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Biomedical subjects

Deborah Cohen

Publications and source records attributed to Deborah Cohen.

At least 19 recordsLinked to original sources
PubMed2007

Alcohol and environmental justice: the density of liquor stores and bars in urban neighborhoods in the United States.

OBJECTIVE: This study had two purposes: (1) to characterize the density of liquor stores and bars that individuals face according to race, economic status, and age in the urban United States and (2) to assess alternative measures of retailer density based on the road network and population. METHOD: We used census data on business counts and sociodemographic characteristics to compute the densities facing individuals in 9,361 urban zip codes. RESULTS: Blacks face higher densities of liquor stores than do whites. The density of liquor stores is greater among nonwhites in lower-income areas than among whites in lower- and higher-income areas and nonwhites in higher-income areas. Nonwhite youths face higher densities of liquor stores than white youths. The density of liquor stores and bars is lower in higher-income areas, especially for nonwhites. CONCLUSIONS: Mismatches between alcohol demand and the supply of liquor stores within urban neighborhoods constitute an environmental injustice for minorities and lower-income persons, with potential adverse consequences for drinking behavior and other social ills. Our results for bars are sensitive to the measure of outlet density as well as population density. Although neither measure is clearly superior, a measure that accounts for roadway miles may reflect proximity to alcohol retailers and thus serve as a useful refinement to the per-capita measure. If so, alcohol policy might also focus on density per roadway mile. Further research on the existence, causes, and consequences of environmental injustice in alcohol retailing is warranted.

Alcohol Drinking↗
PubMed2006

Hispanic concentration and the conditional influence of collective efficacy on adolescent childbearing.

OBJECTIVE: To determine how Hispanic residential concentration moderates the relationship between neighborhood collective efficacy and teenage birth rates. DESIGN: Cross-sectional analysis of census tract level survey data and birth records. SETTING: Sixty-five Los Angeles (California) County census tracts in 2000 and 2001. PARTICIPANTS: Measures of neighborhood collective efficacy from 2600 adults from the Los Angeles Family and Neighborhood Study (LAFANS) survey were linked with demographic information from the US 2000 Census and Los Angeles County birth records for 10- through 19-year-old mothers. MAIN EXPOSURES: Collective efficacy and Hispanic residential concentration. MAIN OUTCOME MEASURES: Married and unmarried teenage birth rates. RESULTS: In census tracts with less than a 50% Hispanic population, a 1-SD increase in collective efficacy was associated with a 5.07 births per 1000 decrease in the unmarried teenage birth rate (P<.05). In census tracts with a 50% or greater Hispanic population, a 1-SD increase in collective efficacy was not statistically related to unmarried rates, but it was associated with a 3.43 increase in the married teenage birth rate (P<.05). CONCLUSIONS: Collective efficacy may help reduce adolescent childbearing in some, but not all, neighborhoods. An interaction between collective efficacy and Hispanic population concentration suggests cultural variation may play a role in how collective efficacy influences adolescent fertility. Possible explanations for the positive relationship between collective efficacy and married birth rates found in segregated Hispanic neighborhoods include profertility orientations and availability of childrearing networks for young parents. To help harness social capital to improve public health outcome, we suggest future studies examine the role of community cultural variation.

Adolescent↗
PubMed2004

The accuracy of endoscopic ultrasound for restaging esophageal carcinoma after chemoradiation therapy.

BACKGROUND: Endoscopic ultrasound (EUS) is an accurate staging modality for esophageal malignancy. Studies have determined that EUS does not retain this accuracy after chemoradiation and that it should not be used as a restaging tool for esophageal carcinoma. In this study, the authors examined their experience with esophageal carcinoma and restaging after neoadjuvant therapy with EUS. METHODS: A retrospective chart review was conducted that included 83 patients with locoregional esophageal adenocarcinoma who were treated with chemoradiation under protocol. All patients underwent surgical resection. EUS was performed for restaging, and the results were compared with findings at surgical pathology using the TNM classification system. RESULTS: All 83 patients identified underwent surgery. There were 77 males, and the mean patient age was 59 years. At restaging, the tumor status (T classification) was assessed correctly by EUS in 22 of 83 patients (29%). The sensitivity of EUS for the individual T classifications were 0% for T0 tumors, 19% for T1 tumors, 27% for T2 tumors, 52% for T3 tumors, and 0% for T4 tumors. In 19 of 83 patients, the tumor classification was correct, whereas 42 of 83 patients were over classified, and 15 of 83 patients were under classified when the EUS results were compared with the surgical pathology results. The lymph node status (N classification) was assessed correctly by EUS in 41 of 83 patients. The sensitivity of EUS for N classification was 48% for N0 disease and 52% for N1 disease. Twenty-two patients were restaged with residual disease according to the EUS results but had no evidence of residual tumor or lymph node involvement according to the surgical pathology results. CONCLUSIONS: EUS did not retain its usefulness as a restaging modality after neoadjuvant chemoradiation for esophageal adenocarcinoma when the standard TNM classification system was used.

