Betty Skipper

Relationship between glycemic control, ethnicity and socioeconomic status in Hispanic and white non-Hispanic youths with type 1 diabetes mellitus.

Objectives:  To determine if there is a disparity in glycemic control between Hispanic and white non‐Hispanic children and adolescents with type 1 diabetes mellitus (DM) and to delineate the factors associated with glycemic control in these populations.

A case-control study of risk factors for sporadic hepatitis C virus infection in the southwestern United States

Objective:We performed a case-control study to evaluate risk factors and possible modes of transmission for hepatitis C virus (HCV) infection in patients with no history of blood transfusion or injection drug use.Methods:Study subjects were selected from among patients seen in gastroenterology outpatient clinics at a university medical center in the southwestern United States. The study group consisted of 58 patients (12%) with chronic HCV infection who reported no history of transfusion or injection drug use, among a total of 477 patients evaluated for a positive HCV antibody test. These 58 patients were matched by age, ethnicity, and gender with 58 control patients diagnosed with gastroesophageal reflux attending the same clinics. Patients and controls were subjected to structured interviews and review of medical records.Results:A variety of variables were significantly associated with increased risk of sporadic HCV infection, including a history of tattoos, needlestick exposure, a history of sexually transmitted disease, intercourse with an injection drug user, five or more lifetime sexual partners, intercourse during menses (for women), lower income, and heavy alcohol intake (>60 g/day). Multivariate analysis identified a history of sexually transmitted disease, heavy alcohol intake, and the presence of a tattoo as independent risk factors for sporadic HCV. In addition, six cases and one control had a history of needlestick exposure. Of the cases, 88% had at least one of these four risk factors, as compared with 26% of controls (odds ratio = 16.5; 95% confidence interval = 4.0–68.8).Conclusions:A history of sexually transmitted disease, heavy alcohol intake, the presence of tattoos, and a history of needlestick exposure were identified as risk factors for sporadic hepatitis C in this case-control study. If we include all patients with a history of blood transfusion or injection drug use, only 2% of the total 477 HCV patients had no identified risk factors.

Tuberculous meningitis in the southwest United States: A community‐based study

This community-based study analyzed 54 patients with definite or probable tuberculous meningitis (TBM) in New Mexico from 1970 through 1990. Patients ranged in age from 4 months to 86 years. The highest age-specific incidence occurred in the elderly, but 22% of patients were less than 10 years old. Native American patients were overrepresented. Patients were as likely to live in small towns as in large urban cities. Symptoms were present for a median of 13 days before admission. The majority of patients had fevers, headache, stiff neck, and mental changes, such as confusion or lethargy. No patient was admitted comatose. Focal neurologic signs were present in 33%. Laboratory testing found hyponatremia in 79%, pulmonary infiltrates on chest x-ray in 40%, ventricular dilatation on CT or MRI in 52%, and tuberculomas in 16%. PPD skin tests were positive in 64%. CSF cultures grew Mycobacterium tuberculosis in 50%, but colony counts were always lower than 102/ml. As a consequence, acid-fast stains of CSF sediment were reported as positive in only 4%. Six patients were not diagnosed during the hospitalization and died of complications. Twenty-three percent of patients who were appropriately treated also died of complications during the initial hospitalization. Tuberculous meningitis continues to be an important disease in small communities, and affects all ages and ethnic and socioeconomic backgrounds.

Prevalence and Correlates of Mental Disorders Among Native American Women in Primary Care

OBJECTIVES We examined the lifetime and the past-year prevalence and correlates of common mental disorders among American Indian and Alaska Native women who presented for primary care. METHODS We screened 489 consecutively presenting female primary care patients aged 18 through 45 years with the General Health Questionnaire, 12-item version. A subsample (n = 234) completed the Composite International Diagnostic Interview. We examined associations between psychiatric disorders and sociodemographic variables, boarding school attendance, and psychopathology in the family of origin. RESULTS The study participants had high rates of alcohol use disorders, anxiety disorders, and anxiety/depression comorbidity compared with other samples of non-American Indian/Alaska Native women in primary care settings. CONCLUSIONS There is a need for culturally appropriate mental health treatments and preventive services.

Residency performance of graduates from a problem‐based and a conventional curriculum

Summary. Performance of 130 graduates in residency from a community‐oriented, problem‐based medical curriculum, and from a parallel, conventional track, were compared on eight dimensions: knowledge, communication with patients, independent learning ability, teamwork, patient education, critical thinking ability, attention to health care costs, and self‐assessment. Ratings were obtained from three evaluators: a doctor‐supervisor, a nurse and the resident him/herself. The study was undertaken to identify differences between graduates from the two curricular tracks. Differences were observed in the areas of health care costs (supervisors) and communication with patients (residents), and a trend was observed in patient education (supervisors) and knowledge (nurses). The outcomes of the study are discussed in light of the literature on residency performance, and in terms of the educational experiences that characterize the two medical curricula.

Mealtime behaviors of preschool children: comparison of children with autism spectrum disorder and children with typical development.

ABSTRACT This study identified mealtime behaviors of young children (3–6 years old) with autism spectrum disorder (ASD) and compared these behaviors to children with typical development matched for age, gender, and ethnicity. The parents of children with ASD (n = 24) and children with typical development (n = 24) completed a mealtime survey to assess early mealtime history, mealtime location and behaviors, food preferences and behaviors, and eating problems. Parental concerns increased significantly after age 1 year in the children with ASD. Matched analysis results showed significant differences between the pairs of children in specific mealtime behaviors. More children with ASD were picky eaters, mouthed nonfood items, resisted new foods, limited foods based on textures, had problems with gagging, had difficulty eating at regular restaurants or at school, resisted sitting at the table, and threw or dumped food. Knowledge of these early differences can help pediatric therapists to assess feeding issues and plan interventions.

