Public Health Commons^™

Dog Walking Among Adolescents: Correlates And Contribution To Physical Activity., Jessa K. Engelberg, Jordan A. Carlson, Terry L. Conway, Kelli L. Cain, Brian E. Saelens, Karen Glanz, Lawrence D. Frank, James F. Sallis

Manuscripts, Articles, Book Chapters and Other Papers

PURPOSE: To assess the association of dog walking with adolescents' moderate-to-vigorous physical activity (MVPA) and body mass index (BMI), and identify correlates of dog walking.

METHODS/DESIGN: Participants were 12-17year-olds (n=925) from the Baltimore, MD and Seattle, WA regions. Differences in accelerometer-assessed minutes/day of MVPA and self-reported BMI (percentile) were compared among adolescents (1) without a dog (n=441) and those with a dog who (2) did (≥1days/week, n=300) or (3) did not (n=184) walk it. Correlates of (1) dog walking (any vs. none) among adolescents with dogs (n=484), and (2) days/week of dog walking among dog walkers (n=300) were investigated. Potential …

Contraceptive Provision To Adolescent Females Prescribed Teratogenic Medications., Stephani L. Stancil, Melissa K. Miller, Holley Briggs, Daryl Lynch, Kathy Goggin, Gregory Kearns

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND AND OBJECTIVES: Rates of adult women receiving contraceptive provision when simultaneously prescribed a known teratogen are alarmingly low. The prevalence of this behavior among pediatric providers and their adolescent patients is unknown. The objective of this study was to describe pediatric provider behaviors for prescribing teratogens concurrently with counseling, referral, and/or prescribing of contraception (collectively called contraceptive provision) in the adolescent population.

METHODS: A retrospective review was conducted examining visits in 2008-2012 by adolescents aged 14 to 25 years in which a known teratogen (US Food and Drug Administration pregnancy risk category D or X) was prescribed. The electronic …

Contextualizing Multilayered Sexual Subjectivities Of Heterosexual Black Female Undergraduate Students At A Predominantly White Institution In The South, Amarachi Rossana Anakaraonye

Theses and Dissertations

This study uses an intersectional theoretical framework to examine Black college women’s sexual health by focusing on how they engage in sexual decision making within their social contexts. This qualitative study analyzed 20 individual in-depth interviews of Black female undergraduate students, ages 18-22, who attend a predominantly white institution (PWI) in the Southeastern United States. The themes that emerged from qualitative data analysis include Black female undergraduate students’ perceptions of the sexual culture of their campus and the protective strategies they employ to navigate the sexual culture in order to achieve and/or maintain physical, emotional, and social well-being. Key findings …

Nutritional Status And Tuberculosis Risk In Adult And Pediatric Household Contacts, Omowunmi Aibana, Xeno Acharya, Chuan-Chin Huang, Mercedes C Becerra, Jerome T Galea, Silvia S Chiang, Carmen Contreras, Roger Calderon, Rosa Yataco, Gustavo E Velásquez, Karen Tintaya, Judith Jimenez, Leonid Lecca, Megan B Murray

Faculty, Staff and Student Publications

BACKGROUND: Studies show obesity decreases risk of tuberculosis (TB) disease. There is limited evidence on whether high body mass index also protects against TB infection; how very high body mass indices influence TB risk; or whether nutritional status predicts this risk in children. We assessed the impact of body mass index on incident TB infection and disease among adults and children.

