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Biomedical subjects

T D Dye

Publications and source records attributed to T D Dye.

18 recordsLinked to original sources
PubMed2006

Tobacco use in the Dominican Republic: understanding the culture first.

OBJECTIVE: To conduct formative research on the landscape of tobacco use to guide survey and subsequent intervention development in the Dominican Republic (DR). DESIGN: Rapid Assessment Procedures, systematic qualitative methods (participant-observations, in-depth interviewing, focus groups) using bilingual mixed age and gendered teams from the United States and DR. SUBJECTS: Over 160 adults (men and women), ages 18 to 90 years, current, former and never smokers, community members and leaders from six underserved, economically disadvantaged DR communities. MAIN OUTCOME MEASURES: Key domains: tobacco use patterns and attitudes; factors affecting smoking initiation, continuation, quitting; perceived risks/benefits/effects of smoking; and awareness/effects of advertising/regulations. RESULTS: Perceptions of prevalence varied widely. While "everybody" smokes, smokers or ex-smokers were sometimes difficult to find. Knowledge of health risks was limited to the newly mandated statement "Fumar es prejudicial para la salud" [Smoking is harmful to your health]. Smokers started due to parents, peers, learned lifestyle, fashion or as something to do. Smoking served as an escape, relaxation or diversion. Quit attempts relied on personal will, primarily for religious or medical reasons. Social smoking (custom or habit) (< 10 cigarettes per day) was viewed as a lifestyle choice rather than a vice or addiction. Out of respect, smokers selected where they smoked and around whom. Health care providers typically were reactive relative to tobacco cessation, focusing on individuals with smoking related conditions. Tobacco advertising was virtually ubiquitous. Anti-tobacco messages were effectively absent. Cultures of smoking and not smoking coexisted absent a culture of quitting. CONCLUSIONS: Systematic qualitative methods provided pertinent information about tobacco attitudes and use to guide subsequent project steps. Integrating qualitative then quantitative research can be replicated in similar countries that lack empirical data on the cultural dimensions of tobacco use.

Adolescent↗
PubMed2001

Body mass index and urinary symptoms in women.

The aim of this study was to assess a possible correlation between obesity and lower urinary tract symptoms in a selected population of women. All the subjects referred for lower urinary tract complaints over a 2-year period received a questionnaire and a frequency/volume chart. The patient population was divided into normal or low weight (BMI < or = 29) and high weight and obese (BMI > or = 30). The main outcome measures were lower urinary tract symptoms (infections, frequency, urgency, voiding difficulty, dysuria, nocturia and incontinence). The statistical analysis was performed using the Mann-Whitney U-test, chi2 test and odds ratios; 694 women received the questionnaire and 553 were evaluated (79.7% response). Overall, 229 (42.4%) were of low or normal BMI; 311 (57.5%) had a high or obese BMI. After adjusting for prior bladder surgery, any surgery, history of medical problems and physical inactivity, only the association between BMI and incontinence remained statistically significant (adjusted OR 1.95; 95% CI 1.18-3.19).

Adult↗
PubMed2001

Impact of family structure and stability on academic outcome in preterm children at 10 years of age.

OBJECTIVE: To compare school performance at age 10 years in a cohort of extremely preterm children and term control subjects and to examine the impact of family composition and stability on performance. STUDY DESIGN: Prospective, longitudinal follow-up from birth to 10 years of age of a regional cohort of children born at 24 to 31 weeks of gestational age and sociodemographically matched term control subjects. Family composition, extent of parental care giving, and family moves were tracked sequentially. At 10 years, academic achievement and school performance were ascertained for 118 of 125 (94%) preterm survivors and 119 of 125 (95%) term children. RESULTS: Term children were more likely to demonstrate optimal school outcome (appropriate grade level without additional classroom assistance) than were preterm children (odds ratio 3.4, 95% CI 1.9-6.0). Medical complications related to prematurity had little impact on school outcome. Among preterm children, optimal school outcome was significantly associated with increased parental education, child rearing by 2 parents (regardless of marital status), and stability in family composition and geographic residence over 10 years. These environmental influences were less pronounced among term control subjects. CONCLUSION: Although preterm children performed less well in school than term children, family factors were stronger predictors of school performance than were perinatal complications.

Child↗
PubMed2000

Attitudes toward clinical guidelines among obstetricians in Northern Ireland.

