This "Controversies in Cardiovascular Research" article evaluates the evidence for and against the hypothesis that the circulating blood level of growth differentiation factor 11 (GDF11) decreases in old age and that restoring... more
This "Controversies in Cardiovascular Research" article evaluates the evidence for and against the hypothesis that the circulating blood level of growth differentiation factor 11 (GDF11) decreases in old age and that restoring normal GDF11 levels in old animals rejuvenates their skeletal muscle and reverses pathological cardiac hypertrophy and cardiac dysfunction. Studies supporting the original GDF11 hypothesis in skeletal and cardiac muscle have not been validated by several independent groups. These new studies have either found no effects of restoring normal GDF11 levels on cardiac structure and function or have shown that increasing GDF11 or its closely related family member growth differentiation factor 8 actually impairs skeletal muscle repair in old animals. One possible explanation for what seems to be mutually exclusive findings is that the original reagent used to measure GDF11 levels also detected many other molecules so that age-dependent changes in GDF11 are ...
Research Interests:
Gestational diabetes (GDM) occurs in up to 9% of pregnancies. Perinatal depression affects up to 20% of women during pregnancy, and can extend into the postpartum period. A number of studies have linked depression and diabetes, however,... more
Gestational diabetes (GDM) occurs in up to 9% of pregnancies. Perinatal depression affects up to 20% of women during pregnancy, and can extend into the postpartum period. A number of studies have linked depression and diabetes, however, whether this applies to GDM or which might come first is less understood. The purpose of this study was to examine the potential relationship between depression identified in the first trimester of pregnancy and the subsequent development of GDM. Women without pre-existing Type I/II diabetes (n = 1021) were evaluated for depression during the first trimester of pregnancy, and medical records were reviewed to identify a positive history of diabetes. Women identified as depressed during the first trimester were more likely to have GDM compared to those not depressed. After controlling for demographic factors and weight-related variables level of depression in the first trimester still predicted later GDM development. Depression identified in early preg...
Infants delivered at ≥ 37 weeks' gestation are considered full term, but research has demonstrated those born at 37 to 38 weeks (early term) have a higher risk for poor birth outcomes than deliveries at 39 to 41 weeks (full term).... more
Infants delivered at ≥ 37 weeks' gestation are considered full term, but research has demonstrated those born at 37 to 38 weeks (early term) have a higher risk for poor birth outcomes than deliveries at 39 to 41 weeks (full term). Despite this, many deliveries occur electively (scheduled, no medical indication) before 39 weeks. This study examined the risks of elective early-term delivery in a disadvantaged, rural sample and compared these results with national findings. Data were available for 638 rural women, recruited prenatally from three counties in rural southern Appalachia, who delivered electively at ≥ 37 weeks. Compared with electively delivered full-term infants, those delivered electively at early term were 7.7 times more likely to be low birth weight, 4.4 times more likely to have a neonatal intensive care unit admission, and 2.5 times more likely to develop jaundice. Those living furthest from the hospital were most likely to deliver electively at <39 weeks. Alth...
Research Interests:
Measurement of carbon monoxide in expired air samples (ECO) is a non-invasive, cost-effective biochemical marker for smoking. Cut points of 6ppm-10ppm have been established, though appropriate cut-points for pregnant woman have been... more
Measurement of carbon monoxide in expired air samples (ECO) is a non-invasive, cost-effective biochemical marker for smoking. Cut points of 6ppm-10ppm have been established, though appropriate cut-points for pregnant woman have been debated due to metabolic changes. This study assessed whether an ECO cut-point identifying at least 90% of pregnant smokers, and misidentifying fewer than 10% of non-smokers, could be established. Pregnant women (N=167) completed a validated self-report smoking assessment, a urine drug screen for cotinine (UDS), and provided an expired air sample twice during pregnancy. Half of women reported non-smoking status early (51%) and late (53%) in pregnancy, confirmed by UDS. Using a traditional 8ppm+cut-point for the early pregnancy reading, only 1% of non-smokers were incorrectly identified as smokers, but only 56% of all smokers, and 67% who smoked 5+ cigarettes in the previous 24h, were identified. However, at 4ppm+, only 8% of non-smokers were misclassified as smokers, and 90% of all smokers and 96% who smoked 5+ cigarettes in the previous 24h were identified. False positives were explained by heavy second hand smoke exposure and marijuana use. Results were similar for late pregnancy ECO, with ROC analysis revealing an area under the curve of .95 for early pregnancy, and .94 for late pregnancy readings. A lower 4ppm ECO cut-point may be necessary to identify pregnant smokers using expired air samples, and this cut-point appears valid throughout pregnancy. Work is ongoing to validate findings in larger samples, but it appears if an appropriate cut-point is used, ECO is a valid method for determining smoking status in pregnancy.