METHODS AND FINDINGS: We conducted a prospective cohort study among household contacts of pulmonary TB cases in Lima, Peru. We determined body mass index at baseline and followed participants for one year for TB infection and disease. We used …

Ethnic Differences In Maternal Adipokines During Normal Pregnancy, Xinhua Chen, Theresa O Scholl

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Two adipokines (adiponectin and resistin) have opposite relations with insulin resistance and inflammation. Our major focus was to determine whether there were detectable ethnic differences in maternal adipokines during pregnancy. We also explored the correlation of the adipokines with maternal glucose homeostasis, blood pressure and anthropometric parameters. Pregnant women (n = 1634) were from a large prospective cohort study in Camden NJ (African-American 36.8%; Hispanic 47.6%; Caucasian 15.6%). Serum adiponectin and resistin were measured at entry (week 16.8) and the 3rd trimester (week 30.7) using the Luminex xMapTechnology. Significant differences were observed among ethnic groups, controlling for confounding variables. African …

The Happy Older Latinos Are Active (Hola) Health Promotion And Prevention Study: Study Protocol For A Pilot Randomized Controlled Trial, Daniel E. Jimenez, Charles F. Reynolds, Margarita Alegría, Philip Harvey, Stephen Bartels

Dartmouth Scholarship

Results of previous studies attest to the greater illness burden of common mental disorders (anxiety and depression) in older Latinos and the need for developing preventive interventions that are effective, acceptable, and scalable. Happy Older Latinos are Active (HOLA) is a newly developed intervention that uses a community health worker (CHW) to lead a health promotion program in order to prevent common mental disorders among at-risk older Latinos. This pilot study tests the feasibility and acceptability of delivering HOLA to older, at-risk Latinos.

Methods/Design: HOLA is a multi-component, health promotion intervention funded by the National Institute of Mental Health (NIMH). …

Effectiveness Of Food-Demos To Increase Nutrition Knowledge, Megan Hemmelgarn

Honors Projects

This research investigated the effectiveness of a one-time food-demo at increasing the knowledge and improving the behavior of vegetable and diary consumption in the diets of college-aged females. Participation included a convenience sample of 26 college-aged females living in residence halls at a Bowling Green State University in Northwest Ohio. Testing was delivered before intervention as a baseline of knowledge and diet behavior. Post-testing was delivered immediately after intervention and evaluated any gain in knowledge from the baseline. One-month after intervention, post 2-testing was distributed evaluating retention of knowledge and behavioral change. Overall, participants experienced knowledge gain immediately after intervention …

‘Much Clearer With Pictures’: Using Community-Based Participatory Research To Design And Test A Picture Option Grid For Underserved Patients With Breast Cancer, Marie-Anne Durand, Shama Alam, Stuart W. Grande, Glyn Elwyn

Dartmouth Scholarship

Women of low socioeconomic status (SES) diagnosed with early stage breast cancer experience decision-making, treatment and outcome disparities. Evidence suggests that decision aids can benefit underserved patients, when tailored to their needs. Our aim was to develop and test the usability, acceptability and accessibility of a pictorial encounter decision aid targeted at women of low SES diagnosed with early stage breast cancer.

Identification And Survival Outcomes Of A Cohort Of Patients With Cancer Of Unknown Primary In Ontario, Canada., Chong S Kim, Malek B Hannouf, Sisira Sarma, George B Rodrigues, Peter K Rogan, Salaheddin M Mahmud, Eric Winquist, Muriel Brackstone, Gregory S Zaric

Epidemiology and Biostatistics Publications

BACKGROUND: Cancer of unknown primary origin (CUP) is defined by the presence of pathologically identified metastatic disease without clinical or radiological evidence of a primary tumour. Our objective was to identify incident cases of CUP in Ontario, Canada, and determine the influence of histology and sites of metastases on overall survival (OS).

MATERIAL AND METHODS: We used the Ontario Cancer Registry (OCR) and the Same-Day Surgery and Discharge Abstract Database (SDS/DAD) to identify patients diagnosed with CUP in Ontario between 1 January 2000, and 31 December 2005. Patient diagnostic information, including histology and survival data, was obtained from the OCR. …

Dynapenic Obesity And The Effect On Long-Term Physical Function And Quality Of Life: Data From The Osteoarthritis Initiative, John A. Batsis, Alicia J. Zbehlik, Dawna Pidgeon, Stephen J. Bartels

Dartmouth Scholarship

Obesity is associated with functional impairment, institutionalization, and increased mortality risk in elders. Dynapenia is defined as reduced muscle strength and is a known independent predictor of adverse events and disability. The synergy between dynapenia and obesity leads to worse outcomes than either independently. We identified the impact of dynapenic obesity in a cohort at risk for and with knee osteoarthritis on function.

