Chin-Shang Li

University of California, Davis, Davis, California, United States

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Publications (69)167.82 Total impact

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    ABSTRACT: Abstract Women who have sex with women (WSW) are a medically underserved population. Data on urologic health in WSW are scant. We hypothesized that the prevalence of urinary symptoms in WSW is similar to population norms and that urinary symptoms in WSW would be associated with known risk factors for urologic problems. WSW were recruited to participate in an internet-based survey via invitations, listserves, and social media. Primary outcome measures were the validated Overactive Bladder Questionnaire (OAB-q) and a single question assessing stress urinary incontinence (SUI). OAB status was dichotomized by OAB-q score (0-8=none/mild; >8=moderate/severe). SUI was dichotomized by single item response (none/little bit of the time=none/mild; sometimes through always=moderate/severe). Ethnodemographic, health, sexuality, and relationship data was also collected. Multivariable logistic regression utilizing 17 factors was performed with SAS V9.2, followed by multivariable analysis with stepwise selection based on the initial analysis (included factors, p<0.25). The final study population consisted of 1,566 adult WSW with mean age 34.6±10.4 years. Moderate/severe OAB was present in 354 (23%) women; 275 (18%) reported moderate /severe SUI. Concomitant OAB and SUI were present in 183 (12%). In multivariable analysis with stepwise selection, OAB symptoms were significantly associated with diabetes, history of urinary tract infection, gynecologic surgery, routine health care, and consultation with a provider regarding urinary symptoms. SUI symptoms were associated with sexual bother. This is the first survey report of prevalence and associations of OAB and SUI in a population of WSW. SUI and OAB were prevalent in WSW. Further attention to urological health in WSW is warranted.
    Journal of women's health (2002). 10/2014;
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    ABSTRACT: Increasing studies implicate cancer stem cells (CSCs) as the source of resistance and relapse following conventional cytotoxic therapies. Few studies have examined the response of CSCs to targeted therapies, such as tyrosine kinase inhibitors (TKIs). We hypothesized that TKIs would have differential effects on CSC populations depending on their mechanism of action (anti-proliferative vs. anti-angiogenic).
    BMC Cancer 10/2014; 14(1):756. · 3.33 Impact Factor
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    ABSTRACT: To evaluate readmission rates and associated factors to identify potentially preventable readmissions.
    Annals of surgery. 10/2014; 260(4):583-591.
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    ABSTRACT: Despite effective local therapy with surgery and radiotherapy (RT), ~50 % of patients with high-grade soft tissue sarcoma (STS) will relapse and die of disease. Since experimental data suggest a significant synergistic effect when antiangiogenic targeted therapies such as sorafenib are combined with RT, we chose to evaluate preoperative combined modality sorafenib and conformal RT in a phase I/II trial among patients with extremity STS amenable to treatment with curative intent. For the phase I trial, eight patients with intermediate- or high-grade STS >5 cm in maximal dimension or low-grade STS >8 cm in maximal dimension received concomitant sorafenib (dose escalation cohort 1:200 twice daily, cohort 2:200/400 daily) and preoperative RT (50 Gy in 25 fractions). Sorafenib was continued during the entire period of RT as tolerated. Surgical resection was completed 4-6 weeks following completion of neoadjuvant sorafenib/RT. Three sorafenib dose levels were planned. Primary endpoints of the phase I trial were maximal tolerated dose and dose-limiting toxicity (DLT). Eight patients were enrolled in the phase I (five females, median age 44 years, two high-grade pleomorphic, two myxoid/round cell liposarcoma, four other). Median tumor size was 16 cm (range 8-29), and all tumors were located in the lower extremity. Two of five patients treated at dose level 2 developed DLT consisting of grade 3 rash not tolerating drug reintroduction. Other grade 3 side effects included anemia, perirectal abscess, and supraventricular tachycardia. Radiation toxicity (grade 1 or 2 dermatitis; N = 8) and post-surgical complications (three grade 3 wound complications) were comparable to historical controls and other series of preoperative RT monotherapy. Complete pathologic reponse (≥95 % tumor necrosis) was observed in three patients (38 %). Neoadjuvant sorafenib in combination with RT is tolerable and appears to demonstrate activity in locally advanced extremity STS. Further study to determine efficacy at dose level 1 is warranted. (ClinicalTrials.gov identifier NCT00805727).
