 h postinfection in HMECs. Employing transcription profile analysis and neutralizing …

Rickettsia Felis In Cat Fleas, Ctenocephalides Felis Parasitizing Opossums, San Bernardino County, California, Kyle F. Abramowicz, J. W. Wekesa, C. N. Nwadike, Maria L. Zambrano, Sandor E. Karpathy, D. Cecil, J. Burns, Renjie Hu, Marina Eremeeva

Marina E. Eremeeva

Los Angeles and Orange Counties are known endemic areas for murine typhus in California; however, no recent reports of flea-borne rickettsioses are known from adjacent San Bernardino County. Sixty-five opossums (Didelphis virginiana) were trapped in the suburban residential and industrial zones of the southwestern part of San Bernardino County in 2007. Sixty out of 65 opossums were infested with fleas, primarily cat fleas, Ctenocephalides felis (Bouché, 1835). The flea minimum infection rate with Rickettsia felis was 13.3% in pooled samples and the prevalence was 23.7% in single fleas, with two gltA genotypes detected. In spite of historic …

People Can Live Longer By Having More Physical Activity, Li Li

Li Li

We all know being physically active is good for you. But do we know how good? People can live up to 3 years longer, even with as little as 15 min of physical activity a day, according to last October's report by Wen and his colleagues1 at the China Medical University in Taiwan, China.
Many researchers in the field of sport and health sciences know being physically active can bring many benefits to one's life. But this message has sometimes been disseminated using a negative tone. So much so, Bortz2 of California, USA, has coined the word “inactivity” …

Prevalence Of Colorectal Cancer Screening Among A Multimorbid Rural Appalachian Population, Steven T. Fleming, Nancy E. Schoenberg, Yelena N. Tarasenko, Kevin A. Pearce

Yelena N. Tarasenko

Objectives: The purpose of this study was to determine the relation among multiple morbidities and the prevalence of colorectal cancer (CRC) screening among older adult Appalachian residents of Kentucky. This is the first known study to address multiple morbidities exclusively with a health-disparities population.

Methods: This was a cross-sectional study of 1153 subjects, aged 50 to 76 years, from Appalachian Kentucky.

Results: White race, post-high school education, and perception of having more than enough income on which to survive were associated with higher rates of any guideline concordant CRC screening. Statistically significant trends in the outcome of …

Key Findings From A Council On Linkages Survey Of Public Health Workers, Vincent Francisco, Jeffery A. Jones, Robin Pendley

Jeffery A Jones

The US governmental public health workforce is dwindling while the need for additional workers is increasing. In an historic effort to address this issue, in March 2010 the Council on Linkages Between Academia and Public Health Practice (Council on Linkages) surveyed over 70,000 public health workers across the US to determine how, when, and why they entered the governmental public health workforce and reasons they have remained in the workforce. Key survey findings were released in the spring of 2011 and have informed the development by the Council on Linkages of evidence-assisted recruitment and retention strategies for the US public …

The Role Of Social Support In Multiple Morbidity Self-Management Among Rural Residents, Shoshana Bardach, Yelena N. Tarasenko, Nancy E. Schoenberg

Yelena N. Tarasenko

Social support generally is considered a valuable asset that may compensate for health service deficiencies among rural populations. Employing a mixed methods approach, we explored how vulnerable rural residents described social support in the context of self-management for multiple chronic conditions. Participants generally felt support was available, though emotional/ informational support was perceived as less available than other types of support. Participants did not rely heavily on informal support to help them manage their multiple morbidities, preferring to call on their doctor and their own resources. We discuss implications of these findings for meeting this vulnerable population’s self-management needs.

Quantitative Tremor Analysis In Welders: Comparison With Idiopathic Parkinson's Disease And Essential Tremor, Juan Sanchez-Ramos, Dacy Reimer, Theresa A. Zesiewicz, Kelly L. Sullivan, Paul A. Nausieda

Kelly L. Sullivan

Background: Workers chronically exposed to manganese in welding fumes may develop an extra-pyramidal syndrome with postural and action tremors.
Objectives: To determine the utility of tremor analysis in distinguishing tremors among workers exposed to welding fumes, patients with Idiopathic Parkinson’s Disease (IPD) and Essential Tremor (ET).
Methods: Retrospective study of recorded tremor in subjects from academic Movement Disorders Clinics and Welders. Quantitative tremor analysis was performed and associated with clinical status.
Results: Postural tremor intensity was increased in Welders and ET and was associated with visibly greater amplitude of tremor with arms extended. Mean center frequencies (Cf) of welders and …

The Emergency Department As A Potential Intervention Recruitment Venue Among Vulnerable Rural Residents, Yelena N. Tarasenko, Nancy E. Schoenberg, Keisa L. Bennett

Yelena N. Tarasenko

Meeting the health care needs of rural residents is complicated by their substantial medical burdens that frequently outstrip patient and community resources. Nowhere is this more evident than in central Appalachia. Preventive procedures are often sacrificed as patients and providers attend to more pressing medical issues. We report the results of a pilot study designed to explore the need for and appropriateness of a potential intervention placed in an emergency department (ED), with the eventual goal of using the ED to link traditionally underserved patients to preventive services. We used a convenience sample of 49 ED patients to explore their …

