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Biomedical subjects

B J Skipper

Publications and source records attributed to B J Skipper.

At least 37 records · Page 2Linked to original sources
PubMed1996

Food preferences, practices, and cancer-related food and nutrition knowledge of southwestern American Indian youth.

BACKGROUND: Pathways to Health is a cancer prevention and health promotion curriculum for fifth- and seventh-grade Navajo and Pueblo students living in New Mexico. METHODS: A diet and nutrition questionnaire was administered to 1007 fifth- and seventh-grade students before beginning the Pathways to Health intervention. Sections of the questionnaire included listing favorite foods, frequency of intake of selected foods (e.g., "How often do you eat vegetables?"), targeted food practices (e.g., "When you eat chicken, do you eat the skin?"), and applied dietary fat and fiber knowledge questions. Descriptive analyses were generated by grade, gender, and tribe. RESULTS: Students' favorite foods were pizza, hamburgers, and tacos. Only 35.7% of students reported consuming the U.S. Dietary Guidelines recommendation of two or more daily servings of fruit, with only 19.3% reporting more than once-a-day intake of vegetables. The mean score (percent correct responses) to questions identifying common food sources of dietary fat and fiber, and other cancer-related nutrition knowledge questions, was 45.2% and 57.9% for fifth- and seventh-grade students, respectively. CONCLUSIONS: These and related data support the need for nutrition education interventions in this population that target essential cancer prevention skills and motivational information required to make positive dietary choices.

Adolescent↗
PubMed1996

Triage: limitations in predicting need for emergent care and hospital admission.

STUDY OBJECTIVE: Little is known about the accuracy and reliability of current triage methods. We examined agreement among observers with regard to the need for ED care and the ability to predict at triage the need for admission to the hospital and compared these findings with admission rates after medical evaluation and management. METHODS: We used a crossover design in which each subject was subjected to nurse or computer-guided triage first, the other type of triage second, and physician triage last. Our null hypothesis: Triage methods will yield the same results. Our patients were a consecutive sample of patients at the ED of a university-affiliated county referral center. Critically ill patients were excluded. Triage categorization was examined for interobserver agreement (kappa-statistic) and prediction of admission (sensitivity, specificity, and predictive values). RESULTS: Of the 5,106 patients enrolled in the study, 289 (6.2%) were admitted. With regard to the agreement of triage categorizations, we found kappa-values of .452 and .185, respectively, for physician triage compared with nurse (SE +/- .012) and computer triage (SE +/- .012)(P = .001 for the difference between the kappa values). Sensitivity and specificity in predicting admission were 41.3 and 93.8, respectively, for nurses, 61.6 and 87.1, respectively, for physicians; and 68.2 and 73.6, respectively, for computer-aided triage. CONCLUSION: We found great variability among physicians, nurses, and a computer program with regard to triage decisions. Comparison of the three groups' triage decisions with actual data after medical evaluation and management showed that none of the three performed well in predicting which patients required admission. Until triage methods are standardized and validated, triage decisions should not be used to determine the timeliness of access to emergency care.

Adolescent↗
PubMed1995

Tobacco use: baseline results from pathways to health, a school-based project for southwestern American Indian youth.

BACKGROUND: This paper describes a school-based cancer prevention project for fifth- and seventh-grade Navajo and Pueblo Indian children living in the Southwest. Baseline data are presented from 714 students who completed questionnaires on smoking and smokeless tobacco. METHODS: Questionnaires were administered in the fifth- and seventh-grade classrooms prior to students receiving the Pathways to Health cancer prevention curriculum. RESULTS: In our sample there were increases from fifth to seventh grade in self-reported current cigarette use and intention to use. Also, boys were more likely to use and intend to use cigarettes than girls. The use of smokeless tobacco also increased with increasing grade level, though this trend was less pronounced for girls. A significant gender difference was found in the use of smokeless tobacco with boys reporting higher use. However, reported use by girls was higher than is typically noted for non-Hispanic white girls. CONCLUSIONS: There is evidence of experimentation and regular use of tobacco products by both Navajo and Pueblo boys and girls. Even more students indicate intention to use tobacco products in the future. These data confirm the need for primary prevention programs designed for this population of American Indians.

