Michael Dulin - Academia.edu (original) (raw)

Papers by Michael Dulin

Research paper thumbnail of Preliminary Validation of the Hypertension Self-Care Activity Level Effects (H-SCALE) and Clinical Blood Pressure Among Patients With Hypertension

The Journal of Clinical Hypertension, 2013

This study establishes preliminary validation of a measure that assesses hypertension self-care a... more This study establishes preliminary validation of a measure that assesses hypertension self-care activities with clinical blood pressure (BP). The Hypertension Self-Care Activity Level Effects (H-SCALE) was administered to patients with hypertension to assess levels of self-care. Patients (n=154) were predominantly female (68.6%) and black (79.2%). Greater adherence to self-care was associated with lower systolic and diastolic BP for 5 of the 6 self-care behaviors. Medication adherence was correlated with systolic BP (r=À0.19, P<.05) and weight management adherence was correlated with diastolic BP (r=À0.22, P<.05) after controlling for other covariates. Increased adherence to recommended dietary practices was strongly correlated with higher systolic (r=0.29, P<.05) and diastolic BP (r=0.32, P<.05). The H-SCALE was acceptable for use in clinical settings, and adherence to self-care was generally aligned with lower BP. Assessment of hypertension self-care is important when working with individuals to control their BP. J Clin Hypertens (Greenwich). 2013;15:637-643.

Research paper thumbnail of Racial disparities in health literacy in a primary care setting

The ability to calculate is an important aspect of health literacy and essential for many chronic... more The ability to calculate is an important aspect of health literacy and essential for many chronic disease self-care activities. The Newest Vital Sign (NVS) assesses numeracy skills in a face-to-face interview. The NVS uses a nutrition food label to ask 4 items requiring basic math skills and 2 reading items. In this study, we used the NVS as part of a self-administered questionnaire (SAQ) examining hypertension self-care. We hypothesized that participants would have higher health literacy scores because they could use paper and pencil to make calculations. Logistic regression was performed to determine odds ratios (OR) and 95% confidence intervals (CIs). Eligible participants had hypertension (n=196) and were recruited from a primary care clinic. Participants were 77% Black, 67% women, and they had an average age of 56. Only 48% of the participants attempted all 6 NVS items. Blacks had 60% reduced odds of completing the full NVS (OR=0.40; 95% CI=0.17-0.93). Don't know responses ...

Research paper thumbnail of Association between health literacy and medical care costs in an integrated healthcare system: a regional population based study

BMC health services research, 2015

Low health literacy is associated with higher health care utilization and costs; however, no larg... more Low health literacy is associated with higher health care utilization and costs; however, no large-scale studies have demonstrated this in the Veterans Health Administration (VHA). This research evaluated the association between veterans' health literacy and their subsequent VHA health care costs across a three-year period. This retrospective study used a Generalized Linear Model to estimate the relative association between a patient's health literacy and VHA medical costs, adjusting for covariates. Secondary data sources included electronic health records and administrative data in the VHA (e.g., Medical and DCG SAS Datasets and DSS-National Data Extracts). Health literacy assessments and identifiers were electronically retrieved from the originating health system. Demographic and cost data were retrieved from the VHA centralized databases for the corresponding patients who had VHA use in all three years. In a study of 92,749 veterans with service utilization from 2007-2009...

Research paper thumbnail of Preliminary Validation of the Hypertension Self-Care Activity Level Effects (H-SCALE) and Clinical Blood Pressure Among Patients With Hypertension

The Journal of Clinical Hypertension, 2013

This study establishes preliminary validation of a measure that assesses hypertension self-care a... more This study establishes preliminary validation of a measure that assesses hypertension self-care activities with clinical blood pressure (BP). The Hypertension Self-Care Activity Level Effects (H-SCALE) was administered to patients with hypertension to assess levels of self-care. Patients (n=154) were predominantly female (68.6%) and black (79.2%). Greater adherence to self-care was associated with lower systolic and diastolic BP for 5 of the 6 self-care behaviors. Medication adherence was correlated with systolic BP (r=À0.19, P<.05) and weight management adherence was correlated with diastolic BP (r=À0.22, P<.05) after controlling for other covariates. Increased adherence to recommended dietary practices was strongly correlated with higher systolic (r=0.29, P<.05) and diastolic BP (r=0.32, P<.05). The H-SCALE was acceptable for use in clinical settings, and adherence to self-care was generally aligned with lower BP. Assessment of hypertension self-care is important when working with individuals to control their BP. J Clin Hypertens (Greenwich). 2013;15:637-643.