Eschar-Associated Spotted Fever Rickettsiosis, Bahia, Brazil, Nanci Silva, Marina Eremeeva, Tatiana Rozental, Guilherme S. Ribeiro, Christopher D. Paddock, Eduardo Antonio G. Ramos, Alexsandra R.M. Favacho, Mitermayer G. Reis, Gregory A. Dasch,, Elba R.S. De Lemos, Albert I. Ko

Marina E. Eremeeva

In Brazil, Brazilian spotted fever was once considered the only tick-borne rickettsial disease. We report eschar-associated rickettsial disease that occurred after a tick bite. The etiologic agent is most related to Rickettsia parkeri, R. africae, and R. sibirica and probably widely distributed from São Paulo to Bahia in the Atlantic Forest.

Emergence Of A Novel Human Ehrlichia-Muris Like Organism In North America – Wisconsin And Minnesota, Bobbi S. Pritt, Lynne M. Sloan, Diep K. Hoang-Johnson, Ulrike G. Munderloh, Susan M. Paskewitz, Kristina M. Mcelroy, Jevon D. Mcfadden, Matthew J. Binnicker, David F. Neitzel, Gongping Liu, William L. Nicholson, Curtis M. Nelson, Joni J. Franson, Scott A. Martin, Scott A. Cunningham, Christopher R. Steward, Kay Bogumill, Mary E. Bjorgaard, Jeffrey P. Davis, Jennifer H. Mcquiston, David M. Warshauer, Mark P. Wilhelm, Robin Patel, Vipul A. Trivedi, Marina Eremeeva

Marina E. Eremeeva

Background: Ehrlichiosis is a clinically important, emerging zoonosis. Only Ehrlichia chaffeensis and E. ewingii have been thought to cause ehrlichiosis in humans in the United States. Patients with suspected ehrlichiosis routinely undergo testing to ensure proper diagnosis and to ascertain the cause.

Methods: We used molecular methods, culturing, and serologic testing to diagnose and ascertain the cause of cases of ehrlichiosis.

Results: On testing, four cases of ehrlichiosis in Minnesota or Wisconsin were found not to be from E. chaffeensis or E. ewingii and instead to be caused by a newly discovered ehrlichia species.

All patients had fever, …

Creating Community-Academic Partnerships For Cancer Disparities Research And Health Promotion, John S. Luque, Cathy D. Meade, Janelle M. Menard, Dinorah Martinez Tyson, Clement K. Gwede

John S. Luque

To effectively attenuate cancer disparities in multiethnic, medically underserved populations, interventions must be developed collaboratively through solid community-academic partnerships and driven by community-based participatory research (CBPR). The Tampa Bay Community Cancer Network (TBCCN) has been created to identify and implement interventions to address local cancer disparities in partnership with community-based nonprofit organizations, faith-based groups, community health centers, local media, and adult literacy and education organizations. TBCCN activities and research efforts are geared toward addressing critical information and access issues related to cancer control and prevention in diverse communities in the Tampa Bay area. Such efforts include cross-cultural health promotion, screening, …

Rocky Mountain Spotted Fever In Panama: A Cluster Description, Maribel Tribaldos, Yamitzel Zaldivar, Sergio Bermudez, Franklyn Samudio, Yaxelis Mendoza, Alexander A. Martinez, Rodrigo Villalobos, Marina Eremeeva, Christopher D. Paddock, Kathleen Page, Rebecca E. Smith, Juan Miguel Pascale

Marina E. Eremeeva

Rocky Mountain spotted fever (RMSF) is a tick-borne infection caused by Rickettsia rickettsii. We report a cluster of fatal cases of RMSF in 2007 in Panama, involving a pregnant woman and two children from the same family. The woman presented with a fever followed by respiratory distress, maculopapular rash, and an eschar at the site from which a tick had been removed. She died four days after disease onset. This is the second published report of an eschar in a patient confirmed by PCR to be infected with R. rickettsii. One month later, the children presented within days of one …

Aflatoxin B1 Albumin Adducts In Plasma And Aflatoxin M1 In Urine Are Associated With Plasma Concentrations Of Vitamins A And E, Francis A. Obuseh, Pauline E. Jolly, Yi Jiang, Faisal M. B. Shuaib, John Waterbor, William O. Ellis, Chandrika J. Piyathilake, Renee A. Desmond, Evans Afriyie-Gyawu, Timothy D. Phillips

Evans Afriyie-Gyawu

Background: Although aflatoxin exposure has been shown to be associated with micronutrient deficiency in animals, there are few investigations on the effects of aflatoxin exposure on micronutrient metabolism in humans.
Objective: To examine the relationship between aflatoxin B1 (AFB1) albumin adducts (AF-ALB) in plasma and the aflatoxin M1 (AFM1) metabolite in urine and plasma concentrations of retinol (vitamin A) and α-tocopherol (vitamin E) in Ghanaians.
Methods: A cross-sectional study of 147 adult participants was conducted. Blood and urine samples were tested for aflatoxin and vitamins A and E levels.
Results: Multivariable analysis showed that participants with high AF-ALB (≥ 0.80 …

Overview Of The Essential Tremor, Theresa A. Zesiewicz, Abinaya Chari, Israt Jahan, Amber M. Miller, Kelly L. Sullivan

Kelly L. Sullivan

Essential tremor (ET) is one of the most common movement disorders in the world. Despite this, only one medication (propranolol) is approved by the Food and Drug Administration (FDA) to treat it. Fortunately, recent studies have identified some additional medications as treatment of ET. Surgical procedures, such as deep brain stimulation of the ventral intermediate nucleus of the thalamus, offer treatment for refractory tremor. The epidemiology, pathogenesis, and medical and surgical treatment of ET will be discussed in this paper.

