Remote diagnosis of cervical neoplasia: 2 types of telecolposcopy compared with cervicography.
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Adolescent↗
Biomedical subjects
Mark S Litaker
Publications and source records attributed to Mark S Litaker.
A tyrosine hydroxylase microsatellite and hemodynamic response to stress in a multi-ethnic sample of youth.
OBJECTIVE: Behavioral stress is believed to have an impact on cardiovascular health. As the rate-limiting enzyme in the pathway for catecholamine synthesis, tyrosine hydroxylase is a candidate gene for variability in cardiovascular function. The aim of this study was to determine whether a relationship exists between a tyrosine hydroxylase microsatellite and resting hemodynamic function, and/or hemodynamic responsivity to laboratory stress. DESIGN: Subjects underwent 2 laboratory stressors: a video game challenge and a social competence interview. SETTING: The stressors were administered in a laboratory setting. PARTICIPANTS: Subjects were 292 10- to 20-year-old normotensive African-American and European-American twin pairs. MAIN OUTCOME MEASURES: Blood pressure (BP) and heart rate (HR) were measured at rest and in response to the stressors. RESULTS: Chi-square analyses using re-sampling to account for the twin design indicated that allele and genotype frequencies were significantly different between European Americans and African Americans (P < or = .0001). Analyses of variance indicated that the 184 and 199 bp alleles were associated with an attenuation of the hemodynamic response to stress with increasing age (P < or = .003, P < or = .002, respectively), while the 188 bp allele was associated with a higher resting systolic blood pressure (SBP) (P < or = .02), and greater hemodynamic response to stress with increasing BMI (P < or = .02). CONCLUSIONS: This study showed that in a multi-ethnic sample of normotensive adolescents, specific alleles of this tyrosine hydroxylase microsatellite were associated with protective or deleterious cardiovascular effects with subjects at rest and responding to stress.
Adolescent↗
Low accuracy and low consistency of fourth-graders' school breakfast and school lunch recalls.
OBJECTIVE: To determine the accuracy and consistency of fourth-graders' school breakfast and school lunch recalls obtained during 24-hour recalls and compared with observed intake. DESIGN: Children were interviewed using a multiple-pass protocol at school the morning after being observed eating school breakfast and school lunch. SUBJECTS: 104 children stratified by ethnicity (African-American, white) and gender were randomly selected and interviewed up to 3 times each with 4 to 14 weeks between each interview. STATISTICAL ANALYSIS: Match, omission, and intrusion rates to determine accuracy of reporting items; arithmetic and/or absolute differences to determine accuracy for reporting amounts; total inaccuracy to determine inaccuracy for reporting items and amounts combined; intraclass correlation coefficients (ICC) to determine consistency. RESULTS: Means were 51% for omission rate, 39% for intrusion rate, and 7.1 servings for total inaccuracy. Total inaccuracy decreased significantly from the first to the third recall (P=0.006). The ICC was 0.29 for total inaccuracy and 0.15 for omission rate. For all meal components except bread/grain and beverage, there were more omissions than intrusions. Mean arithmetic and absolute differences per serving in amount reported for matches were -0.08 and 0.24, respectively. Mean amounts per serving of omissions and intrusions were 0.86 and 0.80, respectively. APPLICATIONS/CONCLUSIONS: The low accuracy and low consistency of children's recalls from this study raise concerns regarding the current uses of dietary recalls obtained from children. To improve the accuracy and consistency of children's dietary recalls, validation studies are needed to determine the best way(s) to interview children.
Child↗
The efficacy of telecolposcopy compared with traditional colposcopy.
