Betty Skipper

University of New Mexico, Albuquerque, NM, United States

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Publications (64)138.93 Total impact

  • [show abstract] [hide abstract]
    ABSTRACT: This study compared parenting ability in mothers with systemic sclerosis (SSc) and systemic lupus erythematosus (SLE), two chronic, autoimmune, connective tissue diseases that primarily affect women. Seventy-four mothers with SSc and 68 mothers with SLE completed self-report questionnaires on demographic characteristics, pain, fatigue, occupational performance, and parenting. Results showed that mothers with SSc were slightly older, were more educated, and had decreased occupational performance. Mothers with SLE had more pain and fatigue. There were no significant differences between mothers with SSc and SLE who had children 5 years of age and younger. However, there were significant differences between the mothers with SSc and SLE who had children aged 6 to 18 years on four items on the Parenting Disability Index: playing games with child, getting up with child during the night, keeping child out of unsafe situations, and helping child solve personal/social problems. These differences may be due to differences in the levels of pain, fatigue, and occupational performance, possibly stemming from differences in disease manifestations.
    OTJR Occupation Participation Health 01/2014; 34(1):12-9. · 0.80 Impact Factor
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    ABSTRACT: Objective: To assess the effects of an Internet self-management program for systemic sclerosis on self-efficacy, health efficacy, and management of care, pain, fatigue, functional ability, and depression. Methods: Participants logged on to a password-protected website and completed modules and learning activities at their own pace over 10 weeks. Participants were encouraged to log on to the discussion board, participate in an interactive component of the website, and respond to questions posted for each module. Participants completed pre- and post-intervention questionnaires on perceived self-efficacy, health efficacy, ability to manage care, functional disability, depression, pain, and fatigue. They also completed an 8-question evaluation form regarding satisfaction with the website, program content, discussion boards, and learning activities. Results: Sixteen participants completed the study and post-intervention measures. There were significant improvements in mean scores for ability to manage care (effect size [ES] 0.62, P =.025), health efficacy (ES 0.72, P =.012), and significant decreases in fatigue (ES -0.55, P =.045) and depression (ES -0.71, P =.013). Self-efficacy improved, but not significantly. The evaluation of the program revealed mean scores ranging from 4.2 (action plans contributed to learning) to 4.9 (information presented clearly) on a 5-point scale, where 5 is most satisfied. Conclusions: These findings from this pilot study suggest that a self-management program delivered using an Internet format can lead to statistically significant changes in health efficacy and management of care, fatigue, and depression. These results need to be confirmed with a larger randomized controlled trial with a longer follow-up period.
    Arthritis care & research. 10/2013;
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    ABSTRACT: To examine the availability of trial of labor after cesarean delivery (TOLAC) in New Mexico from 1998 to 2012 and maternity care providers' perception of barriers to TOLAC. Hospital maternity unit directors were surveyed regarding TOLAC availability from 1998 to 2012. Maternity care providers (obstetrician-gynecologists, certified nurse-midwives, and family medicine physicians) were surveyed in 2008 regarding resources and barriers to providing TOLAC and emergency cesarean delivery. Trial of labor after cesarean delivery was available in 100% of counties with maternity care units in 1998 (22/22); by 2008, availability decreased to 32% (7/22). After changes in national guidelines, availability increased slightly to 9 of 22 (41%) in 2012. Barriers to TOLAC included anesthesia availability (88%), hospital and medical malpractice policies (80%), malpractice cost (69%), and obstetric surgeon availability (59%). In hospitals without TOLAC services, 73% of maternity care providers indicated a surgeon could be present in the hospital within 20 minutes of the emergency delivery decision; only 43% indicated obstetric anesthesia personnel could be present within 20 minutes (P<.001). Availability of TOLAC in New Mexico has decreased dramatically. Policy changes are needed to support TOLAC access in rural and community hospitals. : III.
