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Biomedical subjects

J S Preisser

Publications and source records attributed to J S Preisser.

At least 19 recordsLinked to original sources
PubMed2026

Genomic basis of developmental defects of enamel and sex-specific effects.

We conducted a multi-ancestry genome-wide association study (GWAS) of developmental defects of enamel (DDE) in the primary dentition among 6,061 U.S. preschool-aged children (3-5 years). We investigated four DDE phenotypes (demarcated opacities, diffuse opacities, hypoplastic defects, and a combined DDE trait) leveraging main-effect models, joint gene-sex interaction testing (2df), and sex-stratified analyses. SNP-based heritability for the combined DDE trait was estimated at 20%, with concordance analyses robustly supporting a genetic etiology. We identified 39 unique genome-wide significant loci (P<5&#xd7;10 ), with five surpassing a study-wide Bonferroni-corrected statistical significance criterion (P<1.25&#xd7;10 9), including Y RNA and ALDH1A1. The main-effect GWAS identified 20 loci, including HBS1L and MYB, genes regulating hematopoiesis with plausible roles in amelogenesis. Joint test and sex-stratified analyses revealed 19 additional loci, including ALDH1A1, TENM2, and DLGAP2, demonstrating sex-specific heterogeneity. Nineteen loci exhibited sex-specific differences after Bonferroni correction (P<2x10-3), including genes involved in retinoic acid signaling (ALDH1A1), odontogenesis (TENM2), and neurodevelopment (DLGAP2, CDH10). Pathway enrichment highlighted ectodermal and synapse organization networks, suggesting shared etiological mechanisms between DDE and systemic conditions like neurofibromatosis and autism spectrum disorder. Notably, no locus generalized in an external GWAS of permanent dentition DDE, underscoring fundamental biological differences in the genetic architectures governing primary versus permanent enamel formation. Crucially, a comprehensive cross-trait pleiotropy lookup against early childhood caries (ECC) revealed no shared genetic architecture, supporting the notion that the established clinical and epidemiological association between DDE and ECC is likely driven by structural defects increasing caries lesion susceptibility rather than genetic pleiotropy. By integrating gene-sex interaction testing, this study offers novel insights into the complex, sexually dimorphic genetic etiology of DDE and augments the biological evidence base that can support the development of precision pediatric dentistry.

developmental defects of enamel↗
PubMed2001

Why older community-dwelling adults do not discuss urinary incontinence with their primary care physicians.

OBJECTIVES: This study explored reasons why older adults with urinary incontinence (UI) do not initiate discussions with or seek treatment for UI from their primary care provider. DESIGN: A randomized, prospective controlled trial involving 41 primary care sites. SETTING: Primary care practice sites. PARTICIPANTS: 49 older adults age 60 and older not previously screened for UI by their primary care doctor. MEASUREMENTS: Demographic data, self-reported bladder-control information using questionnaires, and health status. RESULTS: Adults who did not discuss UI were older, had less-frequent leaking accidents and fewer nighttime voids and were less bothered by UI than those who did. The two main reasons why patients did not seek help were the perceptions that UI was not a big problem (45%) and was a normal part of aging (19%). CONCLUSIONS: Embarrassment or lack of awareness of treatment options were not significant barriers to discussing UI. Adults with a fairly high frequency of UI (average of 1.7 episodes per day) did not view UI as abnormal or a serious medical condition.

Aged↗
PubMed2001

The incidence of green tobacco sickness among Latino farmworkers.

We estimated the prevalence and incidence density (ID) and the risk factors of green tobacco sickness among minority farmworkers in North Carolina. Using a prospective surveillance design, 182 farmworkers were interviewed up to 5 times at biweekly intervals in 1999. The green tobacco sickness prevalence was 24.2%, whereas the ID was 1.88 days per 100 days worked. Greater work experience (5+ years, ID = 0.87; first year ID = 2.41) and tobacco use (ID of 1.18 vs 2.39) were negatively associated with green tobacco sickness. Task (e.g., priming ID, 4.04; topping ID, 1.86; barning ID, 0.62) and working in wet clothing (25% of workdays ID, 2.97; fewer than 25% of workdays ID, 1.29) had the largest effect. More effort must be directed toward preventing this occupational illness that affects workers who have little control over workplace safety.

Adolescent↗
PubMed2001

Environmental and behavioral predictors of salivary cotinine in Latino tobacco workers.

