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For patients with cardiovascular disease, blood pressure variability (BPV), distinct from hypertension, is an important determinant of adverse cardiac events. Whether pre-operative BPV adversely affects outcomes after percutaneous coronary intervention (PCI) is to this point unclear.To investigate the relationship between blood pressure variability and outcomes for patients post-PCI.Patients undergoing PCI in a single state in 2017 were studied (Visit-to-visit systolic BPV, as measured by both standard deviation and largest change, was higher in patients who had myocardial infarction, were readmitted, or died within one year following PCI. Systolic BPV, as measured by largest change or standard deviation, was higher in patients who had MACE, or readmissions (As BPV is easily measured and captured in the electronic medical record, these findings describe a novel method of identifying at-risk patients who undergo PCI. Aggressive risk modification for patients with elevated BPV and known coronary artery disease is indicated.

Introduction: Exposure to residential radon is a preventable cause of cancer. Prevention requires testing, but the percentage of homes that have been tested is small. One reason for the low testing rates may be that printed brochures fail to motivate people to obtain and return a radon test. Methods: We developed a radon app for smartphones that contained the same information as printed brochures. We conducted a randomized, controlled trial that compared the app to brochures in a population comprised largely of homeowners. Cognitive endpoints included radon knowledge, attitudes toward testing, perceived severity and susceptibility to radon, and response and self-efficacy. Behavioral endpoints were participants’ requests for a free radon test and the return of the test to the lab. Participants (N = 116) were residents of Grand Forks, North Dakota, a city with one of the nation’s highest radon levels. Data were analyzed by general linear models and logistic regression. Results: Participants in both conditions showed significant increases in radon knowledge (p < 0.001), perceived susceptibility (p < 0.001), and self-efficacy (p = 0.004). There was a significant interaction, with app users showing greater increases. After controlling for income, app users were three times more likely to request a free radon test. However, contrary to expectation, app users were 70% less likely to return it to the lab (p < 0.01). Conclusions: Our findings confirm the superiority of smartphones in stimulating radon test requests. We speculate that the advantage of brochures in promoting test returns may be due to their ability to serve as physical reminders.

Cardiorespiratory endurance (CRE) is an important health marker. The aim of this study was to examine temporal trends of CRE performance for Italian children between 1984 and 2010. Using a repeated cross-sectional study design, 5303 CRE test results were available for 2520 children aged 11-13 years from a single Northern Italian middle-high school between 1984 and 2010. CRE was measured as 1000-m and 12-min run test performance. With adjustments for BMI, temporal trends in means were estimated using linear regression, with trends in distributional characteristics described visually and estimated as the ratio of coefficients of variation (CVs). There was a significant small increase in BMI (effect size (ES) [95%CI]: 0.40 [0.32, 0.48]) over the entire period. When adjusted for BMI, there were significant small to moderate declines in mean running speed (ES [95%CI]: 1000-m, - 0.34 [-0.39, - 0.29]); 12-min, - 0.65 [-0.70, - 0.60]). Declines were larger for boys compared to girls. Variability substantially increased over time (ratio of CVs: range, 1.7-2.9), with larger declines in children with low running speed compared to children with average or high running speed. Our findings may be important to public health because low CRE is significantly related to current and future health. Refereed/Peer-reviewed

Blood pressure variability (BPV) describes visit-to-visit blood pressure (BP) changes independent of hypertension. Preoperative BPV and intraoperative BPV are associated with increased postoperative outcomes. We investigated the impact of both preoperative BPV and intraoperative BPV on elective surgical outcomes, specifically whether preoperative BPV and intraoperative BPV were independent risk factors for surgical complications.We investigated 600 patients undergoing elective surgery lasting more than two h and who had ≥8 outpatient BP recordings over three preoperative years. Age, sex, ethnicity, BMI, current medical problems, and medications at time of surgery were recorded. BPV was calculated as the standard deviation (SD) of systolic or diastolic BP for the 369 valid patients. Average BPV were compared between adverse outcomes of readmission, wound infection, acute kidney injury, death, myocardial infarction, and cerebral vascular accident.Three-hundred-sixty-nine (52.6% male, 47.4% female, 98.1% non-Hispanic) patients (mean age 62.5) were included in the study. Preoperative systolic (P = 0.043) and diastolic (P = 0.009) BPV were higher for patients with the combined endpoint of all adverse events. Preoperative systolic BPV was correlated with intraoperative BPV (P = 0.010). Both systolic and diastolic preoperative BPV was found to be independent from intraoperative BPV. Otolaryngology procedures were associated with less adverse outcomes (P = 0.034), whil antimicrobials (P = 0.022), autonomic drugs (P0.001), or respiratory drugs (P = 0.032) was associated with an increased likelihood of adverse outcome.Preoperative DBPV is associated with increased risk of readmission, wound infection and the combined endpoint of all adverse events. Intraoperative systolic blood pressure variability (SPBV) is associated with increased risk of acute kidney injury and the combined endpoint of all adverse events. Preoperative DBPV and intraoperative SBPV are independent risk factors for ninety-d postoperative outcomes. BPV should be considered in individualized risk assessment when assessing patient eligibility for elective procedures.