Adolescent↗
PubMed1995

Homelessness and substance use among alcohol abusers following participation in project H&ART.

Project H&ART was a randomized intervention trial for homeless alcohol abusers in Albuquerque, N.M. Interventions were four months in duration and included: a high intensity program (case management plus peer-supervised housing), a medium intensity group (peer-supervised housing only); a housed, and a nonhoused control group. Clients were interviewed at baseline and re-interviewed ten months following program entry to determine substance use, housing stability and employment status. Program graduation rates were about 25% for the three housed groups. The outcome evaluation revealed significant within groups improvements in all of the outcomes, no between groups or racial outcome differences, and more favorable alcohol use and housing stability outcomes among program graduates than dropouts. On follow-up, women in the study had fewer days of alcohol use and had more days of stable housing, but were less likely to be employed, compared with men. We suggest that clients' personal motivation for recovery, rather than program-related factors, were most influential in determining outcomes.

Adolescent↗
PubMed1995

Alcohol abuse screening instruments: normative test data collected from a first DWI offender screening program.

OBJECTIVE: A variety of instruments are used by Driving While Impaired (DWI) screening programs nationwide to assess offenders for alcohol- or drug-related problems. This study presents normative data from five standardized instruments administered by a DWI screening program: the MAC scale of the MMPI, the Alcohol Use Inventory (AUI), the Michigan Alcoholism Screening Test (MAST), the Drug Abuse Screening Test (DAST) and the Skinner's Trauma Scale (STS). METHOD: The population under study were 2,317 first DWI offenders who completed screening evaluations in 1989-91. The sample included 24% women; the racial distribution was 46% Hispanic, 43% non-Hispanic white, 8% Native American and 3% other races. A statistical model was developed to determine associations among scores on the various instruments and age, gender, ethnicity, education, blood alcohol concentration (BAC) and validity measures on the MMPI-2 (L and K scale scores) RESULTS: There were significant differences in test scores among the ethnic- and gender-specific client groups. Test scores were significantly higher among men than women for the MAST, the D1 and D2 scales of the AUI, the MAC, and the STS. Correlations among the instruments were generally low, and the percentage of persons who scored above instrument cut-points varied significantly. The MAST identified the highest percentage of persons as alcoholic. MMPI profile validity was the most significant independent variable associated with test scores. Persons with scores in the valid range had higher mean scores on each of the instruments. CONCLUSIONS: The choice of instruments used in the DWI assessment can greatly influence the percentage of offenders assessed as having alcohol-related problems.

Accidents, Traffic↗
PubMed1995

Risk factors for homelessness: a study of families of origin.

OBJECTIVE: This study's objective was to test the hypothesis that there are health issues and other factors in families of origin that have an association with, and may be risk factors for, homelessness. METHODS: This case control study identified risk factors in a group of homeless patients at a health clinic for the homeless. Two comparison groups from an academic family practice center were included. One comparison group was county indigent patients, and the other was patients who had health insurance. RESULTS: Significant differences in families of origin among these three groups were identified. On univariate analysis, homeless persons were found to have an increased prevalence of alcoholism in the family of origin, earlier departure from the home, minority status, a self-described negative childhood, experiences of abuse as a child, high birth order in large families, less parental education, less-skilled parental occupations, less feeling of love in the childhood family, less likelihood of the father being in the home, more risk of the father having been in jail, and less identification with a religious group. Multivariate analysis revealed that compared to the study groups, the following family of origin factors were associated with homelessness: ethnic group, alcoholism, feeling loved as a child, and having one's father in jail. CONCLUSIONS: Homelessness is a multifactorial issue, but risk factors can be identified that may distinguish individuals at increased risk. Root causes may begin in childhood and be related to the family of origin.

