• 10-Year Epidemiology of Ankle Injuries in Men’s and Women’s Collegiate Soccer Players

      Gulbrandsen, Matt; Chhabra, Anikar (The University of Arizona., 2020)
      Background: Data from the National Collegiate Athletic Associ-ation (NCAA) Injury Surveillance Program (ISP) has indicated that ankle injuries are the most common injuries among NCAA soccer players. Objective:To review 10 years of NCAA-ISP data for soccer players’ ankle injuries to understand how the time period (2004-2005 through 2008-2009 versus 2009-2010 through 2013-2014), anatomical structure injured, and sex of the athlete affected the injury rate, mechanism, and prognoses. Design:Descriptive epidemiology study. Setting: Online injury surveillance. Main Outcome Measure(s): The NCAA-ISP was queriedfor men’s and women’s soccer ankle data from 2004 to 2014. Ankle injury rates were calculated on the basis of injuries per 1000 athlete-exposures. Rate ratios (RRs) were used to compare injury rates. Injury proportion ratios (IPRs) were used to compare injury characteristics. Results: When compared with the 2004-2005 through 2008-2009 seasons, the 2009-2010 through 2013-2014 seasons showed a similar rate of injuries (RR¼0.94, 95% confidence interval [CI]¼0.85, 1.04) but fewer days missed (P,.001) and fewer recurrent injuries (IPR¼0.55, 95% CI¼0.41,0.74). The 4 most common ankle injuries, which accounted for 95% of ankle injuries, were lateral ligament complex tears(65.67%), tibiofibular ligament (high ankle) sprains (10.3%), contusions (10.1%), and medial (deltoid) ligament tears (9.77%). Of these injuries, high ankle sprains were most likely to cause athletes to miss 30þdays (IPR¼1.9, 95% CI¼1.24, 2.90). Men and women had similar injury rates (RR¼1.02, 95% CI¼0.94, 1.11). Men had more contact injuries (IPR¼1.28, 95% CI¼1.16, 1.41) and contusion injuries (IPR¼1.34, CI¼1.03, 1.73) but fewer noncontact injuries (IPR¼0.86, 95% CI¼0.78, 0.95) and lateral ligamentous complex injuries (IPR¼0.92, 95% CI¼0.86, 0.98). Conclusions: Although the rate of ankle injuries did not change between the 2004-2005 through 2008-2009 seasons and the 2009-2010 through 2013-2014 seasons, the prognoses improved. Among the 4 most common ankle injuries, high anklesprains resulted in the worst prognosis. Overall, male and female NCAA soccer players injured their ankles at similar rates; however, men were more likely to sustain contact injuries.
    • 3D Volumetric Measurement of Normal Pediatric Livers: Creating a Reference Database and Predictive Model

      Sandoval, Amber; Bardo, Dianna M. E. (The University of Arizona., 2020)
      Background: Accurate and reproducible measurements of pediatric organs are necessary for defining normal organ volume, size, growth rates, and patterns of development, which aids in determining pathological variants. Currently, no modern reliable database exists for normal liver volume (LV) in children, and although predictive equations have been proposed, many are based on adult data, ethnically homogenous populations, or are derived from smaller samples and have not utilized advanced imaging technology in determining LV in vivo. Objective: To establish normal LV measurements in children, using a three-dimensional (3D) volumetric approach, with additional consideration for height, weight, body surface area (BSA), and body mass index (BMI), and to develop a predictive model using these parameters. Materials and methods: A retrospective review of normal contrast enhanced abdomen and pelvis CT images of 184 patients from 1 month to 18 years, identified within the Phoenix Children’s Hospital picture archive communications system (PACS) was performed. Gender, age, height and weight were recorded for each patient; BSA and BMI were calculated. LV measurements were obtained using segmentation images software (IntelliSpace, Phillips Healthcare, Haifa, Israel). Results: Univariate analysis of LV was most strongly correlated with and predicted by BSA (R2 = 0.90, p < 0.0001), which could be defined by: LV = -115.5 + 941.7*BSA. In multivariate analysis, BSA (p < 0.0001), gender (p = 0.01), and height (p = 0.001) were the covariates that best predicted LV with an adjusted R2 value of 0.90. 3 Stratifying the model by age did not modify the predictive capabilities of the covariates. Further stratifying by gender revealed inconsistent effect modification in some age groups. Conclusion: Univariate analysis of LV was most strongly correlated with and predicted by BSA, which can be defined by: LV = -115.5 + 941.7*BSA.
    • A Randomized Control Trial of Benefits of Intrahopsital Exercise on Post-Transplantation Deconditioning in the Pediatric Hematopoietic Stem Cell Transplant Population