Background: Exposure to radon at home is the largest cause of lung cancer after smoking, and the combination of smoking and radon increases lung cancer risk several-fold. North Dakota has some of the highest residential radon levels in the United States. Although family physicians in North Dakota commonly counsel patients about smoking cessation, little is known about their knowledge and practices concerning radon. Methods: We mailed a questionnaire to 350 North Dakota family physicians regarding radon knowledge, beliefs, their own radon testing, and radon counseling of patients. The responses were analyzed by descriptive statistics, analysis of variance, and logistic regression. Results: Sixty-one percent of the surveys were completed. Seventy percent of family physicians correctly identified radon as radioactive; 67% reported that they do not inform patients about radon; and 80% reported never discussing the combined hazards of radon and smoking. Conversely, 35% of family physicians reported that they tested their own homes for radon. Discussion: Most North Dakota family physicians are knowledgeable about radon, and more than one third have tested their own homes. However, only a minority transmit this knowledge to their patients. Future efforts should educate physicians about communicating radon risks, especially in conjunction with smoking.

Background The initial confirmatory factor analysis of the Alcohol Related Neurodevelopmental Disorder Behavioral Checklist (ABC) utilized a population of 203 children. The analysis identified 10 independent measures (executive functioning, attention and concentration, cognition, memory, confabulation, gullibility, communication skills, academic skills, living/social skills, and juvenile justice). The 10 measures differentiated children with FASD from non-FASD controls. In this study, we present a validity study of the ABC using a different population of children with FASD and non-FASD controls. Methods A chart review identified 224 children with ABC checklist scores who had been evaluated for FASD. From this sample, we implemented a case-control study of 76 children diagnosed with FASD and 76 non-FASD controls who were matched by gender and closest age in years (mean age was 8.5 years). Results The averages of the total score and individual domain scores were compared between the 2 data sets and then between children with FASD and non-FASD controls. Children with FASD had significantly higher scores on all 10 measures than the non-FASD controls. There were very high sensitivity and specificity scores for the total score cutoff and for all 10 of the individual measures. Conclusions In an independent sample, we found minimal differences between the previous data and the current validation study on measures of average total score cutoffs, scores for the 10 measures and correlations. Combining the 2 samples yielded robust differences in scores between children with FASD and non-FASD controls. The sensitivity, specificity and accuracy estimates were also very high. The ABC Screen appears to have acceptable epidemiologic performance data to support its use as a screening tool and as an initial step in differentiating children with FASD from those who do not have FASD.

Background The etiology of brain cancer is poorly understood. The only confirmed environmental risk factor is exposure to ionizing radiation. Because nuclear reactors emit ionizing radiation, we examined brain cancer incidence rates in the USA in relation to the presence of nuclear reactors per state. Methods Data on brain cancer incidence rates per state for Whites by sex for three age groups (all ages, 50 and older, and under 50) were obtained from cancer registries. The location, number, and type of nuclear reactor, i.e., power or research reactor, was obtained from public sources. We examined the association between these variables using multivariate linear regression and ANOVA. Results Brain cancer incidence rates were not associated with the number of nuclear power reactors. Conversely, incidence rates per state increased with the number of nuclear research reactors. This was significant for both sexes combined and for males in the ‘all ages’ category (β = 0.08, p = 0.0319 and β = 0.12, p = 0.0277, respectively), and for both sexes combined in the’50 and older’ category (β = 0.18, p = 0.0163). Brain cancer incidence rates for counties with research reactors were significantly higher than the corresponding rates for their states overall (p = 0.0140). These findings were not explicable by known confounders. Conclusions Brain cancer incidence rates are positively associated with the number of nuclear research reactors per state. These findings merit further exploration and suggest new opportunities for research in brain cancer epidemiology.

Radon is a preventable cause of lung cancer, but the percentage of homes tested for radon is low. We previously developed a smartphone app that informs users about radon and allows them to request a free radon test. Here we conducted a randomized, controlled trial comparing the radon app versus printed brochures on radon knowledge, attitudes, and behaviors, including the proportion of participants requesting radon tests. Participants (N = 138) were undergraduates at a midwestern university. Data were analyzed by t-tests, general linear models, and logistic regression. App users showed significantly greater increases in radon knowledge (p = 0.010) and self-efficacy (p 0.001) and requested tests three times more often than brochure recipients (41.4% vs. 13.2%, p 0.001). However, the rate of test usage in each condition was low, ~3%. In conclusion, the radon app markedly outperformed brochures in increasing knowledge and requests for radon tests. Future work should focus on methods to increase test usage.