Research paper thumbnail of Examining the relationship between hypertension self-care activities and blood pressure in a primary care setting

Assessment of individuals' hypertension self-care activities may provide important informatio... more Assessment of individuals' hypertension self-care activities may provide important information to clinicians and practitioners working to control high blood pressure. The Hypertension Self-Care Activity Level Effects (H-SCALE) measures the six recommended self-care activities: medication adherence; smoking cessation; weight maintenance; healthy diet; alcohol reduction and engagement in physical activity. We assessed patients' self-care activities and then abstracted blood pressure from their medical record. Unadjusted and adjusted partial correlations were performed to examine the relationships between hypertension self-care scores and systolic and diastolic blood pressure (SBP/DBP). We anticipated that scores indicating better self-care would be correlated with lower SBP and DBP. Patients were recruited from a primary care clinic. Participants had hypertension (n=154), were 79% Black, 69% women, with an average age of 55. For five of six self-care scales, correlations betwe...

Research paper thumbnail of BMI at birth and overweight at age four

Obesity Research & Clinical Practice, 2016

Extensive investigation has established that an elevated weight at birth is associated with subse... more Extensive investigation has established that an elevated weight at birth is associated with subsequent obesity and obesity related negative health outcomes. The significance of overweight at birth, however, remains ill-defined. Historically, it has been difficult to approximate adiposity in infancy in a way that is both simple and meaningful. Body-mass-index (BMI) growth charts for children younger than two years of age only became available in 2006 when published by the WHO. This retrospective cohort analysis utilised anthropometric data extracted from the electronic medical record of a large integrated healthcare system in North Carolina. BMI and weight-for-age (WFA) &amp;amp;amp;amp;amp;amp;amp;amp;gt;85% of WHO growth charts measured newborn overweight and macrosomia respectively. Logistic regression models assessed the associations between newborn macrosomia and overweight and overweight at 4 years of age, as well as associations with maternal BMI. Models included demographic data, gestational age, and maternal diabetes status as covariates. Both BMI and WFA &amp;amp;amp;amp;amp;amp;amp;amp;gt;85% at birth were significantly associated with overweight at age 4 years. However, the greater odds of overweight was associated with newborn BMI &amp;amp;amp;amp;amp;amp;amp;amp;gt;85%, with an adjusted odds ratio (AOR) of 2.08 (95% confidence interval [CI]: 1.4-3.08) versus 1.57 (95% CI: 1.08-2.27). Maternal obesity was also more robustly correlated with newborn BMI &amp;amp;amp;amp;amp;amp;amp;amp;gt;85%, AOR of 4.14 (95% CI: 1.6-10.7), than with newborn WFA &amp;amp;amp;amp;amp;amp;amp;amp;gt;85%, AOR of 3.09 (95% CI: 1.41-6.77). BMI &amp;amp;amp;amp;amp;amp;amp;amp;gt;85% at birth is independently associated with overweight at 4 years. Newborn overweight is perhaps superior to newborn macrosomia in predicting overweight at age 4.

Research paper thumbnail of The science of primary health-care improvement: potential and use of community-based participatory research by practice-based research networks for translation of research into practice

