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Timothy Heeren

Publications and source records attributed to Timothy Heeren.

33 records · Page 2Linked to original sources
PubMed2004

Education modifies the effect of alcohol on memory impairment: the third national health and nutrition examination survey.

We examined whether the relation of alcohol consumption to prevalence of verbal memory impairment was modified by education among 4,804 elderly subjects in the Third National Health and Nutrition Examination Survey. Verbal memory was assessed using delayed recall, with impairment defined as a combined score <4. Alcohol consumption over the previous month prior to the interview was assessed using a food frequency questionnaire. Prevalence of verbal memory impairment decreased from 11.3 to 7.2, 5.7, 5.1 and 4.4% in increasing categories of alcohol consumption (none, 1-4, 5-14, 15-30 and >30 drinks per month) in men, and from 7.2 to 3.5 and 2.8% (for none, 1-14, and >14 per month) in women, respectively. Adjusting for age, race, and other factors, prevalence ratios of verbal memory impairment decreased with each increasing alcohol category, but the effect was attenuated when further adjusted for education. There was a much stronger protection from alcohol among subjects with more education: prevalence ratios were reduced from 1.0 to 0.2 to 0.1 for non-drinkers, 1-14, and >14 drinks/month, respectively (p for trend = 0.007). Our results suggest that alcohol intake is associated with a greater decrease in the prevalence of verbal memory impairment among more educated subjects than among those with less education, possibly related to differences in drinking patterns.

Aged↗
PubMed2004

Health-related quality of life of patients with HIV disease: impact of hepatitis C coinfection.

Health-related quality of life (HRQOL) is diminished in patients infected with both hepatitis C virus (HCV) and human immunodeficiency virus (HIV), but the effect of HIV/HCV coinfection on HRQOL is unknown. We compared the HRQOL of urban HIV/HCV coinfected patients with that of patients infected with either HCV or HIV alone. We then compared the 3 groups with a US population sample, adjusting for demographic characteristics. HRQOL for the group of HIV/HCV coinfected patients was statistically similar to that of HRQOL in patients with either HCV or HIV alone, but the 3 groups had a significantly decreased HRQOL than did the adjusted US population. Using multivariate techniques, we determined that age, unemployment, injection drug use, and depression were associated with impaired HRQOL. These findings underscore the importance of a multidisciplinary approach to the treatment of these patient populations.

Adult↗
PubMed2004

Changing patterns of sun protection between the first and second summers for very young children.

OBJECTIVES: To determine if an intensive intervention directed to mothers of newborns would increase levels of sun protection practice and lower rates of sunburning for their children; and to examine changes in sun protection practices and burning rates experienced between the first and second summers of life. DESIGN: Randomized study. SETTING AND PARTICIPANTS: Mothers of infants residing in the coastal town of Falmouth, Mass. INTERVENTION: Mothers were randomly selected to receive hospital education alone or hospital education plus tailored materials and telephone counseling. MAIN OUTCOME MEASURES: Child's sun protection practices and degree of skin damage at mean ages 6 and 18 months, as reported by the mother. RESULTS: Baseline surveys were completed by 108 mothers; 92 (85%) of the mothers completed posttests. There were few differences between intervention and control groups in use of sun protection for infants from the first summer (mean age, 6 months) to the second summer (mean age, 18 months). The child's routine use of hats, shirts, and shade dropped substantially from the first to the second summer. Conversely, sunscreen use rose from 34% to 93% (P<.001) for both groups during the same period. During the first summer, 22% of children received a sunburn or tan compared with 54% during the second summer (P<.001). CONCLUSIONS: Comprehensive sun protection begins to decline at a much earlier age than previously reported. Future studies should focus on parents' beliefs about the need for, and practice of, vigilant sun protection as their children grow from infancy to toddlerhood.

Adolescent↗
PubMed2004

The views of U.S. medical school deans toward academic primary care.

