George L. White

Timing intercourse to achieve pregnancy: Current evidence

Physicians who counsel women for preconception concerns are in an excellent position to give advice to couples regarding the optimal timing of intercourse to achieve pregnancy. The currently available evidence suggests that methods that prospectively identify the window of fertility are likely to be more effective for optimally timing intercourse than calendar calculations or basal body temperature. There are several promising methods with good scientific bases to identify the fertile window prospectively. These include fertility charting of vaginal discharge and a commercially available fertility monitor. These methods identify the occurrence of ovulation clinically and also identify a longer window of fertility than urinary luteinizing hormone kits. Prospectively identifying the full window of fertility may lead to higher rates of conception. Proper information given early in the course of trying to achieve pregnancy is likely to reduce time to conception for many couples, and also to reduce unnecessary intervention and cost.

Associations between body-mass index and surgery for rotator cuff tendinitis.

BACKGROUND Rotator cuff tendinopathy is a common entity. We hypothesized that obesity, because of biomechanical and systemic risk factors, increases the risks of rotator cuff tendinitis, tears, and related surgical procedures. METHODS A frequency-matched case-control study was conducted. Three hundred and eleven patients who were fifty-three to seventy-seven years old and who underwent rotator cuff repair, arthroscopy, and/or other repair of the shoulder in a large hospital from 1992 to 2000 were included in the study. These surgical procedures were used as proxies for the risk of rotator cuff tendinitis. These patients were age and frequency-matched to 933 controls, who were randomly drawn from a pool of 10,943 potential controls consisting of Utah state residents who were enrolled in a large cancer-screening trial. Age-adjusted odds ratios were calculated with use of the International Classification of Diseases, Ninth Revision procedural codes and body-mass-index groups. The data were stratified according to gender and age. Multiple linear regression analyses also were performed. RESULTS There was an association between increasing body-mass index and shoulder repair surgery. The highest odds ratios for both men (odds ratio = 3.13; 95% confidence interval = 1.29 to 7.61) and women (odds ratio = 3.51; 95% confidence interval = 1.80 to 6.85) were for individuals with a body-mass index of > or =35.0 kg/m(2). Tests for trend also were highly significant for both men (p = 0.002) and women (p < or = 0.001). Multiple linear regression analysis also indicated a significant association between increasing body-mass index and shoulder surgery (beta = 1.57; 95% confidence interval = 0.97 to 2.17; p < or = 0.001). CONCLUSIONS There is an association between obesity and shoulder repair surgery in men and women who are fifty-three to seventy-seven years of age. The results of the present study suggest that increasing body-mass index is a risk factor for rotator cuff tendinitis and related conditions.

Climate conditions and physical activity in the United States.

OBJECTIVE To identify the influence season and climate have on physical activity among US adults. METHODS Seven weather classifications from 255 weather stations were linked with 355 counties covered by the 2003 BRFSS. RESULTS The percentage meeting the recommendations for physical activity ranged from 30.9% in Puerto Rico to 60.9% in Montana and significantly varied across seasons: 44.6% in winter, 46.2% in spring, 48.4% in summer, and 45.8% in fall. Counties in the top 25% meeting the recommendations for physical activity had the highest percentage of days with dry moderate conditions. Counties in the bottom 25% had the highest percentage of days with moist tropical conditions. CONCLUSION Season and climate significantly influence physical activity in the United States.

In vitro fertilization availability and utilization in the United States: a study of demographic, social, and economic factors

OBJECTIVE To characterize the demographic correlates of IVF availability and utilization. DESIGN Demographic analysis of public data. SETTING Each of the 50 states in the United States was used as a unit of analysis. PATIENT(S) Patients undergoing IVF, as demographically estimated. INTERVENTION(S) Publicly available data were collected through the Society for Assisted Reproductive Technology and the Centers for Disease Control. The US Census Bureau data were collected by using software available from the Centers for Disease Control. MAIN OUTCOME MEASURE(S) The number of physicians performing IVF and the number of IVF cycles per 100,000 reproductive-age women were used to estimate IVF availability and utilization. RESULT(S) In 2005, 1,031 providers performed 98,242 fresh IVF cycles in 430 centers. Overall availability was 2.5 IVF physicians per 100,000, and utilization was 236 IVF cycles per 100,000. Availability and utilization of IVF were highly correlated. Mean IVF availability and utilization were significantly higher in states with IVF insurance coverage. In adjusted analyses, IVF availability correlated positively with mandated insurance coverage, percentage of single persons, and median income. Utilization of IVF correlated with IVF availability, percentage urbanization, and percentage of individuals >or=25 years of age who had a bachelors degree. CONCLUSION(S) Lower rates of IVF utilization in some states are correlated with a lack of insurance coverage and decreased availability of physicians providing this service.