Objective: Children with fetal alcohol spectrum disorder (FASD) are overrepresented in early intervention programs, foster care, special education, juvenile corrections, and mental health services. In this study, we examine relationships between FASD and non-FASD controls for adverse childhood experiences (ACEs), and neurodevelopmental disorders. Methods: A chart review was conducted among patients seen at our clinic from 2010-2017 with data on FASD, ACEs, neurodevelopmental diagnoses, and foster or residential care placement available. Results: Relative risk for FASD was increased in patients with increased ACE scores (RR = 5.08), increased numbers of neurodevelopmental diagnoses (RR = 2.36), and patients who have been in foster or residential care (RR = 9.53). FASD risk increased as ACE scores or the number of neurodevelopmental diagnoses increased. Patients with any ACEs were 3.96 times more likely to have FASD, and those with eight or more ACEs were 6.31 times more likely to have FASD than those with no ACEs. Patients with three or more neurodevelopmental diagnoses were 6.55 times more likely to have FASD than those with two or fewer diagnoses. Nine or more diagnoses increased the risk for FASD ten-fold (RR = 10.91). Conversely, patients diagnosed with FASD were more likely to have at least three ACEs (RR = 3.71), at least five neurodevelopmental diagnoses (RR = 1.61), and high rates of previous foster or residential care placement (RR = 5.39). Conclusion: This study demonstrates that all children being considered for placement in foster care or residential should be screened for FASD.

Background: Prenatal exposure to alcohol and tobacco are both associated with increased risk for adverse outcomes. American Indians experience disproportionate rates of adverse birth outcomes. The Indian people living in the Great Plains Area of the Indian Health Services have increased exposure to alcohol and smoking during pregnancy. This study aims to assess the relationship between prenatal alcohol and tobacco exposure and early hospitalization in a rural Tribal Nation. Methods: We used data from the prospective Safe Passage Study on pregnancies and hospitalizations within the first year of life. The relationship between time to hospitalization and prenatal tobacco/alcohol exposure, maternal demographics, post-traumatic stress disorder and depression were evaluated. The analysis utilized Chi-square tests. Kaplan-Meier curves were used to estimate the likelihood of hospitalization during the first year of life by substance use category. Results: From a sample of 432 infants, we identified 260 (60.2%) who had a hospitalization. We found no significant effect from that if mother drank, amount drank, amount smoked or if mother smoked, on the risk of hospitalization. We did identify an effect for exposure to alcohol or smoking and age to hospitalization. Exposure was associated with younger age at hospitalization. However, after controlling for mother’s age, this effect was not significant. Mother’s age was significant in all models of hospitalization risk from parental exposure. Discussion: Reducing prenatal exposure to tobacco and alcohol may decrease hospitalization rates for infants from this Tribal Nation, especially among young mothers.

Background Outpatient blood pressure variability (BPV) predicts hospitalization and death in non-surgical patients independently of hypertension. We hypothesized that preoperative BPV predicts postoperative outcomes. Methods We assessed 22,233 veterans undergoing CABG, colectomy, hip replacement, pancreatectomy, carotid endarterectomy or AV-fistula with ≥10 outpatient BP’s over three preoperative years. Calculating BPV as SD of systolic or diastolic BP, we used logistic regression considering demographics, comorbidities, and pre-admission cardiovascular medications to estimate odds ratios for 90-day mortality or readmission, MI, CVA, renal failure, and wound infection, choosing the lowest 5%ile of systolic/diastolic BPV for reference. Results Covariate-adjusted ORs for adverse outcomes increased as BPV increased. For instance, the highest 5%ile of systolic BPV had covariate-adjusted ORs of 2.96 and 1.78 for 90-day mortality and readmission. Systolic and diastolic BPV trended together but affected outcomes independently. Conclusions Preoperative BPV predicts postoperative outcomes. BPV should be considered in individualized risk assessment and subgroup risk stratification.

Evidence suggests that changes in intestinal microbiota may not only influence gastrointestinal function but also affect the central nervous system (CNS). However, it is unclear whether alteration of the intestinal microbiota affects progression or inflammatory aspects of Alzheimer’s disease (AD), one of the most common dementing neurodegenerative diseases. To understand the relationship of gut intestinal microbiota with AD pathology, wild type control (C57BL/6) mice were compared to a mouse line that has the human Aβ sequence knocked into the mouse APP gene (App(NL-G-F)). In addition, we used probiotics to manipulate the gut microbiota of these animals. Fecal samples were collected to examine the overall diversity in intestinal microbiota. To study brain and intestinal inflammation, biochemical and histological analyses were performed. Altered metabolic pathways that could be associated with AD or the probiotic-mediated changes were examined by quantifying eicosanoid and bile acid profiles in brain and serum using ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). We observed that brain pathology was associated with intestinal dysbiosis and increased intestinal inflammation and leakiness in the App(NL-G-F) mice. However, modulating gut bacteria using probiotics significantly decreased intestinal inflammation and gut permeability with minimal effect on plaque deposition, cytokine levels, or gliosis in the brain. Mass spectrometry data revealed altered levels of several bile acids and prostaglandins in serum as well as in brain due to AD or probiotic supplementation. Our study characterizes intestinal dysfunction in an Alzheimer’s disease mouse model and the potential of probiotic intervention to ameliorate this condition.