PURPOSE: To understand the views of U.S. medical school deans about their primary care faculties. METHOD: In 2000, the authors mailed a questionnaire containing 43 multipart items to deans of 130 U.S. allopathic medical schools. The questionnaire assessed the deans' attitudes about and evaluation of primary care at their school and their school's efforts to strengthen it. Deans were asked to compare family medicine, general internal medicine, and general pediatrics with nonprimary care clinical departments at their schools. RESULTS: Of the 83 (64%) deans who responded, 82% reported their school had departments or divisions of family medicine, general internal medicine, and general pediatrics. Deans rated general internal medicine and general pediatrics higher than nonprimary care faculty on clinical expertise and productivity (p < .001) and family medicine equivalent to nonprimary care faculty. Deans rated all three primary care faculties superior to nonprimary care faculty for teaching skills (p < .001) and programs (p < .05), but lower than nonprimary care disciplines for research productivity (p < .01) and revenues (p < .001). They rated family medicine and general pediatrics lower for research skills (p < .001), but 73% of deans stated research was equally important for primary care and nonprimary care departments. Deans considered overall financial resources to be equivalent for primary care and nonprimary care departments, but 77% of deans felt primary care departments or divisions needed financial support from the medical school to survive. Most deans attempted to strengthen primary care by changing the curriculum to promote primary care and by providing financial support. CONCLUSIONS: Deans ranked primary care faculty high on clinical and teaching measures. Although they considered research to be an important activity for primary care faculty, they evaluated it low relative to nonprimary care departments.

Administrative Personnel↗
PubMed2004

Hair testing and self-report of cocaine use by heroin users.

AIM: Failure to disclose cocaine use can have a negative impact on medical care and research validity. This study was performed to identify predictors of cocaine non-disclosure among individuals who self-reported heroin use during a medical care encounter. DESIGN: A prospective comparison of self-report of cocaine use among heroin users and hair analysis for cocaine. SETTING: Four health-care clinics at an academic, inner-city hospital. PARTICIPANTS: Patients presenting for a health-care visit who were willing to self-report use of heroin and were not engaged in any form of drug treatment. MEASUREMENTS: (1) Self-report using standardized instruments: the Drug Addiction Severity Test (DAST), the Addiction Severity Index (ASI) and quantity/frequency questions for heroin and cocaine use. (2) Biochemical evidence: analysis of hair by radioimmunoassay (RIA) for cocaine and opiate levels. FINDINGS: Among 336 heroin users who tested positive for cocaine in hair, 34.2% did not report their recent cocaine use. The mean cocaine level for discordant individuals was significantly lower than for concordant individuals (109.6 ng/10 mg versus 470.57 ng/10 mg; P < 0.0001). Multivariate predictors of disclosure included opiate and cocaine levels in hair and the ASI drug severity subscore. CONCLUSIONS: Although self-report has been validated for treatment system patients, almost a third of the out-of-treatment heroin users in this medical clinic study failed to disclose concomitant cocaine use. The likelihood of non-disclosure was greatest for heavy users of heroin and light users of cocaine. Confirmation of self-report with biochemical analysis in the medical setting may be necessary to improve both clinical care and research validity.

Adult↗
PubMed2004

A national survey of flexible sigmoidoscopy training in primary care graduate and postgraduate education programs.

