Biomedical subjects

Janet Rice

Publications and source records attributed to Janet Rice.

18 recordsLinked to original sources

PubMed2006

Development of scales measuring the capacity of community-based initiatives.

This article describes the development of two measures for the capacity of local public health initiatives. Data obtained from a qualitative study of eight community-based initiatives served as the basis for the development of a survey instrument. It was administered to a national sample of both leaders and nonleaders of 291 such initiatives. Because survey results for leaders and nonleaders differed, results could not be combined into a single data set for analysis. Results for each data set were analyzed by employing exploratory principal components and factor analyses. A 44-item, six-factor scale resulted for leaders and a 38-item, five-factor scale resulted for nonleaders. The high degree of overlap (22 items) between the two scales resulted in a combined 60-item instrument that can be administered to both leaders and nonleaders but analyzed separately.

Black or African American↗

PubMed2006

Skewed contraceptive method mix: why it happens, why it matters.

Contraceptive prevalence has been central to family planning research over the past few decades, but researchers have given surprisingly little consideration to method mix, a proxy for method availability or choice. There is no 'ideal' method mix recognized by the international community; however, there may be reason for concern when one or two methods predominate in a given country. In this article method skew is operationally defined as a single method constituting 50% or more of contraceptive use in a given country. Of 96 countries examined in this analysis, 34 have this type of skewed method mix. These 34 countries cluster in three groups: (1) sixteen countries in which traditional methods dominate, most of which are in sub-Saharan Africa; (2) four countries in which female sterilization predominates (India, Brazil, Dominican Republic and Panama); and (3) fourteen countries that rely on a single reversible method (the pill in Algeria, Kuwait, Liberia, Morocco, Sudan and Zimbabwe; the IUD in Cuba, Egypt, Kazakhstan, Kyrgyz Republic, Moldova, Turkmenistan and Uzbekistan; and the injectable in Malawi). A review of available literature on method choice in these countries provides substantial insight into the different patterns of method skew. Method skew in some countries reflects cultural preferences or social norms. Yet it becomes problematic if it stems from restrictive population policies, lack of access to a broad range of methods, or provider bias.

Contraceptive Devices, Female↗

PubMed2006

The relationship between the neighbourhood environment and adverse birth outcomes.

Intrauterine growth retardation and preterm birth are more frequent in African-American women and women of lower socio-economic status, but the reasons for these disparities are not fully understood. The physical and social environments in which these women live may contribute to these disparities. We conducted a multilevel study to explore whether conditions of mothers' neighbourhood of residence contribute to adverse birth outcomes independent of individual-level determinants. We analysed data from 105 111 births in 1015 census tracts in Louisiana during 1997-98, merging it with data from other existing sources on neighbourhood socio-economic status, neighbourhood physical deterioration, and neighbourhood density of retail outlets selling tobacco, alcohol and foods. After controlling for individual-level sociodemographic factors, tract-level median household income was positively associated with both birthweight-for-gestational-age and gestational age at birth. Neighbourhood physical deterioration was associated with these birth outcomes in ecological analyses but only inconsistently associated with them after controlling for individual-level factors. Neither gestational age nor birthweight-for-gestational-age was associated with the neighbourhood density of alcohol outlets, tobacco outlets, fast-food restaurants or grocery supermarkets. We conclude that measures of neighbourhood economic conditions are associated with both fetal growth and the length of gestation independent of individual-level factors, but that readily available measures of neighbourhood retail outlets are not. Additional studies are needed to better understand the nature of environmental influences on birth outcomes.

Adolescent↗

PubMed2005

Assessment of sexually transmitted diseases as risk factors for HIV seroconversion in a New Orleans sexually transmitted disease clinic, 1990-1998.