Background. Ovarian cancer is associated with high serum calcium and low serum albumin in clinical and epidemiologic studies. Whether high calcium and low albumin predispose to ovarian cancer or reflect existing cancer is unclear. Objective. Test the hypothesis that serum calcium increases and serum albumin decreases in women who develop ovarian cancer. Methods. Two hundred and four women donated sera to the Janus Serum Bank in Norway pre- and post-diagnosis of ovarian cancer, donations separated by approximately 14 years. We measured calcium and albumin in these sera and calculated the albumin-corrected calcium. Sera were adjusted for patient age and storage time. Results. Post-diagnosis, mean age- and storage-adjusted calcium increased, from 2.53 to 2.68 mmol/L (p < .001). Mean age- and storage-adjusted, albumin-corrected calcium increased from 2.3 to 2.7 mmol/L (p < .001). Conversely, mean age- and storage-adjusted albumin decreased, from a mean of 51.3 to 40.9 g/L (p < .001). Significant changes were observed in women with early stage and metastatic cancer. Conclusions. These data support the hypothesis that calcium and albumin are serum biomarkers of extant ovarian cancer. Longitudinal changes in calcium and albumin may be useful in ovarian cancer early detection.

Importance: Understanding occupational therapy practice patterns for adolescents who have autism spectrum disorder (ASD) provides a baseline to determine areas of need and effective interventions. Objective: To identify puberty-related challenges addressed and interventions used by occupational therapy practitioners with adolescents ages 8–16 yr with ASD. Design: A nonexperimental survey design with a stratified random sample was used. Setting: The Occupational Therapy–Autism and Puberty Survey was distributed in the United States online through the Qualtrics platform (available October 2017–January 2018). Participants: Occupational therapists (89%) or occupational therapy assistants with experience with adolescents who have ASD were included. The 71 eligible respondents were primarily White women with an average 16 yr of experience. Outcomes and Measures: Nine key challenges and 11 interventions regarding puberty and ASD were identified. Hypotheses were generated before data collection. Results: More practitioners (>47%) addressed emotional regulation and personal hygiene, and fewer (92%) reported using social learning approaches and behavioral strategies, and most (>80%) reporting having received education in these interventions. Significant differences were found between reported education and use of behavioral skills training incorporating applied behavioral analysis (p < .001), parent training (p = .002), and technology (p = .003). Conclusions and Relevance: Practitioners are neglecting to address puberty-specific challenges with adolescents who have ASD. Opportunities exist to expand the interventions used and challenges addressed by occupational therapy practitioners for adolescents with ASD. What This Article Adds: This article expands occupational therapy literature by giving a baseline understanding of the puberty-related challenges that practitioners are addressing with adolescents who have ASD. This information can assist the profession in developing effective interventions and educational opportunities to allow practitioners to successfully address puberty-specific challenges.

OBJECTIVES Determine the rates of screening for substance use in pregnant women versus non-pregnant women attending the emergency department (ED). METHODS We captured all ED visits by women of childbearing age (12-50 years in our study) over a 5-year period (2012-2017) (n = 72,752) from a local community hospital. The 2742 pregnant women were then matched by ethnicity, marital status, and arrival method to 9888 non-pregnant women. We then compared rates of screening for substance use by pregnancy status stratifying by age and diagnosis. RESULTS The proportion of non-pregnant women who were screened for substance use was 3.66% compared to 1.90% of pregnant women, yielding an odds ratio (OR) of 1.96 (95% CI = 1.44 to 2.67). We then stratified the results by presenting complaint and age. Non-pregnant women 14 to 19 and 30 to 34 had the highest likelihood for screening (OR > 3.0). The presenting complaint showed little effect on screening. CONCLUSION Pregnant women were screened only 51% as often as non-pregnant women for substance use in the ED. These results are of particular concern as we continue to see a rise in substance use during pregnancy which results in an increased burden on the healthcare system and society. This study replicates a previous study showing that the rates of screening are lower for pregnant women than non-pregnant women presenting to the ED. Earlier recognition of substance use offers increased opportunities for intervention and prevention of adverse outcomes from substance use during both the current pregnancy and future pregnancies.