      Smith, Charles; The University of Arizona College of Medicine – Phoenix; Ngwube, Alexander (The University of Arizona., 2019)
      Deconditioning is a common adverse effect of short and long-term immobilization. For months pediatric hematopoietic stem cell transplant patients can be quarantined while hospitalized, much of which time is spent immobilized putting these patients at a higher risk for loss of muscle strength, functionality, endurance, and quality of life. Studies have shown that exercise as an effective countermeasure to deconditioning in stem cell transplant patients. However, research is lacking in pediatric HSCT due to the complications associated with treatment. This study was conducted to determine if there is a correlation between intrahopsital exercise and improved functionality, endurance, strength, and quality of life. In addition, this randomized control study looked at the merit and feasibility of adding an exercise routine into treatment plans. We have currently recruited 23 of our target 40 patients, 12 in the control arm and 11 in the intervention arm, ages 8-17 at Phoenix Children’s Hospital. Each participant received baseline measured by an OT or a PT for functionality using (WeeFIM), muscle strength using manual muscle testing (MMT), endurance using the 6-minute walk test, and quality of life using the NIH PROMIS measures. Measurements were taken again at discharge and 6-weeks post-discharge. During hospital admittance the intervention group performed exercise routines 3-times weekly while the control group were encouraged to spend time out of bed. Patients recruited were receiving their first HSCT and did not have any post-HSCT complications such as severe infection or GVHD. Data and results are limited due to the timepoint of the study and the limited number of recruited patients affecting the power of the study. No statistically significant difference is noted between the two arms in functional status, muscle strength, or endurance. There appears to be an increase in quality of life patients in the interventional arm compared to the control arm. Simple analysis has shown that compliance with time out of bed decreases across both groups the further away from transplant. Currently the study is midway, and data is limited to make any conclusions but shows promise.
    • A Systematic Review of Physician-Patient Interactions and the Effect of Health Care Provider Bias and Knowledge on Adolescent Contraception Counseling in Developing Countries and Comprehensive Review: Contraceptive Use and Impact of Physician Counseling for Adolescent Patients of Method Choices and Side Effects in Developing Countries

      Cooke, Alexandra; The University of Arizona College of Medicine – Phoenix; Beyda, David (The University of Arizona., 2019)
      Unmet need for contraceptives in developing countries remains a social and health problem and adolescents are more likely to struggle in starting long-acting contraceptive methods, often due to side effect or other concerns. This study aimed to analyze the biases in the provider-patient relationship and counselling practices for adolescent patients in developing countries. Attention was placed on patient’s preferred method, cultural and moral biases, knowledge gaps of patient and providers, side effect knowledge, and attitudes impacting the relationship upon counseling quality and likelihood of contraceptive use. Systematic review of articles with MeSH terms “developing countries,” “contraception,” “adolescents,” and other search terms yielded 6745 articles; 14 articles were chosen for further review. Findings highlight negative impacts of providers’ ethical concerns and knowledge gaps when addressing method use and side effects. Low knowledge base by providers of varying skill level also highlight a need for improved training on family planning methods.
    • A Systematic Review of the Effectiveness of HIV Intervention Programs on HIV Rates, Condom Use, and Abstinence in Adolescents in Low Resource Countries and The Pathophysiology, Role, Prevention, and Treatment of HIV in Low Resource Countries

      Keerthi, Svadharma; The University of Arizona College of Medicine – Phoenix; Yoblonski, Lara (The University of Arizona., 2019)
      There are high rates of HIV in adolescent girls in low resource countries due to the high incidence and prevalence of sexual violence. The purpose of this project is to collect the data of educational programs that aim to decrease rates of HIV and describe their characteristics, specifically, the rates of HIV, the rate of sexual violence, condom use, and sexual practices before and after intervention by education programs. The data shows that none of the studied measures changed after educational programs.
    • A Systematic Review on the Effect of Misoprostol in the Prevention of Postpartum Hemorrhage in Sub-Saharan African Women of Reproductive Age