    Annals of Surgical Oncology 02/2014; · 4.12 Impact Factor
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    ABSTRACT: Introduction With increasing longevity, a growing proportion of patients that present with lower extremity peripheral arterial disease (PAD) are ≥ 80 years old. While smoking and diabetes (DM) have traditionally been the main risk factors associated with PAD, we noted a pattern of severe infrapopliteal PAD in patients ≥ 80 years old in the absence of these traditional risk factors. As recognition of patterns of disease affects decisions regarding diagnostic and therapeutic approach, we sought to confirm this observation. Methods A single-center retrospective review was performed of all patients that underwent lower extremity arteriography between 3/2007 and 9/2009. Arteriograms were scored in blinded fashion. Any infrapopliteal PAD was defined as one or more infrapopliteal arteries with either >50% stenosis or total occlusion. Severe infrapopliteal PAD was defined as 2 or more infrapopliteal arteries with >50% stenosis or total occlusion. Fisher’s exact test and two-sample t-test or Wilcoxon rank-sum test were used for analysis. Results 297 patients comprised the study population. 82% (= 145/176) of those ≤ 70 years old versus 96% (= 46/48) of those ≥ 80 years old had any infrapopliteal PAD (p = 0.02). 30% of patients > 80 years old with infrapopliteal PAD had no history of DM or smoking, while only 5% of younger patients had infrapopliteal PAD in the absence of DM or smoking (p < 0.0001). A similar pattern was seen for severe infrapopliteal PAD. Tissue loss was an indication for lower extremity arteriography in 45% of those ≤ 70 years of age versus 65% of those ≥ 80 (p = 0.022). Conclusions A significant proportion of patients ≥ 80 years of age with PAD develop arterial disease in the infrapopliteal pattern in the absence of the traditional risk factors of smoking and DM. Our data also showed that this pattern of disease is significantly associated with tissue loss and critical limb ischemia, particularly in patients ≥ 80 years of age. Primary care providers need to be educated to suspect ischemic etiology for foot pain and ulcers in elderly patients not otherwise thought to have risk factors associated with PAD. Vascular specialists need to anticipate this pattern of disease when planning interventions. As smoking becomes less prevalent and as the population ages, octogenarians with severe infrapopliteal arterial occlusive disease will become a larger proportion of the patients treated by vascular specialists.
    Annals of Vascular Surgery 01/2014; · 0.99 Impact Factor
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    ABSTRACT: A majority of individuals infected with human immunodeficiency virus (HIV) have inadequate access to antiretroviral therapy and ultimately develop debilitating oral infections that often correlate with disease progression. Due to the impracticalities of conducting host-microbe systems-based studies in HIV infected patients, we have evaluated the potential of simian immunodeficiency virus (SIV) infected rhesus macaques to serve as a non-human primate model for oral manifestations of HIV disease. We present the first description of the rhesus macaque oral microbiota and show that a mixture of human commensal bacteria and ''macaque versions'' of human commensals colonize the tongue dorsum and dental plaque. Our findings indicate that SIV infection results in chronic activation of antiviral and inflammatory responses in the tongue mucosa that may collectively lead to repression of epithelial development and impact the microbiome. In addition, we show that dysbiosis of the lingual microbiome in SIV infection is characterized by outgrowth of Gemella morbillorum that may result from impaired macrophage function. Finally, we provide evidence that the increased capacity of opportunistic pathogens (e.g. E. coli) to colonize the microbiome is associated with reduced production of antimicrobial peptides.
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    ABSTRACT: A majority of individuals infected with human immunodeficiency virus (HIV) have inadequate access to antiretroviral therapy and ultimately develop debilitating oral infections that often correlate with disease progression. Due to the impracticalities of conducting host-microbe systems-based studies in HIV infected patients, we have evaluated the potential of simian immunodeficiency virus (SIV) infected rhesus macaques to serve as a non-human primate model for oral manifestations of HIV disease. We present the first description of the rhesus macaque oral microbiota and show that a mixture of human commensal bacteria and "macaque versions" of human commensals colonize the tongue dorsum and dental plaque. Our findings indicate that SIV infection results in chronic activation of antiviral and inflammatory responses in the tongue mucosa that may collectively lead to repression of epithelial development and impact the microbiome. In addition, we show that dysbiosis of the lingual microbiome in SIV infection is characterized by outgrowth of Gemella morbillorum that may result from impaired macrophage function. Finally, we provide evidence that the increased capacity of opportunistic pathogens (e.g. E. coli) to colonize the microbiome is associated with reduced production of antimicrobial peptides.