We report the results of a cohort study of 182 seasonal and migrant farmworkers engaged in tobacco production in two North Carolina counties. Data were collected on tobacco work tasks and risk factors for exposure to nicotine, including smoking, every 2 weeks over a 10-week period during the summer of 1999. Saliva samples were collected for cotinine analysis at every contact. Salivary cotinine levels increased across the season, independent of smoking status. Multivariate analyses identified a model (R2 = 0.68) in which predictors of cotinine included greater age, later-season work, wet working conditions, smoking, and work task. Harvesting ("priming") tobacco was associated with higher cotinine levels than other tasks. This study demonstrates that tobacco workers experience substantial work-related exposure to nicotine. The long-term effects of such exposure should be investigated.

Adult↗
PubMed2001

Predictors of incidence and prevalence of green tobacco sickness among Latino farmworkers in North Carolina, USA.

STUDY OBJECTIVE: The characteristics of some populations make epidemiological measurement extremely difficult. The objective of this study is to identify risk factors that explain variation among incidence densities and proportions of one occupational illness, green tobacco sickness, within one such special population, Latino migrant and seasonal farmworkers in the United States. DESIGN: Prospective cohort study. SETTING: 37 farmworker residential sites located in Granville and Wake Counties, North Carolina, USA. PARTICIPANTS: 182 migrant and seasonal farmworkers that included 178 Latino men, three Latino women, and one non-Hispanic white man. MAIN RESULTS: Green tobacco sickness had a prevalence of 0.082, and an incidence density of events per 100 days of 1.88 among the farmworkers. Prevalence and incidence density increased from early to late agricultural season. Major risk factors included lack of work experience, work activities, and working in wet clothes. Tobacco use was protective. CONCLUSION: Green tobacco sickness has a high incidence among migrant and seasonal farmworkers. Because workers have little control over most risk factors, further research is needed to identify ways to prevent this occupational illness.

Adolescent↗
PubMed2001

Training farmworkers about pesticide safety: issues of control.

Farmworkers experience a lack of control over the conditions of their work environment. In trying to reduce the effects of exposure to pesticides, most health care providers give instructions to farmworkers about how to protect themselves. Outreach programs that target farmworkers focus on health education and recommend washing hands, wearing appropriate clothing, and avoiding direct contact. The research reported in this paper shows that farmworkers in North Carolina perceive many of these preventive measures to be outside their control. The ability of farmworkers to engage in safe practices depends on their capability to communicate with their employer, have positive work relationships, and the availability of protective equipment. The perceptions of control identified in this paper are issues that service providers and policy makers should consider to provide programs that will effectively promote pesticide safety and healthier farmworkers.

Agricultural Workers' Diseases↗
PubMed2000

Migrant farmworkers and green tobacco sickness: new issues for an understudied disease.

BACKGROUND: The transition from family tobacco production to dependence on hired labor has placed migrant and seasonal farmworkers (MSF) at risk for green tobacco sickness (GTS). No previous studies of GTS have focused on MSF. METHODS: One hundred and forty-four Hispanic MSF working in tobacco production in North Carolina were surveyed to obtain self-reports of GTS, preventive behaviors, and treatments. RESULTS: Forty-one percent reported having GTS at least once during the summer. Most had taken no precautions to prevent GTS. Ninety-six percent of those with GTS had tried to treat it. Antinausea medications were the most common treatments. Only 9% sought medical treatment; 7% lost work time. CONCLUSIONS: The incidence of GTS obtained by interviewing MSF is much higher than that in other studies, which have relied on rates of medical treatment or farmers' reports for their workers. MSF constitute a population at risk for GTS who have little control over work conditions to prevent GTS or seek treatment.

Agricultural Workers' Diseases↗
PubMed2000

The association of depressive symptoms and urinary incontinence among older adults.

OBJECTIVES: To examine the relationship of urinary incontinence (UI) and depressive symptoms (DS) in older adults. DESIGN: A randomized, controlled trial to determine the effects of clinical practice guideline implementation on provider attitudes and behavior, and patients' UI, health status, quality of life, and satisfaction with care. Baseline and endpoint data were collected from patients via computer-assisted telephone interviewing. SETTING: Forty-one nonacademic primary care practices (PCP) in North Carolina. PARTICIPANTS: A total of 668 community-dwelling adults (age > 60) who had visited the one of the selected PCPs. INTERVENTION: PCPs in the intervention group were given instruction in the detection and management of UI, educational materials for providers and patients, office system supports, and academic detailing. MEASUREMENTS: The dependent measure was assessed using an eight-item screener for DS. UI (status, frequency, amount), health (physical, mental), and demographic (age, gender, marital status) and self-report information about bladder control served as predictors. RESULTS: Wilcoxon rank sum tests showed that UI status was associated with moderate to severe DS (43% vs 30%, P = .05). Multivariate analyses showed that UI status, physical and mental health, and gender were significant predictors of DS. Among UI adults (n = 230), physical and mental health, life satisfaction, and the perception that UI interfered with daily life were significant predictors of DS. CONCLUSIONS: This study provides clear evidence that UI is related to DS in older adults.