      Kassi, Luce Auriane; The University of Arizona College of Medicine – Phoenix; Brady, Michael (The University of Arizona., 2019)
      Postpartum hemorrhage (PPH) is the leading cause of maternal death worldwide. Oxytocin is the uterotonic drug of choice to prevent PPH. This systematic review was performed to evaluate the use of misoprostol as a possible alternative in resource-poor settings. Articles were selected on PubMed and the International Journal of Obstetrics and Gynecology based on their primary outcomes (estimated blood loss (EBL) in mL), region (Sub-Saharan Africa) and purpose (comparing (1) misoprostol with oxytocin or with a controlled placebo (2) and different doses of misoprostol). All meta-analyses used a Cohen’s D scale. There was no difference between the use of oxytocin over misoprostol and meta-analysis shows that when used separately, both medications decreased total EBL. Misoprostol at 400 and 600 mcg did not show any difference on EBL compared to oxytocin. In combination with oxytocin, there was no difference on EBL compared to misoprostol alone. When oxytocin was not added to misoprostol, there also was no difference on EBL compared to misoprostol alone. This study suggests that misoprostol may be a sustainable alternative to prevent PPH in resource-poor areas where oxytocin is unavailable.
    • Abnormal Face‐hand Testing is Associated with Anosognosia in Patients with Neuropathologically‐confirmed Alzheimer’s Disease

      Derksen, Brenna; The University of Arizona College of Medicine - Phoenix; Jacobson, Sandra (The University of Arizona., 2014-04)
      Objective To investigate whether specific elements of the neurological and neuropsychological evaluation are associated with anosognosia for memory impairment in subjects with neuropathologically-confirmed Alzheimer’s disease. Methods Included were subjects from the Arizona Study of Aging and Neurodegenerative Disease with clinically documented dementia and neuropathological confirmation of AD for whom anosognosia could be confirmed based on antemortem data. Anosognosia was defined by a discrepancy between 1) the patient’s self-report and results of testing, and/or 2) the patient’s self-report and the caregiver’s report regarding memory impairment. The anosognosic and non-anosognosic groups were compared on targeted clinical, cognitive, and neuropathological findings. Results Of 61 subjects included, 34 were diagnosed as anosognosic, and 27 non-anosognosic. The anosognosic group performed worse on two tests of frontal systems function - letter fluency (COWAT) (p=0.010) and a score derived from the Trailmaking test (Trailmaking B time – Trailmaking A time) (p=0.015). In addition, significantly more anosognosic subjects (92%) had abnormal results on face-hand testing (double simultaneous stimulation) compared to non-anosognosic subjects (62% abnormal; p=0.018). Significance In this study of patients with moderate Alzheimer’s disease (mean CDR=2), the anosognosic group showed significantly greater impairment on tests of frontal/executive function. In addition, this group had a significantly higher rate of abnormal face-hand testing, consistent with right parietal pathology. The FHT, which takes about 30 seconds to administer, may prove useful as a marker for anosognosia risk in AD.
    • Acute Exercise Alters Promoter Methylation in Human Skeletal Muscle

