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Hutton J.,Womans Hospital of Texas | Rowan P.,University of Houston | Greisinger A.,Kelsey Research Foundation | Mouzoon M.,Kelsey Seybold Clinic
American Journal of Obstetrics and Gynecology | Year: 2014

Objective Although it is commonly accepted that rubella is well-controlled, a recent reemergence of both pertussis and measles might also predict a reemergence of rubella. This study was designed to estimate the current incidence of rubella exposure in pregnancy. Study Design This was a prospective, descriptive study, conducted in Houston, TX, at The Woman's Hospital of Texas. Women are typically screened for rubella immunity at the beginning of pregnancy. Rubella nonimmunity is defined as a titer less than 10 IU/mL in the US. Women who were non-immune early in pregnancy (<20 weeks) were recruited for this study and asked to be tested again for rubella immunity at the time of delivery. Results Of 298 women who were rubella nonimmune (IgG <10 IU/mL) early in pregnancy, 19 converted to immune status (IgG >40 IU/mL, defined as at least a 4-fold increase) at time of delivery, a rate of 6.38% (4.12% to 9.75%; 95% Wilson-Score confidence interval). For the 19 patients who converted to immune status at time of delivery, 8 patients had levels of 40-150 IU/mL, 6 patients had levels of 151-300 IU/mL, 2 patients had levels of 301-500 IU/mL, and 3 patients had levels >500 IU/mL. Conclusion Pregnancy is a critical time to evaluate rubella exposure. This study estimated the current incidence of rubella exposure in pregnancy to be 6.38%. © 2014 Elsevier Inc.


El-Zein R.A.,University of Texas M. D. Anderson Cancer Center | Monroy C.M.,University of Texas M. D. Anderson Cancer Center | Cortes A.,University of Texas M. D. Anderson Cancer Center | Spitz M.R.,University of Texas M. D. Anderson Cancer Center | And 2 more authors.
BMC Cancer | Year: 2010

Background: DNA repair capacity is an important determinant of susceptibility to cancer. The hOGG1 enzyme is crucial for repairing the 8-oxoguanine lesion that occurs either as a byproduct of oxidative metabolism or as a result of exogenous sources such as exposure to cigarette smoke. It has been previously reported that smokers with low hOGG1 activity had significantly higher risk of developing lung cancer as compared to smokers with high hOGG1 activity.Methods: In the current study we elucidate the association between plasma levels of 8-OHdG and the OGG1 repair capacity. We used the commercially available 8-OHdG ELISA (enzyme-linked immunosorbent assay), the Comet assay/FLARE hOGG1 (Fragment Length Analysis by Repair Enzymes) assay for quantification of the levels of 8-OHdG and measured the constitutive, induced and unrepaired residual damage, respectively. We compared the DNA repair capacity in peripheral blood lymphocytes following H2O2exposure in 30 lung cancer patients, 30 non-, 30 former and 30 current smoker controls matched by age and gender.Results: Our results show that lung cancer cases and current smoker controls have similar levels of 8-OHdG lesions that are significantly higher compared to the non-smokers controls. However, lung cancer cases showed significantly poorer repair capacity compared to all controls tested, including the current smokers controls. After adjustment for age, gender and family history of smoking-related cancer using linear regression, we observed a 5-fold increase in risk of lung cancer associated with high levels of residual damage/reduced repair capacity. Reduced OGG1 activity could be expected to be a risk factor in other smoking-related cancers.Conclusion: Our study shows that the Comet/FLARE assay is a relatively rapid and useful method for determination of DNA repair capacity. Using this assay we could identify individuals with high levels of residual damage and hence poor repair capacity who would be good candidates for intensive follow-up and screening. © 2010 El-Zein et al; licensee BioMed Central Ltd.


