Biomedical subjects
Nancy Andrews
Publications and source records attributed to Nancy Andrews.
Randomized trial of a physician-based intervention to increase the use of folic acid supplements among women.
OBJECTIVE: Fewer than one third of American women take folic acid daily, although many women report that they would take folic acid if their physicians advised them to do so. This study determined the impact of a physician intervention during routine gynecologic visits on folic acid supplementation. STUDY DESIGN: Patients were assigned randomly to receive brief folic acid counseling, a reminder phone call, and 30 folic acid tablets (n = 162 women; intervention group) or to receive counseling about other preventive health behaviors and a folic acid informational pamphlet (n = 160 women; control group). Self-reported folic acid use was compared at baseline and at 2 months. RESULTS: Of the 279 patients who completed the study, weekly folic acid intake increased in the intervention group by 68%, compared with 20% in the control group ( P =.008). No significant differences were found in daily intake. The women who were most influenced by the intervention were black and lower income and not planning pregnancies. CONCLUSION: With little effort expended to encourage folic acid use, gynecologists could potentially reduce the risk of folate-preventable birth defects among their patients by as much as 11%.
Folic acid use by women receiving routine gynecologic care.
OBJECTIVE: Many health professional groups recommend folic acid supplementation for all women able to become pregnant. In this study, we document folic acid supplement use among a sample of women receiving routine gynecologic care. METHODS: A short questionnaire was administered to 322 women aged 18-45 years who were seeking routine gynecologic care at participating clinics in Little Rock, Arkansas. Questions covered knowledge and use of folic acid supplements, pregnancy intention, and demographic and socioeconomic characteristics. Primary study outcomes were self-reported folic acid awareness, daily or weekly use of folic acid supplements, and intention to begin taking folic acid. Factors affecting study outcomes were examined individually by computing crude odd ratios and adjusted for other covariates using unconditional logistic regression. RESULTS: Although 61.8% of women reported awareness of the association between folic acid and birth defects prevention, only 27.1% of these women, and 22.7% of all study participants, reported daily use of a folic acid supplement. Substantially more women (39.8%) were taking a folic acid supplement at least once per week. Age, race, educational level, folic acid awareness, marital status, pregnancy intent, and other preventive health behaviors were the most important predictors of compliance. CONCLUSION: The results indicate a need for targeted interventions directed toward minority women, young women, and those of lower socioeconomic and educational status. The routine gynecologic visit is an ideal opportunity to counsel women of reproductive age to take folic acid daily. LEVEL OF EVIDENCE: III
Iron metabolism in mice with partial frataxin deficiency.
Friedreich ataxia (FRDA), the most common autosomal recessive inherited ataxic disorder, is the consequence of deficiency of the mitochondrial protein frataxin, typically caused by homozygous intronic GAA expansions in the corresponding gene. The yeast frataxin homologue (yfh1p) is required for cellular respiration. Yfh1p appears to regulate mitochondrial iron homeostasis and protect from free radical toxicity. Complete loss of frataxin in knockout mice leads to early embryonic lethality, indicating an important role for frataxin during development. Heterozygous littermates with partial frataxin deficiency are apparently healthy and have no obvious phenotype. Here we evaluate iron metabolism and sensitivity to dietary and parenteral iron loading in heterozygote frataxin knockout mice (Fx(+/-)). Iron concentrations in the liver, heart, pancreas and spleen, and cellular iron distribution patterns were compared between wild type and Fx(+/-) mice. Response to parenteral iron challenge was not different between Fx(+/-) mice and wild type littermates, while sporadic iron deposits were observed in the hearts of dietary iron-loaded Fx(+/-) mice. Finally, we evaluated the effect of partial frataxin deficiency on susceptibility to cardiac damage in the mouse model of hereditary hemochromatosis (HH), the Hfe knockout mice. HH, an iron overload disease, is one of the most frequent genetic diseases in populations of European origin. By breeding Hfe(-/-) with Fx(+/-) mice, we obtained compound mutant mice lacking both Hfe and one frataxin allele. Sparse iron deposits in areas of mild to moderate cardiac fibrosis were found in the majority of these mice. However, they did not develop any neurological symptoms. Our studies indicate an association between frataxin deficiency, iron deposits and cardiac fibrosis, but no obvious association between iron accumulation and neurodegeneration similar to FRDA could be detected in our model. In addition, these results suggest that frataxin mutations may have a modifier role in HH, that predisposes to cardiomyopathy.
Ergonomics: muscle fatigue, posture, magnification, and illumination.
Chronic low-level trauma very often goes unnoticed until symptoms prompt sufferers to seek medical help. Many combined risk factors, rather than a single event or practice, lead to cumulative trauma disorders. Muscle fatigue leads to muscle trauma as well as a cascade of other injuries. With preemptive ergonomic strategies, such as the use of magnification and illumination, many of the common disabilities associated with dental careers can be avoided or reduced. The information in this article is of particular interest to not only the practicing dentist, but the entire dental team.
The flu...and you.
Seasonal influenza is primarily an upper respiratory illness that recurs yearly in slightly different forms. The "flu shot," or yearly vaccine, is the best precaution for preventing flu. All health care workers at risk are advised to be vaccinated every year. Occasionally more dangerous or even deadly forms develop, possibly leading to epidemics and pandemics. Both type A and B can cause epidemics, but influenza type A has greater potential to develop new and deadly subtypes and is responsible for the current "bird flu" that threatens to mutate to a form capable of a human pandemic. The flu is spread by droplets of oral and respiratory secretions. In dental facilities, in addition to Standard Precautions, Droplet Precautions should be observed when people with highly contagious respiratory infections such as influenza are present. Consistent use of masks and careful hand hygiene, including use of alcohol-based waterless agents in both treatment and public areas by both employees and patients, are the most important precautions to control influenza. CDC Respiratory Hygiene/Cough Etiquette (available in posters from the CDC) is the perfect starting point to inform workers and patients how to keep the dental office "a safe place to be healed" rather than a place to contract the flu.