PURPOSE: This investigation examined the role of ulcerative and non-ulcerative sexually transmitted diseases (STDs) in increasing susceptibility to HIV seroconversion in a large population of uninfected and predominantly heterosexual persons attending a New Orleans STD clinic. METHODS: A retrospective cohort of clients with repeat HIV tests between January 1990 and April 1998 was constructed using three independent sources of information. Multivariate Cox regression was used to identify risk factors for HIV seroconversion while controlling for the effects of behavioral risk factors. A time-dependent covariate for STD allowed HIV seroconversion to be examined in relation to the timing of STD diagnosis. RESULTS: Having a recent syphilis or GUD diagnosis was associated with significantly increased hazards of seroconversion (among men: hazard ratio [HR], 4.2 [2.4-7.2]; among women: 5.0 [1.9-13.0]). Among men with no history of GUD or syphilis, those with recent gonorrhea within 1 year prior to seroconversion were 2.8 (1.5-5.2) times as likely to seroconvert. CONCLUSIONS: This study suggests that both ulcerative and non-ulcerative STD may be associated with increased risk of HIV transmission and therefore comprehensive STD control strategies may be particularly effective tools for HIV prevention.

Adult↗

PubMed2005

Evaluation of a hepatitis A immunization program.

BACKGROUND: The purpose of this study was to evaluate the effectiveness of a hepatitis A vaccine requirement targeted at child-care center attendees 2-5 years of age in Maricopa County, AZ. A case-control study conducted before implementation in 1997 found that individuals with hepatitis A were 6 times more likely to have worked in or attended a child-care center than were matched controls, and 40% of hepatitis A cases were attributable to attending or working in a child-care center. METHODS: A case-control study was conducted postimplementation in 1999. Cases were individuals reported to surveillance staff between August 1, 1999 and April 30, 2000. Cases were included if they met the Centers for Disease Control and Prevention hepatitis A surveillance case definition. Each case (n = 72) was matched to 2 controls (n = 144) based on age and neighborhood. RESULTS: Cases were more likely to have had contact with a hepatitis A case [odds ratio (OR), 7.04; 95% confidence interval (CI), 1.96, 25.31] than were their matched controls in the unadjusted analysis. Individuals with direct contact with a child-care center (OR 0.221; CI 0.05, 0.99) were protected against disease. In the multivariate analysis, contact with a hepatitis A case (OR 5.63; CI 1.22, 25.91) was significantly associated with disease, and the protective effect of education (OR 0.19; CI 0.06, 0.60) remained significant. CONCLUSION: The results of this study suggest the vaccination requirement had some impact on the epidemiology of hepatitis A in Maricopa County. The risk associated with child-care centers seen in the 1997 study is no longer significantly associated with hepatitis A disease.

Arizona↗

PubMed2005

Reproductive decision-making among HIV-Infected women.

OBJECTIVE: To describe factors related to reproductive decision-making among HIV-infected women. MATERIALS AND METHODS: A sample of HIV-infected women (N=104) who received care at an HIV clinic in the southern United States were interviewed about their reproductive decision-making. Women who became pregnant subsequent to HIV diagnosis were compared to women who did not become pregnant, and women who underwent a sterilization procedure subsequent to HIV diagnosis were compared to women who did not get sterilized. RESULTS: Compared to women who did not get pregnant after receiving an HIV diagnosis, women who became pregnant were more likely to be young, single, diagnosed earlier in the epidemic and to have more recently used a noninjecting drug. Among women who did not get pregnant, 63% reported their diagnosis greatly affected that decision. Having a partner who wants more children was not associated with pregnancy. Compared to women who did not get sterilized after learning their HIV status, women who did get sterilized tended to be Baptist and already had a prior live birth. Neither a woman's desire nor her partner's desire for more children was associated with sterilization. CONCLUSIONS: HIV is an important influence on HIV-infected women's reproductive choices, regardless of the decision being made. Reproductive counseling by HIV care providers needs to be sensitive to all the issues faced by these women.

Adolescent↗

PubMed2004

Adherence to HAART among HIV-infected persons in rural Louisiana.