Galler G.,St Lukes Episcopal Hospital | Garcia-Torres F.,Kelsey Seybold Clinic | DuPont A.W.,University of Texas Medical Branch | Greisinger A.,Kelsey Research Foundation
American Journal of Tropical Medicine and Hygiene | Year: 2010

This study evaluated occurrence of travel and travelers' diarrhea in patients with irritable bowel syndrome (IBS). A survey was mailed to 591 patients of a clinical practice who had IBS. Based on survey responses, patients were categorized as having IBS, post-infectious IBS (PI-IBS), unclassified functional bowel disorder (UFBD), or post-infectious UFBD (PI-UFBD). Of 201 persons who returned questionnaires meeting inclusion criteria, 57.7%, 11.4%, 24.9%, and 6.0% had IBS, UFBD, PI-IBS, and PI-UFBD, respectively. Travel during six months before illness onset was more common in patients with PI-IBS or PI-UFBD than in persons with idiopathic IBS or UFBD (P = 0.006). Survey results demonstrated that 16.1% of post-infectious bowel disorder cases and 7.5% of overall IBS cases in a general medical population developed chronic disease within six months of an international trip. Symptoms of established functional bowel disorder in each clinical category were shown to worsen after travel-related acute diarrhea. Copyright © 2010 by The American Society of Tropical Medicine and Hygiene.


Liliana Escobar-Chaves S.,University of Texas Health Science Center at Houston | Markham C.M.,University of Texas Health Science Center at Houston | Addy R.C.,University of Texas Health Science Center at Houston | Greisinger A.,Kelsey Research Foundation | And 2 more authors.
Obesity | Year: 2010

Media consumption may contribute to childhood obesity. This study developed and evaluated a theory-based, parent-focused intervention to reduce television and other media consumption to prevent and reduce childhood obesity. Families (n = 202) with children ages 6-9 were recruited from a large, urban multiethnic population into a randomized controlled trial (101 families into the intervention group and 101 into the control group), and were followed for 6 months. The intervention consisted of a 2-hour workshop and six bimonthly newsletters. Behavioral objectives included: (i) reduce TV watching; (ii) turn off TV when nobody is watching; (iii) no TV with meals; (iv) no TV in the childs bedroom; and (v) engage in fun non-media related activities. Parents were 89% female, 44% white, 28% African American, 17% Latino, and 11% Asian, mean age 40 years (s.d. = 7.5); 72% were married. Children were 49% female, mean age 8 years (s.d. = 0.95). Sixty-five percent of households had three or more TVs and video game players; 37% had at least one handheld video game, and 53% had three or more computers. Average childrens weekday media exposure was 6.1 hours. At 6 months follow-up, the intervention group was less likely to report the TV being on when nobody was watching (adjusted odds ratio (AOR) 0.23, P < 0.05), less likely to report eating snacks while watching TV (AOR = 0.47, P < 0.05), and less likely to have a TV in the childs bedroom (AOR = 0.23, P < 0.01). There was a trend toward reducing actual media consumption but these outcomes did not reach statistical significance. Effective strategies to reduce childrens TV viewing were identified. © 2010 The Obesity Society.


Businelle M.S.,University of Texas M. D. Anderson Cancer Center | Kendzor D.E.,University of Texas M. D. Anderson Cancer Center | Reitzel L.R.,University of Texas M. D. Anderson Cancer Center | Costello T.J.,University of Texas M. D. Anderson Cancer Center | And 7 more authors.
Health Psychology | Year: 2010

Objective: Although there has been a socioeconomic gradient in smoking prevalence, cessation, and disease burden for decades, these disparities have become even more pronounced over time. The aim of the current study was to develop and test a conceptual model of the mechanisms linking socioeconomic status (SES) to smoking cessation. Design: The conceptual model was evaluated using a latent variable modeling approach in a sample of 424 smokers seeking treatment (34% African American; 33% Latino; 33% White). Hypothesized mechanisms included social support, neighborhood disadvantage, negative affect/stress, agency, and craving. Main Outcome Measure: The primary outcome was Week 4 smoking status. Results: As was hypothesized, SES had significant direct and indirect effects on cessation. Specifically, neighborhood disadvantage, social support, negative affect/stress, and agency mediated the relation between SES and smoking cessation. A multiple group analysis indicated that the model was a good fit across racial/ethnic groups. Conclusion: The present study yielded one of the more comprehensive models illuminating the specific mechanisms that link SES and smoking cessation. Policy, community, and individual-level interventions that target low SES smokers and address the specific pathways identified in the current model could potentially attenuate the impact of SES on cessation. © 2010 American Psychological Association.