Thyroid disease associated with exposure to the Nevada nuclear weapons test site radiation: A reevaluation based on corrected dosimetry and examination data

Background: A study was begun in 1965 to 1966 to determine whether children exposed to radioactive iodine from nuclear weapons testing at the Nevada Test Site from 1951 through 1962 were at higher risk of thyroid disease. In 1993, we reported that among those examined in 1985 to 1986 (Phase II) there was an association between radiation from the Nevada Test Site and thyroid neoplasms. Methods: We reevaluated the relationship between exposure to Nevada Test Site fallout and thyroid disease using newly corrected dose estimates and disease outcomes from the Phase II study. A prospective cohort of school children 12 to 18 years old living in Utah, Nevada, and Arizona was first examined for thyroid disease in 1965 to 1966 and reexamined in 1985 to 1986. In the Phase II report, 2497 subjects formed the basis for this analysis. Thyroid disease, including thyroid neoplasms and thyroiditis, was expressed as cumulative incidence and risk ratios (RRs) with a dose–response expressed as excess risk ratio (ERR/Gy). Results: The RR between thyroid radiation dose in the highest dose group and thyroid neoplasms increased from 3.4 (in the earlier analysis) to 7.5. The RR for thyroiditis increased from 1.1 to 2.7 with an ERR/Gy of 4.9 (95% confidence interval = 2.0 to 10.0). There were too few malignant thyroid neoplasms to estimate risk. Conclusions: Persons exposed to radioactive iodine as children have an increased risk of thyroid neoplasms and autoimmune thyroiditis up to 30 years after exposure.

Orbital emphysema: A potentially blinding complication following orbital fractures

A case of visual loss due to orbital emphysema secondary to a blow-out fracture of the orbit is presented. Because vision returned to 20/20 following an optic nerve decompression procedure, we hypothesize that our patient developed a compressive optic neuropathy with ischemia due to the emphysema. Essential instructions concerning the injury that the emergency physician should give the patient suffering an orbital blow-out are also presented.

Inexpensive and Time‐Efficient Hand Hygiene Interventions Increase Elementary School Children’s Hand Hygiene Rates

MICHELLE SNOW, RN, MSPH, MSHR GEORGE L. WHITE, JR., PhD, MSPH HAN S. KIM, PhD, MSPH Routine hand hygiene has been cited by the World Health Organization and the Centers for Disease Control and Prevention as a cost-effective and important hygiene measure in preventing the spread of infectious diseases. Several studies have explored children’s hand hygiene habits, effects of scheduled hand hygiene, hand hygiene environmental barriers, educational programs, and application of various hand hygiene products, all with the aim of increasing the frequency of hand hygiene in children and decreasing absenteeism at school. Though these studies did have merit and achieved statistical significance, sustainability of hand hygiene was not evaluated. In addition, no published peer-reviewed research was found that explored the influence of a verbal cue to action coupled with teacher modeling or hand hygiene education that included a visual experience for the children to see the effectiveness of their hand washing. Therefore, this project focused on 2 interventions. Intervention 1 involved verbal cue to action coupled with teacher modeling of hand hygiene, and intervention 2 involved teacher cue to action, hand hygiene education, and an opportunity for children to see the effectiveness of their hand hygiene efforts.

The Role of Control in Depression, Anxiety, and Life Satisfaction among Visually Impaired Older Adults

Abstract Two groups of visually impaired older adults, minimally (n = 40) and severely impaired (n = 40), were compared on depression, anxiety, life satisfaction, and various dimensions of control....

Autologous dermis graft at the time of evisceration or enucleation

Aim: To present a new technique using autologous dermis graft at the time of enucleation or evisceration to replace the ocular surface area lost when the corneal scleral button is excised. Methods: A retrospective, interventional, non-comparative case series of patients who had an autologous dermis graft placed to assist in closure of Tenon’s capsule and conjunctiva at the time of enucleation or evisceration. Medical records were reviewed and the following variables were recorded: age, sex, history of previous ocular surgery or radiation treatment, indication for surgery, type of surgery, laterality, type of orbital implant, size of implant, length of follow up, and complications. Results: Nine patients were identified (three male, six female) Five had enucleation with implant placement and four had evisceration with implant placement. Four individuals received unwrapped porous polyethylene spherical implants, three received silicone implants, and two received hydroxylapatite implants. Follow up ranged from 30 to 112 weeks (mean (SD), 61 (28) weeks). No operative or early complications were observed. One patient who had enucleation after two rounds of brachytherapy for uveal melanoma developed subsequent late exposure of the implant. There were no complications involving the graft donor site. Conclusions: This small series shows that the use of a dermis graft is a safe and effective new technique to facilitate orbital rehabilitation. It is hypothesised that the extra surface area produced with a dermis graft preserves the fornices and allows a larger implant. It may also allow the implant to be placed more anteriorly which assists with both implant and prosthesis motility.

Using behavior change theories to enhance hand hygiene behavior.

It is well-documented that proper hand hygiene reduces nosocomial infections (Centers for Disease Control, 2000), while it is also well-documented that compliance by health care providers to proper hand hygiene remains less than satisfactory (Larson et al., 2001). It is the purpose of this brief communication to propose a theoretically driven approach that can be used by health educators in a variety of settings focusing on different target groups. While most research and interventions on hand hygiene have focused on the specific needs of health care providers (e.g. physicians and nurses), a theoretically based approach would be equally applicable to a variety of targeted groups, such as lay care providers, professional food handlers, home food prep, crowded conditions of dorms and classrooms and toddlers in day care centers, with some modifications.