Dual Use Of Va And Non-Va Hospitals By Veterans With Multiple Hospitalizations, Alan N. West, Mary E. Charlton, Mary Vaughan-Sarrazin

Dartmouth Scholarship

Background: Veterans who are hospitalized in both VA and non-VA hospitals within a short timespan may be at risk for fragmented or conflicting care. To determine the characteristics of these “dual users,” we analyzed administrative hospital discharge data for VA-enrolled veterans of any age in seven states, including any VA or non-VA hospitalizations they had in 2004 – 2007. Method: For VA enrollees in Arizona, Iowa, Louisiana, Florida, South Carolina, Pennsylvania, or New York in 2007, we merged 2004 – 2007 discharge data for all VA hospitalizations and all non-VA hospitalizations listed in state health department or hospital association databases. …

A Comparison Of A Multistate Inpatient Ehr Database To The Hcup Nationwide Inpatient Sample., Jonathan P Deshazo, Mark A Hoffman

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: The growing availability of electronic health records (EHRs) in the US could provide researchers with a more detailed and clinically relevant alternative to using claims-based data.

METHODS: In this study we compared a very large EHR database (Health Facts©) to a well-established population estimate (Nationwide Inpatient Sample). Weighted comparisons were made using t-value and relative difference over diagnoses and procedures for the year 2010.

RESULTS: The two databases have a similar distribution pattern across all data elements, with 24 of 50 data elements being statistically similar between the two data sources. In general, differences that were found are consistent …

Maternal Psychiatric Disease And Epigenetic Evidence Suggest A Common Biology For Poor Fetal Growth, Timothy H. Ciesielski, Carmen J. Marsit, Scott M. Williams

Dartmouth Scholarship

We sought to identify and characterize predictors of poor fetal growth among variables extracted from perinatal medical records to gain insight into potential etiologic mechanisms. In this process we reevaluated a previously observed association between poor fetal growth and maternal psychiatric disease. We evaluated 449 deliveries of >36 weeks gestation that occurred between 9/2008 and 9/2010 at the Women and Infants Hospital in Providence Rhode Island. This study group was oversampled for Small-for-Gestational-Age (SGA) infants and excluded Large-for-Gestational-Age (LGA) infants. We assessed the associations between recorded clinical variables and impaired fetal growth: SGA or Intrauterine Growth Restriction (IUGR) diagnosis. After …

Improving Child Survival Through A District Management Strengthening And Community Empowerment Intervention: Early Implementation Experiences From Uganda., Anne R. Katahoire, Dorcus K. Henriksson, Eric Ssegujja, Peter Waiswa, Florence Ayebare, Danstan Bagenda, Anthony K. Mbonye, Stefan S. Peterson

Journal Articles: Epidemiology

BACKGROUND: The Community and District Empowerment for Scale-up (CODES) project pioneered the implementation of a comprehensive district management and community empowerment intervention in five districts in Uganda. In order to improve effective coverage and quality of child survival interventions CODES combines UNICEF tools designed to systematize priority setting, allocation of resources and problem solving with Community dialogues based on Citizen Report Cards and U-Reports used to engage and empower communities in monitoring health service provision and to demand for quality services. This paper presents early implementation experiences in five pilot districts and lessons learnt during the first 2 years of …

The Effect Of Standard Dose Multivitamin Supplementation On Disease Progression In Hiv-Infected Adults Initiating Haart: A Randomized Double Blind Placebo-Controlled Trial In Uganda., David Guwatudde, Molin Wang, Amara E. Ezeamama, Danstan Bagenda, Rachel Kyeyune, Henry Wamani, Yukari C. Manabe, Wafaie W. Fawzi

Journal Articles: Epidemiology

BACKGROUND: Efficacy trials investigating the effect of multivitamin (MV) supplementations among patients on Highly Active Antiretroviral Therapy (HAART) have so far been inconclusive. We conducted a randomized, double blind, placebo controlled trial to determine the effect of one recommended daily allowance (RDA) of MV supplementation on disease progression in patients initiating HAART.