Age Distribution↗
PubMed2000

Factors influencing use of the prostate-specific antigen screening test in primary care.

OBJECTIVE: To evaluate the use of the prostate-specific antigen (PSA) test and digital rectal examination (DRE) in prostate cancer screening by primary care physicians. STUDY DESIGN: Physician survey and retrospective medical record review. METHODS: We randomly selected and reviewed the medical records of 3 cross-sectional samples of male patients and surveyed their primary care physicians at 1-year intervals. All the physicians practiced in Colorado. The study spanned 3 years, including late 1992, when the American Cancer Society recommended the use of PSA in a prostate cancer screening guideline. RESULTS: We reviewed the medical records of 4772 male patients and surveyed 109 primary care physicians. We found that PSA testing for men aged 50 or older increased significantly from 1992 to 1994, from 24% in 1992 to 35% in 1993 and 40% in 1994 (overall odds ratio, 2.94; P < .05). Over the same time period, the DRE rate remained relatively unchanged (39% in 1992, 41% in 1993, and 36% in 1994). Overall PSA use was positively associated with patient age greater than 59 years, patient non-smoking status, physician "readiness to change cancer screening behavior," private insurance status, and nonsolo practice. Before the release of a prostate cancer screening guideline, participating physicians cited the American Cancer Society as the organization that most influenced their practice with respect to cancer screening. The magnitude of the reported influence of the American Cancer Society was correlated with the subsequent use of PSA in 1994 by primary care physicians after adjustment for change in DRE and baseline PSA rates, although the association did not reach statistical significance in multivariable regression models. CONCLUSIONS: Primary care physicians in Colorado significantly increased their use of the PSA test from 1992 to 1994, during which time the American Cancer Society issued a guideline recommending the use of PSA for prostate cancer screening. The reported influence of the American Cancer Society on cancer screening practices correlated with the subsequent increase in PSA testing.

Cross-Sectional Studies↗
PubMed1999

Bivariate logistic regression: modelling the association of small for gestational age births in twin gestations.

Clustered binary responses, such as disease status in twins, frequently arise in perinatal health and other epidemiologic applications. The scientific objective involves modelling both the marginal mean responses, such as the probability of disease, and the within-cluster association of the multivariate responses. In this regard, bivariate logistic regression is a useful procedure with advantages that include (i) a single maximization of the joint probability distribution of the bivariate binary responses, and (ii) modelling the odds ratio describing the pairwise association between the two binary responses in relation to several covariates. In addition, since the form of the joint distribution of the bivariate binary responses is assumed known, parameters for the regression model can be estimated by the method of maximum likelihood. Hence, statistical inferences may be based on likelihood ratio tests and profile likelihood confidence intervals. We apply bivariate logistic regression to a perinatal database comprising 924 twin foetuses resulting from 462 pregnancies to model obstetric and clinical risk factors for the association of small for gestational age births in twin gestations.

Adolescent↗
PubMed1999

Robust regression for clustered data with application to binary responses.

Generalized estimating equations (GEE) can be highly influenced by the presence of unusual data points. A generalization of the GEE procedure, which yields parameter estimates and fitted values that are resistant to influential data, is introduced. Resistant generalized estimating equations (REGEE) include weights in the estimating equations to downweight influential observations or clusters. Influential observations are downweighted according to their leverage or residual in an example of correlated binary regression applied to 137 urinary incontinent elderly patients from 38 medical practices.

Aged↗
PubMed1998

Relationship between patient reports of urinary incontinence symptoms and quality of life measures.