Adult↗
PubMed1994

Risk factors for violent behavior in elementary school boys: have you hugged your child today?

Seventeen Hispanic elementary schoolboys with violent behavior problems were compared with 27 matched control students who were not overtly violent at school. Violent boys were significantly more likely to not live with their fathers, to have unmarried parents, to have more siblings, and to have fathers who never show them affection. Parents of violent boys were more likely than those of matched control students to use spanking for discipline and to admit that they rarely express affection for their sons.

Adult↗
PubMed1994

Nitrogen dioxide and respiratory illness in children. Part III: Quality assurance in an epidemiologic study.

This report describes the quality assurance and quality control program developed for the previously reported epidemiologic study of nitrogen dioxide (NO2) and respiratory illness in children (Health Effects Institute Research Report 58, Parts I and II). The specific aims of the program were to make certain that data were sufficiently accurate, complete, verifiable, and retrievable. The quality assurance and quality control program consisted of: a written protocol, standard operating procedures, written records, a project management system, appropriate data processing, data verification, and data analysis planning, and was staffed by qualified and appropriately trained personnel. Within the activities of the overall program, two focused quality assurance studies were conducted. During the first of these focused studies, parents maintained a calendar-diary of their child's daily respiratory symptoms. Telephone interviews were conducted at intervals of two weeks, and parents used the calendars to report on symptom occurrence since the previous call. To assess the comparability of illness events based on symptom reports from the parents with usual clinical diagnostic methods, nurse practitioners examined children during illness, and office and clinic records of outpatient visits were reviewed. Using the parent reports, respiratory illnesses were defined as symptom episodes of at least two consecutive days; lower respiratory illnesses included at least one day of either wet cough or wheeze. Runny or stuffy nose was reported for 93% of illnesses; and wet cough for 33% and wheeze for 6% of illnesses. In comparison with the diagnoses made by a nurse practitioner, parent reports of wet cough or wheeze were sensitive (93.4%) for detecting lower respiratory illnesses, but nonspecific (with specificity of only 24.2%). The majority of the false-positive lower respiratory illnesses had the symptom of wet cough. The comparison of parent reports with outpatient records provided similar findings. These findings indicate that standardized reporting of respiratory illnesses can be achieved with regular telephone interviews, but the classification of specific illnesses from the observations of parents' information may differ from diagnoses made by clinicians. The second focused quality assurance study evaluated the measurement error associated with the parents' use of passive diffusion samplers for NO2. Midway through the study, technicians conducted home visits to assess compliance with stated procedures, and to make independent measurements of NO2. Based on criteria for placement and use of the samplers, conditions of noncompliance were observed on about 40% of visits.(ABSTRACT TRUNCATED AT 400 WORDS)

Data Collection↗
PubMed1993

Comparability of parent reports of respiratory illnesses with clinical diagnoses in infants.

In a cohort study of respiratory illnesses from birth through age 18 months, the investigators assessed the occurrence of illness by telephone reports of respiratory symptoms. To assess the comparability of illness events based on symptom reports with usual clinical modalities, a nurse practitioner examined children during illnesses, and office and clinic records of outpatient visits were reviewed. Respiratory illnesses were defined as symptom episodes of at least 2 days; lower respiratory illnesses included at least 1 day of either wet cough or wheeze. This report is based on 10,771 illnesses in the 1,315 subjects enrolled. Runny or stuffy nose was reported for most (93%) illnesses, wet cough in 33%, and wheeze in 6%. In comparison with the diagnoses made by a nurse practitioner, parent report of wet cough or wheeze was sensitive (93.4%) for detecting lower respiratory illnesses, but nonspecific with specificity of only 24.2%. The majority of the false-positive lower respiratory illnesses had the symptom of wet cough. The comparison of parent reports with outpatient records provided similar findings. Standardized reporting of respiratory illnesses can be achieved with a telephone surveillance system but classification of specific illnesses from the surveillance information may differ from diagnoses made by clinicians.