The purpose of this study was to examine factors associated with nonadherence to highly active antiretroviral therapy (HAART) in patients seen in HIV clinics throughout nonurban Louisiana. A convenience sample of 273 patients from 8 areas in nonurban Louisiana were interviewed to obtain demographic, clinical and adherence information. Associations between demographic, clinical, and behavioral factors and nonadherence were examined. Ideally, non-adherence should not exceed 5% in patients for whom HAART was prescribed. Mean age was 38.6 years (range, 19-66), 29.3% were female, 60.1% were African American, 34.4% reported nonadherence to their HAART medication (defined as the subject's self-report of missing any doses of HAART medication in the prior week). In the prior month, participants reported the following behaviors: binge drinking (12.8%), problem drinking (12.8%), and illicit drug use (16.5%). Depression was found in 49.8% of the respondents. In logistic regression analysis, problem drinking odds ratio [OR] (95% confidence interval [CI]): 3.92 (1.69,9.09) was found to be associated with nonadherence. Demographic and behavioral factors such as illicit drug use and depression were not associated with nonadherence on multivariable analysis. Problem drinking was associated with lack of adherence to HAART over the past week. Interventions to treat problem drinking are needed and may improve adherence to medication for HIV-infected persons living in rural, town, and small-city areas.

Adult↗

PubMed2004

Leukoreduction in the setting of open heart surgery: a prospective cohort-controlled study.

BACKGROUND: Proven clinical benefits of leukoreduced blood components include reduced febrile nonhemolytic transfusion reactions, alloimmunization against HLA antigens, and CMV transmission. Immunomodulatory effects of leukoreduction have also been postulated to play a significant role in the clinical outcome of open heart surgery. STUDY DESIGN AND METHODS: A prospective case control study was implemented in which all patients admitted over a 1-year period for open heart surgery at a single hospital were given leukoreduced blood products. Clinical outcomes were prospectively measured and compared to a historical cohort of patients from the previous year when leukoreduced blood products were not routinely used. RESULTS: A significant improvement in the mean postoperative length of stay was seen in the study group (N = 645) versus control group (N = 501; 10.1 vs. 9.5 days; p = 0.005). No significant changes were seen in the rate of mediastinitis, operative mortality, or stay in the intensive care unit. There was no difference in the postoperative length of stay among study patients who did not receive transfusion (N = 308) versus control patients who did not receive transfusion (N = 296; 6.2 vs. 6.4 days; p = 0.104). CONCLUSIONS: The use of leukoreduced blood was associated with a decrease in the postoperative length of stay in the setting of open heart surgery. The mechanisms through which these changes in clinical outcomes are generated remain unknown.

Aged↗

PubMed2004

Reassessing the level of unintended pregnancy and its correlates in Vietnam.

Despite rapidly increasing contraceptive use and rapidly declining fertility, unintended pregnancy and induced abortion remain common in Vietnam. This study reassesses the level of unintended pregnancy in Vietnam and its correlates, drawing on retrospective calendar data gathered for the Vietnam Demographic and Health Survey II. Data from 13,540 "segments" of outcomes and contraceptive practice were analyzed. Based on the calendar data, 40 percent of pregnancies during the 1994-97 period are estimated to have been unintended, a proportion 48 percent higher than the prevailing estimate calculated from the reported intendedness of live births. When concealment of pregnancies ending in induced abortions is taken into account, the unintended pregnancy rate in Vietnam is likely to approach levels found only in developing countries. Unintended pregnancy was found to be associated with age, early marriage, spousal age difference, number of living sons, past unintended pregnancy, geographic region, contraceptive use prior to pregnancy, and the family planning supply environment. The findings suggest that broadening the method mix at the community level, targeting high-risk and underserved groups, and expanding postabortion counseling and services are likely to have a dramatic impact on the unintended pregnancy rate in Vietnam.

Abortion, Induced↗

PubMed2004

A qualitative evaluation of the Students of Service (SOS) program for sexual abstinence in Louisiana.

Abstinence-only programs for preventing teen pregnancy are the only options in some states but are the programs of choice in others. Effectiveness data, however, are lacking. The SOS Adolescent Family Life Program (SOS), an abstinence-only teen pregnancy prevention program, was implemented in south central Louisiana. Peer mentoring with an abstinence and life skills curriculum comprised the major components. SOS was implemented in the same grades in the same schools with new students each year for five years. During the final years of the program, qualitative evaluation was conducted with principals, teachers, peer mentors, and students. Use of peer mentors was reaffirmed as valuable; however, quality of peer mentoring was questioned and was a major issue for improvement. Other issues included: starting sexuality education in earlier grades, updating curricula and materials, offering more interactive classes, improving peer mentor training, and using teacher input to improve educational aspects of the program. Qualitative assessments provided valuable insights for future improvement in abstinence-only programs.