OBJECTIVE: To determine if patient reports of urinary incontinence symptoms can predict quality of life as measured by the short forms of the Incontinence Impact Questionnaire and the Urogenital Distress Inventory, two standardized, disease-specific instruments. METHODS: Telephone surveys were conducted of 384 community dwelling incontinent women, aged 60 years and older, who admitted to at least one episode of incontinence per week during the previous 3 months. Subjects were asked if they considered the incontinence a problem, as well as questions regarding volume and frequency of voids and urine loss. Each subject completed both standardized quality of life questionnaires. Responses to incontinence symptom questions were correlated with the standardized measures. RESULTS: The question, "Do you consider this accidental loss of urine a problem that interferes with your day-to-day activities or bothers you in other ways?" was the best predictor of the subject's responses to both quality-of-life measures, with a correlation coefficient of 0.69 for the Incontinence Impact Questionnaire and 0.67 for the Urogenital Distress Inventory. The patients' symptoms that best correlated with both quality of life measures and the report of bothersome incontinence were frequent episodes of incontinence (0.40-0.58), greater amounts of urine loss (0.26-0.54), and more frequent voids (0.24-0.41). CONCLUSION: Primary care practitioners may screen for problematic incontinence by asking if patients' incontinence is bothersome to them and by obtaining simple historic information on voiding and leaking patterns. These questions may provide an efficient tool to detect bothersome incontinence in older women.

Aged↗
PubMed1998

Duplex ultrasound scanning defines operative strategies for patients with limb-threatening ischemia.

PURPOSE: To characterize the accuracy of color-flow duplex ultrasound (DUS) in planning lower extremity revascularization procedures, we prospectively compared operations predicted by means of DUS arterial scanning (DUSAS) and operations predicted by means of conventional angiography (CA) with actual operations performed in 36 patients undergoing 40 vascular reconstructions for critical (grade II/III) lower extremity ischemia. METHODS: All patients were examined with lower extremity DUSAS followed by CA. DUSAS was performed from the aorta to the pedal vessels of the affected extremity. Adequacy of inflow was assessed, and the best distal target vessel with continuous, unobstructed flow was defined. An operative prediction was made and recorded based upon the DUSAS findings, and in a blinded fashion, based upon subsequent CA. The McNemar test for comparing correlated proportions was applied to test for the statistical significance of the difference (P < .05) between correct operations predicted by DUSAS and CA. RESULTS: Of the actual operations performed, 83% were correctly predicted by means of DUSAS (95% CI; range, 77% to 89%). Seven operations were incorrectly predicted with DUSAS. Of the actual operations performed, 90% were correctly predicted by means of CA (95% CI; range, 81% to 99%). Four operations were incorrectly predicted with CA. The McNemar test determined that the difference between correct operations predicted by means of DUSAS and correct operations predicted by means of CA was not statistically significant (P = .50). CONCLUSIONS: With few exceptions, DUSAS can be used to reliably predict infrainguinal reconstruction strategies. Vessels defined as adequate with DUSAS are rarely unfit for bypass. Prospective investigation of lower extremity revascularization based solely upon DUSAS is warranted.

Adult↗
PubMed1998

Ten-year trends in cigarette smoking among young adults, 1986-1996: the CARDIA study. Coronary Artery Risk Development In Young Adults.

PURPOSE: To calculate ten-year smoking trends in a longitudinal cohort of young adults, and to characterize trends by race, sex, education, and birth cohort. METHODS: Data on cigarette smoking have been collected for ten years (1986-1996) from 5115 black and white men and women, aged 18-30 years, participating in the Coronary Artery Risk Development In Young Adults (CARDIA) study. Regression analysis adjusting for intra-person correlation over time and weighting for factors affecting follow-up was used to estimate change in smoking rates. RESULTS: Overall, smoking rates declined in white women (-0.50%/year, p < 0.001) and white men (-0.24%/year, p = 0.03). Rates remained stable in black women and increased in black men (0.37%/year, p = 0.01). Declining rates were generally observed in white women of all educational levels and birth cohorts and in several subgroups of white men. Increasing rates among black men could be attributed primarily to increasing rates in the youngest birth cohort. Among black men and women, prevalence of smoking in 1986 was considerably lower in the youngest birth cohort compared to the oldest; however, the increasing rates of change in smoking rates observed among the youngest birth cohorts (and decreasing rates in the oldest) lessened the disparity in prevalence rates across birth cohorts by 1996. Smoking initiation rates were highest among black men; cessation rates were highest among white women. CONCLUSIONS: These findings confirm that declines in smoking prevalence are not occurring across all groups, and reveal populations in special need of targeted interventions, particularly young black men.

Adolescent↗
PubMed1998

Environmental correlates of resident agitation in Alzheimer's disease special care units.