OBJECTIVE: Rural women have increased rates of cervical neoplasia, but colposcopic services are limited in rural clinics. The purpose of this study was to estimate the efficacy of telecolposcopy for women in rural health care sites. METHODS: Women with an indication for colposcopy were examined by local colposcopists at one of two rural clinics. Images of the colposcopic examination were transmitted to a tertiary care center for interpretation by an expert colposcopist. Another colposcopist (site expert) in attendance at the rural site also examined the same subjects, but did not share findings with the other colposcopists. Colposcopists independently determined the adequacy of the examination, colposcopic impression, biopsy intent and site, and management. Agreement between colposcopic impressions and cervical histology were assessed by using percent agreement, Cohen's kappa statistic, and McNemar's test with Bonferroni's adjustment. RESULTS: Teleconsultation was required for 36.2% of colposcopic examinations. A significantly lower percentage of satisfactory colposcopic examinations was noted by the distant colposcopists (60.0%) compared with the other colposcopists (P <.001). Colposcopic impression agreement with histology varied minimally, 59.7% (kappa = 0.31) for local colposcopists, 52.7% (kappa = 0.22) for site experts, 55.7% (kappa = 0.27) for distant experts who concurrently viewed the examination, and 49.7% (kappa = 0.16) for distant experts who viewed the examination on videotape at a later time. CONCLUSION: Teleconsultation was used for a substantial number of examinations. Diagnostic accuracy was maintained, but determination of colposcopic examination adequacy may be impaired by telecolposcopy. Telecolposcopy may help reduce barriers to medical access for women in rural areas.
Adolescent↗
Over-the-counter antifungal drug misuse associated with patient-diagnosed vulvovaginal candidiasis.
OBJECTIVE: To estimate what proportion of symptomatic women purchasing over-the-counter antifungal products for immediate treatment of presumed vulvovaginal candidiasis have vulvovaginal candidiasis or other genitourinary conditions. METHODS: A time-location sample of 95 symptomatic women who purchased and presented with an over-the-counter antifungal product for immediate and personal treatment of presumed vulvovaginal candidiasis were evaluated by clinical examination and pertinent laboratory tests. The percentage of women diagnosed having vulvovaginal candidiasis or other conditions, proportions of women with vulvovaginal candidiasis compared between groups with and without a prior diagnosis of vulvovaginal candidiasis, and groups that read or did not read the over-the-counter package label were assessed. RESULTS: The actual diagnoses for women who self-diagnosed vulvovaginal candidiasis were: vulvovaginal candidiasis 33.7%, bacterial vaginosis 18.9%, mixed vaginitis 21.1%, normal 13.7%, other diagnoses 10.5%, and trichomonas vaginitis 2.1%. Women with a previous clinically based diagnosis of vulvovaginal candidiasis were not more accurate in diagnosing vulvovaginal candidiasis than women without a prior clinical diagnosis (chi(2) = 0.27, P =.6). Women who read the package label were no more likely to have vulvovaginal candidiasis than were women who did not read the label (Fisher exact test, P =.39). CONCLUSION: Many women who self-diagnose and use an over-the-counter product for treatment of presumed vulvovaginal candidiasis do not have vulvovaginal candidiasis. A history of a previous clinically based diagnosis of vulvovaginal candidiasis and reading the package label do not help women self-diagnose vulvovaginal candidiasis properly. Ready access to these products is associated with wasted financial expenditures, unfulfilled expectations, and a delay in correct diagnosis for a substantial number of women.
Adult↗
Theory-based intervention for dementia behaviors: a within-person analysis over time.
The historic "black-box" approach to treatment effectiveness research has hampered the development of effective activity interventions for persons with dementia. The purpose of this case study is to test the effectiveness of activities derived from the Need-Driven Dementia-Compromised Behavior Model. Activities that matched skill level and personality style of interest resulted in a pattern of greater time on task (p =.0012), participation (p =.004), and positive mood (p =.0001) and fewer dementia-related behaviors (p =.009) compared with activities matched to skill level only. Practitioners may improve behavioral outcomes for persons with dementia by prescribing activities based on an assessment of skill level and style of interest.
Aged↗
Hemostatic and inflammatory markers in obese youths: effects of exercise and adiposity.