      DeMenna, Jacob; The University of Arizona College of Medicine - Phoenix; Coletta, Dawn (The University of Arizona., 2016-04)
      Background And Significance: Insulin resistance is an underlying disease of obesity and type 2 diabetes, which is a metabolic health crisis in the United States. Insulin resistance is caused by a combination of environmental and genetic factors. Understanding the epigenetic factors, specifically DNA methylation and how it influences the expression of genes linked to insulin resistance is of critical importance. Research Question: In this project, we set out to identify patterns of changes in DNA methylation in response to an acute exercise in healthy control subjects. Methods: Five lean (BMI = 23.6 ± 3.3 kg/m2) volunteers underwent a euglycemic hyperinsulinemic clamp with a baseline muscle biopsy and a single bout of aerobic exercise on a stationary bicycle for 48 minutes, rotating between 70 and 90% of VO2max, with a muscle biopsy taken 24 hours after completing the exercise. DNA was isolated from the baseline and 24 hours muscle biopsy, and next‐generation reduced representation bisulfite sequencing (RRBS) was performed, with analysis of the data using methylSig, and KEGG pathway analysis. Results: RRBS analysis captured 676,937 methylation sites, and of these 47,459 were differently methylated following acute exercise (P<0.05) with 4,574 sites occurring in promoter and untranslated (5’ and 3’) regions. The site with the greatest increase in methylation was within the gene NADP(+) ‐dependent malic enzyme cytosolic form (ME1) that demonstrated a significant methylation difference of +63.3%. A site in the gene for adenomatosis polyposis coli down‐regulated 1‐like (APCDD1L) was observed to have the most significant decrease in methylation by ‐65.3%. The gene with the highest incidence of differentially methylated sites was the gene for cardiomyopathy associated 5 (CMYA5) with 11 sites demonstrating a mean increase in methylation of 30.47%. The gene family with sequence similarity 176, member B protein (FAM176B) had the highest frequency of methylated sites (n=7) that were decreased in methylation with a mean decrease of ‐24.28%. KEGG pathway analysis was performed, which revealed significant (P<0.05) increases in methylation in the pathways of Wnt signaling, Heterotrimeric G‐protein signaling ‐Gi alpha and Gs alpha mediated, Cadherin signaling, Melanogenesis, Axon Guidance, and Neuroactive ligand‐receptor interaction. Significantly 4 enriched pathways with decreased methylation post exercise demonstrated one pathway, the Calcium signaling pathway. Conclusion: Our data demonstrates that a single bout of exercise can alter the DNA methylation pattern in skeletal muscle. Changes were observed in genes related to metabolic pathways, supporting previously published findings of changes in mRNA and proteins involved in metabolism following exercise. Future work is warranted with obese and type 2 diabetic participants to explore the differences in response to exercise between these groups.
    • Additional Hearing Screenings in Pediatrics: Does Earlier, More Consistent Screening Make a Difference?

      Loeb, Sophie; The University of Arizona College of Medicine – Phoenix; Samaddar, Kristen (The University of Arizona., 2019)
      Phoenix Children’s Hospital has implemented a program, following the guidelines set by the Ear Foundation, to do annual hearing screenings from birth to school age. This is in contrast to the recommendations by Bright Futures, which state that screening should be done at birth and then annually after the child has begun kindergarten. This study may help determine the incidence of failed hearing screenings and frequency with which failed screenings translate to an intervention, as well as drive clinical decisions on the frequency/number of screenings at well-child checks.
    • Adductor Canal Nerve Block to Improve Total Knee Arthroplasty Recovery

      Kozinn, Rachel; The University of Arizona College of Medicine - Phoenix; Sachdev, Harkanwal; Kozinn, Stuart (The University of Arizona., 2018-02-26)
      Pre-operative peripheral nerve block (PNB) is an adjunct anesthesia technique used in patients undergoing total knee arthroplasty to improve post-operative pain and speed overall recovery. Effective pain management and ability to ambulate post-operatively directly affects the patient’s pace of rehabilitation and recovery. Two types of peripheral nerve blocks, the standard femoral nerve block, and a more specific adductor canal block, have relative advantages and disadvantages. Research on the effectiveness of the adductor canal block for analgesia in patients who have received a total knee arthroplasty is limited. The purpose of this scholarly project is to study the efficacy of the adductor canal block (ACB) as compared with the femoral nerve block (FNB) for post-operative pain management in total knee arthroplasty. We have retrospectively reviewed 40 patients who each received a total knee arthroplasty by a single orthopedic surgeon during the study period from January 2014 to June 2015.
    • After receiving language concordant, individual health education interventions, do Spanish speaking, diabetic inpatients at a safety net hospital demonstrate acquired diabetes self-management competency as measured by pre-training and post training evaluation of key, diabetes self-management knowledge?

      Cagle, Jonathan; The University of Arizona College of Medicine - Phoenix; Abdollahi, Shagyegh (The University of Arizona., 2018-03-28)
      The purpose of this research was to assess the quality of the inpatient, health education diabetes program as it relates to primary Spanish speaking patients. Complications from diabetes account for huge personal and financial costs. There is substantial evidence supporting the use of targeted diabetes education to reduce complications but we need to know if our education interventions are valid. In order to accomplish this by auditing the knowledge of a sample of inpatient diabetics before and after receiving the standard MMC Spanish language diabetes education interventions via Spanish language pre and post surveys (standardized by the previously validated SKILLD survey). Demographic and clinical data were analyzed and all significant data (p value <0.05) were considered for their importance. The data demonstrated that in all 10 items on the survey, overall patients were able to demonstrate significant improvement in survey scores. Additionally, comparisons of demographic data demonstrated that being less than 50 years old was associated with improved survey scores. This indicates overall benefit of the training program as well as possible insight into need for more aggressive training for patients greater than 50 years in age.
    • Alcohol Withdrawal: Does Sex Matter?