OBJECTIVES: Expanding the pool of primary care endoscopists to perform flexible sigmoidoscopy (FS) has been advocated as a strategy for building colorectal cancer screening capacity. The principal aim of this study was to evaluate the availability and structure of FS training among internal medicine (IM), family practice (FP), physician assistant (PA), and nurse practitioner (NP) training programs. METHODS: A postal survey of all accredited IM (n = 445), FP (n = 471), PA (n = 118), and NP (n = 149) training programs nationwide was conducted. The primary outcome was the proportion of programs offering or mandating FS training; and secondary outcomes, if applicable, were the number of participating trainees, the number of required procedures, the availability of instruction in endoscopic biopsy technique, mentors, and barriers. RESULTS: The overall response rate was 63%. Most IM (89%) and FP (99%) programs offered FS training versus only 12% of PA and 0% of NP programs. Family practice programs were more likely to offer training (p < 0.0001), require training (p < 0.0001), and teach biopsy techniques (p < 0.0001); Internal medicine programs were more likely to have minimum requirements (p < 0.0001) and required >/= 25 procedures per trainee (p < 0.0001). Physician assistant programs were less structured and often lacked minimum requirements. CONCLUSIONS: Flexible sigmoidoscopy training is widely available among FP and IM programs but more restricted or nonexistent among PA and NP programs. The lack of minimum standards for ensuring competency highlights the need for a standardized credentialing process.

Clinical Competence↗
PubMed2004

Screening flexible sigmoidoscopy using an upper endoscope is better tolerated by women.

BACKGROUND: Flexible sigmoidoscopy (FS) is a commonly used method for colorectal cancer screening. Women are more likely than men to have a FS with a limited depth of insertion, in part due to differences of anatomy and perception of pain. AIM: The objective of this prospective single-blinded randomized clinical study is to assess satisfaction in women undergoing screening FS using an upper endoscope (E, diameter 9.8 mm) versus a standard sigmoidoscope (S, diameter 13.3 mm) as measured by pain and discomfort and overall satisfaction using a validated survey instrument. Secondary endpoints of FS efficacy included the depth of insertion of the instrument, frequency of polyp detection, and complication rate. RESULTS: A total of 160 asymptomatic women undergoing screening FS were entered over a 4-month period (July through November 2002). All procedures were performed by two experienced physician assistants. The two groups were of similar age (E = 57.5, S = 58.2, p= 0.579) and had a similar rate of previous abdominal surgery (E = 51.2%, S = 45.0%, p= 0.428) or hysterectomy (E = 34.2%, S = 26.3%, p= 0.274). Depth of insertion of the scope was 54.5 cm (+/-9.2 cm) with the E and 51.6 cm (+/- 10.3 cm) with the S (p= 0.058). Polyps were found more frequently in the study group (18.3%) compared with the control group (p= 10.2%) though this did not reach statistical significance (p= 0.131). Overall satisfaction with FS was similar in both groups (p= 0.694) but pain and discomfort were less in the patients undergoing FS using the E (p= 0.006). Controlling for age and previous surgery the differences in pain scores remained significant (p= 0.035). Endoscopist assessment of procedure difficulty (p= 0.726) and complication rates (p= 0.614) was equivalent. Controlling for the presence of polyps, the total duration for the procedure was 7.2 min in the E group and 5.7 min in the S group (p= 0.008). There were no significant differences between women with and without hysterectomy on either overall satisfaction or pain and discomfort. CONCLUSION: Screening FS in women using an upper endoscope is a feasible approach to colorectal cancer screening. Patients screened with an upper endoscope reported less pain and discomfort compared to standard sigmoidoscope while overall satisfaction did not differ. The trend toward increased polyp detection in patients undergoing FS with an upper endoscope may be related to a more thorough examination due to less patient discomfort and/or an increased depth of insertion of the upper endoscope. Thinner, more flexible endoscopes should be considered when performing screening FS in women.

Aged↗
PubMed2003

The reliability of passively collected AIDS surveillance data in Massachusetts.