    Obstetrics and Gynecology 08/2013; 122(2 Pt 1):242-7. · 4.80 Impact Factor
  • Janet L Poole, Betty Skipper, Cindy Mendelson
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    ABSTRACT: Patient self-management programs usually require participants to attend group sessions, which can be difficult for individuals with mobility issues. In addition, many programs are not disease specific. The purpose of this study was to evaluate the effects of a mail-delivered self-management program for individuals with scleroderma (SSc). The program consisted of a workbook and exercise DVD that provided information on medical aspects of the disease, dysphagia, fatigue management, advocacy, activities of daily living, oral hygiene, skin and wound care, psychosocial changes, exercises, and other features of the condition. Participants provided feedback on the effects of the self-management program by responding to questions on demographic and six self-report questionnaires, keeping a health log, and participating in a program evaluation interview. A total of 49 participants completed the program and returned the postintervention questionnaires. Participants consistently reported that the program was easy to use. Depression, fatigue, and pain decreased, and hand function, self-efficacy for controlling pain, and self-efficacy "other" improved; however, the only statistically significant change was in self-efficacy for pain. This is the first study to develop and assess the effects of a mail-delivered format for self-management for people with SSc. A self-management program should help individuals with SSc develop self-management strategies to manage this complex disease and advocate for themselves to promote better health.
    Clinical Rheumatology 05/2013; · 2.04 Impact Factor
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    ABSTRACT: Adolescents Committed to Improvement of Nutrition and Physical Activity (ACTION) was undertaken to determine feasibility of a school-based health center (SBHC) weight management program. Two urban New Mexico SBHCs were randomized to deliver ACTION or standard care. ACTION consisted of eight visits using motivational interviewing to improve eating and physical activity behavior. An educational nutrition and physical activity DVD for students and a clinician toolkit were created for use as menu of options. Standard care consisted of one visit with the SBHC provider who prescribed recommendations for healthy weight. Sixty nondiabetic overweight/obese adolescents were enrolled. Measures included BMI percentile, waist circumference, insulin resistance by homeostasis model assessment (HOMA-IR), blood pressure, triglycerides, and HDL-C levels. Pre- to postchanges for participants were compared between groups. Fifty-one students (mean age 15 years, 62% female, 75% Hispanic) completed pre- and postmeasures. ACTION students (n = 28) had improvements in BMI percentile (P = 0.04) and waist circumference (P = 0.04) as compared with students receiving standard care (n = 23). No differences were found between the two groups in blood pressure, HOMA-IR, triglycerides, and HDL-C. The ACTION SBHC weight management program was feasible and demonstrated improved outcomes in BMI percentile and waist circumference.
    Journal of obesity 01/2013; 2013:575016.
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    ABSTRACT: Abstract Background: Acanthosis nigricans (AN) is a dermatologic condition associated with hyperinsulinemia, a marker of insulin resistance that is the principal abnormality in metabolic syndrome (MetS). We examined the association of AN with the clustering of MetS components. Methods: A cross-sectional study was conducted in an urban school-based health center in New Mexico. Students without diabetes were evaluated for AN, a family history of type 2 diabetes, body mass index (BMI), and MetS components. The clustering of MetS components by BMI category and AN status was assessed by comparing the group means of summed average z-scores of fasting insulin, triglycerides, high-density lipoprotein-cholesterol, and systolic blood pressure among the students. A multivariate model with BMI category and AN status controlling for Tanner stage was performed to identify the variables associated with the clustering of MetS components. Results: Complete data were available for 90 children (age, 9.7±1.4 years; 94% Hispanic; 60% female). In multivariate modeling of MetS cluster z-score, significant differences were found between the students with BMI <85th percentile [-0.27; 95% confidence interval (95% CI)=-0.42 to -0.11] and (a) the students with BMI 85th-94.9th percentile with AN (0.74; 95% CI=0.17-1.31) and (b) the students with BMI ≥95th percentile with AN (0.86; 95% CI=0.54-1.18). No significant differences in the MetS cluster z-score were seen between the students with BMI <85th percentile and those with BMI 85th-94.9th percentile without AN (0.24; 95% CI=-0.33 to 0.81) or those with BMI ≥95th percentile without AN (0.31; 95% CI=-0.13 to 0.75). Conclusions: Overweight/obese Hispanic elementary school-aged children with AN exhibit clustering of MetS components and could benefit from early intervention.