METHODS: Eligible subjects were randomized to receive placebo or MV supplementation including vitamins B-complex, C and E. Participants were followed for up to 18 months. Primary endpoints were: change in CD4 cell count, weight and quality of life (QoL). Secondary endpoints were: i) development of a new or …

Improving Early Infant Hiv Diagnosis In Kenya: Study Protocol Of A Cluster-Randomized Efficacy Trial Of The Hitsystem., Sarah Finocchario-Kessler, Kathy Goggin, Samoel Khamadi, Brad Gautney, Jacinda K. Dariotis, Charles Bawcom, An-Lin Cheng, Niaman Nazir, Catherine Martin, Andrea Ruff, Michael Sweat, Vincent Okoth

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Early infant diagnosis among human immunodeficiency virus (HIV)-exposed infants is a critical component of prevention of mother-to-child transmission programs. Barriers to early infant diagnosis include poor uptake, low retention at designated re-testing intervals, delayed test results, passive systems of communication, and poor linkage to treatment. This study will evaluate the HIV Infant Tracking System (HITSystem), an eHealth intervention that streamlines communication and accountability between the key early infant diagnosis stakeholders: HIV+ mothers and their HIV-exposed infants, healthcare providers, and central laboratory personnel. It is hypothesized that the HITSystem will significantly improve early infant diagnosis retention at 9 and 18 …

Fetal, Neonatal, Infant, And Child International Growth Standards: An Unprecedented Opportunity For An Integrated Approach To Assess Growth And Development., Cutberto Garza

Global Health Faculty Publications

The recent publication of fetal growth and gestational age-specific growth standards by the International Fetal and Newborn Growth Consortium for the 21st Century Project and the previous publication by the WHO of infant and young child growth standards based on the WHO Multicentre Growth Reference Study enable evaluations of growth from ∼9 wk gestation to 5 y. The most important features of these projects are the prescriptive approach used for subject selection and the rigorous testing of the assertion that growth is very similar among geographically and ethnically diverse nonisolated populations when health, nutrition, and other care needs are met …

Comparison Of Body Composition Assessment Techniques In Older Adult Females, Lauren Yacapraro

Honors Projects

Comparison of Body Composition Assessment Techniques in Older Adult Females

Introduction: As the aging population increases, the need for accurate assessment of chronic disease risk also increases. There is considerable debate over the best way to assess this risk. BMI is a weight-to-height ratio that is commonly used to assess adiposity and obesity related risk. However, it does not differentiate lean (i.e., muscle and bone) versus fat mass – the true predictors of obesity-related diseases (e.g., cardiovascular disease and diabetes). This is prevalent in post-menopausal women who often experience age-related gains in fat mass and losses in lean mass.

Methods: …

Identifying Cases Of Undiagnosed, Clinically Significant Copd In Primary Care: Qualitative Insight From Patients In The Target Population, Nancy K. Leidy, Katherine Kim, Elizabeth D. Bacci, Barbara P. Yawn, David M. Mannino, Byron M. Thomashow, R. Graham Barr, Stephen I. Rennard, Julia F. Houfek, Meilan K. Han, Catherine A. Meldrum, Barry J. Make, Russ P. Bowler, Anna W. Steenrod, Lindsey T. Murray, John W. Walsh, Fernando Martinez

Preventive Medicine and Environmental Health Faculty Publications

BACKGROUND: Many cases of chronic obstructive pulmonary disease (COPD) are diagnosed only after significant loss of lung function or during exacerbations.

AIMS: This study is part of a multi-method approach to develop a new screening instrument for identifying undiagnosed, clinically significant COPD in primary care.