BACKGROUND AND AIMS Fetal alcohol spectrum disorder (FASD) is a preventable condition that imposes a significant financial burden on societies. Funding of FASD prevention is a small portion of the total expenditures associated with FASD. This paper aimed to review the literature on the costs of and savings from prevention of FASD and present a model for the United States and Canada of projected savings based on expansion of existing evidence-based prevention models. METHODS A systematic review of published literature on the cost of FASD prevention was conducted and experts in the field were interviewed. Studies that reported the cost of primary prevention of FASD were eligible for further consideration. RESULTS Applying evidenced-based prevention programs to women at highest risk to have a future child with FASD greatly reduces the cost of prevention. In the United States, one case of FASD can be prevented for as little as USD $20 200 - 47 615. Cost of prevention is considerably less expensive than cost of care for a case of FASD. CONCLUSION Expansion of risk-based prevention strategies for fetal alcohol spectrum disorder in the United States and Canada would be an economically efficient and worthwhile investment for society.

Background Fetal alcohol spectrum disorder (FASD) is a highly prevalent lifelong disorder with high rates of comorbid neurodevelopmental disorders. Individuals with FASD are often exposed to abuse, neglect and foster home placements which have uncertain effects on the lifelong course of FASD. In this study we compare the prevalence of adverse childhood events (ACEs) and neurodevelopmental disorders in subjects with fetal alcohol spectrum disorders (FASD) and non-FASD controls. Methods A cross-sectional chart review of patients referred to a regional developmental center was used to identify people with FASD and non-FASD controls. We recorded the number of ACEs and neurodevelopmental disorders in each patient’s chart. The most common diagnoses were attention deficit hyperactivity disorder, comprehension deficits, sleep disorders, and cognitive impairments. T-tests and a regression equation were utilized to determine significant differences between the groups. Results The review identified 203 subjects, 98 with FASD and 105 non-FASD controls. Group mean age was 8.6 years and 64.5% were male. People with FASD were more likely to have any ACEs (mean 5.3) with ACE scores 3.7 points higher than non-FASD controls (mean 1.69) (t = 11.29; p p = .026) but not for non-FASD controls (R = .130, p = .094). Conclusions: Both FASD and subsequent exposure to ACEs are associated with increased risk for development of comorbid neurodevelopmental disorders. Prevention of ACEs during childhood may decrease risk for development of comorbid neurodevelopmental disorders.

BACKGROUND Blood pressure variability (BPV) is associated with adverse events (AEs) independently of hypertension. It has been suggested that calcium channel blockers (CCBs) may reduce BPV, and thus be particularly valuable in hypertensives with high BPV. We sought to investigate how CCB affect BPV progression and whether long-term adverse effects of BPV differ after CCB treatment than after treatment with other antihypertensives. METHODS We retrospectively analyzed 25,268 US veterans who had been followed for 3 years without hypertensive therapy, started on a single class of antihypertensive agents (thiazides, CCBs, ACE inhibitors, or beta blockers [BBs]), treated for 6 years, and then followed for 3 additional years. BPV was calculated as SD of systolic or diastolic blood pressures from at least 10 measurements over each 3-year period. A combined AE endpoint included hospitalization, coronary artery bypass grafting, carotid endarterectomy, angioplasty, amputation, arteriovenous fistula creation, and mortality was assessed in years 9–12. RESULTS Post-medication high BPV and BB or thiazide use were associated with increased AE risk. Medication type also affected mean post-medication BPV. The effects of medications except for BBs on AE and mortality was independent of the patient BPV. CONCLUSIONS The possible deleterious effects of thiazides should be considered within the context of the study population, who were mostly male and received only a single class of hypertensives. While CCB may ameliorate BPV over time, this study does not support choosing CCB over other agents specifically to lessen BPV-associated risk.

In the forensic context, fetal alcohol spectrum disorder (FASD) affects one of every six people. Seldom is FASD diagnosed correctly, which can have serious consequences for people in forensic systems whose impairments are unrecognized. Impairments in FASD increase risk of exploitation and manipulation while in police custody (e.g., rights waivers and false/exaggerated confessions) and risk of making uninformed and impulsive decisions prior to trial (e.g., plea bargaining) and at sentencing (e.g., allocutions). Forensic systems should improve screening for FASD, and defense attorneys and prosecutors need increased awareness of FASD. Due to multiple cognitive and adaptive impairments and high rates of comorbid mental health and neurodevelopmental disorders, the negative impact of this disorder on capacity to assist at trial, understand plea options, and exercise appropriate caution at all phases of the legal system is substantial. Judges need to exercise judicial leadership in improving recognition of FASD and its effects across the legal system. This is especially important with respect to closely related (comorbid) issues of gullibility, confabulation, impaired comprehension, and attention deficits.