    PLoS ONE 11/2013; 8(11):e80863. · 3.53 Impact Factor
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    ABSTRACT: To examine the age and gender-specific trends of Schedule II opioid use among California residents, with special reference to multiple provider users (doctor shoppers). Utilizing data from the California Prescription Drug Monitoring Program, we examined age and gender-specific trends of Schedule II opioid use during calendar years 1999-2007. Specifically, we analyzed the following: (1) the prevalence of Schedule II opioid users among California's population and (2) the proportion of these opioid users who were doctor shoppers (defined as an individual who used more than five different prescribers for all Schedule II opioids he or she obtained in a calendar year). Among all age and gender groups, the prevalence of Schedule II opioid users in California increased by 150%-280% and the prevalence of doctor shoppers among users increased by 111%-213% over 9 years. The prevalence of opioid users was lowest among 18-44 year old men (1.25%) and highest among 65-year and older women (5.31%) by 2007. The prevalence of doctor shoppers was approximately 1.4% among those up to age 64 years and 0.5% among those 65 years and older. The gender difference in doctor shoppers among all age groups was negligible. On average, the cumulative morphine-equivalent amount of Schedule II opioid per individual obtained per year was threefold to sixfold higher for doctor shoppers than for the general population across different age and gender groups. Age and gender differences in opioid use were relatively small, whereas the trends for use of opioids and multiple providers grew at a disquieting rate. Copyright © 2013 John Wiley & Sons, Ltd.
    Pharmacoepidemiology and Drug Safety 08/2013; · 2.90 Impact Factor
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    ABSTRACT: Disparities in smoking rates remain prominent within Asian Americans. Medical pluralism and cultural tailoring may enhance Asian Americans engaging with tobacco cessation assistance. We conducted a retrospective analysis of a community clinic's smoking cessation program targeting a Chinese population that offered acupuncture, nicotine replacement therapy (NRT), and counseling from 2007 to 2010. Most participants used acupuncture, with about half choosing acupuncture and NRT, followed by more than 40% choosing acupuncture only; few chose NRT only. Tobacco cessation rates at 6 months were relatively high for the acupuncture + NRT group and only acupuncture group (37.7% vs. 28.9%). In comparing tobacco reduction >50% from baseline with an expanded only NRT group, the acupuncture + NRT group had a higher odds ratio than the only acupuncture group, which had a lower odds ratio. Our evaluation of this real-world community program offering acupuncture as a cultural adjunct to a tobacco cessation program suggests that acupuncture might help with engagement by Chinese American male smokers into a tobacco cessation program that offers counseling and NRT. Future larger studies should further evaluate the efficacy of offering acupuncture in combination with NRT on the outcomes of cessation and reduction.
    Health Promotion Practice 05/2013; · 0.55 Impact Factor
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    ABSTRACT: PURPOSE: Malignancies may cause urinary tract obstruction, which is often relieved with placement of a percutaneous nephrostomy tube, an internal double J nephro-ureteric stent (double J), or an internal external nephroureteral stent (NUS). We evaluated the affect of these palliative interventions on quality of life (QoL) using previously validated surveys. METHODS: Forty-six patients with malignancy related ureteral obstruction received nephrostomy tubes (n = 16), double J stents (n = 15), or NUS (n = 15) as determined by a multidisciplinary team. QoL surveys were administered at 7, 30, and 90 days after the palliative procedure to evaluate symptoms and physical, social, functional, and emotional well-being. Number of related procedures, fluoroscopy time, and complications were documented. Kruskal-Wallis and Friedman's test were used to compare patients at 7, 30, and 90 days. Spearman's rank correlation coefficient was used to assess correlations between clinical outcomes/symptoms and QoL. RESULTS: Responses to QoL surveys were not significantly different for patients receiving nephrostomies, double J stents, or NUS at 7, 30, or 90 days. At 30 and 90 days there were significantly higher reported urinary symptoms and pain in those receiving double J stents compared with nephrostomies (P = 0.0035 and P = 0.0189, respectively). Significantly greater fluoroscopy time was needed for double J stent-related procedures (P = 0.0054). Nephrostomy tubes were associated with more frequent minor complications requiring additional changes. CONCLUSION: QoL was not significantly different. However, a greater incidence of pain in those receiving double J stents and more frequent tube changes in those with nephrostomy tubes should be considered when choosing palliative approaches.
