PubMed Health⌕ Search

Biomedical subjects

John G Spangler

Publications and source records attributed to John G Spangler.

14 recordsLinked to original sources
PubMed2006

Commentary on possible manganese toxicity from showering: response to critique.

Manganese is an essential trace element that is toxic at high doses. We recently reported the potential for manganese to be absorbed via the olfactory system during showering with water contaminated by this element. In this commentary we respond to criticisms of our article and find using new methods that our previous calculations may have underestimated exposure. These data, which must be confirmed, highlight the potential for neurologic absorption of this element.

Baths↗
PubMed2006

Training and evaluating tobacco-specific standardized patient instructors.

BACKGROUND AND OBJECTIVES: A comprehensive training program to develop tobacco-specific standardized patient instructors (SPIs) was implemented and evaluated at Wake Forest University. METHODS: Descriptive statistics were used to assess SPIs' experience with the training program and medical students' perceptions of the SPI-student interaction. Two standardized scales, used to assess student performance on counseling (Tobacco Intervention Risk Factor Interview Scale [TIRFIS]) and cultural competency (Tobacco Beliefs Management Scale-Tobacco Cultural Concerns Scale [TBMS-TCCS]), were tested for internal and interrater reliability and sensitivity to varied student performance. Costs of the program were measured. RESULTS: SPIs highly rated the content, organization, and presenters of the training program. Medical students positively evaluated their experience with the SPIs. The TIRFIS and TBMS-TCCS subscales demonstrated good internal reliability, and inconsistencies in ratings by different SPIs were minimal. In addition, a range of scores on both measures attest to the sensitivity of the instruments to assess variations in student performance. Significant start-up costs are associated with developing this training program, although costs decline when SPIs are retained long term. CONCLUSIONS: The SPI training program was effective in developing a cohort of knowledgeable and reliable SPIs to train medical students in ways to improve their tobacco intervention counseling skills. Retaining SPIs long term should be a primary goal of implementing a cost-effective, successful training program.

Clinical Competence↗
PubMed2005

Smokeless tobacco use accelerates age-related loss of bone mineral density among older women in a multi-ethnic rural community.

Cigarette smoking is a recognized risk factor for low bone mineral density (BMD) and osteoporosis. Despite the prevalence of smokeless tobacco (ST) use by women in some areas of the United States, minority groups in the United Kingdom, and populations in South Asia and Africa, no data exist to evaluate its effect on bone health. The objective of the study is to identify risk factors for low BMD among older women in a multi-ethnic population, with particular attention to smoking and ST use. Data were collected in Robeson County, North Carolina. ST use from childhood is common among women in this community. Two hundred-forty women aged 60 years and older (approximately equal numbers of African Americans, Native Americans and whites) were recruited at a variety of community events to obtain a cross-section of the demographic composition of the county. The main outcome was BMD measured in the heel using a portable dual energy x-ray absorptiometry. Twenty-nine percent of women were current or former smokers, and 26% current or former ST users. Increased BMD was predicted by greater body mass index, estrogen use in the past year, and African American and Native American ethnicity. There was a significant interaction between ST use and age, and between smoking and nutritional supplement use. BMD declined with age; the decline with age was greater for women who were current or former ST users than for those who never used ST. Women who formerly smoked and did not use supplements had a decreased BMD. ST should be considered as an additional risk factor for osteoporosis in populations where its use is prevalent.

Absorptiometry, Photon↗
PubMed2005

Neurotoxicity of inhaled manganese: public health danger in the shower?