Cohort Studies↗
PubMed1993

Nitrogen dioxide and respiratory illnesses in infants.

Nitrogen dioxide is an oxidant gas that contaminates outdoor air and indoor air in homes with unvented gas appliances. A prospective cohort study was carried out to test the hypothesis that residential exposure to NO2 increases incidence and severity of respiratory illnesses during the first 18 months of life. A cohort of 1,205 healthy infants from homes without smokers was enrolled. The daily occurrence of respiratory symptoms and illnesses was reported by the mothers every 2 wk. Illnesses with wheezing or wet cough were classified as lower respiratory tract. Indoor NO2 concentrations were serially measured with passive samplers place in the subjects' bedrooms. In stratified analyses, illness incidence rates did not consistently increase with exposure to NO2 or stove type. In multivariate analyses that adjusted for potential confounding factors, odds ratios were not significantly elevated for current or lagged NO2 exposures, or stove type. Illness duration, a measure of illness severity, was not associated with NO2 exposure. The findings can be extended to homes with gas stoves in regions of the United States where the outdoor air is not heavily polluted by NO2.

Air Pollutants↗
PubMed1993

Tuberculous meningitis in the southwest United States: a community-based study.

This community-based study analyzed 54 patients with definite or probable tuberculous meningitis (TBM) in New Mexico from 1970 through 1990. Patients ranged in age from 4 months to 86 years. The highest age-specific incidence occurred in the elderly, but 22% of patients were less than 10 years old. Native American patients were overrepresented. Patients were as likely to live in small towns as in large urban cities. Symptoms were present for a median of 13 days before admission. The majority of patients had fevers, headache, stiff neck, and mental changes, such as confusion or lethargy. No patient was admitted comatose. Focal neurologic signs were present in 33%. Laboratory testing found hyponatremia in 79%, pulmonary infiltrates on chest x-ray in 40%, ventricular dilatation on CT or MRI in 52%, and tuberculomas in 16%. PPD skin tests were positive in 64%. CSF cultures grew Mycobacterium tuberculosis in 50%, but colony counts were always lower than 10(2)/ml. As a consequence, acid-fast stains of CSF sediment were reported as positive in only 4%. Six patients were not diagnosed during the hospitalization and died of complications. Twenty-three percent of patients who were appropriately treated also died of complications during the initial hospitalization. Tuberculous meningitis continues to be an important disease in small communities, and affects all ages and ethnic and socioeconomic backgrounds.

Adolescent↗
PubMed1993

Nitrogen dioxide and respiratory illness in children. Part I: Health outcomes.

We have carried out a prospective cohort study to test the hypothesis that exposure to nitrogen dioxide increases the incidence and severity of respiratory infections during the first 18 months of life. Between January 1988 and June 1990, 1,315 infants were enrolled into the study at birth and followed with prospective surveillance for the occurrence of respiratory infections and monitoring of nitrogen dioxide concentrations in their homes. The subjects were healthy infants from homes without smokers; they were selected with stratification by type of cooking stove at a ratio of four to one for gas and electric stoves. Illness experience was monitored by a daily diary of symptoms completed by the mother and a telephone interview conducted every two weeks. Illnesses with wheezing or wet cough were classified as involving the lower respiratory tract; all other respiratory illnesses were designated as involving the upper respiratory tract. Exposure to nitrogen dioxide was estimated by two-week average concentrations measured in the subjects' bedrooms with passive samplers. This analysis is limited to the 1,205 subjects completing at least one month of observation; of these, 823 completed the full protocol, contributing 82.8% of the total number of days during which the subjects were under observation. Incidence rates for all respiratory illnesses, all upper respiratory illness, all lower respiratory illnesses, and lower respiratory illness further divided into those with any wheezing, or wet cough without wheezing, were examined within strata of nitrogen dioxide exposure at the time of the illness, nitrogen dioxide exposure during the prior month, and type of cooking stove. Consistent trends of increasing illness incidence rates with increasing exposure to nitrogen dioxide were not evident for either the lagged or unlagged exposure variables. The effect of nitrogen dioxide exposure on illness occurrence during at-risk intervals of two weeks' duration was examined using the generalized estimating equation approach. In these multivariate analyses, none of the odds ratios was significantly elevated for unlagged nitrogen dioxide exposures, lagged nitrogen dioxide exposures, or stove type. Duration of illness was assessed in relation to the same exposure variables; illness duration and nitrogen dioxide exposure were not associated. We have found that indoor exposure to nitrogen dioxide is associated with neither the incidence nor the duration of respiratory illnesses. The study was designed to have sufficient power to detect effects of nitrogen dioxide exposure of magnitudes previously reported and in a range relevant to public health concern; the lack of association cannot be attributed to potential bias from misclassification of outcome or exposure.(ABSTRACT TRUNCATED AT 400 WORDS)