Background Primary care visits can serve many purposes and potentially influence health behaviors. Although previous studies suggest that increasing primary care provider numbers may be beneficial, the mechanism responsible for the association is unclear, and have not linked primary care access to specific preventative interventions. We investigated the association between the number of times patients accessed their primary care provider team and the likelihood they received selected preventative health interventions. Methods Patients with complete data sets from Sanford Health were categorized based on the number of primary care visits they received in a specified time period and the preventative health interventions they received. Patient characteristics were used in a propensity analysis to control for variables. Relative risks and 95% confidence intervals were calculated to estimate the likelihood of obtaining preventative measures based on number of primary care visits compared with patients who had no primary care visits during the specified time period. Results The likelihood of a patient receiving three specified preventative interventions was increased by 127% for vaccination, 122% for colonoscopy, and 75% for mammography if the patient had ≥ 1 primary care visit per year. More primary care visits correlated with increasing frequency of vaccinations, but increased primary care visits beyond one did not correlate with increasing frequency of mammography or colonoscopy. Conclusions One or more primary care visits per year is associated with increased likelihood of specific evidence-based preventative care interventions that improve longitudinal health outcomes and decrease healthcare costs. Increasing efforts to track and increase the number of primary care visits by clinics and health systems may improve patient compliance with select preventative measures.

Aging is a major risk factor for Alzheimer’s disease (AD). Insulin-like growth factor-1 receptor (IGF-1R) regulates general aging and lifespan. However, the contribution of IGF-1 to age-related AD pathology and progression is highly controversial. Based on our previous work, AβPP/PS1 double transgenic mice, which express human mutant amyloid precursor protein (APP) and presenilin-1 (PS-1), demonstrated a decrease in brain IGF-1 levels when they were crossed with IGF-1 deficient Ames dwarf mice (df/df). Subsequently, a reduction in gliosis, amyloid-β (Aβ) plaque deposition, and Aβ1–40/42 concentrations were observed in this mouse model. This supported the hypothesis that IGF-1 may contribute to the progression of the disease. To assess the role of IGF-1 in AD, 9–10-month-old male littermate control wild type and AβPP/PS1 mice were randomly divided into two treatment groups including control vehicle (DMSO) and picropodophyllin (PPP), a selective, competitive, and reversible IGF-1R inhibitor. The brain penetrant inhibitor was given ip. at 1 mg/kg/day. Mice were sacrificed after 7 days of daily injection and the brains, spleens, and livers were collected to quantify histologic and biochemical changes. The PPP-treated AβPP/PS1 mice demonstrated attenuated insoluble Aβ1–40/42. Additionally, an attenuation in microgliosis and protein p-tyrosine levels was observed due to drug treatment in the hippocampus. Our data suggest IGF-1R signaling is associated with disease progression in this mouse model. More importantly, modulation of the brain IGF-1R signaling pathway, even at mid-life, was enough to attenuate aspects of the disease phenotype. This suggests that small molecule therapy targeting the IGF-1R pathway may be viable for late-stage disease treatment.

In the United States, the role of occupational therapy (OT) in provision of community-based health promotion is supported well in the literature; however, few practitioners are working in this arena. This mixed methods multiphase design study presents an example of a needs assessment process: assess before you assess. Participants included OT practitioners, residents in a low-income community housing complex, and older adult residents in another community housing complex. Methods included phenomenological and nonexperimental cross-sectional survey study design. Data analysis included coding, categorizing, and creating themes; composite scoring, Spearman correlations, and independent t tests for comparing variables. Results indicated that OT practitioners need more guidance and involvement to shift their paradigm from rehabilitation to community health promotion. Conducting needs assessments in three phases supports effective health promotion programming in community settings.

Objective: Radon exposure is a proven cause of lung cancer and is a possible cause of other diseases. Recently, several ecologic studies explored the correlation of county-wide incidence rates for non-lung cancers with residential radon levels, using radon data reported by a commercial laboratory. However, the validity of the commercial radon data, i.e., whether they are an accurate representation of the radon levels in the counties from which they were drawn, is unknown. Methods: We compared county-wide radon data from the commercial laboratory with corresponding measurements from the same counties reported previously by the Environmental Protection Agency (EPA). Matching data were available for four states, Iowa, North Dakota, Texas, and Wisconsin, and were compared by paired t-tests. Criterion validity of the commercial tests, i.e., how well the commercial data predicted the EPA data, was tested using non-parametric methods, Kendall’s tau, Lin’s concordance, and Passing–Bablok regression. Results: The commercial and EPA data pairs from the four states were significantly positively correlated, although the size of the correlations was modest (tau = 0.490, Lin = 0.600). Passing–Bablok regression indicated that the commercial radon values were significantly higher than their EPA pairs and significantly overestimated radon at low levels (

