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"Joy, Elizabeth A"
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Mrs. Wishy-Washy's Farm
Tired of being washed by Mrs. Wishy-Washy, a cow, pig, and duck leave her farm and head for the city.
Book
Short-Term Elevation of Fine Particulate Matter Air Pollution and Acute Lower Respiratory Infection
Abstract
Rationale
Nearly 60% of U.S. children live in counties with particulate matter less than or equal to 2.5 μm in aerodynamic diameter (PM2.5) concentrations above air quality standards. Understanding the relationship between ambient air pollution exposure and health outcomes informs actions to reduce exposure and disease risk.
Objectives
To evaluate the association between ambient PM2.5 levels and healthcare encounters for acute lower respiratory infection (ALRI).
Methods
Using an observational case-crossover design, subjects (n = 146,397) were studied if they had an ALRI diagnosis and resided on Utah’s Wasatch Front. PM2.5 air pollution concentrations were measured using community-based air quality monitors between 1999 and 2016. Odds ratios for ALRI healthcare encounters were calculated after stratification by ages 0–2, 3–17, and 18 or more years.
Measurements and Main Results
Approximately 77% (n = 112,467) of subjects were 0–2 years of age. The odds of ALRI encounter for these young children increased within 1 week of elevated PM2.5 and peaked after 3 weeks with a cumulative 28-day odds ratio of 1.15 per +10 μg/m3 (95% confidence interval, 1.12–1.19). ALRI encounters with diagnosed and laboratory-confirmed respiratory syncytial virus and influenza increased following elevated ambient PM2.5 levels. Similar elevated odds for ALRI were also observed for older children, although the number of events and precision of estimates were much lower.
Conclusions
In this large sample of urban/suburban patients, short-term exposure to elevated PM2.5 air pollution was associated with greater healthcare use for ALRI in young children, older children, and adults. Further exploration is needed of causal interactions between PM2.5 and ALRI.
Journal Article
Choices : all-new tales of Valdemar
\"The Heralds of Valdemar are the kingdom's ancient order of protectors. They are drawn from all across the land, from all walks of life, and at all ages--and all are Gifted with abilities beyond those of normal men and women. They are Mindspeakers, FarSeers, Empaths, ForeSeers, Firestarters, FarSpeakers, and more. These inborn talents--combined with training as emissaries, spies, judges, diplomats, scouts, counselors, warriors, and more--make them indispensable to their monarch and realm. Sought and Chosen by mysterious horse-like Companions, they are bonded for life to these telepathic, enigmatic creatures. The Heralds of Valdemar and their Companions ride circuit throughout the kingdom, protecting the peace and, when necessary, defending their land and monarch. Now, twenty-three authors ride with Mercedes Lackey to her magical land of Valdemar, adding their own unique voices to the Heralds, Bards, Healers, and other heroes of this beloved fantasy realm.\"--Amazon.com.
Book
Assessing Health Care Providers’ Knowledge of Arthritis-Appropriate, Evidence-Based Interventions Through Online Self-Assessment
Physical activity is an important nonpharmacological strategy for managing arthritis-attributable pain and improving physical function. To prepare health care providers (HCPs) to deliver this care, the National Association of Chronic Disease Directors, the Centers for Disease Control and Prevention, and Medscape Education developed an online clinical practice assessment activity (CPA). This activity aimed to help HCPs assess their knowledge of arthritis-appropriate, evidence-based interventions (AAEBIs) and better incorporate them into treatment programs.
A 27-question CPA was launched in November 2022 and analyzed in May 2025. Educational effectiveness was assessed with a repeated-pairs preassessment/postassessment. Responses to multiple choice and confidence questions were aggregated and analyzed to help us understand participants' current practices and education needs for the management of patients with arthritis.
Approximately 20,000 HCPs accessed the CPA; 4,395 completed the assessment and were included in the analysis. Less than two-thirds (59.8%) correctly identified recommendations about weekly moderate-intensity physical activity for adults with arthritis. After participating in the CPA, 82.2% agreed or strongly agreed that their awareness of AAEBIs and their benefits had increased.
HCPs showed a need for education to reinforce, improve, or extend knowledge about arthritis risk factors, barriers to physical activity, and physical activity prescription.
Journal Article
Diabetes self-management education improves quality of care and clinical outcomes determined by a diabetes bundle measure
The purpose of this study was to determine the impact of diabetes self-management education (DSME) in improving processes and outcomes of diabetes care as measured by a five component diabetes bundle and HbA1c, in individuals with type 2 diabetes mellitus (T2DM).
A retrospective analysis was performed for adult T2DM patients who received DSME training in 2011-2012 from an accredited American Diabetes Association center at Intermountain Healthcare (IH) and had an HbA1c measurement within the prior 3 months and 2-6 months after completing their first DSME visit. Control patients were selected from the same clinics as case-patients using random number generator to achieve a 1 to 4 ratio. Case and control patients were included if 1) pre-education HbA1c was between 6.0%-14.0%; 2) their main provider was a primary care physician; 3) they met the national Healthcare Effectiveness Data and Information Set criteria for inclusion in the IH diabetes registry. The IH diabetes bundle includes retinal eye exam, nephropathy screening or prescription of angiotensin converting enzyme or angiotensin receptor blocker; blood pressure <140/90 mmHg, LDL <100 mg/dL, HbA1c <8.0%.
DSME patients had a significant difference in achievement of the five element IH diabetes bundle and in HbA1c % compared to those without DSME. After adjusting for possible confounders in a multivariate logistic regression model, DSME patients had a 1.5 fold difference in improvement in their diabetes bundle and almost a 3 fold decline in HbA1c compared to the control group.