CONTEXT: Manganese (Mn) is an essential trace element but is neurotoxic at high doses. Showering with Mn-laden water has never been evaluated as a central nervous system (CNS) delivery vector for Mn, even though intranasally administered Mn in laboratory animals circumvents the blood-brain barrier and passes directly into the brain via olfactory pathways. OBJECTIVE: To review the literature on Mn and attempt to quantify potential human CNS exposure to manganese from showering. DATA SOURCES: We systematically searched Medline 11/9/02 and again on 3/9/04. The following search terms were used: manganese, water, drinking water, shower, showering, bath, bathing and inhalation, then combined with "water or drinking water or showering or shower or bathing or inhalation." STUDY SELECTION: Animal experimental investigations, human epidemiological studies, and consensus and governmental reports were utilized. DATA EXTRACTION: Data were extracted by both authors and extrapolations to humans were calculated by one of us (JGS) controlling for age, length of exposure and known respiratory differences between rats and humans. DATA SYNTHESIS: During a decade of showering in Mn-contaminated water, models for children and adults show higher doses of aerosolized Mn (3-fold and 112-fold greater, respectively) than doses reported to cause Mn brain deposition in rats. CONCLUSIONS: Long-term shower exposure to Mn-laden water may pose a significant risk for CNS neurotoxicity via olfactory uptake in up to 8.7 million Americans. If our results are confirmed, regulatory agencies must rethink existing Mn drinking water standards.

Baths↗
PubMed2005

Primary care providers' concerns and recommendations regarding mammography screening for older women.

BACKGROUND: Morbidity and mortality from breast cancer increase with age; however, mammography screening does not reflect this increased risk for older women. Lack of provider recommendation is a major barrier to screening. METHODS: This is a descriptive study of mammography screening recommendations of community primary care providers in North Carolina (N = 96) participating in a National Cancer Institute funded research project. Providers self-reported screening recommendations for typical patients of different ages and issues and concerns that might influence the decision. Chart reviews compared actual practices with policies stated. RESULTS: Of the providers, 51% recommended biannual, 45% annual for women ages 50 through 74; 4% recommended biannual, 80% annual, 5% did not recommend screening, and 10% had no general policy for women over 75. Cost, inconsistent guidelines, comorbidity, functional status, value of mammography, and patient resistance influenced screening recommendations. Chart review showed even lower rates of recommendation than self-reported figures. CONCLUSIONS: Although the use of screening mammography has increased over the past decade, older women are one of the last subgroups to derive benefit from this screening test. Our survey revealed lower rates for mammography referral in older women. The primary care provider appears to be essential to increasing participation for these older women in breast cancer screening.

Adult↗
PubMed2003

Religiosity is associated with the use of complementary medical therapies by pediatric oncology patients.

PURPOSE: To determine the prevalence of complementary and alternative medicine (CAM) use in pediatric oncology patients, the types of CAM used, and the factors associated with the use of CAM. PATIENTS AND METHODS: A questionnaire regarding CAM use was administered to patients/families seen in the pediatric oncology clinic at Wake Forest University Baptist Medical Center over a 12-month period. RESULTS: Based on 195 completed questionnaires, 91 (47%) patients reported use of CAM since diagnosis. Among CAM users, the most commonly used CAM therapies were faith healing, megavitamins/minerals, massage, other dietary supplements, relaxation techniques, and herbal medicines/teas. Forty-one percent of CAM users had not discussed CAM use with their physician(s). In bivariate analysis, CAM use was not associated with age at the time of survey, time since diagnosis, sex, race, parental education, or family income. A trend was noted between CAM use and older age at diagnosis. Families who reported themselves to be "very" religious were more likely to use CAM than those that are "somewhat" or "not at all" religious. CONCLUSIONS: Use of CAM is common among pediatric oncology patients and often is not discussed with the treating physician(s). Patients from very religious families are more likely to use CAM.

Child↗
PubMed2003

Reliability of a Smoking Cessation Risk Factor Interview Scale (SCRFIS) for use with standardized patient instructors.

BACKGROUND: This study evaluated internal consistency and inter-rater reliability of the smoking cessation risk factor interview scale (SCRFIS). METHODS: Encounters from 16 patient instructors and 414 medical students were used for analyses: Cronbach's alpha and item-to-total correlations measured internal consistency; one-way analysis of variance evaluated comparability of scores across multiple raters, t-tests measured gender bias, and regression analyses compared student counseling skills across three curricula. RESULTS: The total scale was reliable, there was minimal gender bias, and student counseling skills remained relatively constant over time. Interviewing techniques, however, improved among students who participated in the curriculum that emphasized earliest patient contact. CONCLUSION: A preliminary assessment of the measurement adequacy of the SCRFIS suggests that this instrument is a reliable measure of medical student's counseling skills on smoking cessation and is sensitive to changes in curriculum that emphasize patient contact. The SCRFIS may be applied in undergraduate medical curriculum, but it is advisable to evaluate the psychometric properties of this scale when used as an assessment of student performance.