    Journal of pediatric endocrinology & metabolism: JPEM 12/2012; 25(11-12):1095-1102. · 0.75 Impact Factor
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    ABSTRACT: OBJECTIVE The study objective was to determine whether medical students' attendance at a rehabilitation residence for pregnant women with substance-use disorders yielded changes in their attitudes and comfort levels in providing care to this population. METHODS This randomized educational trial involved 96 consecutive medical students during their obstetrics and gynecology clerkship. In addition to attending a half-day prenatal clinic designed for women with substance-use disorders, every student was randomly assigned either to attend (Study group) or not to attend (Control group) a rehabilitation residence for pregnant women with substance-use disorders. The primary objective was to measure differences in responses to a confidential 12-question survey addressing comfort levels and attitudes, at the beginning and end of the clerkship. RESULTS Survey responses revealed improvements in students' comfort levels and attitudes toward pregnant women with substance-use disorders by attending the clinic alone or the clinic and residence. Those who attended the residence reported becoming more comfortable in talking with patients about adverse effects from substance abuse, more understanding of "street" terms, and stronger belief that patients will disclose their substance use to providers. Residents expressed more openly their hardships and barriers while trying to set therapeutic goals. CONCLUSIONS Medical students became more comfortable and insightful about pregnant women with substance-use disorders after attending a rehabilitation residence in addition to a prenatal clinic dedicated to this population.
    Academic Psychiatry 11/2012; 36(6):457-60. · 0.81 Impact Factor
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    ABSTRACT: The primary purpose of the study was to determine the factors that are associated with repeat emergency department (ED) visits in children with diabetes. Emergency department charts and billing data for children up to 18 years of age presenting to the ED with diabetic diagnoses over a 4-year period were reviewed. The overall rate of repeat visits to the ED was 0.24 visits per person-year of follow-up time. In univariate analyses, there were statistically significant effects of age, insurance category, sex, type of practice, and income. In a multivariate analysis, there was a significant interaction of insurance category and age. Revisit rate ratios for children older than 6 years were higher for those with Medicaid compared with those with commercial insurance. Diabetic boys were less likely to revisit the ED than were girls. Type of insurance was associated with repeated visits to the ED in children with diabetes. Other contributing factors included age group and sex.
    Pediatric emergency care 06/2012; 28(7):614-9. · 0.92 Impact Factor
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    ABSTRACT: This study investigates parenting and the impact of symptoms, such as pain and fatigue, on the parenting abilities of mothers with systemic lupus erythematosus (SLE). Participants were 68 mothers with SLE who had children 18 years of age and younger. The mothers completed surveys consisting of a demographic questionnaire and self-report instruments such as the Parenting Disability Index (PDI), Health Assessment Questionnaire, Pain Visual Analog Scale, and Multidimensional Assessment of Fatigue Scale. Analysis of variance was used to compare parenting abilities for women with younger children (birth -5 years) and women with older children (6-18 years) and women with children in both age groups. There were no significant differences between the three groups. However, having more fatigue, functional disability, and less education resulted in higher PDI scores in all groups. Mothers with children younger than age 5 reported that having energy to talk/listen to a child was the most difficult parenting task. Mothers with children between 6 and 18 years of age reported the most difficulties with maintaining discipline, playing games, shopping, and doing household chores. Symptoms of lupus have a significant influence on mothering roles. In daily practice, health care providers may want to consider inquiring about the impact SLE may be having on their patients' parenting roles.
    Clinical Rheumatology 01/2012; 31(6):995-1000. · 2.04 Impact Factor
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    ABSTRACT: We describe the impact of community health workers (CHWs) providing community-based support services to enrollees who are high consumers of health resources in a Medicaid managed care system. We conducted a retrospective study on a sample of 448 enrollees who were assigned to field-based CHWs in 11 of New Mexico's 33 counties. The CHWs provided patients education, advocacy and social support for a period up to 6 months. Data was collected on services provided, and community resources accessed. Utilization and payments in the emergency department, inpatient service, non-narcotic and narcotic prescriptions as well as outpatient primary care and specialty care were collected on each patient for a 6 month period before, for 6 months during and for 6 months after the intervention. For comparison, data was collected on another group of 448 enrollees who were also high consumers of health resources but who did not receive CHW intervention. For all measures, there was a significant reduction in both numbers of claims and payments after the community health worker intervention. Costs also declined in the non-CHW group on all measures, but to a more modest degree, with a greater reduction than in the CHW group in use of ambulatory services. The incorporation of field-based, community health workers as part of Medicaid managed care to provide supportive services to high resource-consuming enrollees can improve access to preventive and social services and may reduce resource utilization and cost.