Turrentine M.A.,Kelsey Seybold West Clinic | Greisinger A.J.,Kelsey Research Foundation | Brown K.S.,Kelsey Research Foundation | Wehmanen O.A.,Kelsey Research Foundation | Mouzoon M.E.,Kelsey Seybold Clinic
Infectious Diseases in Obstetrics and Gynecology | Year: 2013

Background. Infants born to mothers who are colonized with group B streptococcus (GBS) but received <4 hours of intrapartum antibiotic prophylaxis (IAP) are at-risk for presenting later with sepsis. We assessed if <4 hours of maternal IAP for GBS are associated with an increased incidence of clinical neonatal sepsis. Materials and Methods. A retrospective cohort study of women-infant dyads undergoing IAP for GBS at ≥37-week gestation who presented in labor from January 1, 2003 through December 31, 2007 was performed. Infants diagnosed with clinical sepsis by the duration of maternal IAP received (< or ≥4-hours duration) were determined. Results. More infants whose mothers received <4 hours of IAP were diagnosed with clinical sepsis, 13 of 1,149 (1.1%) versus 15 of 3,633 (0.4%), P =. 03. Multivariate logistic regression analysis showed that treatment with ≥4 hours of IAP reduced the risk of infants being diagnosed with clinical sepsis by 65%, adjusted relative risk 0.35, CI 0.16-0.79, and P =. 01. Conclusion. The rate of neonatal clinical sepsis is increased in newborns of GBS colonized mothers who receive <4 hours compared to ≥4 hours of IAP. © 2013 Mark A. Turrentine et al.


Rowan P.,University of Houston | Greisinger A.,Kelsey Research Foundation | Brehm B.,Kelsey Research Foundation | Smith F.,Kelsey Seybold Clinic | McReynolds E.,United Healthcare
Archives of Women's Mental Health | Year: 2012

This study was developed to evaluate the feasibility of implementing systematic depression screening in a large obstetric practice and to evaluate the degree that detection and referral led to linkage with behavioral healthcare. Depression screening was conducted using the Edinburgh Postnatal Depression Scale, administered at the initial pregnancy care appointment. Patients at or above a predetermined score of 14 were advised to seek further behavioral health assessment through the patient's behavioral healthcare coverage. Within 4 weeks of screening, those referred were contacted by telephone, by clinic staff, to determine whether they had pursued behavioral healthcare as recommended. Limited available data for newly established postdelivery screening were similarly evaluated. All 2,199 newly presenting pregnant women who were seen in our obstetric clinics from September 2008 to May 2009 were screened for depression, and 102 (4.6%) scored at or above an EPDS of 14. Follow-up calls revealed that none had pursued further behavioral health assessments. Of these 2,199, screening and follow-up data were available for 569 women at their 6-week postdelivery visit. Of these, 28 (4.9%) were above EPDS of 14, and 5 (17.9%) reported pursuit of further behavioral healthcare following screening and referral. Peripartum depression can be addressed with systematic screening, and the electronic medical record can readily be used to monitor results. Detection and referral at the beginning of pregnancy did not lead to intended linkage with behavioral healthcare, but detection and referral postdelivery had a modest influence. Barriers to pursuing behavioral healthcare need to be discovered and addressed. © Springer-Verlag 2012.


Amos C.I.,University of Houston | Gorlov I.P.,University of Houston | Dong Q.,University of Houston | Wu X.,University of Houston | And 6 more authors.
Journal of the National Cancer Institute | Year: 2010