Adolescent↗

PubMed2004

Effects of a disability awareness and skills training workshop on senior medical students as assessed with self ratings and performance on a standardized patient case.

BACKGROUND: People with disabilities compose one of the largest and fastest growing subgroups of the U.S. population. Disability and rehabilitation issues are not well covered in most North American medical school curricula. This article describes the development and assessment of a 3-hr workshop for medical students on disability skills and awareness. DESCRIPTION: Fourth-year medical students on a required clerkship participated in the workshop on alternate months. The efficacy of the intervention was measured by a comparison between the participant and control students using a pretest and posttest self-efficacy questionnaire and a one-station Standardized Patient (SP) Clinical Case depicting a hemiplegic patient and a caregiver. EVALUATION: Factor analysis of the survey yielded 4 subscales: Attitude, Advocacy, Interaction, Obtaining Services. There was a significant difference between the treatment and control group on the advocacy scale and on the SP communication and interstation exercises. CONCLUSION: A targeted educational intervention can have a positive effect on medical students' knowledge, skills, and attitudes toward patients with disabilities.

Attitude↗

PubMed2003

Oral contraceptives use and the risk of myocardial infarction: a meta-analysis.

This meta-analysis of oral contraceptive use in relation to myocardial infarction is based on 19 case-control studies and 4 cohort studies that met pre-stated inclusion criteria. A comprehensive literature search was performed using the MEDLINE computerized database (for studies from January 1966 through October 2002). In addition, a manual search was performed for references cited in published original and reviewed articles. Current oral contraceptive (OC) users have an overall adjusted odds ratio (OR) of myocardial infarction (MI) of 2.48 [95% confidence interval (CI): 1.91-3.22] compared to never-users. The risk of MI for past OC users is not significantly different from that for never-users, overall OR = 1.15 (95% CI: 0.98-1.35; p = 0.096).

Case-Control Studies↗

PubMed2003

Olfactory functioning in Gulf War-era veterans: relationships to war-zone duty, self-reported hazards exposures, and psychological distress.

To explore possible neurotoxic sequelae of Gulf War (GW) participation, olfactory identification performance, neurocognitive functioning, health perceptions, and emotional distress were assessed in 72 veterans deployed to the GW and 33 military personnel activated during the GW but not deployed to the war zone. Findings revealed that war-zone-exposed veterans reported more concerns about health, cognitive functioning, and depression than did their counterparts who did not see war-zone duty. There was no evidence that performances on olfactory or neurocognitive measures were related to war-zone duty or to self-reported exposure to GW toxicants. However, symptoms of emotional distress were positively correlated with self-report of health and cognitive complaints. Results do not provide support for the hypothesis that objectively-measured sensory (i.e., olfactory) or cognitive deficits are related to war-zone participation but do underscore the increasingly demonstrated association between self-reported health concerns and symptoms of emotional distress.

Adult↗

PubMed2002

Arthrographic findings in Legg-Calvé-Perthes disease.

Plain radiographs and arthrograms on 46 patients with Legg-Calvé-Perthes were evaluated. Measurements of containment including epiphyseal extrusion, caput index, femoral subluxation, percentage acetabular coverage, were determined. Only with arthrography are measurements of acetabular coverage, subluxation and epiphyseal extrusion consistent and reliable. The concept of eccentricity was developed to assist in the understanding of femoral containment.

Arthrography↗

PubMed2002

Research report: learning styles of biomedical engineering students.