    Journal of Community Health 09/2011; 37(3):563-71. · 1.28 Impact Factor
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    ABSTRACT: The FDA approval of mifepristone in 2000 broadened the available options for abortion. The aim of this study was to evaluate whether physicians in New Mexico have integrated the use of mifepristone into their practice. We performed a mail-out survey of New Mexico Obstetrician Gynecologists (Ob-Gyn) and Family Medicine (FM) physicians in 2001 and 2008. Questions addressed integration of abortion services, attitudes towards providing abortion in different scenarios and barriers to offering abortion services. The response rates were 59% for the 2001 survey and 54% in 2008. In 2001 and 2008, 11% and 15% (p=.26) of physicians, respectively, provided any abortion - medical or surgical. Similarly, in 2001 and 2008, 5% and 10% (p=.07) provided medical abortion. Commonly cited barriers to provision of abortion in both years were beliefs against abortion and lack of training. The number of physicians offering any abortion or medical abortion in New Mexico has not changed since the FDA approval of mifepristone. Residency training programs in FM and in Ob-gyn should include training in medical abortion.
    Contraception 08/2011; 84(2):178-83. · 3.09 Impact Factor
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    ABSTRACT: The aim of this study is to better understand anticipated changes in daily methadone doses as a guide for prescription during pregnancy. This retrospective case series involved a single cohort longitudinal design of 139 consecutively chosen women who began methadone therapy before 26 completed gestational weeks. Changes in the single daily dose were based on a standard opiate withdrawal scale and determined from early pregnancy until 6 weeks postpartum. As gestation advanced, the methadone dose increased (86%) rather than remained the same (8%) or decreased (7%). This gradual increase in daily dose during pregnancy (mean increase = 24 mg, 95% confidence level = 20-28 mg) was statistically significant (p < .001) regardless of the initial maintenance dose. By the sixth postpartum week, most subjects (85%) took within 10 mg of their dose at delivery (mean change in dose = -4 mg, 95% confidence interval = -6 to -2 mg). Daily doses of methadone increased until the third trimester, then remained essentially unchanged through the sixth postpartum week.
    Journal of substance abuse treatment 07/2011; 41(4):347-53. · 2.90 Impact Factor
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    ABSTRACT: The purpose of this study was to compare perceived parenting abilities in mothers with systemic sclerosis (SSc) based on the subtype of SSc and age group of their children, and to examine how the degree of pain, fatigue and functional ability relates to parenting ability. In this cross-sectional survey, 74 mothers with SSc, who had children aged 18 years or younger living at home with them, completed a series of questionnaires online or on paper. The questionnaires included the Parent Disability Index (PDI) and surveys regarding demographic information, pain (visual analogue scale), fatigue (Multidimensional Assessment of Fatigue) and functional ability (Health Assessment Questionnaire). An analysis of variance revealed that the mean age of the mother (F(2,71)  = 7.9; p < 0.01), mean PDI score (F(2,68)  = 5.4; p < 0.01) and mean pain score (F(2,71)  = 4.0; p = 0.02) were each associated with the age group of the children. The univariate analysis of variance results showed that dichotomized pain (F(1,69)  = 13.3; p < 0.01), fatigue (F(1,69)  = 18.9; p < 0.01) and disability (F(1,69)  = 9.8; p < 0.01) were each associated with the PDI score. The multivariate analysis of variance results showed that dichotomized pain (F(1,68)  = 7.5; p < 0.01) and fatigue (F(1,68)  = 12.7; p < 0.01) were associated with the PDI. Mothers with SSc report difficulty with parenting, which can be related to the severity of the symptoms. The findings suggest that interventions to reduce pain and fatigue may improve perceived parenting ability.
    Musculoskeletal Care 03/2011; 9(1):32-40.
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    ABSTRACT: Patients with chronic non-cancer pain (CNCP) are common and have a high degree of morbidity. Previous studies document clinician frustration and variability in CNCP management. We conducted this study to gather in-depth clinicians' views about factors that affect management of CNCP. We conducted a survey in the Primary Care MultiEthnic Network, a consortium of PBRNs of primary care clinicians practicing in low-income, medically underserved communities, and in a network of private primary care offices. Of 792 clinicians surveyed, 497 (63%) participated. Responses and accompanying narrative comments clustered around 5 themes: (1) barriers to and uncertainties in optimal management; (2) the complex biopsychosocial nature of CNCP; (3) seriousness of prescription opioid abuse; (4) effort and burden required to properly manage CNCP; and (5) clinician commitment to provide care for CNCP patients and benefits of expanded care model for CNCP. One-third reported a severe outcome (death or life-threatening event) in a CNCP patient for whom they had prescribed opioids. Roughly one-third do not initiate prescribing of opioids. Guidelines and increased continuing medical education alone are unlikely to be the solutions to the challenges of CNCP management. Increased evidence for recommendations and resources for more comprehensive care management are needed.