PURPOSE: To determine the reliability of demographic, clinical, and treatment information collected during routine AIDS surveillance. METHODS: Information from the medical records of a random sample of 212 AIDS cases reported to the Massachusetts Department of Public Health between November 1993 and November 1994 was compared with that from the original case reports. We assessed levels of agreement by calculating overall percent agreement and kappa statistics with 95% confidence limits. We used an intraclass correlation coefficient to compare the CD4+ lymphocyte count reported from the two sources. RESULTS: There was excellent agreement for gender (kappa = 0.97) and race (kappa = 0.87). Agreement was lower for transmission mode (kappa = 0.73), CD4+ cell count (ICC = 0.76) and category of AIDS case definition (kappa = 0.59). There was poor agreement for use of antiretrovirals (kappa = 0.23), use of prophylaxis for Pneumocystis carinii pneumonia (kappa = 0.12) and vital status (kappa = 0.22). The month and year of diagnosis agreed in only 55% of cases reviewed. CONCLUSIONS: Routine AIDS surveillance data was reliable for demographic variables, but less reliable for information about clinical events, laboratory findings, or treatment. Future AIDS surveillance efforts should improve the collection of these data by using sources where this information is more reliable.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Colorectal cancer screening and familial risk: a survey of internal medicine residents' knowledge and practice patterns.

OBJECTIVE: Risk stratification is essential to the appropriate use of colorectal cancer screening recommendations. The principal objective of this study was to assess the knowledge and screening behavior of internal medicine (IM) residents regarding familial colorectal cancer. METHODS: We conducted a survey of IM residents in their second and third year of postgraduate training from two university-based programs (n = 127). The survey instrument assessed physician knowledge of screening recommendations and current practices for individuals with a family history of colorectal cancer, adenomatous polyps, familial adenomatous polyposis, and hereditary nonpolyposis colorectal cancer. The instrument also elicited data regarding familial risk assessment, documentation, and notification of at-risk family members. RESULTS: Eighty-one IM eligible residents (81%) completed the survey. Most respondents identified a family history of colorectal cancer as an important factor in assessing colorectal cancer risk and appropriately implemented relevant screening recommendations. However, for patients with a family history of adenomatous polyps diagnosed before age 60 yr, knowledge and adherence to recommendations advocating screening at age 40 was relatively poor. More importantly, for patients with familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer, respondents lacked the necessary risk assessment skills and knowledge to appropriately implement current recommendations. There were no consistent differences in knowledge or screening behavior when stratified on the basis of program site or postgraduate year status. CONCLUSION: Many IM residents are deficient in their knowledge, risk assessment skills, and screening practices for patients at familial risk of colorectal cancer. Effective educational strategies that promote awareness regarding familial risk, risk assessment skills, and appropriate use of relevant screening guidelines are needed.

Colorectal Neoplasms↗
PubMed2003

Age of first intoxication, heavy drinking, driving after drinking and risk of unintentional injury among U.S. college students.

OBJECTIVES: This study explored whether college students who were first intoxicated by alcohol at ages younger than 19 are more likely to become alcohol dependent and frequent heavy drinkers, drive after drinking, ride with intoxicated drivers and be injured after drinking. It also investigated whether these results occur because these students believe they can drink more and still drive legally and safely. METHOD: In 1999, 14,138 of 23,751 full-time 4-year students from a random sample of 119 college and universities nationwide completed self-administered questionnaires (response rate: 60%). This analysis focused on 12,550 who were aged 19 or older. Respondents were asked the age at which they first got drunk, as well as questions about recent alcohol-related behaviors and consequences. RESULTS: Compared with respondents first drunk at age 19 or older, those first drunk prior to age 19 were significantly more likely to be alcohol dependent and frequent heavy drinkers, to report driving after any drinking, driving after five or more drinks, riding with a driver who was high or drunk and, after drinking, sustaining injuries that required medical attention. Respondents first intoxicated at younger ages believed they could consume more drinks and still drive safely and legally; this contributed to their greater likelihood of driving after drinking and riding with high or drunk drivers. CONCLUSIONS: Educational, clinical, environmental and legal interventions are needed to delay age of first intoxication and to correct misperceptions among adolescents first drunk at an early age about how much they can drink and still drive safely and legally.

Adolescent↗
PubMed2003

Early age of first drunkenness as a factor in college students' unplanned and unprotected sex attributable to drinking.