Experimental Biology and Medicine, Mar 1, 2010

There is a need for new approaches to supplement the existing methods of taking research from ben... more There is a need for new approaches to supplement the existing methods of taking research from bench to bedside and from bedside to practice. Community-based participatory research (CBPR) is an emerging model of research that enhances ongoing clinical research by involving key stakeholders, including community members and patients. A practice-based research network (PBRN) is a group of primary care practices devoted principally not only to the primary care of patients, but also with a mission to investigate questions related to community-based practice and to improve the quality of primary care. Traditionally, PBRN research has not included patients or community members, while CBPR has excluded health providers as key stakeholders. Typical overlap topics of PBRN and CBPR research are health-care disparities, prevention, chronic disease management and mental health. The inclusion of CBPR within a PBRN has been identified as an important next step with the potential to significantly enhance the research process. This review focuses on bringing together the ideals of CBPR and PBRNs in order to tackle intractable problems such as disparities in health-care access and outcomes and translate these results into practice. Specifically, the CBPR PBRN approach can: (1) guide the research process so that studies more closely match the needs of all stakeholders (including providers, patients and community members); (2) assist in the development of the research protocol and identification of research methodologies so that the study is more amenable to participants; (3) facilitate recruitment of research participants; (4) enrich the data collection and analysis; and (5) allow rapid translation of results from the study back into clinical practice and the community. Once these mechanisms have been clearly elucidated, their widespread adoption will positively impact overall health at both a local and national level.

Research paper thumbnail of Policosanol is ineffective in the treatment of hypercholesterolemia: A randomized controlled trial

American Journal of Clinical Nutrition

Background: Policosanol is one of the fastest growing over-thecounter supplements sold in the Uni... more Background: Policosanol is one of the fastest growing over-thecounter supplements sold in the United States. The use of policosanol to treat elevated cholesterol is based on clinical trials conducted in Cuba, which showed sugar cane-derived policosanol to be similar in efficacy to statins. Recent studies have challenged these findings, but there have been no trials conducted in North America that have examined the ability of sugar cane-derived policosanol to lower cholesterol. Objectives: This study investigated the efficacy of sugar canederived policosanol in healthy adults with mild hypercholesterolemia. The primary outcome was the percentage change in LDL cholesterol after 8 wk of therapy. Secondary outcome measures included changes in total cholesterol, HDL cholesterol, triacylglycerols, C-reactive protein, and nuclear magnetic resonancedetermined lipoprotein profile. Dietary habits, weight, and blood pressure were also monitored. Design: Ambulatory, community-dwelling healthy adults with mild hypercholesterolemia (n ҃ 40) were assigned to receive oral policosanol (20 mg) or placebo once daily for 8 wk. This was a doubleblind, randomized controlled trial conducted from January through August 2005. Results: No significant differences in the change in LDL cholesterol were observed between the placebo (n ҃ 20) and policosanol (n ҃ 20) groups. Also, no significant changes in secondary outcome measures, including total cholesterol, HDL cholesterol, triacylglycerol, C-reactive protein, and nuclear magnetic resonance spectroscopydetermined profiles were observed. Policosanol was well tolerated, and no significant adverse events were noted. Conclusion: Policosanol does not alter the serum lipid profile over an 8-wk period in adults with mild hypercholesterolemia.

Research paper thumbnail of A Population Based Study Examining Language as a Predictor of Colorectal Cancer Screening Among Overweight and Obese Hispanic Adults in the United States

The Open Epidemiology Journal, 2009

Objective: Colorectal cancer (CRC) is one of the top two leading causes of cancer deaths in Hispa... more Objective: Colorectal cancer (CRC) is one of the top two leading causes of cancer deaths in Hispanic/Latino adults living in the U.S., and CRC risk increases in people who are overweight. As the U.S. Hispanic population increases along with a growing prevalence of overweight and obesity, studies are needed to determine if overweight Hispanic adults suffer from disparities in their rates of CRC screening. Our study was able to examine the correlation between a preference for using the Spanish language and rates of screening for CRC using national survey data.

Research paper thumbnail of Patient engagement and informed decision making regarding medical imaging

North Carolina medical journal

Misuse and overuse of medical imaging have gained widespread attention due to rising costs, radia... more Misuse and overuse of medical imaging have gained widespread attention due to rising costs, radiation exposure risks, and limited comparative effectiveness evidence. Involving patients in shared decision making offers an opportunity to more clearly define risks and benefits, thus allowing patients to consider both personal values and the best available evidence.

