Phoenix, AZ, United States
Phoenix, AZ, United States

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Taylor M.M.,Centers for Disease Control and Prevention | Taylor M.M.,Indian Health Service | Reilley B.,Indian Health Service | Tulloch S.,Centers for Disease Control and Prevention | And 4 more authors.
Sexually Transmitted Diseases | Year: 2011

Medical record review was used to identify missed opportunities for chlamydia screening among 103 American Indian/Alaska Native women. Of these, 69% had received a pregnancy test and 74% had received a urine test in the previous 12 months. Chlamydia screening may increase if linked to the other routine clinical testing. © 2011 American Sexually Transmitted Diseases Association All rights reserved.


Taylor M.M.,Centers for Disease Control and Prevention | Taylor M.M.,Indian Health Service | Reilley B.,Indian Health Service | Yellowman M.,Indian Health Service | And 5 more authors.
International Journal of STD and AIDS | Year: 2013

Chlamydia cases diagnosed in the women's clinic were more likely to receive expedited partner therapy (EPT) and to be re-tested as compared with urgent and emergent care settings. Fewer re-infections occurred among patients who received EPT. Disproportionate rates of chlamydia occur among American Indian (AI) populations. To describe use of EPT among chlamydia cases diagnosed at an urban Indian Health Service (IHS) facility in Arizona, health records were used to extract confirmed cases of chlamydia diagnosed between January 2009 and August 2011. Medical records of 492 patients diagnosed with chlamydia were reviewed. Among the 472 cases who received treatment, 246 (52%) received EPT. Receipt of EPT was significantly associated with being female (odds ratio (OR) 2.1, 1.03-4.4, P < 0.001) and receipt of care in the women's clinic (OR 9.9, 95% CI 6.0-16.2) or in a primary care clinic (OR 2.4, 95% CI 1.1-5.1). Compared with those receiving care in the women's clinic, the odds of receipt of EPT were significantly less in those attending the urgent/express care clinic (OR 0.1, 95% CI 0.06-0.2), and the emergency department (OR 0.1, 95% CI 0.05-0.2). Among treated patients who underwent re-testing (N = 323, 68% total treated) re-infection was less common among those that received EPT (13% versus 27%; OR 0.5, 95% CI 0.3-0.9). In this IHS facility, EPT was protective in preventing chlamydia re-infection. Opportunities to expand the use of EPT were identified in urgent and emergent care settings. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.


Ferucci E.D.,Alaska Native Tribal Health Consortium | Johnston J.M.,University of Alaska Anchorage | Gaddy J.R.,Oklahoma City Area Indian Health Service | Sumner L.,Phoenix Indian Medical Center | And 5 more authors.
Arthritis and Rheumatology | Year: 2014

Objective. Few studies have investigated the epidemiology of systemic lupus erythematosus (SLE) in American Indian and Alaska Native populations. The objective of this study was to determine the prevalence and incidence of SLE in the Indian Health Service (IHS) active clinical population in 3 regions of the US. Methods. For this population-based registry within the IHS, the denominator consisted of individuals in the IHS active clinical population in 2007, 2008, and/or 2009 and residing in a community in 1 of 3 specified regions. Potential SLE cases were identified based on the presence of a diagnostic code for SLE or related disorder in the IHS National Data Warehouse. Detailed medical record abstraction was performed for each potential case. The primary case definition was documentation in the medical record of ≥4 of the revised American College of Rheumatology criteria for the classification of SLE. Prevalence was calculated for 2007, and the mean annual incidence was calculated for the years 2007 through 2009. Results. The age-adjusted prevalence and incidence of SLE according to the primary definition were 178 per 100,000 person-years (95% confidence interval [95% CI] 157-200) and 7.4 per 100,000 person-years (95% CI 5.1-10.4). Among women, the age-adjusted prevalence was 271, and the age-adjusted incidence was 10.4. The prevalence was highest in women ages 50-59 years and in the Phoenix Area IHS. Conclusion. The first population-based lupus registry in the US American Indian and Alaska Native population has demonstrated that the prevalence and incidence of SLE are high. Our estimates are as high as or higher than the rates reported in the US black population. © 2014, American College of Rheumatology.