OBJECTIVE: To determine the point prevalence of agitated behaviors in a representative sample of Alzheimer's disease Special Care Units, and to determine the extent to which agitation is associated with aspects of the treatment environment. DESIGN: A cross-sectional study in which nonparticipant observers recorded 3723 observations of resident behaviors in 53 Alzheimer's disease Special Care Units. Observational data were gathered on the physical environment and staff treatment in these settings, and resident characteristics were extracted from a data base developed in the study states by the Health Care Financing Agency. Analyses studied the association between aspects of the staff and physical environment and resident agitation levels, controlling for resident cognitive and functional status. SETTING: Special Care Units in nursing homes in Kansas, Maine, Mississippi, and South Dakota. PARTICIPANTS: All residents and staff of the participating units. MAIN OUTCOME MEASURES: Eight specific agitated behaviors and two indexes of resident agitation were measured by direct observation by research assistants on three to four data collection walk-throughs in each of the study facilities. RESULTS: The most common agitated behaviors noted were repetitive mannerisms (4.5% of resident observations) and non-loud verbal excess (3.8%). Wandering, which frequently reflects agitation, was noted in 6.5% of resident observations. The proportion of residents exhibiting an agitated behavior varied from none in some units to 38% in one unit. Independent correlates of low unit agitation levels included favorable scores on measures of the physical environment and of staff treatment activities, low rates of physical restraint use, a high proportion of residents in bed during the day, small unit size, low levels of resident functional dependency, and fewer numbers of comorbid conditions. CONCLUSIONS: While the prevalence of agitation tends to increase as Alzheimer's disease progresses, modifiable treatment factors appear to have a strong influence on the prevalence of agitation. Both physical design and staff treatment appear to influence agitation rates, as do some measures consistent with a low stimulus approach to Alzheimer's care.

Activities of Daily Living↗
PubMed1998

Trends in mortality and cerebral palsy in a geographically based cohort of very low birth weight neonates born between 1982 to 1994.

OBJECTIVE: To analyze whether the increasing survival of very low birth weight infants during the 1980s and 1990s has increased the risk of cerebral palsy among survivors. METHODS: The study cohort consisted of 2076 consecutively born infants, with birth weights of 500 to 1500 g and no major anomaly, born July 1, 1982, through June 30, 1994, to residents of a 17-county region in North Carolina. These infants had a mean birth weight of 1096 g (standard deviation, 251 g) and a mean gestational age of 29 weeks (standard deviation, 3 weeks). One thousand five hundred sixty-eight infants (76%) survived to 1 year adjusted age, at which point 1282 infants (82%) were examined at our medical center. The diagnosis of cerebral palsy was made only if the examining pediatrician and a pediatric physical therapist agreed on the diagnosis. To analyze trends across time, the Cochran-Armitage chi2 test and logistic regression were applied to data for infants categorized into six 2-year epochs according to year of birth. RESULTS: Mortality did not change significantly through 1990, and then began to decrease in 1990 to 1994. During the study period, mortality decreased from 36.8% between 1982 and 1984, to 13.8% between 1992 and 1994. The prevalence of cerebral palsy among survivors was constant from 1982 to 1988 (11.3%), decreased slightly from 1988 to 1990 (9.2%), and was lowest in 1990 to 1994 (5.2%). These secular trends in mortality and cerebral palsy risk remained significant when adjusted for gestational age, gender, and race. When adjusted for surfactant use, the trend in mortality was no longer significant, whereas the trend in cerebral palsy risk persisted. CONCLUSIONS: The increasing survival of very low birth weight infants in the 1980s and 1990s has not resulted in an increased prevalence of cerebral palsy among survivors.

Cerebral Palsy↗
PubMed1997

Categorical data analysis in public health.

A greater variety of categorical data methods are used today than 15 years ago. This article surveys categorical data methods widely applied in public health research. Whereas large sample chi-square methods, logistic regression analysis, and weighted least squares modeling of repeated measures once comprised the primary analytic tools for categorical data problems, today's methodology is comprised of a much broader range of tools made available by increasing computational efficiency. These include computational algorithms for exact inference of small samples and sparsely distributed data, conditional logistic regression for modeling highly stratified data, and generalized estimating equations for cluster samples. The latter, in particular, has found wide use in modeling the marginal probabilities of correlated counted, binary, and multinomial outcomes. The various methods are illustrated with examples including a study of the prevalence of cerebral palsy in very low birthweight infants and a study of cancer screening in primary care settings.

Algorithms↗