Research Interests:
Research Interests:
EJ867639 - Assessing Perceived Professionalism in Medical School Applicants.
Research Interests:
Obstructive sleep apnea syndrome (OSAS) may promote hyperglycemia and insulin resistance. We studied the link between sleep apnea and microvascular diabetic complications in veterans with type 2 diabetes mellitus (DM-2). A retrospective... more
Obstructive sleep apnea syndrome (OSAS) may promote hyperglycemia and insulin resistance. We studied the link between sleep apnea and microvascular diabetic complications in veterans with type 2 diabetes mellitus (DM-2). A retrospective electronic chart of all veterans referred for sleep studies over a 1-year period was reviewed. Ninety-eight patients with a glycosylated hemoglobin &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 6.5% were included in the study. The degree of glycemia (HbA1c) and presence of macro- and microvascular complications were compared with OSAS variables. Statistical analysis examined bivariate associations between OSAS variables and metabolic syndrome parameters. The apnea hypopnea index was significantly related to diabetic microvascular complications, particularly retinopathy. Oxygen desaturation was significantly and inversely related to microalbuminuria, microvascular complications, retinopathy, and HbA1c. Sleep apnea is associated with microvascular complications even in well-controlled DM-2 veterans. Screening for OSAS should be considered in patients with DM-2.
Research Interests:
ABSTRACT
Research Interests:
Purpose: Infants delivered at 37 weeks gestation or later have been considered full term, but recent research demonstrates those born at 37-38 weeks (early term) have higher risk for poor birth outcomes than deliveries at 39-41 weeks... more
Purpose: Infants delivered at 37 weeks gestation or later have been considered full term, but recent research demonstrates those born at 37-38 weeks (early term) have higher risk for poor birth outcomes than deliveries at 39-41 weeks (full term). Despite this, a high percentage of deliveries still occur electively (scheduled with no medical indication) prior to 39 weeks. This study examined these risks in a disadvantaged, rural sample, particularly among those who electively delivered early term, and compared these results to national findings. Methods: Data were available for 1772 women, recruited prenatally, from three counties in rural, Southern Appalachia who delivered at 37+ weeks. Findings: Compared with full term infants, those delivered early term were significantly smaller, had longer hospital stays with higher rates of NICU admission and were more likely to develop jaundice. Similarly, among those with elective deliveries, compared with full term infants, those born early ...
Background: In 2007, the TIPS program was funded to reduce pregnancy smoke exposure in Northeast Tennessee. Methods: Smoking cessation counselors, who used a motivational interviewing brief intervention model (5 A's) were available in... more
Background: In 2007, the TIPS program was funded to reduce pregnancy smoke exposure in Northeast Tennessee. Methods: Smoking cessation counselors, who used a motivational interviewing brief intervention model (5 A's) were available in prenatal practices and offered enrollment to all new prenatal patients smoking at the time of conception. Results: Over a three year period, eligible women (n=1254) were invited to participate, and 1108 (88%) agreed to meet with a counselor at least once. 27% had already attempted to quit smoking, and 80% successfully remained smoke free. An additional 7% subsequently quit smoking and remained smoke free to delivery, for a total cessation rate among all participants of 28%. An additional 15% had at least one quit attempt. Of those who continued to smoke, 63% reduced their smoking levels. Over 10% completely eliminated second-hand-smoke (SHS), and 58% significantly reduced such exposure. Services associated with smoking and SHS changes included meet...