    The Journal of the American Board of Family Medicine 01/2011; 24(5):551-61. · 1.76 Impact Factor
  • American Journal of Obstetrics and Gynecology - AMER J OBSTET GYNECOL. 01/2011; 204(1).
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    ABSTRACT: To determine factors associated with 24-month change in quality of life in children with asthma and their parents during the Childhood Asthma Management Program (CAMP). Participants from 4 CAMP clinical centers were administered the Pediatric Asthma Quality of Life questionnaire and protocol measures of asthma symptoms, lung function, and psychological measures. Multivariate logistic regression analyses determined predictors of moderate change in quality of life. Subclinical levels of depression predicted moderate improvement in child-reported quality of life. Level of depressed affect together with clinical asthma features predicted moderate decline. Improvement in parent quality of life was predicted by perception of illness burden, whereas family features and a child missing school predicted moderate decline. This ancillary study provided an opportunity to examine the determinants of 24-month change in parent and child of quality of life within a subset of the CAMP participants. Moderate changes in quality of life occur in clinical studies and have both psychosocial correlates and illness characteristics.
    Quality of Life Research 12/2010; 19(10):1517-27. · 2.41 Impact Factor
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    ABSTRACT: Determine whether infants exposed to chronic maternal methadone with abnormal intrapartum fetal heart rate (FHR) patterns are more likely to require treatment for neonatal abstinence syndrome (NAS). Intrapartum FHR tracings analyzed in 104 pregnancies at ≥ 34 weeks gestation for FHR variability, accelerations, and decelerations. FHR patterns compared between neonates based on treatment with methadone for NAS. Secondary analysis included relation between maternal methadone dose and intrapartum FHR patterns, initiation of methadone, age at methadone initiation, and total neonatal methadone dose. Study powered to detect 30% increase in NAS incidence in neonates with abnormal FHR tracings. Seventy-six (73%) of 104 neonates required methadone treatment for NAS. Neonates who required methadone had higher average baseline FHR (131 vs. 126 bpm; p < 0.04) in active labor and less likely to have FHR tracings without accelerations (1.7% vs. 20.3%; p = 0.007) in latent labor. No significant associations between neonate's need for methadone and intrapartum FHR variability or FHR decelerations. No association between maternal methadone dose (range 30-280 mg) and treatment for NAS. The need for an infant to require methadone treatment for NAS was not reliably predicted by the intrapartum FHR patterns or the maternal methadone dose.
    The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 12/2010; 24(7):955-9. · 1.36 Impact Factor
  • Clinical Pediatrics 10/2010; 49(10):989-91. · 1.27 Impact Factor
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    ABSTRACT: ABSTRACT The purposes of this study were to compare dexterity, visual perception, and abilities to carry out activities of daily living (ADL) in persons with different multiple sclerosis (MS) subtypes and to determine what relationships exist between the three variables. Fifty-six persons with MS were administered tests of dexterity, visual perception, and ADL ability. Demographic variables and scores on Kurtzke's Expanded Disability Status Scale were also collected. Scores from the chronic-progressive group were significantly higher than those of the benign and progressive-relapsing groups for the Nine-Hole Peg Test-Left Hand, Grooved Peg Test, and Functional Status Index (except Functional Status Index-Pain). There were no differences between the MS groups for any demographic variables except on the Expanded Disability Status Scale. Visual perception did not correlate with dexterity or ADL ability, and only dexterity scores for the left hand correlated with ADL ability. Persons with the severer subtype of MS were significantly impaired compared with the least severe group for dexterity and ADL ability. Decreased dexterity was associated with needing more assistance and having more perceived difficulty with ADL.
    Occupational Therapy in Health Care 04/2010; 24(2):159-170.
  • Journal of Adolescent Health - J ADOLESCENT HEALTH. 01/2010; 46(2).

Publication Stats

620 Citations
138.93 Total Impact Points


  • 1989–2012
    • University of New Mexico
      • • Occupational Therapy Graduate Program
      • • Department of Pediatrics
      • • Department of Family And Community Medicine
      • • School of Medicine
      Albuquerque, NM, United States
  • 2003
    • St. Louis College of Pharmacy
      San Luis, Missouri, United States
  • 1999
    • The University of Arizona
      • Department of Physiology
      Tucson, AZ, United States
    • University of North Carolina at Chapel Hill
      • Department of Biostatistics
      Chapel Hill, NC, United States
  • 1994–1997
    • University of New Mexico Hospitals
      Albuquerque, New Mexico, United States