Research paper thumbnail of Exercise for management and treatment of Parkinson disease

American family physician, Jan 15, 2009

Research paper thumbnail of Communities matter: the relationship between neighborhoods and health

North Carolina medical journal

Understanding the link between neighborhood conditions (both physical and social) and health outc... more Understanding the link between neighborhood conditions (both physical and social) and health outcomes is an essential step toward ameliorating health disparities in low-income and high-risk minority populations. This commentary discusses the evidence that the neighborhood is a key social determinant of health and describes tools that can be used to help overcome disparities in community health.

Research paper thumbnail of Cost analysis of the use of emergency departments for primary care services in Charlotte, North Carolina

North Carolina medical journal

Patients often inappropriately seek emergency services for ambulatory care-sensitive conditions (... more Patients often inappropriately seek emergency services for ambulatory care-sensitive conditions (ACSCs). The unnecessary use of emergency departments (EDs) is an expensive burden on hospitals and payers. Here, we identify factors influencing ED visits for ACSCs and analyze the costs of such visits for EDs and primary care clinics. Age, race, sex, and insurance data from 2007 for 3 primary care safety net clinics and 4 EDs in Charlotte, North Carolina, were analyzed using the New York University (NYU) algorithm to identify ACSC diagnoses. Cost analyses used hospital charge data and net margins as surrogates for payer and hospital system costs. A total of 113,730 (59.4%) of 191,622 ED visits were for ACSCs. Factors that increased the number of ACSC-related visits included lack of insurance coverage; receipt of Medicaid insurance; age of less than 2 years; African American, Hispanic, or Native American race or ethnicity; and female sex. Charges in the EDs were 320%-728% higher than tho...

Research paper thumbnail of Policosanol is ineffective in the treatment of hypercholesterolemia: a randomized controlled trial

The American journal of clinical nutrition, 2006

Policosanol is one of the fastest growing over-the-counter supplements sold in the United States.... more Policosanol is one of the fastest growing over-the-counter supplements sold in the United States. The use of policosanol to treat elevated cholesterol is based on clinical trials conducted in Cuba, which showed sugar cane-derived policosanol to be similar in efficacy to statins. Recent studies have challenged these findings, but there have been no trials conducted in North America that have examined the ability of sugar cane-derived policosanol to lower cholesterol. This study investigated the efficacy of sugar cane-derived policosanol in healthy adults with mild hypercholesterolemia. The primary outcome was the percentage change in LDL cholesterol after 8 wk of therapy. Secondary outcome measures included changes in total cholesterol, HDL cholesterol, triacylglycerols, C-reactive protein, and nuclear magnetic resonance-determined lipoprotein profile. Dietary habits, weight, and blood pressure were also monitored. Ambulatory, community-dwelling healthy adults with mild hypercholeste...

Research paper thumbnail of Axoplasm enriched in a protein mobilized by nerve injury induces memory-like alterations in Aplysia neurons

The Journal of neuroscience : the official journal of the Society for Neuroscience, 1995

Axon regeneration after injury and long-term alterations associated with learning both require pr... more Axon regeneration after injury and long-term alterations associated with learning both require protein synthesis in the neuronal cell body, but the signals that initiate these changes are largely unknown. Direct evidence that axonal injury activates molecular signals in the axon was obtained by injecting axoplasm from crushed or uncrushed nerves into somata of sensory neurons with uncrushed axons. Those injected with crush axoplasm behaved as if their axons had been crushed, exhibiting increases in both repetitive firing and spike duration, and a decrease in spike afterhyperpolarization 1 d after injection. Because similar changes occur in the same cells after learning, these data suggest that some of the long-lasting adaptive changes that occur after injury and learning may be induced by common axoplasmic signals. Since the signals in axoplasm must be conveyed to the cell soma, we have begun to test the hypothesis that at least some of these signals are proteins containing a nuclea...