    CardioVascular and Interventional Radiology 02/2013; · 2.09 Impact Factor
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    ABSTRACT: BACKGROUND: Skeletal surveys for non-accidental trauma (NAT) include lateral spinal and pelvic views, which have a significant radiation dose. OBJECTIVE: To determine whether pelvic and lateral spinal radiographs should routinely be performed during initial bone surveys for suspected NAT. MATERIALS AND METHODS: The radiology database was queried for the period May 2005 to May 2011 using CPT codes for skeletal surveys for suspected NAT. Studies performed for skeletal dysplasia and follow-up surveys were excluded. Initial skeletal surveys were reviewed to identify fractures present, including those identified only on lateral spinal and/or pelvic radiographs. Clinical information and MR imaging was reviewed for the single patient with vertebral compression deformities. RESULTS: Of the 530 children, 223 (42.1%) had rib and extremity fractures suspicious for NAT. No fractures were identified solely on pelvic radiographs. Only one child (<0.2%) had vertebral compression deformities identified on a lateral spinal radiograph. This infant had rib and extremity fractures and was clinically paraplegic. MR imaging confirmed the vertebral body fractures. CONCLUSION: Since no fractures were identified solely on pelvic radiographs and on lateral spinal radiographs in children without evidence of NAT, nor in nearly all with evidence of NAT, inclusion of these views in the initial evaluation of children for suspected NAT may not be warranted.
    Pediatric Radiology 01/2013; · 1.57 Impact Factor
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    ABSTRACT: BACKGROUND: There are conflicting data regarding improvements in postoperative outcomes with perioperative epidural analgesia. We sought to examine the effect of perioperative epidural analgesia vs. intravenous narcotic analgesia on perioperative outcomes including pain control, morbidity, and mortality in patients undergoing gastric and pancreatic resections. METHODS: We evaluated 169 patients from 2007 to 2011 who underwent open gastric and pancreatic resections for malignancy at a university medical center. Emergency, traumatic, pediatric, enucleations, and disseminated cancer cases were excluded. Clinicopathologic data were reviewed among epidural (E) and non-epidural (NE) patients for their association with perioperative endpoints. RESULTS: One hundred twenty patients (71 %) received an epidural and 49 (29 %) did not. There were no significant differences (P > 0.05) in mean pain scores at each of the four days (days 0-3) among the E (3.2 ± 2.7, 3.2 ± 2.3, 2.3 ± 1.9, and 2.1 ± 1.9, respectively) and NE patients (3.7 ± 2.7, 3.4 ± 1.9, 2.9 ± 2.1, and 2.4 ± 1.9, respectively). Within each of the E and NE patient groups, there were significant differences (P < 0.0001) in mean pain scores from day 0 to day 3 (P < 0.0001). Of the E patients, 69 % also received intravenous patient-controlled analgesia (PCA). Ileus (13 % E vs. 8 % NE), pneumonia (12 % E vs. 8 % NE), venous thromboembolism (6 % E vs. 4 % NE), length of stay [11.0 ± 12.1 (8, 4-107) E vs. 12.2 ± 10.7 (7, 3-54) NE], overall morbidity (36 % E vs. 39 % NE), and mortality (4 % E vs. 2 % NE) were not significantly different. CONCLUSIONS: Routine use of epidurals in this group of patients does not appear to be superior to PCA.
    Journal of Gastrointestinal Surgery 01/2013; · 2.36 Impact Factor
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    ABSTRACT: BACKGROUND: Diabetic foot ulcers (DFUs) represent a significant source of morbidity and an enormous financial burden. Standard care for DFUs involves systemic glucose control, ensuring adequate perfusion, debridement of nonviable tissue, off-loading, control of infection, local wound care and patient education, all administered by a multidisciplinary team. Unfortunately, even with the best standard of care (SOC) available, only 24% or 30% of DFUs will heal at weeks 12 or 20, respectively.The extracellular matrix (ECM) in DFUs is abnormal and its impairment has been proposed as a key target for new therapeutic devices. These devices intend to replace the aberrant ECM by implanting a matrix, either devoid of cells or enhanced with fibroblasts, keratinocytes or both as well as various growth factors. These new bioengineered skin substitutes are proposed to encourage angiogenesis and in-growth of new tissue, and to utilize living cells to generate cytokines needed for wound repair.To date, the efficacy of bioengineered ECM containing live cellular elements for improving healing above that of a SOC control group has not been compared with the efficacy of an ECM devoid of cells relative to the same SOC. Our hypothesis is that there is no difference in the improved healing effected by either of these two product types relative to SOC. METHODS: To test this hypothesis we propose a randomized, single-blind, clinical trial with three arms: SOC, SOC plus Dermagraft(R) (bioengineered ECM containing living fibroblasts) and SOC plus Oasis(R) (ECM devoid of living cells) in patients with nonhealing DFUs. The primary outcome is the percentage of subjects that achieved complete wound closure by week 12. DISCUSSION: If our hypothesis is correct, then immense cost savings could be realized by using the orders-of-magnitude less expensive acellular ECM device without compromising patient health outcomes. The article describes the protocol proposed to test our hypothesis.Trial registration: ClinicalTrials.gov: NCT01450943. Registered: 7 October 2011.