METHODS: Subjects with varied histories of COPD diagnosis, risk factors and history of exacerbations were recruited through five US clinics (four pulmonary, one primary care). Phase I: Eight focus groups and six telephone interviews were conducted to elicit descriptions of risk factors for COPD, recent or historical acute respiratory events, and symptoms to inform the …

Continuing To Confront Copd International Surveys: Comparison Of Patient And Physician Perceptions About Copd Risk And Management, Ana M. Menezes, Sarah H. Landis, Meilan K. Han, Hana Muellerova, Zaurbek Aisanov, Thys Van Der Molen, Yeon-Mok Oh, Masakazu Ichinose, David M. Mannino, Kourtney J. Davis

Preventive Medicine and Environmental Health Faculty Publications

PURPOSE: Using data from the Continuing to Confront COPD International Physician and Patient Surveys, this paper describes physicians' attitudes and beliefs regarding chronic obstructive pulmonary disease (COPD) prognosis, and compares physician and patient perceptions with respect to COPD.

METHODS: In 12 countries worldwide, 4,343 patients with COPD were identified through systematic screening of population samples, and 1,307 physicians who regularly saw patients with COPD were sampled from in-country professional databases. Both patients and physicians completed surveys about their COPD knowledge, beliefs, and perceptions; physicians answered further questions about diagnostic methods and treatment choices for COPD.

RESULTS: Most physicians (79%) responded …

A Case Of Cutaneous Larva Migrans Presenting In A Pregnant Patient., Kasie Kudrewicz, Kylee N Crittenden, Alison Himes

Women’s Health Articles

Cutaneous larva migrans (CLM) is a pruritic dermatitis caused by migration of animal hookworm larvae into the skin. We present a case of CLM in a 31-year-old pregnant woman. The treatment of CLM relies on antihelminthic agents, such as thiabendazole, albendazole, and ivermectin. This case was interesting in that the standard treatment options previously mentioned were contraindicated owing to the patient's pregnancy. Cryotherapy with liquid nitrogen resulted in complete resolution of her lesion and symptoms.

Cohort Of Birth Modifies The Association Between Fto Genotype And Bmi, James Niels Rosenquist, Steven F. Lehrer, A. James O'Malley, Alan M. Zaslavsky, Jordan W. Smoller, Nicholas A. Christakis

Dartmouth Scholarship

A substantial body of research has explored the relative roles of genetic and environmental factors on phenotype expression in humans. Recent research has also sought to identify gene-environment (or g-by-e) interactions, with mixed success. One potential reason for these mixed results may relate to the fact that genetic effects might be modified by changes in the environment over time. For example, the noted rise of obesity in the United States in the latter part of the 20th century might reflect an interaction between genetic variation and changing environmental conditions that together affect the penetrance of genetic influences. To evaluate this …

Comparison Of Individual And Pooled Urine Samples For Estimating The Presence And Intensity Of Schistosoma Haematobium Infections At The Population Level, Abraham Degarege, Berhanu Erko, Zeleke Mekonnen, Mengistu Legesse, Yohannes Negash, Jozef Vercruysse, Bruno Levecke

Journal Articles: Epidemiology

BACKGROUND: There is a lack of cost-effective diagnostic strategies to evaluate whether mass drug administration (MDA) programmes to control Schistosoma haematobium progress as anticipated. The purpose of this study is to provide a proof-of-principle for examination of pooled urine samples as a strategy for rapid assessment of presence and intensity of Schistosoma haematobium infections at the population level.

METHODS: A total of 640 urine samples were collected from 520 school-aged children (520 at baseline and 120 at follow-up) during a clinical trial that was designed to assess the efficacy of praziquantel against Schistosoma haematobium infections in Ethiopia. Individual and pooled …

Clinical Presentation Of Patients With Ebola Virus Disease In Conakry, Guinea, Elhadj Ibrahima Bah, Marie-Claire Lamah, Tom Fletcher, Shevin T. Jacob, David Brett-Major, Amadou Alpha Sall, Nahoko Shindo, William A. Fischer, Francois Lamontagne, Sow Mamadou Saliou, Daniel G. Bausch, Barry Moumié, Tim Jagatic, Armand Sprecher, James V. Lawler, Thierry Mayet, Frederique A. Jacquerioz, María F. Méndez Baggi, Constanza Vallenas, Christophe Clement, Simon Mardel, Ousmane Faye, Oumar Faye, Baré Soropogui, Nfaly Magassouba, Lamine Koivogui, Ruxandra Pinto, Robert A. Fowler