Research paper thumbnail of Systolic Blood Pressure Control Among Individuals With Type 2 Diabetes: A Comparative Effectiveness Analysis of Three Interventions

American journal of hypertension, Jan 9, 2015

The relative effectiveness of 3 approaches to blood pressure control-(i) an intensive lifestyle i... more The relative effectiveness of 3 approaches to blood pressure control-(i) an intensive lifestyle intervention (ILI) focused on weight loss, (ii) frequent goal-based monitoring of blood pressure with pharmacological management, and (iii) education and support-has not been established among overweight and obese adults with type 2 diabetes who are appropriate for each intervention. Participants from the Action for Health in Diabetes (Look AHEAD) and the Action to Control Cardiovascular Risk in Diabetes (ACCORD) cohorts who met criteria for both clinical trials were identified. The proportions of these individuals with systolic blood pressure (SBP) <140mm Hg from annual standardized assessments over time were compared with generalized estimating equations. Across 4 years among 480 Look AHEAD and 1,129 ACCORD participants with baseline SBPs between 130 and 159mm Hg, ILI (OR = 1.46; 95% CI = [1.18-1.81]) and frequent goal-based monitoring with pharmacotherapy (OR = 1.51; 95% CI = [1.16-...

Research paper thumbnail of Management of cervical lymphadenitis in children

American family physician, 2008

Research paper thumbnail of Endemic Toxoplasmosis in Pigs on a Farm in Maryland: Isolation and Genetic Characterization of Toxoplasma gondii

Journal of Parasitology, 2008

The prevalence of Toxoplasma gondii was investigated on a poorly managed pig farm in Maryland. Se... more The prevalence of Toxoplasma gondii was investigated on a poorly managed pig farm in Maryland. Serum and tissue samples from 48 of the 100 pigs on the farm were available for T. gondii evaluation. Serological testing was performed using both ELISA and the modified agglutination test (MAT). Antibodies to T. gondii were detected by ELISA in 12 of 48 animals, while antibodies were detected in 34 of 48 pigs by MAT with titers of 1:10 in 1, 1:20 in 4, 1:40 in 7, 1:80 in 3, 1:160 in 8, 1:320 in 3, 1:640 in 4, and 1:1,280 in 4. Hearts of 16 pigs with MAT titers of 1:10 or higher were bioassayed for T. gondii in cats; 11 cats shed T. gondii oocysts. Hearts of 22 pigs were autolyzed and bioassayed only in mice; T. gondii was isolated from 3 of these 22 pigs. Genetic typing of the 14 T. gondii isolates using the SAG1, SAG2, SAG3, BTUB, GRA6, c22-8, c29-2, L358, PK1, and Apico loci revealed 4 genotypes; 10 isolates belonged to type II lineage (genotypes 1 and 2), 3 belonged to genotype 3, and 1 belonged to genotype 4. Genotype 1 and 2 have type II alleles at all genetic loci, except the former has type II allele and the latter has a type I allele at locus Apico. Both genotypes 1 and 2 are considered to belong to the clonal type II lineages. Genotype 3 and 4 are nonclonal isolates. Results document high prevalence of T. gondii in pigs on a farm in Maryland.

Research paper thumbnail of Evidence That Long-Term Hyperexcitability of the Sensory Neuron Soma Induced by Nerve Injury in Aplysia Is Adaptive

Journal of Neurophysiology, 2005

Peripheral axotomy induces long-term hyperexcitability (LTH) of centrally located sensory neuron ... more Peripheral axotomy induces long-term hyperexcitability (LTH) of centrally located sensory neuron (SN) somata in diverse species. In mammals this LTH can promote spontaneous activity of pain-related SNs, and such activity may contribute to neuropathic pain and hyperalgesia. However, few axotomized SN somata begin to fire spontaneously in any species, and why so many SNs display soma LTH after axotomy remains a mystery. Is soma LTH a side effect of injury with pathological but no adaptive consequences, or was this response selected during evolution for particular functions? A hypothesis for one function of soma LTH in nociceptive SNs in Aplysia californica is proposed: after peripheral injury that produces partial axotomy of some SNs, compensation for sensory deficits and protective sensitization are achieved by facilitating afterdischarge near the soma, which amplifies sensory input from injured peripheral fields. Four predictions of this hypothesis were confirmed in SNs that innervate the tail. First, LTH of SN somata was induced by a relatively natural axotomizing event-a small cut across part of the tail in the absence of anesthesia. Second, soma LTH was selectively expressed in SNs having axons in cut or crushed nerves rather than nearby, uninjured nerves. Third, after several weeks soma LTH began to reverse when functional recovery of the interrupted afferent pathway was shown by reestablishment of a centrally mediated siphon reflex. Fourth, axotomized SNs developed central afterdischarge that amplified sensory discharge coming from the periphery, and the after-depolarization underlying this afterdischarge was enhanced by previous axotomy.