    Trials 01/2013; 14(1):8. · 2.21 Impact Factor
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    ABSTRACT: The Joint Commission Venous Thromboembolism (VTE) National Hospital Inpatient Quality Measure VTE-5 outlines four criteria for discharge patient education when starting anticoagulation (usually, warfarin) therapy. The criteria do not specify content regarding patient recognition of potentially dangerous warfarin-related scenarios. A study was conducted to investigate how well patients assess the risks and consequences of potential warfarin-related safety threats. From an adult population on long-term warfarin, 480 patients were randomly selected for a telephone-based survey. Warfarin-knowledge questions were drawn from a previous survey; warfarin-associated risk scenarios were developed via focus interviews. Expert anticoagulation pharmacists categorized each scenario as urgent, moderately urgent, or not urgent, as did survey participants. For the 184 patients (38% completion rate), the mean knowledge score was 69% (standard deviation [SD], 0.20). Overall classification accuracy of situational urgency was 59% (95% confidence interval [CI], 57.3%-60.3%). Respondents overestimated non-urgent-severity situations 23% of the time (95% CI, 20.8%-24.7%), while underestimating urgent-severity situations 21% of the time (95% CI, 19.0%-23.9%). A significant percentage of patients failed to recognize the urgency of stroke symptoms (for example, loss of vision), the risk of bleeding after incidental head trauma, or medication mismanagement. Despite fair factual warfarin knowledge, participants did not appear to recognize well the clinical severity of warfarin-associated scenarios. Warfarin education programs should incorporate patient-centered strategies to teach recognition of high-risk situations that compromise patient safety.
    Joint Commission journal on quality and patient safety / Joint Commission Resources 01/2013; 39(1):22-31.
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    ABSTRACT: PURPOSE To determine if pelvis and lateral spine radiographs, the images which give the highest radiation dose, should routinely be performed during initial bone surveys for suspected non-accidental trauma. METHOD AND MATERIALS This retrospective study was IRB approved with waiver of informed consent. The radiology database was queried from May 2005 to May 2011 using diagnostic codes 77075 and 77076 for suspected non-accidental trauma. Studies performed for skeletal dysplasia were excluded. Both initial skeletal surveys and their reports were reviewed to identify fractures present, and specifically whether any fractures were identified on the lateral spine radiograph and pelvis exams. Imaging was also reviewed by 2 pediatric radiologists with more than 15 years of imaging experience. Clinical information and MR imaging was also reviewed for the single patient with positive findings on lateral spine radiograph. RESULTS A total of 530 studies, performed over 6 years duration, were reviewed. Of these, 221 had rib and extremity fractures suspicious for NAT. No fractures were identified solely on pelvic radiographs. Only one patient had compression deformities identified on a lateral spine radiograph. In addition, this infant had rib fractures and was clinically paraplegic. MR imaging confirmed the vertebral body fractures. CONCLUSION Given that no fractures were identified solely on pelvis radiographs and that no vertebral fractures were encountered on lateral radiographs in neurologically normal patients, inclusion of these views in the initial evaluation of patients for suspected non-accidental trauma may not be warranted. Excluding these two views would substantially decrease radiation exposure--especially gonadal radiation. In our cohort, the single patient with a vertebral compression deformity was clinically paraplegic; thus clinical information such as neurological symptoms can be used to guide imaging options. CLINICAL RELEVANCE/APPLICATION Unwarranted radiation incident to lateral spine and pelvic radiographs can be avoided while initially evaluating suspected NAT by bone survey without compromising diagnostic ability
    Radiological Society of North America 2012 Scientific Assembly and Annual Meeting; 11/2012
  • Debra Bakerjian, Chin-Shang Li
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    ABSTRACT: US Census predicts that the numbers of older adults will more than double in the next 20 years. Our ability to meet the healthcare demands of this population with more chronic illness is dependent upon adequate geriatric trained providers, yet accurately measuring the geriatric workforce (supply side) is challenging. Past methods have relied upon surveys of professional organizations and labor force statistics. Validity of these workforce estimates have been questioned because of individual inconsistencies in identifying a geriatric specialty, inherent problems of self-reported data, and lack of data from groups such as self-employed persons or those not certified but working in the industry. The National Provider Identifier (NPI) database is a searchable, online, HIPAA compliant public registry of all provider organizations