Adult↗
PubMed2003

Tobacco use among Mexican farmworkers working in tobacco: implications for agromedicine.

This survey evaluated tobacco use of migrant tobacco workers in eastern North Carolina. Sixty-nine (38%) out of 181 mostly male, Mexican farmworkers were smokers. Compared to non-smokers, three times more smokers reported alcohol use in the past week (p=0.002). More smokers compared to non-smokers reported poor to fair health, and fewer had worked previously in tobacco agriculture, but these differences were not statistically significant. Also not statistically significant, those smokers who were older and those who understood the most English smoked more cigarettes per day. Because farmworkers are exposed to many non-tobacco respiratory irritants, and because of the health risks of smoking, those who smoke should be urged to quit.

Adult↗
PubMed2003

Tobacco use in a tri-ethnic population of older women in southeastern North Carolina.

OBJECTIVE: While many studies have evaluated the epidemiology of tobacco use nationally and among specific populations, less is known about the epidemiology of tobacco use among elderly women. We examined the epidemiology of tobacco use among a tri-racial population of elderly women in southeastern North Carolina. DESIGN: Survey SETTING: Senior centers, community events, and communal meal settings in Robeson County, North Carolina. PARTICIPANTS: Two hundred forty (240) women aged 60 and older, with approximately 80 women recruited from each ethnic group: Native American, African-American, and White. MAIN OUTCOME MEASURES: Demographic information, health history, and use of alcohol, cigarettes, and smokeless tobacco (ST). RESULTS: Of the total sample of 240 women, 38 (16%) were current ST users. In logistic regression analysis, current ST use was inversely associated with age and education, but positively associated with Native American or African-American ethnicity. Sixteen (17%) of the total sample were current smokers. In logistic regression, younger age and any alcohol use in the past year were associated with current smoking CONCLUSIONS: In a tri-ethnic, community-based sample of older women, rates of current ST use were greater than national rates found among women of all ages in each ethnic group. On the other hand, rates of current smoking among these older women were lower than the national prevalence for women among all ages in these 3 respective ethnic groups. The distinctly different epidemiology of ST use vs cigarette smoking among these women high-lights the need to tailor tobacco interventions to each specific product.

Black or African American↗
PubMed2002

Tobacco intervention training: current efforts and gaps in US medical schools.

CONTEXT: Research has documented that US medical schools inadequately teach tobacco intervention skills. OBJECTIVE: To examine effective training methods for tobacco intervention in undergraduate medical education. DATA SOURCES: Using indexing terms related to tobacco intervention and medical education, we searched MEDLINE (1966-June 2002) and the Cochrane Database of Systematic Reviews (through issue 2, 2002). Reference lists of relevant articles were also read to identify additional articles. Because of their importance to tobacco intervention, we also reviewed Ockene and colleagues' tobacco education research and the tobacco treatment guidelines of the United States Public Health Service and the United States Preventive Services Task Force. STUDY SELECTION: All study designs that incorporated process or outcome evaluation of tobacco intervention educational methods for medical students were included in this review. Of an initial 1241 articles retrieved, 82 included medical students. Reviewing abstracts and references of these articles identified 13 pertinent studies. DATA EXTRACTION: Quality criteria for inclusion consisted of explicit evaluation of the educational methods used. Data extraction identified all evaluations and any problems in program implementation. DATA SYNTHESIS: Enhanced instructional methods (eg, the use of patient-centered counseling, standardized patient instructors, role playing, or a combination of these) are more effective for teaching tobacco intervention than are traditional didactic methods alone and can be effectively inserted into medical school curricula. CONCLUSIONS: Various educational methods have been used to train medical students in tobacco intervention. Nonetheless, gaps still exist within undergraduate medical education, including a lack of integration of tobacco dependence information throughout all 4 years of medical school curricula, specific training in smokeless tobacco intervention, tobacco intervention training that addresses cultural issues, and long-term studies showing that such training is retained.