OBJECTIVES: To evaluate the attitudes of, and the influences on decisions made by, obstetricians in Northern Ireland in order to understand the feasibility of applying guidelines to obstetric practice. DESIGN: Cross-sectional postal survey. SETTING: Northern Ireland. POPULATION: Consultants, senior registrars, registrars, and senior house officers in obstetrics in Northern Ireland (n = 170). Responses were received from 68 x 8% (n = 117), with complete data available for 67 x 1% (n = 114). MAIN OUTCOME MEASURES: An attitudes score was constructed by consolidating responses to a variety of statements about guidelines. Individual responses to guidelines statements and the standardised attitudes T-score were analysed by demographic and practice characteristics. RESULTS: Attitudes toward guidelines were generally positive, with women practitioners more likely to have positive attitudes toward guidelines than did their male counterparts. Younger obstetricians were more likely to report that practitioners should incorporate guidelines into their practices. Doctors who responded that their decisions were influenced by specific tools related to guidelines, such as computerised databases, during the previous three months had more positive attitudes toward guidelines than doctors who did not use such tools. Furthermore, doctors based in teaching hospitals were more likely than others to have been influenced by the guidelines of professional societies. CONCLUSIONS: Generally guidelines appear to be quite well received, with doctors reporting that their practice often is influenced by them. Doctors who reported that their decisions were influenced by guidelines had an especially positive attitude toward them. However, some tools which target the application of evidence-based methods (e.g. computerised databases) are used infrequently by obstetricians. The challenge remains to encourage the further development of guidelines and tools that are useful and appropriate for practitioners.

Adult↗
PubMed1999

Organisational variation, satisfaction, and women's time investment in prenatal care.

This study measured the amount of time women spent obtaining prenatal care, and related that time spent to satisfaction with care. Women with Medicaid coverage (n = 364) were interviewed about several parameters related to their most recent prenatal visit: (1) how long it took them to get to the visit; (2) how long they waited upon arrival; and (3) how much time they spent with practitioners during the visit. Women were asked questions regarding satisfaction with the most recent visit, and with their care in general. They received care from four sources: private practitioners, community health centres (CHCs), hospital clinics and health department clinics. Women's satisfaction with care decreased as time spent with practitioners decreased, relative to time spent travelling and waiting. Those obtaining care from CHCs were more likely to have shorter waiting times and longer visit times than women obtaining care from other sources. Women spent approximately 3 h during pregnancy in face-to-face contact with practitioners. Satisfaction with care is closely associated with women's relative time investment in obtaining care. Both satisfaction and time investment parameters vary widely by source of prenatal care.

Adult↗
PubMed1999

Tracking sexual contacts of HIV patients: a study of physician practices.

Notification of sexual partners of HIV-infected individuals has become a focus of debate at local, state, and national levels. Issues of confidentiality and ethical concerns continue to pose challenges to state and local health departments addressing this issue. We conducted a telephone survey with physicians in Syracuse, New York to ascertain opinions about HIV partner notification and the role of public health agencies in that notification process. In general, physicians mostly relied upon the HIV-infected individuals to notify their own partners but were supportive of enhanced efforts regarding partner notification.

AIDS Serodiagnosis↗
PubMed1998

Early language development in children exposed to or infected with human immunodeficiency virus.