Journal Articles: Epidemiology

BACKGROUND: In March 2014, the World Health Organization was notified of an outbreak of Zaire ebolavirus in a remote area of Guinea. The outbreak then spread to the capital, Conakry, and to neighboring countries and has subsequently become the largest epidemic of Ebola virus disease (EVD) to date.

METHODS: From March 25 to April 26, 2014, we performed a study of all patients with laboratory-confirmed EVD in Conakry. Mortality was the primary outcome. Secondary outcomes included patient characteristics, complications, treatments, and comparisons between survivors and nonsurvivors.

RESULTS: Of 80 patients who presented with symptoms, 37 had laboratory-confirmed EVD. Among confirmed …

Undernutrition And Associated Risk Factors Among School Age Children In Addis Ababa, Ethiopia, Dawit Degarege, Abraham Degarege, Abebe Animut

Journal Articles: Epidemiology

BACKGROUND: Causes of child undernutrition are diverse and change in space and time. Investigating current determinants of undernutrition remains vital to design an effective intervention strategy. The study assessed prevalence of undernutrition and its associated factors among children living in Addis Ababa, Ethiopia.

METHODS: A community based cross-sectional study was conducted in 459 school age children and their parents or caregivers living in Lideta sub-city, Addis Ababa, Ethiopia. Participants were selected using a multi-stage simple random sampling technique. Height and weight of children was measured and their parents or care givers were interviewed for factors associated with undernutrition.

RESULTS: About …

Reassessment Of Risk Genotypes (Grn, Tmem106b, And Abcc9 Variants) Associated With Hippocampal Sclerosis Of Aging Pathology, Peter T. Nelson, Wang-Xia Wang, Amanda B. Partch, Sarah E. Monsell, Otto Valladares, Sally R. Ellingson, Bernard R. Wilfred, Adam C. Naj, Li-San Wang, Walter A. Kukull, David W. Fardo

Pathology and Laboratory Medicine Faculty Publications

Hippocampal sclerosis of aging (HS-Aging) is a common high-morbidity neurodegenerative condition in elderly persons. To understand the risk factors for HS-Aging, we analyzed data from the Alzheimer’s Disease Genetics Consortium and correlated the data with clinical and pathologic information from the National Alzheimer’s Coordinating Center database. Overall, 268 research volunteers with HS-Aging and 2,957 controls were included; detailed neuropathologic data were available for all. The study focused on single-nucleotide polymorphisms previously associated with HS-Aging risk: rs5848 ( GRN ), rs1990622 ( TMEM106B ), and rs704180 ( ABCC9 ). Analyses of a subsample that was not previously evaluated (51 HS-Aging cases …

Age-Related Factors Influencing The Occurrence Of Undernutrition In Northeastern Ethiopia, Abraham Degarege, Elifaged Hailemeskel, Berhanu Erko

Journal Articles: Epidemiology

BACKGROUND: Undernutrition is a major public health problem on the globe particularly in the developing regions. The objective of the current study was to assess the prevalence of undernutrition in different age groups and examine the relationship of the disease to parasitic and socioeconomic factors among communities in Harbu Town, northeastern Ethiopia.