and clinicians who receive payment from Medicare and Medicaid, available since September 2007. The NPI database is likely to be more accurate than other data sources due to regulatory requirements to use NPI identifier for payment, standardized fields, and that the downloadable file contains only active data. The NPI registry provides a 10 digit unique identification number that replaces social security numbers and provides taxonomy to identify provider specialties. This registry, which is a continuously updated compilation, includes current identifier data for almost 3.5 million providers of which 2.6 million are clinicians. Purpose: This study aims to measure the gaps between the demand and the supply of the geriatric workforce at the national and state levels analyzing the NPI dataset. Methods: Using our original algorithm to identify geriatric clinicians, we estimate characteristics of supply side including (a) the number of geriatric care providers (e.g. nurses, physicians, therapists) and (b) their detailed characteristics such as gender, licensure type, location, and types of providers (e.g., individual versus group practice). These supply side estimates will be compared with demand side estimates, which were calculated based on the total population and demographic (age) compositions at the national and state level. Expected Results: The estimated demands for geriatric providers are hypothesized to exceed the estimated supply in most states. We hypothesize great variability between states, with western states having fewer geriatric trained clinicians per capita. Policy Implications: Specific, accurate estimates of the gaps between the demand and the supply of the geriatric workforce will assist workforce planners, healthcare educators and policymakers to better meet the rapidly growing demand for geriatric care.
    140st APHA Annual Meeting and Exposition 2012; 10/2012
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    ABSTRACT: INTRODUCTION: Tobacco control has been most successful with population-based approaches such as smoke-free policies. Targeting individual behaviors is still necessary, but most adult cessation interventions do not address secondhand smoke concerns. We used a multi-staged, formative research to design, adapt and refine a novel household pair-based intervention with a smoker and nonsmoker for the clinical health education setting. METHOD: Our approach used three phases of focus groups which first interviewed a diverse general population and then targeted a high-risk population. Grounded theory was used after each focus group phase to refine and target interview questions. Focus groups were designed to assess feasibility of intervention strategies within a clinical health education setting and acceptability of specific intervention components. All groups were audio-recorded and iteratively analyzed. RESULTS: A total of 110 people participated in one of three phases of focus groups (n=13). 54% were smokers; 52% were female; 21% African American; 59% were Chinese-speaking immigrants. Phase 1 revealed preferences for intervention content, particularly communication strategies related to quitting and eliminating tobacco smoke exposure, and acceptability of biomarker feedback about smoke exposure. Phase 2 demonstrated preferences for intervention context, including acceptability of biomarker sampling methods, the pair-based intervention design, and refinement of messages about becoming smoke-free together and positive social support. Phase 3 focused the intervention design and messages for the target population, Chinese immigrants, who were selected to optimize an evaluation of the intervention's efficacy. CONCLUSION: A multi-stage formative process is useful in helping to develop a novel intervention with multiple components.
    140st APHA Annual Meeting and Exposition 2012; 10/2012
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    ABSTRACT: OBJECTIVE: To assess the frequency and associations of barrier protection use during sexual activity in a population of women who have sex with women (WSW). METHODS: WSW were invited to participate in an international internet-based survey. Information regarding ethnodemographics, sexual health, and barrier use during sexual activities was collected. RESULTS: The study cohort comprised 1557 participants. Barrier use was least prevalent during digital genital stimulation (11.3% ever used barriers) and most prevalent during stimulation with a sex toy (34.4% ever used barriers). Univariate analysis revealed that women in non-monogamous relationships were more likely than monogamous women to always use barrier protection for sexual activity (14.3% vs 3.5%). On multivariate analysis, there was no association between barrier use and frequency of casual sexual activity or history of sexually transmitted infection. Small associations were noted between barrier use and certain sexual activities, age, race, and number of partners. CONCLUSION: Many WSW do not use barrier protection during sexual activity, even in the context of potentially risky sexual behaviors. Safer-sex practices among WSW merit increased attention from healthcare providers and public health researchers.