OBJECTIVES: To compare language development in infants and young children with human immunodeficiency virus (HIV) infection to language development in children who had been exposed to HIV but were uninfected, and (among subjects with HIV infection) to compare language development with cognitive and neurologic status. DESIGN: Prospective evaluation of language development in infected and in exposed but uninfected infants and young children. SETTING: Pediatric Infectious Disease Clinic, State University of New York-Health Science Center at Syracuse. SUBJECTS: Nine infants and young children infected with HIV and 69 seropositive but uninfected infants and children, age 6 weeks to 45 months. RESULTS: Mean Early Language Milestone Scale, 2nd edition (ELM-2) Global Language scores were significantly lower for subjects with HIV infection, compared with uninfected subjects (89.3 vs 96.2, Mann-Whitney U test). The proportion of subjects scoring >2 SD below the mean on the ELM-2 on at least one occasion also was significantly greater for subjects with HIV infection, compared with uninfected subjects (4 of 9 infected subjects, but only 5 of 69 uninfected subjects; Fisher's exact test). Seven of the 9 subjects with HIV infection manifested deterioration of language function. Four manifested unremitting deterioration; only 1 of these 4 demonstrated unequivocal abnormality on neurologic examination. Three subjects with HIV infection and language deterioration showed improvement in language almost immediately after the initiation of antiretroviral drug treatment. Magnetic resonance imaging or computed tomography of the brain were performed in 6 of 7 infected subjects with language deterioration, and findings were normal in all 6. ELM-2 Global Language scaled scores showed good agreement with the Bayley Mental Developmental Index or the McCarthy Global Cognitive Index (r = 0. 70). Language deterioration, or improvement in language after initiation of drug therapy, coincided with or preceded changes in global cognitive function, at times by intervals of up to 12 months. CONCLUSIONS: Language deterioration occurs commonly in infants and young children with HIV infection, is seen frequently in the absence of abnormalities on neurologic examination or central nervous system imaging, and may precede evidence of deterioration in global cognitive ability. Periodic assessment of language development should be added to the developmental monitoring of infants and young children with HIV infection as a means of monitoring disease progression and the efficacy of drug treatment.

Child, Preschool↗
PubMed1997

Physical activity, obesity, and diabetes in pregnancy.

Gestational diabetes mellitus (GDM) is the most common medical complication of pregnancy. Women with GDM are at elevated for numerous maternal health complications, and their infants are at elevated risk for death and morbidity. Management of GDM has traditionally been through diet and close monitoring of glucose levels, with initiation of insulin therapy when diet alone fails to maintain euglycemia. Recently, however, it has been suggested that alternative treatment modalities, such as exercise, may overcome a peripheral resistance to insulin, thus preventing GDM or controlling hyperglycemia in women with GDM. In this study, conducted from October 1995 to July 1996, the authors used a population-based birth registry to determine whether exercise has a preventive role in the development of GDM in women living in central New York State. They used contingency tables and chi-square statistics to examine bivariate differences among maternal and demographic variables and the occurrence of GDM. When stratified by prepregnancy body mass index category, exercise was associated with reduced rates of GDM only among women with a body mass index greater than 33 (odds ratio = 1.9, 95% confidence interval 1.2-3.1). The effect of exercise in obese women was further complicated by insurance status. When the data were stratified by insurance status, it appeared that women of higher socioeconomic status who were obese and did not exercise were at a significantly elevated risk of GDM compared with their counterparts of lower socioeconomic status. The results of this study suggest that for some women exercise may play a role in reducing the risk that they will develop GDM during pregnancy.

Adult↗
PubMed1997

Association between pre-pregnancy obesity and the risk of cesarean delivery.

OBJECTIVE: To explore the relationship between pre-pregnancy obesity and the risk for cesarean delivery. METHODS: The population studied included 20,130 women with live births after 20 weeks' gestation in central New York state between June 1, 1994, and May 31, 1995. Women who were obese before pregnancy were compared with nonobese women with regard to mode of delivery. Obesity was defined as body mass index (BMI) greater than 29. Separate analyses were conducted on the entire sample and on a subset of women with singleton pregnancies and no prior cesarean deliveries, as an estimate of the risk of primary cesarean delivery in obese women. Statistical analyses included chi 2 test, crude odds ratio (OR) with 95% confidence interval (CI), and adjusted OR with 95% CI, using logistic regression to control for confounding variables. RESULTS: The adjusted OR was 1.64 (95% CI 1.46, 1.83) for obese women with singleton pregnancies and no prior cesarean deliveries to undergo cesarean delivery. The adjusted OR was 1.66 (95% CI 1.51, 1.82) for obese women in the entire sample to undergo cesarean delivery. In addition, increasing BMI was associated with increased risk for cesarean delivery. CONCLUSION: Compared with nonobese women, women who are obese before pregnancy are at increased risk for cesarean delivery. Preconceptional counseling regarding dietary and life-style modifications may alter this pattern.

Adult↗
PubMed1997

A cost evaluation of implementing a quality-oriented, regional perinatal data system.