      Canales, Francisco; The University of Arizona College of Medicine - Phoenix; Carlson, Richard (The University of Arizona., 2018-03-28)
      Alcohol Withdrawal Syndrome (AWS) occurs after an individual significantly reduces or completely stops consuming alcohol after a period of constant consumption. Existing literature plentifully describes social factors that contribute to lower likelihood of development of alcohol dependence among women. Physiological differences make alcohol dependent women more likely to develop alcoholrelated hepatic complications. Animal studies suggest that ovarian hormones are neuroprotective and lead to lower incidence of seizures and allow for quicker recovery from AWS.
    • Alternative Treatments for Osteoporosis in Postmenopausal Women - A Systematic Review

      McCann, Lelan; Beyda, David (The University of Arizona., 2020)
      Introduction: Many postmenopausal women desire non-pharmaceutical alternatives to bisphosphonates for the treatment of osteoporosis and prevention strategies against osteoporosis. Although highly effective in the treatment of osteoporosis, bisphosphonates have a serious side effect profile. These side effects limit the use and duration of bisphosphonates for the treatment of osteoporosis, thus revealing the need for alternative therapies for osteoporosis. Methods: The systematic review was conducted by searching the electronic database of PubMed/MEDLINE using the MeSH terms “postmenopausal osteoporosis” and “vitamins” from January 1961 to April 2019. The review included randomized controlled trials that studied the effects of vitamin supplementation on bone turnover markers and bone mineral density in postmenopausal women with or without osteoporosis. The articles selected for use in this review were assessed for quality using an assessing instrument developed by Jadad et al (1). Results: Twelve articles were included in the final systematic review. These studies showed that vitamin supplements, soy isoflavones, or probiotics decreased the measured markers of bone turnover in studies with a treatment period ranging from 84 days to 48 months. Discussion: Supplementation with probiotic supplements, folic acid, vitamin K, calcium, and phytochemicals with vitamins D and K are shown to be beneficial to bone health with evidence that bone turnover markers are decreased in these treatment groups, although these findings demonstrate that vitamin or probiotic supplementation are not effective in increasing bone mineral density.
    • An Analysis of Mortality, Morbidity, and Primary Care Providers in Arizona's 126 Primary Care Areas

      Wassermann, Michael; The University of Arizona College of Medicine – Phoenix; Cartsonis, Jonathan (The University of Arizona., 2019)
      The United States is currently facing a primary care provider shortage. Medical schools nationwide have increased enrollment in order offset the effects of the shortage. In order to justify the effects of increasing total quantity of future physicians, there should be a demonstrated relationship between total quantity of providers and a reduction in morbidity / mortality at a population health level. This study investigates if there is any association between the total number of primary care providers and mortality per 100,000 persons (all deaths, heart disease, all cancer, chronic lower respiratory disease, and all accidents), or morbidity per 100,000 persons (chronic diseases, congestive heart failure, hypertension, uncontrolled diabetes, and stroke)? Is there any difference in total number of primary care providers, mortality per 100,000 persons, or morbidity per 100,000 persons in rural vs urban primary care areas? Data was gathered from the Arizona Department of Health Services community profiles dashboard. 2013 morbidity / mortality data for all 126 of Arizona’s Primary Care Areas was analyzed utilizing linear regression and Wilcoxon rank sum. Linear regression demonstrated a statistically significant reduction in a number of mortality / morbidity categories as total number of primary care providers increased. Correlation data demonstrated a statistically significant relationship between number of primary care providers and increase in chronic lower respiratory diseases (p value = 0.027). Additionally, rural primary care areas showed higher incidence of congestive heart failure (p < 0.001) and chronic diseases (p = 0.02) and lower total numbers of primary care providers (p < 0.001) compared with urban primary care areas. Our findings demonstrate distinct differences between urban and rural primary care areas. There may be some association between total number of primary care providers and their potential effect on mortality/morbidity incidence. Further research needs to be completed in order to elucidate a greater understanding of these potential relationships.
    • An Analysis of the “Angelina Jolie Effect”: Does the Media Influence Patients’ Contralateral Prophylactic Mastectomy Decisions?