    International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 10/2012; · 1.41 Impact Factor
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    ABSTRACT: INTRODUCTION: While the anti-resorptive effects of the bisphosphonates (BPs) are well documented, many questions remain about their mechanisms of action, particularly following long-term use. This study evaluated the effects of alendronate (Ale) treatment on TGF-β1 signaling in mesenchymal stem cells (MSCs) and osteocytes, and the relationship between prolonged alendronate treatment on systemic TGF-β1 levels and bone strength. METHODS: TGF-β1 expression and signaling were evaluated in MSCs and osteocytic MLO-Y4 cells following Ale treatment. Serum total TGF-β1 levels, a bone resorption marker (DPD/Cr), three-dimensional microCT scans and biomechanical tests from both the trabecular and cortical bone were measured in ovariectomized rats that either received continuous Ale treatment for 360days or Ale treatment for 120days followed by 240days of vehicle. Linear regression tests were performed to determine the association of serum total TGF-β1 levels and both the trabecular (vertebrae) and cortical (tibiae) bone strength. RESULTS: Ale increased TGF-β1 signaling in the MSCs but not in the MLO-Y4 cells. Ale treatment increased serum TGF-β1 levels and the numbers of TGF-β1-positive osteocytes and periosteal cells in cortical bone. Serum TGF-β1 levels were not associated with vertebral maximum load and strength but was negatively associated with cortical bone maximum load and ultimate strength. CONCLUSIONS: The increase of serum TGF-β1 levels during acute phase of estrogen deficiency is likely due to increased osteoclast-mediated release of matrix-derived latent TGF- β1. Long-term estrogen-deficiency generally results in a decline in serum TGF-β1 levels that are maintained by Ale treatment. Measuring serum total TGF-β1 levels may help to determine cortical bone quality following alendronate treatment.
    Bone 10/2012; · 4.46 Impact Factor
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    ABSTRACT: BACKGROUND: Agriculture poses varied dangers to hired farm workers in the U.S., but little information exists on occupational risks for chronic musculoskeletal pain. We examined common work positions, such as kneeling, carrying heavy loads, and repetitive motion that may increase the risk for chronic musculoskeletal pain. METHODS: MICASA is a population-based study of occupational exposures and health in hired farm workers in California. This analysis includes 759 participants, 18-55 years old, engaged in farm work and residing in Mendota, CA. Chronic pain was defined as pain lasting 6 weeks or longer at specific body sites (back, knee, hip, etc.) over the entire farm work career. RESULTS: Mean age was 37.9 years. Sixty-five percent participants were born in Mexico, 27.7% were born in El Salvador, and 4.2% were U.S-born. Chronic pain was associated with older age and female sex. After adjustment for age, years working in agriculture, and smoking, stooping/bending >30 hr/week among both men (OR = 2.49, 95% CI: 1.03-5.99) and women (OR = 2.15, 95% CI: 1.04-4.46) was associated with chronic hip pain. Driving tractors or other heavy farm equipment >60 hr/week was associated with increased odds of chronic hip pain (OR = 2.16, 95% CI: 1.02-4.54) among men. We also observed significant associations with kneeling or crawling >35 hr/week among women for both chronic back pain (OR = 2.96, 95% CI: 1.27-6.93) and knee pain (OR = 3.02, 95% CI: 1.07-8.50), respectively. CONCLUSIONS: Chronic musculoskeletal pain is prevalent among farm workers and is associated with common work positions. Further research should focus on developing preventive interventions for tasks associated with increased pain risk. These interventions should be targeted to specific types of agricultural tasks. Am. J. Ind. Med. © 2012 Wiley Periodicals, Inc.
    American Journal of Industrial Medicine 09/2012; · 1.97 Impact Factor

Publication Stats

375 Citations
167.82 Total Impact Points

Institutions

  • 2008–2014
    • University of California, Davis
      • Department of Public Health Sciences
      Davis, California, United States
  • 2013
    • Peking Union Medical College Hospital
      Peping, Beijing, China
    • University of Washington Seattle
      • Department of Radiology
      Seattle, WA, United States
  • 2010–2012
    • California State University, Sacramento
      Sacramento, California, United States