Aim To conduct a systematic review and quantitative analysis of the world literature on the economic impact of fetal alcohol spectrum disorder (FASD). Methods A comprehensive literature review was conducted using multiple electronic databases and reference materials. Results Thirty-two studies from 4 countries met the inclusion criteria (United States [n = 20], Canada [n = 9], Sweden [n = 2], and New Zealand [n = 1]). The studies reported the economic impact of FASD on health care, special education, residential care, criminal justice system, productivity losses due to morbidity and premature mortality, productivity losses of caregivers of children with FASD, and intangible costs. The economic estimates vary considerably due to the different methodologies used by different studies. The mean annual cost for children with FASD was estimated to be $22,810 and for adults $24,308. Residential costs for children with FASD were 4-fold greater than for adults with FASD. The costs of lost productivity for adults were 6.3-fold greater than for children. Conclusions The data on the economic burden of FASD are scarce, and the existing estimates likely underestimate the full economic impact of this disorder on the affected individuals, their caregivers, and society. However, the current research is sufficient to demonstrate that FASD is a serious public health problem associated with tremendous economic burden.

Objective Recently, increased attention has been focused on the diagnosis of the most prevalent category of fetal alcohol spectrum disorders, alcohol-related neurodevelopmental disorders (ARNDs). In 2013, proposed criteria for neurodevelopmental disorders associated with prenatal alcohol exposure (ND-PAE) were included in the appendix of the latest revision of the Diagnostic and Statistical Manual of Mental Disorders. The concordance of the 2 sets of criteria is unknown. This study examines the overlap in diagnostic criteria for ND-PAE and the ARND Behavioral Checklist in children. Methods Clinical charts from June 2013 to July 2016 were reviewed to identify patients with an evaluation for ARNDs and where the criteria for ND-PAE were also available. Results The review found 86 charts with a diagnosis of ARNDs, which included the ARND Checklist and the ND-PAE criteria. We then calculated the sensitivity and specificity comparing the ND-PAE with the ARND Checklist as the comparison standard. The sensitivity was 95.0%, specificity was 75.0%, and the ND-PAE diagnosis correctly classified 89.5% of cases identified as meeting criteria for ARNDs by the checklist. The receiver operating characteristics resulted in a large shared area under the curve of 90.1%. Conclusion The 2 diagnostic constructs of ARNDs and ND-PAE seem to be very similar. Both the ARND and the ND-PAE variables are written in familiar formats and could be widely used by a variety of health care providers.

Objective: The increasing rate of thyroid cancer diagnoses in the U.S. reflects the increasing use of ultrasonography and of specialist medical care. North Dakota is a rural state with limited access to specialist care, yet its incidence of thyroid cancer is significantly greater than that of the U.S. overall. We sought to identify factors responsible for the high incidence of thyroid cancer in North Dakota. Methods: We examined county-specific incidence rates for thyroid cancer in North Dakota in relation to demographic and geographic factors, including median household income, percent of land fertilized, cattle density per capita, and source of drinking water (city or well water), using structural equation modeling. We included county level data on residential radon levels and estimates of radioactive iodine in milk following nuclear weapons testing in the 1950s. Results: Thyroid cancer incidence rates were significantly associated with median income (p &lt, 0.05), percent of land fertilized (p &lt, the use of city water (p &lt, 0.01), and cattle density per capita (p &lt, 0.001). Conclusions: The risk of thyroid cancer in North Dakota is positively associated with income and with factors related to land and water use. Our finding that thyroid cancer incidence rates are associated with the use of city water was unexpected and merits examination in other locations with a mix of city and well water use.

The state of North Dakota has one of the highest incidence rates for colorectal cancer in the USA. Its high incidence rate, coupled with a large variation in incidence rates among counties within the state, makes North Dakota a “natural laboratory” in which to investigate environmental clues to colorectal cancer. We conducted a hypothesis-generating study to explore potential determinants of colorectal cancer in North Dakota. We obtained county-specific incidence rates for North Dakota’s 53 counties from the statewide cancer registry and corresponding data on county demographic, agricultural, and geophysical features from population-based sources. Candidate demographic/agricultural variables included median household income, population density, colorectal cancer screening rates, average farm size (in acres), and the percent of county fertilized. Geophysical variables included the uranium content of soil, residential radon levels, and source of drinking water (municipal or well water). Statistical analyses were performed via multivariate regression and structural equation modeling. Colorectal cancer incidence rates across North Dakota counties varied 3-fold. The structural equation model identified a significant role for well water use (p

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with an unknown cause and invariably fatal outcome. We sought to evaluate a correlation between motor neuron disease (MND) mortality rates and residential radon levels that was previously reported for counties in the United Kingdom. We examined the relationships between age-adjusted MND mortality rates in U.S. states with residential radon levels, well water use, and other variables using structural equation modeling. We observed a significant correlation between MND mortality rates and radon levels. However, in structural equation models, radon did not have a significant, direct effect on MND mortality rates. Conversely, MND mortality rates were significantly and directly predicted by race and by the percentage of the population of each state using well water (p