Genome-wide association studies of white persons with lung cancer have identified a region of extensive linkage disequilibrium on chromosome 15q25.1 that appears to be associated with both risk for lung cancer and smoking dependence. Because studying African American persons, who exhibit lower levels of linkage disequilibrium in this region, may identify additional loci that are associated with lung cancer, we genotyped 34 single-nucleotide polymorphisms (SNPs) in this region (including LOC123688, PSMA4, CHRNA5, CHRNA3, and CHRNB4 genes) in 467 African American patients with lung cancer and 388 frequency-matched African American control subjects. Associations of SNPs in LOC123688 (rs10519203; odds ratio [OR] = 1.60, 95% confidence interval [CI] = 1.25 to 2.05, P =. 00016), CHRNA5 (rs2036527; OR = 1.67, 95% CI = 1.26 to 2.21, P =. 00031), and CHRNA3 (rs1051730; OR = 1.81, 95% CI = 1.26 to 2.59, P =. 00137) genes with lung cancer risk reached Bonferroni-corrected levels of statistical significance (all statistical tests were two-sided). Joint logistic regression analysis showed that rs684513 (OR = 0.47, 95% CI = 0.31 to 0.71, P =. 0003) in CHRNA5 and rs8034191 (OR = 1.76, 95% CI = 1.23 to 2.52, P =. 002) in LOC123688 were also associated with risk. The functional A variant of rs1696698 in CHRNA5 had the strongest association with lung cancer (OR = 1.98, 95% CI = 1.25 to 3.11, P =. 003). These SNPs were primarily associated with increased risk for lung adenocarcinoma histology and were only weakly associated with smoking phenotypes. Thus, among African American persons, multiple loci in the region of chromosome 15q25.1 appear to be strongly associated with lung cancer risk. © 2010 The Author. Published by Oxford University Press. All rights reserved.


Hawley S.T.,University of Michigan | McQueen A.,University of Washington | Bartholomew L.K.,University of Texas at Austin | Greisinger A.J.,Kelsey Research Foundation | And 3 more authors.
Cancer | Year: 2012

BACKGROUND: The purpose of this study was to identify factors associated with colorectal cancer (CRC) screening test preference and examine the association between test preference and test completed. METHODS: Patients (n = 1224) were 50-70 years, at average CRC risk, and overdue for screening. Outcome variables were preference for fecal occult blood test (FOBT), colonoscopy (COL), sigmoidoscopy (SIG), or barium enema (BE), measured by telephone survey, and concordance between test preference and test completed assessed using medical records. RESULTS: Thirty-five percent preferred FOBT, 41.1% COL, 12.7% SIG, and 5.7% BE. Preference for SIG or COL was associated with having a physician recommendation, greater screening readiness, test-specific self-efficacy, greater CRC worry, and perceived pros of screening. Preference for FOBT was associated with self-efficacy for doing FOBT. Participants who preferred COL were more likely to complete COL compared with those who preferred another test. Of those screened, only 50% received their preferred test. Those not receiving their preferred test most often received COL (52%). CONCLUSIONS: Lack of concordance between patient preference and test completed suggests that patients' preferences are not well incorporated into screening discussions and test decisions, which could contribute to low screening uptake. Physicians should acknowledge patients' preferences when discussing test options and making recommendations, which may increase patients' receptivity to screening. Cancer 2011. © 2011 American Cancer Society.


Medina G.G.,University of Houston | McQueen A.,University of Washington | Greisinger A.J.,Kelsey Research Foundation | Bartholomew L.K.,University of Houston | Vernon S.W.,University of Houston
Gastroenterology Research and Practice | Year: 2012

Background. Despite the availability of multiple effective tests for colorectal cancer (CRC), screening rates are low. Greater understanding of barriers between screeners and nonscreeners may improve public health initiatives to increase CRC screening (CRCS). Methods. We conducted a content analysis of 625 responses to the question: "Was there anything that would have made getting tested easier?" Respondents were patients at a multispecialty practice who participated in a behavioral intervention trial to increase CRCS. Using clinic records, we classified patients as early-screeners (<6 months), late-screeners(6-12 months), and nonscreeners (>12 months). Results. Both screeners and nonscreeners reported the same categories of barriers. However, earlyscreeners predominantly cited dislike of test attributes such as bowel preparation, whereas nonscreeners cited concerns regarding finances and work and family responsibilities. Conclusion. Multilevel strategies that address scheduling barriers and external screening barriers may improve CRCS. Future studies may test hypotheses about mediators explaining how screeners overcome barriers. Copyright © 2012 Gilda G. Medina et al.

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