      Gosney, Jayme; The University of Arizona College of Medicine – Phoenix; Bernard, Robert (The University of Arizona., 2019)
      Following genetic testing and counseling, many women elect to undergo prophylactic surgery to reduce their risk of developing breast and ovarian cancer. Bilateral prophylactic mastectomy (BPM) can decrease a woman’s risk of developing breast cancer by more than 90%.4 However, contralateral prophylactic mastectomy (CPM) does not increase survival for the majority of women with breast cancer, which is contrary to the increasing incidence of CPM.5,7 Angelina Jolie published an op-ed in The New York Times in May 2013 regarding her decision to undergo BPM. She pursued preventative surgery due to her strong family history of breast cancer and positive test for a BRCA mutation. While Jolie’s situation is not analogous to that of women undergoing CPM, it is possible that in many women’s minds, the situations are similar. This study is a retrospective review that examines the relationship between popular magazine articles written about prophylactic mastectomy and the number of CPM surgeries performed.
    • An assessment of the prevalence and degree of Post Traumatic Stress Disorder in Syrian refugees in Arizona

      Alattar, Zana; Beyda, David (The University of Arizona., 2020)
      Background: In the absence of information on the mental health impact of the Syrian conflict on refugees resettled in the United States, we measured the prevalence of Post Traumatic Stress Disorder (PTSD) among Syrian refugees in Arizona. Methods: 50 participants were surveyed with the Arabic version of the Harvard Trauma Questionnaire (HTQ). Univariate logistic regression was used to ascertain the odds of PTSD score >2.5 relative to survey characteristics. Multivariate linear regression was used to ascertain the mean difference of raw scores relative to survey characteristics. Results: Overall PTSD prevalence among Syrian refugees was 18%, nearly 9 times higher than the 2.3% of Syrian refugees who are referred to behavioral health services upon arrival to Arizona. The odds ratios for patients who experienced trauma and torture were significantly higher than all other questionnaire responses. Discussion: This suggests the need for expansion of behavioral health screening and the use of validated tools to identify PTSD rates among this population
    • An ecological snapshot of Clostridioides difficile: characterizing genetic diversity of C. difficile within Banner-University Medical Center Phoenix

      Brussels, Aaron; Vedantam, Gayatri (The University of Arizona., 2020)
      RATIONALE: The genetic diversity of Clostridioides difficile within hospitals is known to vary geographically: the C. difficile ecology within Banner-University Medical Center Phoenix (BUMCP) is uncharacterized. METHODS: A laboratory-based surveillance study design was used unique to-be-discarded stool samples testing positive for C. difficile infection (CDI) at BUMCP per their existing testing protocol were collected and banked over a 16 month period. Each deidentified sample underwent selection and culture before being prepared for and subjected to capillary PCR in order to determine genetic type (ribotype) of each offending strain of C. difficile. RESULTS: A total of 267 samples met inclusion criteria for this study; 225 were successfully genetically typed, and 83 unique ribotypes were identified. 17 ribotypes (20.5%) are responsible for 60.5% of all typeable cases of CDI during the study period, while 43 strains (51.8%) were each represented by only one case (15.1% of typeable cases) and another 23 strains (27.7%) were represented by two cases (20.4% of typable cases). CONCLUSIONS: There is an uneven distribution of disease burden relative to ribotype. This finding is consistent with similar investigations in other geographies. The highest burdens of disease are attributable to ribotypes 027, 106 and 176 – all well-documented hypervirulent outbreak associated strains.
    • Analysis of Field Delivered Therapy for Chlamydia and Gonorrhea in Maricopa County