Air Pollutants↗
PubMed1993

Nitrogen dioxide and respiratory illness in children. Part II: Assessment of exposure to nitrogen dioxide.

Repeated measurements of nitrogen dioxide were obtained from 1988 to 1991 in the homes of 1,205 infants living in Albuquerque, NM. Passive diffusion samplers were used to obtain a series of two-week integrated measurements from the home of each infant for use in a cohort study of the relation of residential exposure to nitrogen dioxide and respiratory illnesses. Information on stove use and time spent inside the residence was collected at two-week and two-month intervals, respectively. During the winter, in the bedrooms of homes with gas cooking stoves, mean nitrogen dioxide concentrations were 21 parts per billion (ppb); mean concentrations in the living room and kitchen were 29 ppb and 34 ppb, respectively. In homes with electric cooking stoves, the mean bedroom concentration was 7 ppb during the winter. Lower indoor concentrations were observed during the summer in homes with both gas and electric stoves. On average, infants spent approximately 12.3 hours per day in their bedrooms, 7.3 hours in the living rooms, 35 minutes in the kitchens, and 3.8 hours out of their homes. (As a condition of participation, none of the infants spent more than 20 hours per week in day care outside of their homes). The mean time infants spent in the kitchen during cooking was approximately nine minutes per day. We tested whether exposures of infants living in homes with gas stoves could be reasonably estimated by measurements in the bedroom in comparison with time-weighted average concentrations based on time-activity data and simultaneous nitrogen dioxide measurements in the kitchen, living room, and bedroom. In 1,937 two-week intervals from 587 infants, 90% of time-weighted exposure (on the three-level classification used in this study) estimates were in agreement with estimates based on bedroom concentrations alone. The agreement of the time-weighted nitrogen dioxide exposure estimates with the bedroom concentrations is attributed to limited amounts of cooking stove use (the mean was 29 minutes per day), small room-to-room differences in nitrogen dioxide concentrations (the mean kitchen-bedroom difference was 12 ppb), and the relatively large proportion of time that infants spent in their bedrooms.

Air Pollution, Indoor↗
PubMed1992

On the probability that kidneys are different in autosomal dominant polycystic disease.

We hypothesized that highly variable cyst fluid sodium concentrations are a characteristic of every kidney in autosomal dominant polycystic kidney disease (ADPKD). We added our data on sodium concentrations in 124 fluids from ten ADPKD kidneys to data published by others of concentrations in 32 fluids from five kidneys. The values ranged from 3 to 207 mEq/liter; none fell between 59 and 74 mEq/liter. Fluids were designated as low (< 60 mEq/liter; 50 fluids) or high (> 60 mEq/liter; 106 fluids) sodium fluids. Transmission electron microscopy identified differences in the depths of apical tight junctions between cells from cyst walls of 12 of the low and 10 of the high sodium fluids from two kidneys (mean +/- SE depths of 2039 +/- 74 A vs. 386 +/- 18 A respectively; P < 0.0001). When fluids were grouped by kidney of origin, six of the 15 kidneys had only high sodium fluids. The probability that chance had led to the sampling of only high sodium fluids in these organs, given that 32% of all fluids were low sodium fluids, was calculated at < 0.00015. The possibility must be considered that all kidneys are not alike in ADPKD.