OBJECTIVES: To determine the relation of hemostatic markers to cardiovascular fitness and adiposity and the effect of physical training (PT) on these markers. STUDY DESIGN: Seventy-four obese teenagers were randomly assigned to 8 months of lifestyle education (LSE), LSE plus moderate-intensity PT, or LSE plus high-intensity PT. Measures included fibrinogen, plasminogen activator inhibitor-1 (PAI-1), D-dimer, C-reactive protein (CRP), fitness, percent body fat (%BF), and visceral adiposity (VAT). RESULTS: At baseline, fibrinogen and CRP were significantly correlated with %BF and VAT (0.27 </= r </= 0.51), and fitness (r = -0.39, r = -0.43, respectively); PAI-1 with %BF (r = 0.30) and VAT (r = 0.48); D-dimer with fitness (r = -0.24). Although PT produced significant changes in fitness and adiposity, there were no significant group differences in the hemostatic markers. Change in PAI-1 was significantly correlated with its baseline value (r = -0.47) and change in %BF (r = 0.38). Changes in D-dimer and CRP were significantly correlated with their respective baseline values (r = -0.68,r = -0.48, respectively). CONCLUSIONS: Unfavorable levels of fitness and adiposity were associated with higher levels of hemostatic markers, putting individuals with this profile at greater risk for future cardiovascular disease. No evidence was provided that 8 months of PT had a direct influence on these markers in obese youths.
Adipose Tissue↗
Effects of exercise intensity on cardiovascular fitness, total body composition, and visceral adiposity of obese adolescents.
BACKGROUND: Little is known about how the intensity of exercise influences cardiovascular fitness and body composition, especially in obese adolescents. OBJECTIVE: Our goal was to determine the effects of physical training intensity on the cardiovascular fitness, percentage of body fat (%BF), and visceral adipose tissue (VAT) of obese adolescents. DESIGN: Obese 13-16-y-olds (n = 80) were assigned to 1) biweekly lifestyle education (LSE), 2) LSE + moderate-intensity physical training, or 3) LSE + high-intensity physical training. The intervention lasted 8 mo. Physical training was offered 5 d/wk, and the target energy expenditure for all subjects in physical training groups was 1047 kJ (250 kcal)/session. Cardiovascular fitness was measured with a multistage treadmill test, %BF with dual-energy X-ray absorptiometry, and VAT with magnetic resonance imaging. RESULTS: The increase in cardiovascular fitness in the high-intensity physical training group, but not in the moderate-intensity group, was significantly greater than that in the LSE alone group (P = 0.009); no other comparisons of the 3 groups were significant. Compared with the LSE alone group, a group composed of subjects in both physical training groups combined who attended training sessions >or=2 d/wk showed favorable changes in cardiovascular fitness (P < 0.001), %BF (P = 0.001), and VAT (P = 0.029). We found no evidence that the high-intensity physical training was more effective than the moderate-intensity physical training in enhancing body composition. CONCLUSIONS: The cardiovascular fitness of obese adolescents was significantly improved by physical training, especially high-intensity physical training. The physical training also reduced both visceral and total-body adiposity, but there was no clear effect of the intensity of physical training.
Adipose Tissue↗
Physical training improves insulin resistance syndrome markers in obese adolescents.
INTRODUCTION: The purpose of this study was to test the hypothesis that physical training (PT), especially high-intensity PT, would have a favorable effect on components of the insulin resistance syndrome (IRS) in obese adolescents. METHODS: Obese 13- to 16-yr-olds (N = 80) were randomly assigned to one of the following 8-month interventions; 1) lifestyle education (LSE)-alone every 2 wk, 2) LSE+moderate-intensity PT, and 3) LSE+high-intensity PT. PT was offered 5 d x wk(-1). Plasma triacylglycerol (TAG), total cholesterol (TC), high-density lipoprotein cholesterol (HDLC), very low-density lipoprotein cholesterol (VLDLC), low-density lipoprotein cholesterol (LDLC), low-density lipoprotein (low density lipoprotein (LDL)) particle size, apolipoproteins AI and B, glucose, insulin, and blood pressure were measured with standardized methods. RESULTS: The intent-to-treat analyses for all subjects who completed pre- and post-tests regardless of their adherence to the interventions showed that the LSE+high-intensity PT group had more favorable changes than the LSE-alone group in TAG level (P = 0.012), TC/HDLC (P = 0.013), and diastolic blood pressure (P = 0.031). For efficacy analyses, all PT subjects who attended at least 2 d x wk(-1) (40%) were combined into one group (LSE+PT) and compared with the LSE-alone group. These two-group analyses showed significant interactions (P < 0.001) between baseline values and group membership for deltaTAG, deltaVLDLC, and deltaTC/HDLC, such that subjects who had the least favorable baseline values showed the most beneficial impact of the PT. Of particular interest was a favorable effect of the PT on LDL particle size. CONCLUSION: PT, especially high-intensity PT, had a favorable effect on several IRS markers in obese adolescents.