OBJECTIVE: Early age of drinking onset has been associated with a greater likelihood among adults of experiencing alcohol dependence, frequent heavy drinking even among nondependent drinkers, and an increased risk of motor vehicle crashes, unintentional injuries, and physical fights after drinking. This study explores whether first getting drunk at a younger age is associated with a greater likelihood of college students reporting that they had unplanned or unprotected sexual intercourse because of their drinking. METHODOLOGY: In 1999 11 739 full-time 4-year college students from 128 randomly selected US colleges and universities completed a self-administered survey that asked them about their drinking practices and whether their drinking had caused them, since the beginning of the school year, to: 1) engage in unplanned sexual intercourse or 2) not use protection when having sex. RESULTS: Among college students who drink, those first drunk before age 13 compared with those never drank until age 19 or older had a 2.0 times greater odds of having unplanned sex and a 2.2 times greater odds of having unprotected sex reportedly because of drinking, even after controlling for age, race/ethnicity, marital status, parental drinking history, age of first smoking, and marijuana use. After further controlling for history of alcohol dependence and frequency of heavy drinking those first drunk before age 13 had a 1.5 times greater odds of unplanned sex and a 1.7 times greater odds of unprotected sex reportedly because of drinking. CONCLUSIONS: Clinical, educational, legal, and community interventions to delay age of first getting drunk need to be coupled with efforts to prevent unplanned and unprotected sexual intercourse among US college students.

Adolescent↗
PubMed2003

Secular changes in sleep position during infancy: 1995-1998.

OBJECTIVE: Prone sleeping among infants has been associated with an increased risk of sudden infant death syndrome. The objective of this study was to compare factors associated with sleep position in 1995-1996 and 1997-1998 and to assess secular trends in use of prone infant sleep position from 1995 through 1998 among families stratified by race and education. METHODS: A prospective cohort study was conducted in eastern Massachusetts and northwest Ohio of 12 029 mothers of infants who weighed > or =2500 g at birth. Descriptive statistics and multivariate odds ratios were used to relate maternal and infant characteristics to prone and supine sleeping. RESULTS: A total of 14 206 mothers (25% of those eligible) were enrolled. A total of 12 029 mothers (85% of enrolled) responded to the 1-month and 11 552 mothers (81% of enrolled) responded to the 3-month follow-up questionnaire. A decline in use of the prone sleep position and increase in use of the supine position was observed during the 4 years of the study. Factors associated with prone and supine sleep position were similar in 1995-1996 and 1997-1998. In 1997-1998, use of prone sleeping at 1 month of age reached the goal of < or =10% only among infants of white and Asian women, married women, women who were older than 25 years, women who were college graduates, and women with incomes >$55 000 per year. At 3 months of age, however, prone sleeping increased to 12% to 17% in these groups. These same groups were most likely to use the supine position; 38% to 45% were supine at 1 month, increasing to 56% to 64% by 3 months of age. However, as of the end of 1998, approximately 27% of infants of non-college-educated black and Hispanic mothers were placed to sleep in the prone position and only 20% to 30% were being placed to sleep in the supine position at 3 months of age. CONCLUSIONS: Recommendations to avoid prone sleep position and especially the recommendation that supine sleep position is preferred have not been effectively delivered to black and Hispanic families and to families of low-income and less than a college education.

Chi-Square Distribution↗
PubMed2002

Magnitude of alcohol-related mortality and morbidity among U.S. college students ages 18-24.