Counseling↗
PubMed2002

Use of a peripheral dexa measurement for osteoporosis screening.

BACKGROUND AND OBJECTIVES: Osteoporosis is a substantial cause of morbidity and mortality in the United States. While screening for this disease is important, few studies have evaluated the role of an osteoporosis screening device in afamily practice setting. This study evaluated the influence of a peripheral-dexa (p-dexa) heel bone mineral density (BMD) measurement and a patient education program on changes in pharmacologic treatment for suspected osteopenia or osteoporosis by primary care physicians over a 1-year follow-up. METHODS: Using a computerized database (ages 50 to 75 years), 1,927 women were identified. An invitation was mailed to register for a screening to have a p-dexa heel BMD scan done and to attend an osteoporosis prevention presentation. Medication history, age, height, weight, and risk factors for osteoporosis were collected. A follow-up chart review was carried out on women who werefound to have heel BMD T-scores of <-.6 (suggested by the World Health Organization). Date of menopause onset, pharmacotherapy for osteoporosis, calcium, vitamin D, and physician intervention were assessed. RESULTS: There were 292 women (15.2%) who self registered, obtained BMD testing, and attended an educational program. Of these women, 87 (30%) had at least one risk factor for osteoporosis, in addition to menopause. Mean BMD was .489 +/- .113 gm/cm2 (normal >.42 gm/cm2). A post-screening chart review was completed in 102 women (36.6%) at greatest risk for osteoporosis based on a T-score <-.6. Following the intervention, 26 women were started on antiresorptive therapy (primarily estrogen), and three additional women had a second antiresorptive agent added to estrogen. CONCLUSIONS: P-dexa heel BMD has utilityfor screening patients at riskfor osteoporosis. However, only 15% of invited women attended the screenings, and pharmacotherapy treatment did not significantly change after screening in the majority of women at riskfor osteoporosis, based on p-dexa screening.

Absorptiometry, Photon↗
PubMed2002

Differential impact of cardiovascular disease (CVD) risk factor clustering on CVD and renal disease among African-American and white patients with type 2 diabetes mellitus.

OBJECTIVES: To determine if clustering of cardiovascular disease (CVD) risk factors has a differential impact on CVD and renal disease among African Americans compared to Whites with type 2 diabetes DESIGN: Cross-sectional. METHODS: Prevalent CVD, macroalbuminuria, and CVD risk factors were measured in 323 African-American and White adult patients with type 2 diabetes. CVD risk factors were dichotomized according to standard guidelines. Data were analyzed by race according to the presence of any 3 or more CVD risk factors. RESULTS: Despite a similar prevalence of hypertension, the prevalence of macroalbuminuria in the presence of 3 or more CVD risk factors tended to be higher among African Americans compared to Whites (28.9% vs 13.6%, P = 0.05). The presence of 3+ CVD risk factors was associated with an odds ratio (OR) of 2.5 (P = 0.001, 95% CI, 1.44-4.27) for macroalbuminuria in African Americans compared to an OR of 1.4 (P = 0.25, 95% CI, 0.78-2.53) in Whites. The race/3+ CVD risk factors interaction was statistically significant (P = 0.007). Conversely, the presence of 3+ risk factors was associated with an OR of 1.6 (P = 0.019, 95% CI, 1.08-2.28) for CVD in Whites compared to an OR of 0.8 (P = .287, 95% CI, 0.54-1.20) in African Americans. The prevalence of any CVD in the presence of 3+ risk factors was 61% and 49% in Whites and African Americans respectively (P = .217). The race/3+ CVD risk factors interaction was statistically significant (P = 0.029). CONCLUSIONS: These findings suggest that among persons with diabetes, a clustering of 3+ CVD risk factors is more predictive for renal disease among African Americans, and more predictive for CVD in Whites. Further research should clarify the impact of CVD risk factor clustering on the incidence of vascular disease among African Americans and Whites with type 2 diabetes.

Black or African American↗