Absorptiometry, Photon↗
Qualitative assessment of telemedicine network and computer-based telecolposcopy.
OBJECTIVE: To qualitatively assess telemedicine network and computer-based telecolposcopy. MATERIALS AND METHODS: A site expert and local colposcopist examined women presenting consecutively for colposcopic examination at 1 of 2 rural clinics. Images from the exam were transmitted to distant experts at a telemedicine center by an existing telemedicine network and computer-based telecolposcopy system. Colposcopists rated both systems with respect to complications, ease and confidence of procedure, and system resolution and visualization. RESULTS: Rates of technically defective examinations were similar for network (25.1%) and computer-based (22.5%) telecolposcopy (p =.46). The ease of telecolposcopic examinations and colposcopists' confidence in and comfort with telecolposcopy were practically equal for both systems. Mean perceived quality of care was greater for network (3.92) compared with computer-based (3.82) telecolposcopy (Wilcoxon signed rank test, p =.03; Likert scale, 1 = minimal, 5 = maximum). Image resolution was rated better for computer-based (3.36) compared with network (3.07, p <.0001) telecolposcopy. However, visualization was better for the latter system in comparison (3.43 vs 3.07, p <.0001). CONCLUSIONS: The quality of telecolposcopy was considered above average based on all parameters evaluated for each type of telecolposcopy. Although a few significant differences were detected, colposcopists perceived network and computer-based telecolposcopy to be very similar by subjective assessment.
Journal Article↗
Emotional well-being in a person with dementia.
Self-reported mood and observations of affect are often used as indicators of emotional well-being. The purpose of this case study was to (a) describe the self-reported mood and affective pattern of an older man with severe cognitive impairments, (b) assess consistency in his responses to mood state, (c) compare mood pattern to premorbid personality, and (d) determine the concordance between self-reported mood and observed affect. Observations of mood and affect were taken three times per day for 35 days. There was concordance between self-reported mood and observed affect. The participant was consistent in his responses to mood 75% of the time. The pattern of self-reported mood reflected the participant's long-standing personality traits of extraversion and neuroticism. Results, although not generalizable, demonstrate the need to consider the perspective of the person with dementia when addressing quality-of-life issues in research and practice.
Activities of Daily Living↗
Children's Social Desirability and Dietary Reports.
We investigated telephone administration of the Children's Social Desirability (CSD) scale and our adaptation for children of the Social Desirability for Food scale (C-SDF). Each of 100 4th-graders completed 2 telephone interviews 28 days apart. CSD scores had adequate internal consistency and test-retest reliability, and a 14-item subset was identified that sufficiently measures the same construct. Our C-SDF scale performed less well in terms of internal consistency and test-retest reliability; factor analysis revealed 2 factors, 1 of which was moderately related to the CSD. The 14-item subset of the CSD scale may help researchers understand error in children's dietary reports.
Child↗
Accuracy of fourth-graders' dietary recalls of school breakfast and school lunch validated with observations: in-person versus telephone interviews.
OBJECTIVE: To investigate the accuracy of children's dietary recalls of school breakfast and school lunch validated with observations and obtained during in-person versus telephone interviews. DESIGN: Each child was observed eating school breakfast and school lunch and was interviewed that evening about that day's intake. SETTING: Ten elementary schools. PARTICIPANTS: A sample of fourth-graders was randomly selected within race (black, white) and gender strata, observed, and interviewed in person (n = 33) or by telephone (n = 36). MAIN OUTCOMES MEASURED: Rates for omissions (items observed but not reported) and intrusions (items reported but not observed) were calculated to determine accuracy for reporting items. A measure of total inaccuracy was calculated to determine inaccuracy for reporting items and amounts combined. ANALYSIS: Analysis of variance; chi-square. RESULTS: Interview type (in person, telephone) did not significantly affect recall accuracy. For omission rate, intrusion rate, and total inaccuracy, means were 34%, 19%, and 4.6 servings for in-person recalls and 32%, 16%, and 4.3 servings for telephone recalls of school breakfast and school lunch. CONCLUSIONS AND IMPLICATIONS: The accuracy of children's recalls of school breakfast and school lunch is not significantly different whether obtained in person or by telephone. Whether interviewed in person or by telephone, children reported only 67% of items observed; furthermore, 17% of items reported were not observed.