Adult↗
PubMed1992

Navajo birth outcomes in the Shiprock uranium mining area.

The role of environmental radiation in the etiology of birth defects, stillbirths, and other adverse outcomes of pregnancy was evaluated for 13,329 Navajos born at the Public Health Service/Indian Health Service Hospital in the Shiprock, NM, uranium mining area (1964-1981). More than 320 kinds of defective congenital conditions were abstracted from hospital records. Using a nested case-control design, families of 266 pairs of index and control births were interviewed. The only statistically significant association between uranium operations and unfavorable birth outcome was identified with the mother living near tailings or mine dumps. Among the fathers who worked in the mines, those of the index cases had histories of more years of work exposure but not necessarily greater gonadal dosage of radiation. Also, birth defects increased significantly when either parent worked in the Shiprock electronics assembly plant. Overall, the associations between adverse pregnancy outcome and exposure to radiation were weak and must be interpreted with caution with respect to implying a biogenetic basis.

Abnormalities, Radiation-Induced↗
PubMed1991

Heritability of ventilatory function in smoking and nonsmoking New Mexico Hispanics.

Familial aggregation of ventilatory function has been described in several populations, but the effects of age and cigarette smoking on the extent of aggregation have not been well characterized. We used data from a survey of a Hispanic population in New Mexico to obtain estimates of heritability for FVC and FEV1 as percentages of predicted value. Product-moment correlations for FVC of spouse pairs were 0.18 (n = 90 pairs) if neither smoked, 0.013 (n = 45 pairs) if only the wife smoked, 0.18 (n = 118 pairs) if only the husband smoked, and -0.04 (n = 83 pairs) if both smoked. Correlations for FEV1 of spouse pairs were similar. Because parent-child correlations did not vary with sex, we calculated product-moment correlations from the pooled data. The parent-child correlations for nonsmoking parents with nonsmoking children 6 to 17 yr of age and living in the same house were 0.16 (n = 335 pairs) and 0.17 for FVC and FEV1, respectively. For parents whose children were 25 yr of age or older, the parent-child correlations for those living in different houses were 0.37 (n = 63 pairs) for FVC and 0.40 for FEV1 if neither smoked, and 0.24 (n = 27 pairs) for FVC and 0.14 for FEV1 if both smoked. Heritability estimates, estimated by path analysis, were 0.43 for FVC and 0.42 for FEV1 if neither family member smoked and 0.65 for FVC and 0.44 for FEV1 if both family members smoked. We conclude that there is a moderate degree of heritability of FVC and FEV1 with no substantial change based on age or smoking status.

Age Factors↗
PubMed1991

Growth retardation during the suckling period in expanded litters of rats: observations of growth patterns and protein turnover.

Postnatal patterns of growth and protein turnover were studied in suckling rats derived from expanded (EL) as compared to contracted (control) suckling rats (Widdowson and McCance, 1960). Maximum deviation of body weight growth velocity in EL vs. control litters of animals occurred early in the postnatal period (days 3-9). Fractional protein synthesis (Ks) in heart, diaphragm and gastrocnemius at 15 postnatal days were not significantly different in animals from expanded vs. control litters (e.g., Ks in heart 35.5 +/- 3.8% per day in control and 36.1 +/- 9.2% in expanded litters). Fractional growth rates in these 3 tissues were comparable in EL and controls, while fractional rates of protein breakdown (Kd) were somewhat reduced in diaphragm and gastrocnemius from EL animals (e.g., Kd in diaphragm 10.4% per day in control and 6.1% per day in EL). Absolute rates of protein synthesis and degradation were lower in EL animals, with rates of degradation reduced more than rates of synthesis. RNA activity of striated muscle tissues at 15 postnatal days in EL animals was not reduced vs. controls in contrast to results obtained in malnourished weanling and adult rats.

Aging↗