Standardized DSME taught within an IH American Diabetes Association center is strongly associated with a substantial improvement in patients meeting all five elements of a diabetes bundle and a decline in HbA1c beyond usual care. Given the low operating cost of the DSME program, these results strongly support the value adding benefit of this program in treating T2DM patients.
Journal Article
Incidental Risk of Type 2 Diabetes Mellitus among Patients with Confirmed and Unconfirmed Prediabetes
To determine the risk of type 2 diabetes (T2DM) diagnosis among patients with confirmed and unconfirmed prediabetes (preDM) relative to an at-risk group receiving care from primary care physicians over a 5-year period.
Utilizing data from the Intermountain Healthcare (IH) Enterprise Data Warehouse (EDW) from 2006-2013, we performed a prospective analysis using discrete survival analysis to estimate the time to diagnosis of T2DM among groups.
Adult patients who had at least one outpatient visit with a primary care physician during 2006-2008 at an IH clinic and subsequent visits through 2013. Patients were included for the study if they were (a) at-risk for diabetes (BMI ≥ 25 kg/m2 and one additional risk factor: high risk ethnicity, first degree relative with diabetes, elevated triglycerides or blood pressure, low HDL, diagnosis of gestational diabetes or polycystic ovarian syndrome, or birth of a baby weighing >9 lbs); or (b) confirmed preDM (HbA1c ≥ 5.7-6.49% or fasting blood glucose 100-125 mg/dL); or (c) unconfirmed preDM (documented fasting lipid panel and glucose 100-125 mg/dL on the same day).
Of the 33,838 patients who were eligible for study, 57.0% were considered at-risk, 38.4% had unconfirmed preDM, and 4.6% had confirmed preDM. Those with unconfirmed and confirmed preDM tended to be Caucasian and a greater proportion were obese compared to those at-risk for disease. Patients with unconfirmed and confirmed preDM tended to have more prevalent high blood pressure and depression as compared to the at-risk group. Based on the discrete survival analyses, patients with unconfirmed preDM and confirmed preDM were more likely to develop T2DM when compared to at-risk patients.
Unconfirmed and confirmed preDM are strongly associated with the development of T2DM as compared to patients with only risk factors for disease.
Journal Article
Promoting the athlete in every child: physical activity assessment and promotion in healthcare
Active transportation to and from school, recess, quality physical education, sport and after school activities provide numerous opportunities for children and adolescents to achieve the recommended 60 min/day of moderate to vigorous PA. 5 6 Despite these opportunities, only 27.1% of US high school students surveyed participate in at least 60 min/day of PA on 7 days of the week, and only 29% attend daily physical education. 7 By age 15, only 17% of US girls, compared to 33% of boys, report at least 1 hour of moderate-to-vigorous PA daily. 8 Multiple sectors of society (eg, school, public health, healthcare) need to focus efforts and resources to ensure that youth and families are encouraged to be physically active on most, if not all, days of the week. 11 The pediatric Physical Activity Vital Sign While the best evidence for influencing youth PA lies in schools, 6 healthcare providers retain an important role in promoting PA as a part of healthy lifestyle education. 6 Physicians regularly see children and adolescents for preventive care, providing multiple opportunities to assess, educate and counsel patients and parents about the importance of regular PA, exercise and sports to promote health and well-being.
Journal Article
Sexual violence in sport: American Medical Society for Sports Medicine Position Statement
The American Medical Society for Sports Medicine (AMSSM) convened a group of experts to develop a Position Statement addressing the problem of sexual violence in sport. The AMSSM Sexual Violence in Sport Task Force held a series of meetings over 7 months, beginning in July 2019. Following a literature review, the Task Force used an iterative process and expert consensus to finalise the Position Statement. The objective of this Position Statement is to raise awareness of this critical issue among sports medicine physicians and to declare a commitment to engage in collaborative, multidisciplinary solutions to reduce sexual violence in sport.
Journal Article
A Retrospective Chart Review Suggests That Coordinated, Multidisciplinary Treatment for Patients with Anorexia Nervosa Improves Odds of Weight Restoration
The objective of this study was to conduct a secondary data analysis of clinical information documented in the electronic medical record to assess the clinical outcomes of patients who received three different treatment approaches on clinical outcomes for treatment of patients with anorexia nervosa (AN).
Historical electronic medical record (EMR) data on patients aged 6 to 80 years diagnosed with AN seen in a healthcare system between 2007 and 2017 were stratified, according to services received, into three groups: Group A (n = 48) received hospital-based services; Group B (n = 290) saw one or two provider types; Group C (n = 26) received outpatient coordinated multidisciplinary care from three provider types. Clinical outcomes [body mass index for adults (BMI), body mass index percentile (BMI%ile) for pediatric patients] defined AN severity and weight restoration. EMR data were analyzed using a generalized mixed-effects model and a Markov Transition model to examine the odds of weight restoration and the change in odds of weight restoration across the number of provider visits, respectively.
Patients receiving coordinated multidisciplinary care had significantly higher odds of weight restoration compared with patients receiving hospital-based services only (OR = 3.76, 95% CI [1.04, 13.54],
= 0.042). In addition, patients receiving care from 1 to 2 providers (OR = 1.006, 95% CI [1.003, 1.010],
= 0.001) or receiving coordinated multidisciplinary care (OR = 1.005, 95% CI [1.001, 1.011],
= 0.021) had significantly higher odds of weight restoration per provider visit day compared with patients receiving hospital-based services only.
This retrospective chart review supports the coordinated, multidisciplinary care model for the weight restoration in patients with AN in an outpatient setting.
Journal Article