Research paper thumbnail of Obesity and asthma: Pathophysiology and implications for diagnosis and management in primary care

Experimental Biology and Medicine, 2014

The effects of obesity on asthma diagnosis, control, and exacerbation severity are increasingly r... more The effects of obesity on asthma diagnosis, control, and exacerbation severity are increasingly recognized; however, the underlying pathophysiology of this association is poorly understood. Mainstream clinical practice has yet to adopt aggressive management of obesity as a modifiable risk factor in asthma care, as is the case with a risk factor like tobacco or allergen exposure. This review summarizes existing data that support the pathophysiologic mechanisms underlying the association between obesity and asthma, as well as the current and future state of treatment for the obese patient with asthma. Our review suggests that evidence of chronic inflammatory response linking obesity and asthma indicates a need to address obesity during asthma management, possibly using patient-centered approaches such as shared decision making. There is a need for research to better understand the mechanisms of asthma in the obese patient and to develop new therapies specifically targeted to this unique patient population.

Research paper thumbnail of Preliminary Validation of the Hypertension Self-Care Activity Level Effects (H-SCALE) and Clinical Blood Pressure Among Patients With Hypertension

The Journal of Clinical Hypertension, 2013

This study establishes preliminary validation of a measure that assesses hypertension self-care a... more This study establishes preliminary validation of a measure that assesses hypertension self-care activities with clinical blood pressure (BP). The Hypertension Self-Care Activity Level Effects (H-SCALE) was administered to patients with hypertension to assess levels of self-care. Patients (n=154) were predominantly female (68.6%) and black (79.2%). Greater adherence to self-care was associated with lower systolic and diastolic BP for 5 of the 6 self-care behaviors. Medication adherence was correlated with systolic BP (r=À0.19, P<.05) and weight management adherence was correlated with diastolic BP (r=À0.22, P<.05) after controlling for other covariates. Increased adherence to recommended dietary practices was strongly correlated with higher systolic (r=0.29, P<.05) and diastolic BP (r=0.32, P<.05). The H-SCALE was acceptable for use in clinical settings, and adherence to self-care was generally aligned with lower BP. Assessment of hypertension self-care is important when working with individuals to control their BP. J Clin Hypertens (Greenwich). 2013;15:637-643.

Research paper thumbnail of Racial disparities in health literacy in a primary care setting

The ability to calculate is an important aspect of health literacy and essential for many chronic... more The ability to calculate is an important aspect of health literacy and essential for many chronic disease self-care activities. The Newest Vital Sign (NVS) assesses numeracy skills in a face-to-face interview. The NVS uses a nutrition food label to ask 4 items requiring basic math skills and 2 reading items. In this study, we used the NVS as part of a self-administered questionnaire (SAQ) examining hypertension self-care. We hypothesized that participants would have higher health literacy scores because they could use paper and pencil to make calculations. Logistic regression was performed to determine odds ratios (OR) and 95% confidence intervals (CIs). Eligible participants had hypertension (n=196) and were recruited from a primary care clinic. Participants were 77% Black, 67% women, and they had an average age of 56. Only 48% of the participants attempted all 6 NVS items. Blacks had 60% reduced odds of completing the full NVS (OR=0.40; 95% CI=0.17-0.93). Don't know responses ...

Research paper thumbnail of Association between health literacy and medical care costs in an integrated healthcare system: a regional population based study

BMC health services research, 2015

Low health literacy is associated with higher health care utilization and costs; however, no larg... more Low health literacy is associated with higher health care utilization and costs; however, no large-scale studies have demonstrated this in the Veterans Health Administration (VHA). This research evaluated the association between veterans' health literacy and their subsequent VHA health care costs across a three-year period. This retrospective study used a Generalized Linear Model to estimate the relative association between a patient's health literacy and VHA medical costs, adjusting for covariates. Secondary data sources included electronic health records and administrative data in the VHA (e.g., Medical and DCG SAS Datasets and DSS-National Data Extracts). Health literacy assessments and identifiers were electronically retrieved from the originating health system. Demographic and cost data were retrieved from the VHA centralized databases for the corresponding patients who had VHA use in all three years. In a study of 92,749 veterans with service utilization from 2007-2009...