We evaluated the cost impact of implementing a perinatal data system (PDS) on birth certificate (BC) processing and perinatal quality improvement (QI) reporting. Relevant staff in all birthing hospitals in the 15-county Central New York region (N = 23) were interviewed at baseline prior to implementation of the PDS and one year after implementation of the PDS to ascertain the time and costs of BC processing and of QI report generation. The average time and cost to collect and complete BCs did not change significantly from baseline to year 1. The time and costs to complete QI reports decreased significantly by 70 percent during this same period. Hospitals fully using the PDS for QI reporting purposes took, on average, six percent of the time it took other hospitals to generate comparable QI reports. The PDS significantly reduced the time and cost of generating perinatal reports from a consolidated database over what hospitals had done previously. Given the richness of the reports and the efficiency with which they are produced, hospitals are encouraged to adopt electronic means of BC processing and accessing these data for QI reporting purposes.

Automation↗
PubMed1997

Prenatal HIV screening in pregnant women: a medical-legal review.

Identifying pregnant women's human immunodeficiency virus (HIV) infection status provides them with the opportunity to seek appropriate treatment and to take measures to prevent vertical and horizontal transmission. Prenatal screening program options include targeting at-risk women, testing on a voluntary basis, or mandating prenatal HIV screening. When examining these options, the number of cases identified, programmatic costs, long-term health care costs, and legal implications must all be considered. Research indicates that targeting at-risk women misses a significant percentage of seropositive women, although programmatic costs may be lower. It is difficult to ascertain the difference between voluntary and mandatory programs with respect to the number of cases identified and treated. As a result, long-term savings are difficult to calculate. Mandatory programs would have the greatest direct costs and place the greatest burden on the woman's constitutional rights. By making HIV counseling and testing a routine component of prenatal care, voluntary programs could achieve the benefits of prenatal HIV screening without violating the woman's civil liberties.

AIDS Serodiagnosis↗
PubMed1997

Unintended pregnancy and breast-feeding behavior.

OBJECTIVES: This study assessed the effect of unintended pregnancy on breast-feeding behavior. METHODS: All women delivering a live birth between January 1, 1995, and July 31, 1996 (n = 33,735), in the 15-county central New York region were asked whether they had intended to become pregnant and their breast-feeding plans. RESULTS: Women with mistimed pregnancies, and pregnancies that were not wanted were significantly less likely to breast-feed than were women whose pregnancies were planned. After adjustment for confounding variables and contraindications for breast-feeding, the odds ratios of not breast-feeding remained significant. CONCLUSIONS: Promoting breast-feeding among women with unintended pregnancies is important to improve health status.

Breast Feeding↗
PubMed1996

Physical activity and the risk of preterm labor: an epidemiological review and synthesis of recent literature.

Considerable recent research effort of physical activity and pregnancy has included evaluation of preterm labor, preterm delivery, and gestational age at delivery. This review specifically evaluates recent studies that included such assessments of gestational parameters. Methodological difficulties (eg, small sample size, selective clinical populations) have prevented clear generalizable findings regarding the impact of physical activity on preterm labor and delivery. The outcomes evaluated are often times not similar from study to study and, with the associated differences in research design, prevent valid meta-analyses of this topic. Because there is some evidence that gestation and birthweight may decrease among physically active women, larger-scale, randomized clinical trials designed specifically to evaluate whether this association is simply a minor change in gestation and birthweight, or if this difference is manifested clinically in higher rates of preterm labor and delivery and low birthweight, are warranted. Without larger, population-based randomized studies, clinicians will remain unclear about the potential risks and/or benefits related to gestational duration of maternal exercise in their populations.

Exercise↗
PubMed1995

Violence, pregnancy and birth outcome in Appalachia.

Few studies have followed pregnant women prospectively to examine the impact of violence on birth outcome. We included such an assessment in a prospective study of pregnancy among low-income women. Nurses and social workers interviewed pregnant women (n = 364) and asked if they had been the object of violence since they became pregnant. These prenatal interviews were linked with information from perinatal records and with birth and death information. In total, 15.9% of women in the study indicated they had been abused since they became pregnant. Abused women were more likely to be teenagers and to have partners who were teenagers. Abused women were more likely to be primiparous, to smoke during pregnancy and to have physical problems related to stress. Women battered during pregnancy were more likely to suffer fetal distress or fetal death [Odds Ratio (OR) 3.68; 95% Confidence Interval (CI) 1.36, 9.94], even after adjusting for maternal age and smoking status. Finally the infants of abused women were more likely to remain in hospital after their mother's discharge (OR: 3.75; 95% CI: 1.38, 10.23). Our findings suggest that fetuses may be compromised in utero, as shown by higher rates of fetal distress and fetal death found among women physically abused during pregnancy.