Research Interests:
Research Interests:
Research Interests:
In addition to fetal alcohol syndrome and fetal alcohol spectrum disorders, prenatal alcohol exposure is associated with many other adverse pregnancy and birth outcomes. Research suggests that alcohol use during pregnancy may increase the... more
In addition to fetal alcohol syndrome and fetal alcohol spectrum disorders, prenatal alcohol exposure is associated with many other adverse pregnancy and birth outcomes. Research suggests that alcohol use during pregnancy may increase the risk of miscarriage, stillbirth, preterm delivery, and sudden infant death syndrome. This research has some inherent difficulties, such as the collection of accurate information about alcohol consumption during pregnancy and controlling for comorbid exposures and conditions. Consequently, attributing poor birth outcomes to prenatal alcohol exposure is a complicated and ongoing task, requiring continued attention to validated methodology and to identifying specific biological mechanisms.
Research Interests:
This article focuses on a systems biology approach to studying the pathophysiology of cigarette smoking during pregnancy. Particular emphasis is given to the damaging role of oxidative stress. Cigarette smoking exerts multiple adverse... more
This article focuses on a systems biology approach to studying the pathophysiology of cigarette smoking during pregnancy. Particular emphasis is given to the damaging role of oxidative stress. Cigarette smoking exerts multiple adverse affects but abundant evidence, mostly in adults, suggests that oxidative stress and free radical damage is a major pathophysiological factor. Smoking during pregnancy is known to contribute to numerous poor birth outcomes, such as low birth weight, preterm birth as well as life-long health and developmental problems. It is clinically important to know the separate contributions that cigarette derived-nicotine and smoking-induced free oxidative stress make to these poor outcomes. Surprisingly, the extent to which smoking dependent oxidative stress contributes to these poor outcomes is not well studied but the application of redox proteomics should be useful. Considerable biochemical evidence suggests that antioxidants, such as tocopherols and ascorbate,...
Research Interests:
Research Interests:
Research Interests:
Cognitive Science, Child Development, Birth Weight, Prospective studies, Pregnancy, and 20 moreHumans, Child, African American, Smoking, Female, Cocaine, Ethanol, Infant, Follow-up studies, Newborn Infant, Older Women, Adult, Maternal Age, Body Weight, Long Term Effect, Body Height, Illicit Drug Use, Neurosciences, Prenatal Cocaine Exposure, and Substance-Related Disorders
Research Interests:
Research Interests:
Although physical abuse during pregnancy has been linked to poor birth outcomes, the role of psychological abuse is less well understood. Associations between birth outcomes and types of psychological abuse during pregnancy (being... more
Although physical abuse during pregnancy has been linked to poor birth outcomes, the role of psychological abuse is less well understood. Associations between birth outcomes and types of psychological abuse during pregnancy (being threatened, screamed at, or insulted) were examined in 489 women with no history of physical abuse. Being threatened was significantly associated with adverse birth outcomes, with women reporting any instance during pregnancy twice as likely to deliver a low birth weight baby. These results remained after controlling for background factors. Finally, most of the variance between threats and birth weight was accounted for by mediating health behaviors (specifically prenatal care utilization and pregnancy weight gain), suggesting pathways for the negative effects of being threatened by an intimate partner during pregnancy.
Research Interests:
To assess the attitudes and behaviours of North Carolina tobacco farmers around crop diversification. Cross-sectional telephone survey. Active tobacco farmers in 14 North Carolina counties (n = 1236), interviewed between January and April... more
To assess the attitudes and behaviours of North Carolina tobacco farmers around crop diversification. Cross-sectional telephone survey. Active tobacco farmers in 14 North Carolina counties (n = 1236), interviewed between January and April 1997 (91% response rate). Interest in, experience with, and perceived barriers to diversification. Most farmers (95%) grew/raised a commodity other than tobacco (mean = 2.8). A total of 60% of farmers expressed interest in trying other on-farm activities to supplement their tobacco and 60% reported taking action in the past year around supplementation. Younger age and college education were positively associated with interest. College education, off-farm income, and larger farm size were associated with the number of actions taken. For perceived external barriers to diversification, use of tobacco, percent income from tobacco, lack of college education, and younger age were most strongly associated with the number of barriers. For internal barriers (personal factors), percent income from tobacco, use of tobacco, and lack of college education were most strongly associated with the number of barriers. Most farmers were involved in diverse operations and expressed interest in continuing to diversify, although the breadth of diversification was narrow. Farmers noted many barriers to diversifying. If conventional production and marketing techniques are employed for non-tobacco alternatives, these alternatives may not provide the sustainable profitability that tobacco has afforded. Competition from foreign tobacco growers is the primary threat to the future of American growers and tobacco dependent communities.