Child↗
Diabetic ketoacidosis depletes plasma tryptophan.
Diabetic ketoacidosis (DKA) is a severe metabolic disturbance of insulin-dependent diabetes mellitus (IDDM) which has a significant effect on amino acid metabolism. Amino acids serve as precursors for various neurotransmitters which are involved in affective disorders, and patients with IDDM are known to have an increased prevalence of affective disorders. We monitored the plasma concentrations of 23 amino acids in six adolescents prior to treatment of DKA and at 6, 24 and 120 hours after initiation of treatment. The well-known increase in the concentrations of the glucogenic amino acids and the decrease in the branched-chain amino acids were observed in response to treatment of DKA. Low levels of tryptophan were found prior to treatment of DKA. Treatment increased the plasma tryptophan levels, but the mean concentration remained low throughout the sampling period. Only the glutamate-derived amino acids (glutamate, proline and glutamine) from the Krebs cycle pool were significantly affected by treatment. Glutamine declined initially, but recovered as the plasma pH normalized. Our results indicate that DKA causes a depletion of plasma tryptophan. This depletion may predispose some patients with IDDM to have affective disorders secondary to a neurotransmitter imbalance.
Adolescent↗
What is the least costly strategy to evaluate cervical abnormalities in rural women? Comparing telemedicine, local practitioners, and expert physicians.
OBJECTIVE: This study establishes the least costly strategy for evaluation of rural women in need of colposcopy among 3 alternatives: telemedicine, local practitioners, and referral experts. METHODS: Women in rural Georgia who needed colposcopy were examined by an expert colposcopist on site, by a local practitioner, and by a distant expert colposcopist linked by telemedicine. Independent determinations of biopsy intent were used to model the differing biopsy costs of the 3 methods. Record review determined the average total cost of telemedicine. Reports of average cost in year 2000 dollars from societal perspective include medical costs and pain and suffering due to additional biopsies and curettage, telemedicine costs, and costs of potential diagnostic delay for a 1-year time horizon. RESULTS: From the societal perspective in the baseline case, the average cost per patient evaluated was dollar 270 for patients seen by referral experts. The cost was dollar 38 less (e.g., dollar 232) for patients seen by local practitioners, and dollar 35 more (e.g., dollar 305) for patients seen by telemedicine. From the societal perspective, local practitioners were less costly than referral experts because of lower travel costs for patients, but from the medical perspective, their average cost was dollar 32 higher than referral experts because they performed more biopsies and curettage procedures than experts. Telemedicine assistance would have lowered the number of biopsies performed by local practitioners, but as of year 2000 the costs of this technology could not be justified by the savings. CONCLUSION: From the societal perspective, local practitioners performing colposcopy are the least costly way to evaluate cervical abnormalities in rural patients with substantial time and travel costs.
Colposcopy↗
Patient acceptance and the psychological effects of women experiencing telecolposcopy and colposcopy.
BACKGROUND: The purpose of the study was to assess patient acceptance and psychological effects in women experiencing telecolposcopy compared with colposcopy. METHODS: Convenience samples of 150 and 263 women scheduled for colposcopy or telecolposcopy, respectively, completed questionnaires assessing anxiety (Prime MD), depression [Center for Epidemiologic Studies/Depressed Mood Scale (CES-D)], health beliefs and concerns, coping style (Miller Behavioral Style Score) and examination acceptance and satisfaction. Test scores and subject responses were compared using the t test and Wilcoxon rank sum test. RESULTS: Mean scores representing mild anxiety (1.3 and 1.2, P =.7) and mild depression (35.4 and 36.3, P =.4) were reported for the telecolposcopy and colposcopy groups, respectively. The telecolposcopy group indicated significantly greater mean scores for the examination, saving them time and money compared with the colposcopy group. Women in both groups were highly satisfied with their examinations and care. CONCLUSIONS: In general, women reported very high levels of satisfaction with telecolposcopy and colposcopy. Potential savings of time and money and improved health care were considered of particular value to women examined by telecolposcopy. Telecolposcopy seems to be well accepted by rural women.
Adaptation, Psychological↗