Date Presented 03/27/20 An exploratory survey was used to determine the knowledge, attitudes, practices, and perceived barriers to EBP implementation held by OT managers. As there is no current research addressing this topic, this study fills a gap in the OT literature and knowledge base regarding EBP. The researchers found that OT managers hold positive attitudes toward EBP, have moderate levels of EBP practices, have high knowledge of EBP, and perceive moderate levels of barriers to implementation. Primary Author and Speaker: Samantha Scheel Additional Authors and Speakers: Madelin Buscho Contributing Authors: Marilyn Klug, LaVonne Fox

Objective Assess the prevalence of prenatal alcohol exposure in the Republic of the Congo by measuring breath alcohol concentration (BrAC) levels using a breathalyzer device. Methods Pregnant women were assessed for alcohol use with a breathalyzer reading during two prenatal visits and during labor and delivery. Results Among 662 pregnant women consented and screened with a breathalyzer, 192 (29.0%) had a positive BrAC during 1st trimester. During the second assessment, approximately 69% (132) of the 192 pregnant women had a second positive BrAC. A third assessment during labor and delivery identified 60 women (31%) with a third positive BrAC. About 19% (36) of the 192 pregnant women had positive BrACs at all three times. Among women who were positive on the first and second assessments, 30% had a BrAC that was above 0.07, which is almost equivalent of binge drinking (four or more standard drinks in about 2 h). The mean BrAC reading decreased as the pregnancy progressed. Conclusions The results of this study utilizing a unique exposure detection methodology suggest that the use of BrAC may be a useful objective option to detect and quantify alcohol consumption during pregnancy. The prevalence of alcohol use identified during pregnancy in the Republic of the Congo was increased over 20% when compared to maternal reports from a previous study. Nearly one of every five women identified at the first prenatal visit continued drinking throughout pregnancy. Urgent measures are needed to reduce alcohol consumption among this population of pregnant women.

We review selected information on comorbidity and present a logic model with data-based examples of comorbidity. We utilize published data and results from two datasets to illustrate key features of comorbidity and their associated impact on complexity of care, cost of care, and service utilization. In many conditions, comorbidity is typical and may be considered as a part of the disorder phenotype. We present an 8-part logic model of comorbidity and discuss each component of the model in detail. Available research provides data from primarily single entity diagnoses. We suggest that future research should emphasize: (1) studies of participants with more representative comorbidity to make the results more generalizable to clinical populations; (2) examine benefits and risks from polytherapies used at the same time; (3) improve data on optimal timing of interventions in the context of developmental trajectory of infants, children, and adolescents; and (4) examine interventions and timing of intervention to optimize prevention of phenotype severity.

This study assesses whether blood pressure variability is associated with adverse outcomes after coronary artery bypass grafting surgery.

A controlled, prospective, 2‐year cohort observational study was conducted to test whether weekly geriatric questions delivered through Twitter Poll could improve geriatrics knowledge during an internal medicine clerkship for third‐year medical students. Pre‐ and post‐rotation test results used a modified University of California, Los Angeles geriatric knowledge test that included questions linked to 26 Association of American Medical Colleges geriatric competencies for medical students. Data were analyzed using a general linear model repeated‐measure design and Student t‐test. The primary outcome showed that Twitter Poll participants had more than twice the geriatrics knowledge (p = .002) than students who did not use Twitter Poll. Subset analysis showed different test performances according to sex (p = .03), training site (p = .002), and cohort (p = .003). This study is the first demonstration of Twitter Poll efficacy in medical education and raises questions about whether it could be even more effective if linked to spaced timing of didactic content or supported by annotated answers to geriatrics questions. J Am Geriatr Soc 66:2389–2393, 2018.

BACKGROUND Blood pressure variability (BPV) has been associated with poor health outcomes in high-risk patients, but its association with more general populations is poorly understood. METHODS We analyzed outcomes from 240,622 otherwise unselected patients who had 10 or more outpatient blood pressure readings recorded over a 3-year period and were aged from 20 to 100 years. RESULTS Whether calculated as SD, average change, or greatest change and systolic or diastolic blood pressure, we found that higher outpatient BPV was associated with subsequent hospitalization and mortality. Systolic pressure average change exceeding 10–12 mm Hg or diastolic exceeding 8 mm Hg significantly increased risk of hospitalization and death (odds ratios [ORs] from 2.0 to 4.5). Variability in the highest decile increased risks even more dramatically, with propensity-matched ORs from 4.4 to 42. A systolic change exceeding 35 mm Hg increased the relative risk of death 4.5-fold. Similarly, a diastolic change greater than 23–24 mm Hg almost tripled the risks of hospitalization and death. Neither stratification for hypertension nor propensity matching for risk factors within the database affected these associations. CONCLUSIONS Systolic and diastolic variabilities were each associated with subsequent adverse outcomes. Physicians should pay special attention to patients with swings in blood pressure between clinic visits. Electronic medical records should flag such variability.