O'Connell J.,University of Colorado at Denver | Yi R.,Milliman Inc. | Wilson C.,Phoenix Indian Medical Center | Manson S.M.,University of Colorado at Denver | Acton K.J.,Indian Health Service
Diabetes Care | Year: 2010

OBJECTIVE - American Indians and Alaska Natives are 2.3 times more likely to have diabetes than are individuals in the U.S. general population. The objective of this study was to compare morbidity among American Indian and U.S. adults with diabetes. RESEARCH DESIGN AND METHODS - We extracted demographic and health service utilization data for an adult American Indian population aged 18-64 years (n = 30,121) served by the Phoenix Service Unit from the Indian Health Service clinical reporting system. Similar data for a U.S. population (n = 1,500,002) with commercial health insurance, matched by age and sex to the American Indian population, were drawn from the MartketScan Research Database. We used Diagnostic Cost Groups to identify medical conditions for which each individual was treated and to assign a risk score to quantify his or her morbidity burden. We compared the prevalence of comorbidities and morbidity burden of American Indian and U.S. adults with diabetes. RESULTS - American Indians with diabetes had significantly higher rates of hypertension, cerebrovascular disease, renal failure, lower-extremity amputations, and liver disease than commercially insured U.S. adults with diabetes (P < 0.05). The American Indian prevalence rates were 61.2, 6.9, 3.9, 1.8, and 7.1%, respectively. The morbidity burden among the American Indian with diabetes exceeded that of the insured U.S. adults with diabetes by 50%. CONCLUSIONS - The morbidity burden associated with diabetes among American Indians seen at the Phoenix Service Unit far exceeded that of commercially insured U.S. adults. These findings point to the urgency of enhancing diabetes prevention and treatment services for American Indians/Alaska Natives to reduce diabetes-related disparities. © 2010 by the American Diabetes Association.


Jastaneiah S.S.,King Khaled Eye Specialist Hospital | Al-Rajhi A.A.,King Khaled Eye Specialist Hospital | Abbott D.,Phoenix Indian Medical Center
Saudi Journal of Ophthalmology | Year: 2011

Purpose: To review the clinical experience of fungal keratitis cases at King Khaled Eye Specialist Hospital (KKESH) in Riyadh, Saudi Arabia. Methods: Retrospective observational review and analysis of 124 patient charts with confirmed diagnosis of fungal keratitis between 1984 and 2004. Results: One hundred and twenty four eyes of 124 patients had proven fungal infection; 101 eyes had fungal keratitis and 23 eyes had fungal endophthalmitis complicating keratitis. Estimated proportion of fungal keratitis and endophthalmitis was 10.3%. Mean age was 55. years with male predominance (79.0%). Commonly associated factors were previous intraocular surgery (38.7%) and trauma (20.9%). Major risk factor for progressing to endophthalmitis was previous intraocular surgery (65.2%), p< 0.001. Initial laboratory results were fungal positive only in 30.6% (p< 0.001). Commonest organisms isolated were Aspergillus spp. (29.8%) followed by Trichophyton sp. (16.1%), then Candida and Fusarium sp. Comparison of both phases of the study showed improvement in the rate of successfully treated cases from 34.6% to 58.3%, and a decline in cases progressing to endophthalmitis from 25.0% to 13.9%. Therapeutic penetrating keratoplasty increased from 26.9% to 73.6% (p< 0.001). Thirteen eyes required enucleation or evisceration. Conclusions: In contrast to other studies on fungal keratitis, Aspergillus spp. and Trichophyton sp. were the most commonly isolated fungal pathogens; the former carries the worst prognosis. Risk factors included previous intraocular surgery and trauma. Poor outcome was associated with Aspergillus spp., delayed presentation, previous intraocular surgery and late surgical intervention. This study recommends early surgical intervention to improve the outcome. © 2011.