METHODS: Stool samples of the study participants were examined for intestinal helminth infections using the Kato-Katz method. Blood specimens were diagnosed for Plasmodium infection using CareStartTM Malaria Pf/Pv Combo test. The blood type was determined from blood samples using antisera A and antisera B. In addition, the height …

Women's Fitness Week, Claire T. Lucas, Tiffany M. Finch

Williams Honors College, Honors Research Projects

This project addressed women’s wellness. Many women experience physical and mental health issues related to a lack of physical activity or psychological support. Women’s Fitness Week was offered to women of the University of Akron and the outside community, providing opportunities to learn more about and improve upon the various dimensions of wellness – emotional, environmental, financial, intellectual, occupational, physical, social/cultural, and spiritual. Events were held at the University’s Student Recreation and Wellness Center and encompassed topics such as nutrition, weight training, and self-defense. The goals of this project were to: increase knowledge levels of fitness, health, and wellness, increase …

Effects Of Ambient Coarse, Fine, And Ultrafine Particles And Their Biological Constituents On Systemic Biomarkers: A Controlled Human Exposure Study, Ling Liu, Bruce Urch, Raymond Poon, Mieczyslaw Szyszkowicz, Mary Speck, Diane R. Gold, Amanda J. Wheeler, James A. Scott, Jeffrey R. Brook, Peter S. Thorne, Frances S. Silverman

Research outputs 2014 to 2021

Background: Ambient coarse, fine, and ultrafine particles have been associated with mortality and morbidity. Few studies have compared how various particle size fractions affect systemic biomarkers. Objectives: We examined changes of blood and urinary biomarkers following exposures to three particle sizes. Methods: Fifty healthy nonsmoking volunteers, mean age of 28 years, were exposed to coarse (2.5–10 μm; mean, 213 μg/m3) and fine (0.15–2.5 μm; mean, 238 μg/m3) concentrated ambient particles (CAPs), and filtered ambient and/or medical air. Twenty-five participants were exposed to ultrafine CAP (< 0.3 μm; mean, 136 μg/m3) and filtered medical air. Exposures lasted 130 min, separated by ≥ 2 weeks. Blood/urine samples were collected preexposure and 1 hr and 21 hr postexposure to determine blood interleukin-6 and C-reactive protein (inflammation), endothelin-1 and vascular endothelial growth factor (VEGF; vascular mediators), and malondialdehyde (lipid peroxidation); as well as urinary VEGF, 8-hydroxy-deoxy-guanosine (DNA oxidation), and malondialdehyde. Mixed-model regressions assessed pre- and postexposure differences. results: One hour postexposure, for every 100-μg/m3 increase, coarse CAP was associated with increased blood VEGF (2.41 pg/mL; 95% CI: 0.41, 4.40) in models adjusted for O3, fine CAP with increased urinary malondialdehyde in single- (0.31 nmol/mg creatinine; 95% CI: 0.02, 0.60) and two-pollutant models, and ultrafine CAP with increased urinary 8-hydroxydeoxyguanosine in single- (0.69 ng/mg creatinine; 95% CI: 0.09, 1.29) and two-pollutant models, lasting < 21 hr. Endotoxin was significantly associated with biomarker changes similar to those found with CAPs. conclusions: Ambient particles with various sizes/constituents may influence systemic biomarkers differently. Endotoxin in ambient particles may contribute to vascular mediator changes and oxidative stress.

Continuing To Confront Copd International Physician Survey: Physician Knowledge And Application Of Copd Management Guidelines In 12 Countries, Kourtney J. Davis, Sarah H. Landis, Yeon-Mok Oh, David M. Mannino, Meilan K. Han, Thys Van Der Molen, Zaurbek Aisanov, Ana M. Menezes, Masakazu Ichinose, Hana Muellerova

Preventive Medicine and Environmental Health Faculty Publications

AIM: Utilizing data from the Continuing to Confront COPD (chronic obstructive pulmonary disease) International Physician Survey, this study aimed to describe physicians' knowledge and application of the GOLD (Global initiative for chronic Obstructive Lung Disease) Global Strategy for the Diagnosis, Management and Prevention of COPD diagnosis and treatment recommendations and compare performance between primary care physicians (PCPs) and respiratory specialists.

MATERIALS AND METHODS: Physicians from 12 countries were sampled from in-country professional databases; 1,307 physicians (PCP to respiratory specialist ratio three to one) who regularly consult with COPD, emphysema, or chronic bronchitis patients were interviewed online, by telephone or face …