Interventions To Improve Excreta Disposal For Preventing Diarrhoea, Thomas F. Clasen, Kristof Bostoen, Wolf-Peter Schmidt, Sophie Boisson, Isaac Chun-Hai Fung, Marion W. Jenkins, Beth Scott, Steven Sugden, Sandy Cairncross

Isaac Chun-Hai Fung

Background: Diarrhoeal diseases are a leading cause of mortality and morbidity, especially among young children in low-income countries, and are associated with exposure to human excreta.
Objectives: To assess the effectiveness of interventions to improve the disposal of human excreta for preventing diarrhoeal diseases.
Search Strategy: We searched the Cochrane Infectious Disease Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL), published in The Cochrane Library; MEDLINE; EMBASE; LILACS; the metaRegister of Controlled Trials (mRCT); and Chinese-language databases available under the Wan Fang portal, and the China National Knowledge Infrastructure (CNKI-CAJ). We also handsearched relevant conference proceedings, and …

Reduction Of Circulating Endothelial Cells In Peripheral Blood Of Als Patients, Svitlana Garbuzova-Davis, Robert L. Woods Iii, Michael K. Louis, Theresa A. Zesiewicz, Nicole Kuzmin-Nichols, Kelly L. Sullivan, Amber M. Miller, Diana G. Hernandez-Ontiveros, Paul R. Sanberg

Kelly L. Sullivan

Background: Amyotrophic Lateral Sclerosis (ALS) treatment is complicated by the various mechanisms underlying motor neuron degeneration. Recent studies showed that the blood-brain barrier (BBB) and blood-spinal cord barrier (BSCB) are compromised in an animal model of ALS due to endothelial cell degeneration. A later study demonstrated a loss of endothelium integrity in the spinal cords of ALS patients. Since circulating endothelial cells (CECs) in the peripheral blood are associated with endothelium damage, being detached dysfunctional endothelial cells, we hypothesized that CEC levels may reflect endothelium condition in ALS patients.
Methodology/Principal Findings: CEC levels were estimated in whole blood smears from …

Water, Sanitation And Hygiene For The Prevention Of Diarrhoea, Sandy Cairncross, Caroline Hunt, Sophie Boisson, Kristof Bostoen, Val Curtis, Isaac Chun-Hai Fung, Wolf-Peter Schmidt

Isaac Chun-Hai Fung

Background: Ever since John Snow's intervention on the Broad St pump, the effect of water quality, hygiene and sanitation in preventing diarrhoea deaths has always been debated. The evidence identified in previous reviews is of variable quality, and mostly relates to morbidity rather than mortality.
Methods: We drew on three systematic reviews, two of them for the Cochrane Collaboration, focussed on the effect of handwashing with soap on diarrhoea, of water quality improvement and of excreta disposal, respectively. The estimated effect on diarrhoea mortality was determined by applying the rules adopted for this supplement, where appropriate.
Results: The striking effect …

Public Health Workforce Trust Measures: Comparative Analysis Of T1-T2 Measures Across Two Lhd’S And Organizational Responses To Economic Hard Times, William A. Mase

William A. Mase

This public health workforce research initiative expands practice-based employee trust measurement in a time-one time-two (T1 – T2) quantitative design methodology. The initiative is an expansion of previously conducted research within the Cincinnati and Northern Kentucky Health Departments. Tailored workforce-based quality improvement (QI) initiatives were developed and implemented within the two local health departments (LHD’s). Workforce-based QI was a product of strategic initiatives defined by leadership of both health departments and informed by a critical review of the data collected in 2008. Analysis of additional independent variables and interaction terms were evaluated and are presented for supervisor/employee race concordance. In …

The Effect Of Neuragen Pn® On Neuropathic Pain: A Randomized, Double Blind, Placebo Controlled Clinical Trial, Li Li

Li Li

Background: A double blind, randomized, placebo controlled study to evaluate the safety and efficacy of the naturally derived topical oil, "Neuragen PN®" for the treatment of neuropathic pain.

Methods: Sixty participants with plantar cutaneous (foot sole) pain due to all cause peripheral neuropathy were recruited from the community. Each subject was randomly assigned to receive one of two treatments (Neuragen PN® or placebo) per week in a crossover design. The primary outcome measure was acute spontaneous pain level as reported on a visual analog scale.

Results: There was an overall pain reduction for both treatments from pre to post application. …