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Portland, ME, United States

Greaney M.L.,Harvard University | Lees F.D.,University of Rhode Island | Lynch B.,Maine Medical Partners | Sebelia L.,University of Rhode Island | Greene G.W.,University of Rhode Island
Journal of Nutrition Education and Behavior | Year: 2012

Objective: To explore (1) how migration influenced physical activity and dietary behaviors among Latino immigrants and (2) participants' perception of concepts related to a Health at Every Size (HAES) approach to weight maintenance (mindful eating, taking care of oneself). Methods: Four focus groups (n = 35), homogenous by sex, were conducted in Spanish. Results: Male and female participants spoke of being less physically active and eating less healthful diets since immigrating. Noted barriers to being physically active and eating a healthful diet included time and financial constraints. Participants were interested in the HAES concepts but thought these ideas conflicted with their cultural upbringing. For women, putting family first was identified as a barrier to taking care of oneself. Conclusions and Implications: An HAES approach may be a useful in promoting weight maintenance in this population, as participants were interested in key concepts, but it would be important that HAES interventions incorporate cultural traditions. © 2012 Society for Nutrition Education and Behavior. Source

White R.R.,Maine Medical Partners
Techniques in Orthopaedics | Year: 2013

Periprosthetic tibia fractures are unusual and very little is written about them and their treatment. For fractures adjacent to the tibial component revision, arthroplasty is an option. Reduction and fixation can be difficult because of the small proximal segment and the presence of an implant stem. However, with newer locking plates, internal fixation of these fractures can be accomplished. For fractures of the shaft, conventional techniques of ORIF should be considered and can be effective. This paper shows an example of each of these fractures. © 2013 by Lippincott Williams & Wilkins. Source

White R.R.,Maine Medical Partners
Techniques in Orthopaedics | Year: 2013

Fixation of periprosthetic femur fractures around total hip implants without cerclage cables or strut grafts. Periprosthetic fractures around total hip stems are challenging fractures because it is difficult to gain proximal fixation in the area of the femoral stem. The bone is often osteoporotic and locking fixation is preferred over conventional fixation. Most locking plates do not have the ability to angle the screws around the stem and still lock into the plate. Surgeons have resorted to the use of cerclage cables to fix the plate to the bone and allograft cortical struts to improve the strength of the fixation construct. With the advent of polyaxial locking screws and a plate that is wider at the proximal end of the plate, it is now possible to gain bicortical locking fixation around most total hip stems. This eliminates the need for both cables and strut grafts. This paper describes the implants and techniques to accomplish this fixation and stabilize these complex fractures in a more biologically friendly manner. © 2013 by Lippincott Williams & Wilkins. Source

Hay C.M.,Maine Medical Center | Lachance J.A.,Maine Medical Partners | Lucas F.L.,Center for Outcomes Research and Evaluation | Smith K.A.,Center for Outcomes Research and Evaluation | Jones M.A.,Maine Medical Center
Journal of Lower Genital Tract Disease | Year: 2016

Objective Vulvar squamous cell carcinoma (VSCC) develops through 2 distinct molecular pathways, one involving high-risk human papillomavirus (HPV) infection and the other through early p53 suppressor gene mutation. We sought to evaluate the influence of p53 mutation, HPV status, and p16 expression on local recurrence and disease-specific mortality in early stage VSCC. Materials and Methods We performed a retrospective chart review of all patients with stage I VSCC at the Maine Medical Center from 1998 to 2007 (n = 92). Tumor size, depth of invasion, lymphatic/vascular space invasion, and growth pattern were recorded. Paraffin-embedded tissue blocks were stained by immunohistochemistry for p16 and p53; high-risk HPV was detected by polymerase chain reaction assay. Margin distance was determined by a gynecologic pathologist. Survival analyses were conducted to examine predictors of VSCC recurrence and disease-specific mortality. Results Age, depth of invasion, lymphatic/vascular space invasion, growth pattern, and margin status were not significant predictors of recurrence or disease-specific mortality. Tumor size of greater than 4.0 cm indicated a 4-fold increase in disease-specific mortality but did not significantly increase recurrence. p16-Positive patients were less likely to recur and had no VSCC-related deaths. Human papillomavirus-positive patients were less likely to recur and had no VSCC-related deaths. p53-positive patients were 3 times more likely to recur and nearly 7 times more likely to die from vulvar cancer. Conclusions Our findings suggest that HPV and the surrogate biomarker p16 indicate a less aggressive type of vulvar cancer. p53 positivity was associated with poor prognosis and significantly increased both recurrence and disease-specific mortality. © 2016, American Society for Colposcopy and Cervical Pathology. Source

Gortmaker S.L.,Harvard University | Polacsek M.,University of New England at Biddeford | Rogers V.W.,Kids CO OP | Holmberg R.,Husson Pediatrics | And 4 more authors.
Childhood Obesity | Year: 2015

Background: We evaluated the impact of a brief primary-care-based intervention, The Maine Youth Overweight Collaborative (MYOC), on BMI (kg/m2) z-score change among participants with obesity (BMI ≥95th percentile for age and sex), overweight (BMI ≥85th and <95th percentile), and healthy weight (≥50th and <85th percentile). Methods: A quasi-experimental field trial with nine intervention and nine control sites in urban and rural areas of Maine, MYOC focused on improvements in clinical decision support, charting BMI percentile, identifying patients with obesity, appropriate lab tests, and counseling families/patients. Retrospective longitudinal record reviews assessed BMI z-scores preintervention (from 1999 through October 2004) and one postintervention time point (between December 2006 and March 2008). Participants were youth ages 5-18 having two visits before the intervention with weight percentile greater than or equal to 95% (N=265). Secondary analyses focused on youths who are overweight (N=215) and healthy weight youth (N=506). Results: Although the MYOC intervention demonstrated significant provider and office system improvements, we found no significant changes in BMI z-scores in intervention versus control youth pre- to postintervention and significant flattening of upward trends among both intervention and control sites (p<0.001). Conclusions: This brief office-based intervention was associated with no significant improvement in BMI z-scores, compared to control sites. An important avenue for obesity prevention and treatment as part of a multisector approach in communities, this type of primary care intervention alone may be unlikely to impact BMI improvement given the limited dosage - an estimated 4-6 minutes for one patient contact. © Copyright 2015, Mary Ann Liebert, Inc. 2015. Source

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