Walther K.,University of Arizona | Bendlin B.B.,University of Wisconsin - Medical School | Bendlin B.B.,William S Middleton Memorial Veterans Hospital | Glisky E.L.,University of Arizona | And 4 more authors.
Neurobiology of Aging | Year: 2011

Previous studies have indicated a decreased risk for developing Alzheimer's disease in anti-inflammatory (AI) drug users. Yet few studies have determined whether AI drug use provides a protective effect against normal age-related changes in the brains of older adults. Regional volume changes in gray and white matter were assessed cross-sectionally using optimized voxel-based morphometry in 36 females taking AI drugs as arthritis or pain medication and 36 age- and education-matched female controls. Although mean gray and white matter volume differences between AI drug users and the non-AI group were small, AI drug use interacted with age, such that the non-AI group showed significantly greater age-related volume changes in regions of both gray and white matter compared to the AI drug users. These regions included the superior and medial frontal gyri, middle and inferior temporal gyri, fusiform and parahippocampal gyri, and occipital gray matter as well as temporal, parietal, and midbrain white matter. The results are consistent with the notion that AI drugs provide protection against age-related changes in brain volume. It is possible that inflammation plays a role in volume decreases associated with normal aging, and that suppressing the inflammatory response moderates this decrease. © 2009 Elsevier Inc.


Wongwiwatthananukit S.,University of Hawaii at Hilo | Zeszotarski P.,University of Hawaii at Hilo | Thai A.,Phoenix VA Health Care System | Fuller R.,Phoenix Indian Medical Center | And 4 more authors.
American Journal of Pharmaceutical Education | Year: 2013

Objective. To compare second- and third-year pharmacy students' competence, attitudes, and selfconfidence in providing diabetes care before and after completing a hand-on diabetes training program and to determine if the program had an impact on students' attitude and self-confidence based on their year in the curriculum. Design. The program included classroom lectures and hands-on learning sessions in 5 facets of diabetes care. Pre- and post-test instruments measured students' competence, attitudes, and confidence in diabetes care. Assessment. Students' competence and the mean overall confidence score significantly improved after completing the program, while mean overall attitude score did not. Third-year students had significantly higher confidence scores than did second-year students on both pre- and post-program tests. No significant difference was found for attitude scores between second- and third-year students. Conclusion. The hands-on learning program was an effective approach to training pharmacy students in diabetes care, improving both their competence and confidence.


Krakoff J.,U.S. National Institute of Diabetes and Digestive and Kidney Diseases | Clark J.M.,Welch Center for Prevention | Crandall J.P.,Yeshiva University | Wilson C.,Phoenix Indian Medical Center | And 4 more authors.
Obesity | Year: 2010

Nonalcoholic fatty liver disease (NAFLD) is associated with obesity, insulin resistance, and impaired glucose tolerance. We investigated whether metformin or changes in metabolic measurements (weight, fasting plasma glucose (FPG), or fasting insulin (FI)) improved serum alanine aminotransferase (ALT) activity, as a marker for NAFLD, in the Diabetes Prevention Program (DPP). From 1996 to 1999, 2,153 participants without marked elevations of serum ALT at baseline were randomized (1,081 to placebo, 1,072 to metformin) and treated for an average of 3.2 years. ALT increased during the first 2 years of the study, and was slightly but significantly lower in the participants randomized to metformin. In regression models adjusted for sex, baseline age, FPG, and FI, these differences remained significant, but disappeared after adjustment for weight, FPG, and FI changes at each examination. The 3-year cumulative incidence for development of abnormal ALT concentrations was not significantly different ((mean s.e.) 21.4 1.4% and 24.6 1.4%, P = 0.11) in the metformin vs. placebo groups but was lower in individuals in both groups that lost more weight by the end of year 1 (metformin: 19.4 2.4% vs. 27.5 3.7%, for highest vs. lowest quartile of weight loss; placebo: 18.7 3.4% vs. 28.8 2.6%). Over 3 years of follow-up in persons at high risk for development of diabetes, serum ALT was consistently lower in those treated with metformin compared with placebo. This effect was mediated by weight loss, indicating that the effects of metformin therapy on ALT is via its effects on weight. © 2009 The Obesity Society.