Adenocarcinoma↗
PubMed2004

The transcriptional repressor Mecp2 regulates terminal neuronal differentiation.

Rett syndrome (RTT) is a severe neurodevelopmental disorder with features of autism that results from mutation of the gene encoding the transcriptional repressor methyl-CpG binding protein (MECP2). The consequences of loss of a transcription factor may be complex, affecting the expression of many proteins, thus limiting understanding of this class of diseases and impeding therapeutic strategies. This is true for RTT. Neither the cell biological mechanism(s) nor the developmental stage affected by MECP2 deficiency is known. In vivo analysis of the olfactory system demonstrates that Mecp2 deficiency leads to a transient delay in the terminal differentiation of olfactory neurons. This delay in maturation disrupts axonal targeting in the olfactory bulb, resulting in abnormal axonal projections, subglomerular disorganization, and a persistent reduction in glomerular size. These results indicate a critical cell biological function for Mecp2 in mediating the final stages of neuronal development.

Animals↗
PubMed2004

Opportunistic approaches for delivering preventive care in illness visits.

OBJECTIVE: To describe how clinicians create opportunities to deliver preventive care in illness visits and assess the impact this has on preventive service delivery. METHOD: Detailed and descriptive fieldnotes were collected from 18 purposefully selected family practices, including direct observations of 53 primary care clinicians and 1620 patient encounters. Conversation analysis was used to examine the conversational techniques employed to deliver four preventive services (smoking counseling, immunization delivery, mammography, and cervical cancer screening) in illness visits. Qualitative data was coded and analyzed to assess impact on preventive service delivery rates. RESULTS: Two methods for opportunistic preventive service delivery were observed. In the first, clinicians used the close of the medical encounter to make arrangement for follow-up preventive care. In the second approach, clinicians use a stepwise conversational device to exit talk about the patient's presenting problem and enter into relevant health habit advice. Quantitative analyses show that opportunistic methods are rarely used to deliver preventive services in illness visits. The stepwise technique was the most frequently used method. Patients treated by clinicians who used opportunistic techniques to deliver preventive care in illness visits were more likely to be up-to-date on smoking counseling and cervical cancer screening than those patients who were treated by clinicians who did not use opportunistic approaches. CONCLUSIONS: Opportunistic preventive service delivery in illness visits can be an efficient and effective way to deliver preventive care. Although infrequently used, quantitative data suggest that the use of opportunistic approaches to deliver preventive services during illness visits can enhance preventive care rates. Interventions aimed at helping clinicians develop effective strategies for offering preventive care during illness visits may be an important complement to existing mechanical interventions that might, by themselves, be insufficient to improve preventive care.

Family Practice↗
PubMed2004

Speaking of weight: how patients and primary care clinicians initiate weight loss counseling.

BACKGROUND: Obesity is epidemic in the US and other industrialized countries and contributes significantly to population morbidity and mortality. Primary care physicians see a substantial portion of the obese population, yet rarely counsel patients to lose weight. METHODS: Descriptive field notes of outpatient visits collected as part of a multimethod comparative case study were used to study patterns of physician-patient communication around weight control in 633 encounters in family practices in a Midwestern state. RESULTS: Sixty-eight percent of adults and 35% of children were overweight. Excess weight was mentioned in 17% of encounters with overweight patients, while weight loss counseling occurred with 11% of overweight adults and 8% of overweight children. In weight loss counseling encounters, patients formulated weight as a problem by making it a reason for visit or explicitly or implicitly asking for help with weight loss. Clinicians did so by framing weight as a medical problem in itself or as an exacerbating factor for another medical problem. CONCLUSIONS: Strategies that increase the likelihood of patients identifying weight as a problem, or that provide clinicians with a way to "medicalize" the patient's obesity, are likely to increase the frequency of weight loss counseling in primary care visits.

Adult↗
PubMed2004

Vaginal spasm, pain, and behavior: an empirical investigation of the diagnosis of vaginismus.

This study investigated the roles of vaginal spasm, pain, and behavior in vaginismus and the ability of psychologists, gynecologists, and physical therapists to agree on a diagnosis of vaginismus. Eighty-seven women, matched on age, relationship status, and parity, were assigned to one of three groups: vaginismus, dyspareunia resulting from vulvar vestibulitis syndrome (VVS), and no pain with intercourse. Diagnostic agreement was poor for vaginismus; vaginal spasm and pain measures did not differentiate between women in the vaginismus and dyspareunia/VVS groups; however, women in the vaginismus group demonstrated significantly higher vaginal/pelvic muscle tone and lower muscle strength. Women in the vaginismus group also displayed a significantly higher frequency of defensive/avoidant distress behaviors during pelvic examinations and recalled past attempts at intercourse with more affective distress. These data suggest that the spasm-based definition of vaginismus is not adequate as a diagnostic marker for vaginismus. Pain and fear of pain, pelvic floor dysfunction, and behavioral avoidance need to be included in a multidimensional reconceptualization of vaginismus.

Adult↗