      Ebbing, Brittany; The University of Arizona College of Medicine - Phoenix; Taylor, Melanie (The University of Arizona, 2017-05-08)
      Chlamydia and gonorrhea are among the most frequently reported infectious diseases in the United States. These two diseases are easily treated with antibiotics; however, challenges exist in providing treatment to cases and their sexual partners. Maricopa County implemented a Field Delivered Therapy (FDT) protocol to treat chlamydia and gonorrhea cases and contacts in 2009. Ultimately, this project sought to inform other public health departments across the United States regarding the benefits of FDT program to treat gonorrhea and chlamydia and provide better insight on how to treat the two most commonly reported infectious diseases. Existing data was analyzed from April 1, 2011 to October 31, 2014 (42 months) for all patients that received FDT in Maricopa County utilizing pharmacy records and electronic health records (PRISM and eClinicalWorks). The following pieces of information were collected from these data sources: gender, age, race/ethnicity, diagnosis, number of partners, and time to treatment. The data were then divided into four FDT groups (FDT, expedited partner therapy via FDT, FDT attempted and FDT planned). There were 172 patients in this analysis; 140 diagnosed or in contact with chlamydia and 16 diagnosed or in contact with gonorrhea. There were 79 patients (45.9%) in the FDT group, 28 (16.3%) in the FDT EPT group, 28 (16.3%) in the FDT attempted and 37 (21.5%) in the FDT planned group. The median age of these patients was 23.8 (range 16.6‐31); 111 (64.5%) were female. The median time to treatment for these patients was 24.6 days (range 0‐64.5 days). Most patients (79.6%) lived outside of central Phoenix. The median number of sexual partners reported by these patients was 6.6 (range 1‐19.7 partners). A majority of the patients were <25 years old, except for in the FDT EPT group where 100% of patients were >25 years old. And the group with the largest <19‐year‐old population (32%) was in the FDT group. All the groups had a female majority, except in the FDT EPT group where 75% of the patients were male. Most patients in the FDT only group received testing at an outside hospital or outpatient clinic, while the FDT attempted and planned were more often tested at the STD clinic. Future Direction/Conclusion Many of the patients that received FDT are young women, some pregnant, that lived outside of Central Phoenix. However, a majority of the overall clients that received expedited partner therapy via FDT were male, a typically hard to reach population for treatment of potentially asymptomatic infections. This study demonstrates an effective method of delivering partner treatment to men. This study can be used to inform other public health departments about this novel practice and to help Maricopa County grow their FDT program to reach even more untreated patients.
    • Analysis of Risk Factors Associated with Fatal Motor Vehicle Collisions in Arizona

      Liu, Margaret; The University of Arizona College of Medicine – Phoenix; Fischione, Mark; Skinner, Ruby (The University of Arizona., 2019)
      In 2014, Arizona had 109,554 motor vehicle collisions (MVCs), 708 of which were fatal. The objective of this study was to analyze behavioral patterns in drivers which resulted in fatal MVCs. This was a retrospective chart review of MVCs in 13 Arizona counties from 2007 to 2015. Results showed a high incidence of high-risk behaviors due to substance use and lack of safe driving practices, including 26% of subjects with an ethanol content above the legal limit, 10% with THC in their system at the time of the collision, 9% with amphetamines or cocaine, 8.5% with benzodiazepines, and 5% with opiates. More than 50% had a combination of substances. Other notable characteristics were the lack of seatbelt use in 30% of subjects, and lack of motorcycle helmet use in 69% of motorcycle drivers. More data is needed on distracted driving behaviors, particularly related to cellular phone use, in order to optimally target future legislation and prevention.
    • Analysis of the Efficacy of Diabetes Self-Management Education among an Underserved Population

      Hoelscher, Tyler; Lee, Maurice (The University of Arizona., 2020)
      Question: Does the St. Vincent de Paul Diabetes Self-Management Education (DSME) program improve diabetic control among adults who have received care or are currently receiving care at the St. Vincent de Paul free clinic? Background: Diabetes Mellitus is a disease that requires substantial lifestyle modification to control and prevent significant complication. Because of this, Diabetes Self-Management Education (DSME) is an important part of treatment. This study is designed to evaluate diabetic control among patients who have attended the program as compared to those who have not. Methods: Subjects will be recruited from St. Vincent de Paul’s electronic health records (EHR). Patients having completed at least four DSME classes will be placed into the experimental group, and patients having completed fewer than four classes and who are not currently enrolled in a DSME program will be recruited into the control group. A combo of chart review, biometrics and survey will assess thirteen dichotomous variables either on-site or from medical records. A subject will be considered “controlled” with a pass in at least 70% of variables. Results: The primary outcome for diabetic control, meeting the criteria for 70% of the quality metrics, was met in 46% of patients on the treatment group and 19% of those in the control (P=0.052). A1c was ?8% in 54% of the treatment group and 14% of the control (P=0.02) and blood pressure was controlled in 96% of the treatment group and 52% of the control group (P=0.04). Conclusions: There was a nonsignificant improvement in overall diabetic control among patients who attended the DSME course, though A1c and blood pressure were significantly impacted. Though limited by sample size, the study shows that there is promise for future research in DSME.