Examining students' learning styles can yield information useful to the design of learning activities, courses, and curricula. A variety of measures have been used to characterize learning styles, but the literature contains little information specific to biomedical engineering (BMEN) students. We, therefore, utilized Felder's Index of Learning Styles to investigate the learning style preferences of BMEN students at Tulane University. Tulane BMEN students preferred to receive information visually (preferred by 88% of the student sample) rather than verbally, focus on sensory information (55%) instead of intuitive information, process information actively (66%) instead of reflectively, and understand information globally (59%) rather than sequentially. These preferences varied between cohorts (freshman, sophomore, etc.) and a significantly higher percentage of female students preferred active and sensing learning styles. Compared to other engineering student populations, our sample of Tulane BMEN students contained the highest percentage of students preferring the global learning style. Whether this is a general trend for all BMEN students or a trait specific to Tulane engineers requires further investigation. Regardless, this study confirms the existence of a range of learning styles within biomedical engineering students, and provides motivation for instructors to consider how well their teaching style engages multiple learning styles.

Adolescent↗

PubMedDate not supplied

Medical genetic test reporting for cystic fibrosis (deltaF508) and factor V Leiden in North American laboratories.

PURPOSE: Physicians are ordering an increasing number of genetic tests. Results and additional information provided in the test result report are vital to the physician in making appropriate patient management decisions. Because variability in test result reports can impact patient care, we sought to determine whether variations exist in test reports for cystic fibrosis (CF) and factor V Leiden (fVL) with specific comparison to professional guidelines and recommendations. METHODS: A cross-sectional study design analyzing for the presence of 16 critical elements in CF reports and 12 critical elements in fVL reports solicited from United States and Canadian laboratories. RESULTS: Of 44 laboratories performing CF testing and 72 laboratories performing fVL testing, 64% responded. For CF reports, 21% included ethnicity, 64% described methodology, and 61% discussed genetic counseling. For fVL reports, 80% described methodology and 52% discussed the need for genetic counseling in mutation-positive reports. CONCLUSIONS: Variability exists in report content among North American laboratories performing CF and fVL testing. Many reports lack information deemed critical by professional guidelines and recommendations.

Cross-Sectional Studies↗

PubMedDate not supplied

Physicians' perceived usefulness of and satisfaction with test reports for cystic fibrosis (DeltaF508) and factor V Leiden.

PURPOSE: We sought to determine whether variation in test-report content for cystic fibrosis (CF DeltaF508) and factor V Leiden (fVL) would impact physician-perceived usefulness of and satisfaction with test reports. METHODS: A cross-sectional survey of US physicians from specialties likely to order the tests was performed. Physicians received an introductory letter with a clinical scenario, one randomly assigned mock report, and a one-page survey. The analyses evaluated usefulness of and satisfaction with report elements. RESULTS: For CF and fVL, there were significant differences by mock-report version for most of the survey report items (P < 0.05) and for satisfaction (P < 0.0001); results revealed greater usefulness and satisfaction with more comprehensive reports. The three items in CF and fVL reports where physician-perceived usefulness was most highly correlated (R > 0.70) with satisfaction were (1.clinical decision-making information, (2). genetic counseling information, and (3). implications for family members. CONCLUSION: Opportunities exist to improve the usefulness of genetic test reports in clinical practice.

Attitude of Health Personnel↗

PubMedDate not supplied

Prevention of postoperative mediastinitis: a clinical process improvement model.

In a prospective study of more than 4,000 consecutive patients who underwent any cardiovascular procedure requiring sternotomy incision in a 650-bed tertiary care hospital, a gradual increase in deep sternal infections from 0.8% in 1995 to 2.1% in 1999 was noted. By using a Plan-Do-Check-Act process improvement model, several interventions to decrease the infection rate were planned and implemented based on hypotheses generated from the characteristics of infected patients. These interventions included chlorhexidine preoperative shower, discontinuation of shaving, administration of antibiotics in the holding area, segregation of instruments, and implementation of an insulin protocol. Findings included a decrease in deep sternal and leg infections after implementation of these interventions. Deep sternal infection rates decreased from 2.1% to 1.5% and leg infection rates, from 1.93% to 0.47%. Results were not statistically significant but were clinically relevant. Furthermore, a total of $200,000 was achieved in cost savings in 1 year.

Education, Continuing↗