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Prostate cancer remains the second most commonly diagnosed cancer among the male population worldwide. Vitamin D deficiency has been linked to prostate cancer and its aggressiveness. Herein, we initiated a retrospective study to evaluate... more
Prostate cancer remains the second most commonly diagnosed cancer among the male population worldwide. Vitamin D deficiency has been linked to prostate cancer and its aggressiveness. Herein, we initiated a retrospective study to evaluate vitamin D status and monitoring in veterans with prostate cancer, and to examine the potential link between vitamin D and survival status and length of survival in this population. We found that veterans who were initially vitamin D deficient were significantly less likely to survive than those who were not initially deficient, and that both initial and follow-up vitamin D deficiency were associated with decreased likelihood of survival after prostate cancer diagnosis. We recommend that vitamin D deficiency be replaced in veterans with prostate cancer.
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Tobacco, Adolescent, Birth Weight, Drug Use, Pregnancy, and 21 moreHumans, Smoking Cessation, Substance Use, Smoking, Tobacco Use, Female, Drug Screening, Young Adult, Tennessee, Newborn Infant, Maternal child health, Adult, Pregnant Women, Illicit Drugs, Street Drugs, Gestational Age, Illicit Drug Use, Self report, Prenatal Care, Pregnancy Outcome, and Substance-Related Disorders
Research Interests:
Research Interests:
Humans, Veterans, Amputation, Risk factors, Tennessee, and 14 moreClinical Sciences, Aged, Middle Aged, Adult, Public health systems and services research, Cardiovascular Risk Factor, Retrospective Studies, Cardiovascular Diseases, Risk Factors, Vitamin D Deficiency, Peripheral Arterial Disease, Medical Audit, Peripheral artery disease, and The American
Research Interests:
Research Interests:
... Reply to the Letter to the Editor by Faulhaber, Schulz, and Furlanetto. Alan N. Peiris, MD, PhD, MRCP(UK). Beth Bailey, PhD. Mountain Home VAMC, Department of Internal Medicine, East Tennessee State University, Johnson City,... more
... Reply to the Letter to the Editor by Faulhaber, Schulz, and Furlanetto. Alan N. Peiris, MD, PhD, MRCP(UK). Beth Bailey, PhD. Mountain Home VAMC, Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee. ...
Research Interests:
Research Interests:
Research Interests:
Religious Commitment is a construct known to be predictive of various health-related factors of importance to researchers. However, data collection efficiency and instrument brevity in healthcare settings are priorities regardless of the... more
Religious Commitment is a construct known to be predictive of various health-related factors of importance to researchers. However, data collection efficiency and instrument brevity in healthcare settings are priorities regardless of the construct being measured. Brief, valid instruments are particularly valuable in health research and will be vital for testing mechanisms by which health may be improved or maintained. This series of studies aims to demonstrate that Religious Commitment can be validly measured with a very brief instrument, the Religious Surrender &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Attendance Scale-3 (RSAS-3), which combines a 2-item measure of Surrender, a specific type of religious coping, with a 1-item measure of Attendance at religious services. Three studies are reported, two utilizing undergraduate university students (Ns = 964 and 466) and one utilizing a clinical-based pregnant population (N = 320), all in southern Appalachia. The original 12-item Surrender Scale, a 2-item subset of Surrender items, and Attendance were found to be highly positively correlated with each other and with Intrinsic Religiosity, an additional measure of Religious Commitment employed to demonstrate concurrent validity. Religiosity variables were found to be strongly negatively correlated with Anxiety and stress, which were the health outcomes of interest. Hierarchical multiple regression analysis was used to confirm the similarity of Anxiety and stress prediction using the 12-item and 2-item Surrender measures and to confirm the superior stress prediction of the 3-item instrument RSAS-3. The RSAS-3 is recommended as a measure of Religious Commitment in future health research.