OBJECTIVE: This report estimates the numbers of 18-24 year old United States college students who annually experience alcohol-related deaths, injuries and other health problems. METHOD: We examined traffic and unintentional injury deaths in 1998 reported by the National Highway Traffic Safety Administration and the Centers for Disease Control (CDC). We also examined results of national coroner studies, Department of Education college enrollment data, the National Household Survey on Drug Abuse (NHSDA), the CDC National College Health Risk Behavior Survey and the Harvard School of Public Health College Alcohol Survey (CAS). All survey participants were ages 18-24: 6,930 college and 12,394 noncollege respondents in the NHSDA survey; 3,077 college students in the CDC survey; and 12,217 full-time 4-year college students in the CAS. Based on the number and proportion of 18-24 year olds enrolled in college, data on alcohol involvement in injury deaths among 18-24 year olds and survey responses, we calculated the numbers of 18-24 year old alcohol-related injury deaths and other health problems. RESULTS: We estimate that over 1,400 students aged 18-24 and enrolled in 2- and 4-year colleges died in 1998 from alcohol-related unintentional injuries, including motor vehicle crashes. According to surveys conducted in 1999, in the preceding year, over 2 million of the 8 million college students in the United States drove under the influence of alcohol and over 3 million rode with a drinking driver. Over 500,000 full-time 4-year college students were unintentionally injured under the influence of alcohol and over 600,000 were hit or assaulted by another student who had been drinking. CONCLUSIONS: There is an urgent need for expanding prevention and treatment programs, to reduce alcohol-related harm among U.S. college students and other young adults.

Accidents, Traffic↗
PubMed2002

Level of prenatal cocaine exposure and scores on the Bayley Scales of Infant Development: modifying effects of caregiver, early intervention, and birth weight.

OBJECTIVES: The objectives of this study were 1) to assess whether there is an independent association between the level of prenatal cocaine exposure and infants' developmental test scores after control of potential confounding variables; and 2) if such an association exists, to determine which biological and social variables, individually and in interaction with each other, may modify it. METHODS: In a prospective, longitudinal study of 203 urban term infants, 3 cocaine exposure groups were defined by maternal report and infant meconium assay: unexposed, heavier cocaine exposure (>75th percentile self-reported days of use or meconium benzoylecognine concentration), or lighter cocaine exposure (all others). Examiners, masked to exposure history, tested infants at 6, 12, and 24 months of age with the Bayley Scales of Infant Development. RESULTS: The final mixed linear regression model included as fixed covariates level of prenatal exposure to cocaine, alcohol, and cigarettes; prenatal marijuana exposure; gestational age and birth weight z score for gestational age; and gender. Age at test, caregiver at time of each test (biological mother, kinship caregiver, unrelated foster caregiver), and any previous child-focused early intervention were included as time-dependent covariates. There were no significant adverse main effects of level of cocaine exposure on Mental Development Index (MDI), Psychomotor Development Index (PDI), or Infant Behavior Record. Child-focused early intervention interacted with level of cocaine exposure such that heavily exposed children who received such intervention showed higher adjusted mean MDI scores than all other groups. Although the sample was born at or near term, there was also a significant interaction of cocaine exposure and gestational age on MDI scores, with those in the heavier exposure group born at slightly lower gestational age having higher mean MDI scores compared with other children born at that gestational age. There was also a significant interaction on MDI between child's age and caregiver. At 6 months, the adjusted MDI of children living with a kinship caregiver was 15.5 points lower than that of children living with their biological mother, but this effect was diminished and was no longer significant at 24 months (difference in means: 4.3 points). The adjusted mean MDI of children in unrelated foster care at 6 months was 8.2 points lower than children of biological mothers, whereas it was 7.3 points higher at 24 months. Early intervention attenuated the age-related decline in PDI scores for all groups. Birth weight <10th percentile was associated with lower PDI scores for children with heavier cocaine exposure and with lower MDI scores for all groups. CONCLUSIONS: Heavier prenatal cocaine exposure is not an independent risk factor for depressed scores on the Bayley Scales of Infant Development up to 24 months of age when term infants are compared with lighter exposed or unexposed infants of the same demographic background. Cocaine-exposed infants with birth weight below the 10th percentile for gestational age and gender and those placed with kinship caregivers are at increased risk for less optimal developmental outcomes. Pediatric clinicians should refer cocaine-exposed children to the child-focused developmental interventions available for all children at developmental risk.

Birth Weight↗