Acanthosis Nigricans and Diabetes Risk Factors: Prevalence in Young Persons Seen in Southwestern US Primary Care Practices

PURPOSE Evidence shows acanthosis nigricans is often associated with hyperinsulinemia and may indicate increased risk of type 2 diabetes mellitus. The purpose of this study was to determine the association of acanthosis nigricans with type 2 diabetes risk factors and disease in young persons. METHODS We conducted a cross-sectional study in the Research in Outpatient Settings Network, a practice-based research network in southwestern US communities. Participating clinicians (N = 96) collected data on children and young adults aged 7 to 39 years seen during a 2-week sampling period. The main outcomes were the prevalence of acanthosis nigricans, type 2 diabetes risk factors (ethnicity, family history of type 2 diabetes, hypertension, overweight/obesity), type 2 diabetes, and the relationships among these. RESULTS Among 1,133 patients sampled, risk factors for type 2 diabetes were common: 69% had a family history of the disease; 3% of children (aged 7 to 19 years) and 12% of adults had hypertension; 43% of children and 73% of adults were overweight or obese; and 80% were members of ethnic minorities. Acanthosis nigricans was found in 17% of children and 21% of adults. Among children and adults alike, the more type 2 diabetes risk factors that were present, the higher the prevalence of acanthosis nigricans (P <.001). The prevalence ratio for type 2 diabetes in patients with acanthosis nigricans was 1.97 (95% confidence interval, 1.18–3.27; P = .01) after controlling for age, body mass index, and the number of type 2 diabetes risk factors. Clinicians reported that the identification of acanthosis nigricans frequently led to discussions about lifestyle modification for decreasing the risk of type 2 diabetes. CONCLUSIONS Patients with acanthosis nigricans are likely to have multiple risk factors for type 2 diabetes. Acanthosis nigricans may be an independent risk factor for this disease. Detection of acanthosis nigricans may help clinicians more rapidly identify high-risk individuals for diabetes counseling.

The Syed-Neblett interstitial template in locally advanced gynecological malignancies

Twenty-eight patients with locally advanced malignancies of the cervix and vagina were treated with a combination of external radiation therapy and afterloading Syed-Neblett iridium template. There were 22 patients with squamous cell cancer and two patients with adenocarcinomas of the cervix. Four patients with squamous cell cancer of the vagina were treated with this method. Only patients with locally advanced disease (cervical lesion greater than 4 cm in diameter) and poor vaginal anatomy were selected for this modality of therapy. In our series the incidence of distant failures of 39% seems to confirm the significance of local volume of disease as a prognostic indicator; despite a local control rate of 59%, only 33% of our patients are alive from 25-51 months. Complications occurred in 12 patients (42%). Six patients (22%) developed severe rectal stricture or rectovaginal fistula necessitating diverting sigmoid colostomy; five patients (18%) developed hemorrhagic proctitis with diarrhea and tenesmus; one patient developed vaginal vault necrosis. Complications occurred 7 to 24 months following therapy. Six of the 12 patients developing complications are dead of disease. On the basis of this study and because of the low cure rate and high incidence of complications, the value of the Syed-Neblett template in locally advanced gynecologic malignancies should be reconsidered.

Distress and attitudes toward the learning environment: Effects of a curriculum innovation

The emergence of innovative curricula provides unique opportunities to examine how a modification in the learning environment might influence stress and attitudes among students in medicine. In 1979, the University of New Mexico School of Medicine implemented a problem‐based, community‐oriented, student‐centered curriculum that runs concurrently with the larger traditional track. This longitudinal investigation compares the perceptions of distress and attitudes toward the learning environment of students in these two tracks. The Symptom Questionnaire and the Learning Environment Questionnaire were used to measure distress levels and attitudes toward the learning environment. Students completed these instruments at orientation (first semester) and during the second, third, and fourth semesters of the first 2 years of medical school. The innovative‐track students’ perceptions of distress were significantly lower during the first 2 years of medical school than those of the traditional‐track students. Their e...

Intracardiac and Intrarenal Renin-Angiotensin Systems : Mechanisms of Cardiovascular and Renal Effects

The renin-angiotensin system (RAS) is a hormonal system that controls body fluid volume, blood pressure, and cardiovascular function in both health and disease. Various tissues, including the heart and kidneys, possess individual locally regulated RASs. In each RAS, the substrate protein angiotensinogen is cleaved by the peptidases renin and angiotensin-converting enzyme to form the biologically active product angiotensin II, which acts as an intracrine cardiac and renal hormone. The components of each RAS, including aldosterone (ALDO), may be produced locally and/or may be delivered by or sequestered from the circulation. Overactivity of the cardiac RAS has been associated with cardiac diseases, including cardiac hypertrophy due to volume and/or pressure overload, heart failure, coronary artery disease with myocardial infarction, and hypertension. Overactivity of the renal RAS has been associated with various kidney diseases, including nephropathies and renal artery stenosis. The principal effects of an overactive RAS include the generation of reactive oxygen species, which leads to “oxidative stress,” activation of the nuclear transcription factor κB, and stimulation of pathways and genes that promote vasoconstriction, endothelial dysfunction, cell hypertrophy, fibroblast proliferation, inflammation, excess extracellular matrix deposition, atherosclerosis, and thrombosis. It has been suggested that oxidative stress is the central mechanism underlying the pathogenesis of RAS-related and ALDO-related chronic cardiovascular and renal tissue injury and of cardiac arrhythmias and conduction disturbances.