O'Brien K.L.,Center for American Indian Health | Chandran A.,Center for American Indian Health | Weatherholtz R.,Center for American Indian Health | Jafri H.S.,MedImmune | And 22 more authors.
The Lancet Infectious Diseases | Year: 2015

Background: Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory tract infections in children. We aimed to assess the safety and efficacy of an anti-RSV monoclonal antibody (motavizumab) in healthy term (≥36 weeks' gestational age) infants for the prevention of medically attended RSV acute lower respiratory tract infections. Methods: This phase 3, double-blind, placebo-controlled, randomised trial enrolled healthy Native American infants aged 6 months or younger who were born at 36 weeks' gestational age in southwestern USA, on the Navajo Nation, the White Mountain Apache reservation, and the San Carlos Apache Indian reservation. Participants were randomly assigned (2:1) to receive either five monthly intramuscular doses of motavizumab (15 mg/kg) or placebo. They were followed up for 150 days after the first dose, and the primary endpoints were respiratory admission to hospital with a positive result for RSV by RT-PCR and death caused by RSV. Participants were followed up for medically attended wheezing until they reached age 3 years. Analysis was by intention to treat (ITT). This trial is registered with ClinicalTrials.gov, number NCT00121108. Findings: During the autumn seasons (October to December) between 2004 and 2007, 2127 infants of the 2596 infants enrolled were randomly assigned to receive either motavizumab (1417) or placebo (710). After ITT analysis, motavizumab resulted in an 87% relative reduction (relative risk [RR] 0·13, 95% CI 0·08-0·21) in the proportion of infants admitted to hospital with RSV (21 [2%] of 1417 participants who received motavizumab; 80 [11%] of 710 participants who received placebo, p<0·0001). Serious adverse events were less common in particpants taking motavizumab (212 [15%]) than particpants on placebo (148 [21%]). Six deaths occurred in study participants (motavizumab, n=4 [0·3%]; placebo, n=2 [0·3%]); none were deemed to be related to the study product. Hypersensitivity events were more common in patients given motavizumab (208 [14·7%]) than in placebo recipients (87 [12·3%]; p=0·14). There was no effect on rates of medically attended wheezing in children aged 1-3 years (190 [14·9%] of participants randomly assigned to receive motavizumab vs 90 [14·0%] participants randomly assigned to receive placebo). Interpretation: To our knowledge, this is the only trial of an anti-RSV antibody to prevent serious RSV disease in healthy term infants. Motavizumab significantly reduced the RSV-associated inpatient and outpatient burden and set a benchmark for the efficacy of RSV prevention strategies. The findings do not support a direct, generalisable, causal association between RSV lower respiratory tract infection and subsequent long-term wheezing in term infants. © 2015 Elsevier Ltd.


Li H.K.,Cornell College | Li H.K.,University of Texas Health Science Center at Houston | Li H.K.,Jefferson Medical College | Horton M.,Phoenix Indian Medical Center | And 9 more authors.
Telemedicine and e-Health | Year: 2011

Ocular telemedicine and telehealth have the potential to decrease vision loss from DR. Planning, execution, and follow-up are key factors for success. Telemedicine is complex, requiring the services of expert teams working collaboratively to provide care matching the quality of conventional clinical settings. Improving access and outcomes, however, makes telemedicine a valuable tool for our diabetic patients. Programs that focus on patient needs, consider available resources, define clear goals, promote informed expectations, appropriately train personnel, and adhere to regulatory and statutory requirements have the highest chance of achieving success. © 2011, Mary Ann Liebert, Inc.

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