Adult↗
PubMed1995

Failure to identify human immunodeficiency virus-seropositive newborns: epidemiology and enrollment patterns in a predominantly white, nonurban setting.

OBJECTIVE: To describe the epidemiology of newborn seroprevalence for human immunodeficiency virus (HIV) in a predominantly white, nonurban population, and to determine the factors associated with enrollment at a regional pediatric acquired immunodeficiency syndrome (AIDS) center serving that population. DESIGN: Retrospective case series of children enrolled at a regional pediatric AIDS center during a 6-year period and comparison with universal blind newborn screening data collected by the state of New York during the same time interval. SETTING: The Pediatric AIDS Center at State University of New York-Health Science Center at Syracuse, which serves as the only source of HIV-related pediatric care for children in a 16-country region of upstate New York totaling 1.8 million population. RESULTS: One hundred thirty-nine HIV-seropositive infants were born in the region during the 6-year study period; complete blind screening data were available for 138. Sixty-five (47%) of these infants were white. Thirty-nine (28%) of 138 had been enrolled at the Pediatric AIDS Center within the first 90 days of life. An additional 22 (16%) were enrolled at older than 90 days of life. The remaining 77 (56%) have never been seen at the center and are presumed to be unidentified. County enrollment rates varied from 0% to 100% and correlated with percent nonwhite births (r = .58; 95% confidence interval, 0.04-0.86). Children in outlying counties were at greater risk for nonenrollment than children from Onondaga County (site of the Pediatric AIDS Center) (adjusted relative risk, 1.38; 95% confidence interval, 1.05-1.85). White infants residing outside of Onondaga County were at the greatest risk of nonenrollment; of 50 seropositive white infants residing outside of Onondaga County, only 7 (14%) were enrolled at the center within the first 90 days of life. CONCLUSIONS: Local demographic factors can skew the racial distribution of HIV-seropositive infants dramatically compared with the national experience. White race and residence in counties away from the medical center each constituted risk factors for nonenrollment at the Pediatric AIDS Center. The epidemiology of HIV in this predominantly white, rural population, coupled with physician practices, probably contributed to low identification and enrollment rates. As the AIDS epidemic spreads into similar populations elsewhere, HIV infection in pregnant women or newborn infants is likely to become progressively harder to detect, unless universal screening is adopted.

Black or African American↗
PubMed1994

Infant mortality in Oklahoma, 1970-1990.

Patterns of infant mortality in Oklahoma are unlike the rest of the United States. Oklahoma has a significantly higher post neonatal mortality rate than the United States, with SIDS and congenital disorders being the leading causes of death in that age group. Conversely, Oklahoma has a significantly lower neonatal mortality rate than the United States. Vital statistics information for the period 1970-1990 are examined to describe patterns of infant death in Oklahoma. Despite long-term decreasing trends in infant death, disconcerting trends were observed in 1990 suggesting that a stronger infant mortality reduction strategy is needed in Oklahoma. Potential areas for public health intervention are suggested based on Oklahoma-specific data.

Cause of Death↗
PubMed1992

Retrospective maternal mortality case ascertainment in West Virginia, 1985 to 1989.

OBJECTIVE: The death of women from pregnancy-related causes remains a threat to national maternal and child health. Maternal deaths as persistent, albeit rare occurrences are overlooked if vital registration systems are relied on to report such deaths. STUDY DESIGN: Live birth records were matched with death records for women of reproductive age to detect if a woman died within 1 year of delivery. The data for potential cases were reviewed by committee and classified as maternal and nonmaternal deaths. RESULTS: Of all linked birth-death records, 32% were related to pregnancy: 81% were directly related to pregnancy and 19% were indirectly related to pregnancy. The most frequent causes of death were hemorrhage and embolism. Thirty-eight percent of the women were transferred to tertiary hospitals before death. The case ascertainment through this study improved maternal death detection by 100% over official vital statistics. CONCLUSION: Enhanced maternal mortality surveillance increased the detection of maternal death in West Virginia. Case review of these deaths yielded important information useful in shaping the state's perinatal system.

Adult↗