Research paper thumbnail of Preliminary Validation of the Hypertension Self-Care Activity Level Effects (H-SCALE) and Clinical Blood Pressure Among Patients With Hypertension

The Journal of Clinical Hypertension, 2013

This study establishes preliminary validation of a measure that assesses hypertension self-care a... more This study establishes preliminary validation of a measure that assesses hypertension self-care activities with clinical blood pressure (BP). The Hypertension Self-Care Activity Level Effects (H-SCALE) was administered to patients with hypertension to assess levels of self-care. Patients (n=154) were predominantly female (68.6%) and black (79.2%). Greater adherence to self-care was associated with lower systolic and diastolic BP for 5 of the 6 self-care behaviors. Medication adherence was correlated with systolic BP (r=À0.19, P<.05) and weight management adherence was correlated with diastolic BP (r=À0.22, P<.05) after controlling for other covariates. Increased adherence to recommended dietary practices was strongly correlated with higher systolic (r=0.29, P<.05) and diastolic BP (r=0.32, P<.05). The H-SCALE was acceptable for use in clinical settings, and adherence to self-care was generally aligned with lower BP. Assessment of hypertension self-care is important when working with individuals to control their BP. J Clin Hypertens (Greenwich). 2013;15:637-643.

Research paper thumbnail of Examining the relationship between hypertension self-care activities and blood pressure in a primary care setting

Assessment of individuals' hypertension self-care activities may provide important informatio... more Assessment of individuals' hypertension self-care activities may provide important information to clinicians and practitioners working to control high blood pressure. The Hypertension Self-Care Activity Level Effects (H-SCALE) measures the six recommended self-care activities: medication adherence; smoking cessation; weight maintenance; healthy diet; alcohol reduction and engagement in physical activity. We assessed patients' self-care activities and then abstracted blood pressure from their medical record. Unadjusted and adjusted partial correlations were performed to examine the relationships between hypertension self-care scores and systolic and diastolic blood pressure (SBP/DBP). We anticipated that scores indicating better self-care would be correlated with lower SBP and DBP. Patients were recruited from a primary care clinic. Participants had hypertension (n=154), were 79% Black, 69% women, with an average age of 55. For five of six self-care scales, correlations betwe...

Research paper thumbnail of BMI at birth and overweight at age four

Obesity Research & Clinical Practice, 2016

Extensive investigation has established that an elevated weight at birth is associated with subse... more Extensive investigation has established that an elevated weight at birth is associated with subsequent obesity and obesity related negative health outcomes. The significance of overweight at birth, however, remains ill-defined. Historically, it has been difficult to approximate adiposity in infancy in a way that is both simple and meaningful. Body-mass-index (BMI) growth charts for children younger than two years of age only became available in 2006 when published by the WHO. This retrospective cohort analysis utilised anthropometric data extracted from the electronic medical record of a large integrated healthcare system in North Carolina. BMI and weight-for-age (WFA) &amp;amp;amp;amp;amp;amp;amp;amp;gt;85% of WHO growth charts measured newborn overweight and macrosomia respectively. Logistic regression models assessed the associations between newborn macrosomia and overweight and overweight at 4 years of age, as well as associations with maternal BMI. Models included demographic data, gestational age, and maternal diabetes status as covariates. Both BMI and WFA &amp;amp;amp;amp;amp;amp;amp;amp;gt;85% at birth were significantly associated with overweight at age 4 years. However, the greater odds of overweight was associated with newborn BMI &amp;amp;amp;amp;amp;amp;amp;amp;gt;85%, with an adjusted odds ratio (AOR) of 2.08 (95% confidence interval [CI]: 1.4-3.08) versus 1.57 (95% CI: 1.08-2.27). Maternal obesity was also more robustly correlated with newborn BMI &amp;amp;amp;amp;amp;amp;amp;amp;gt;85%, AOR of 4.14 (95% CI: 1.6-10.7), than with newborn WFA &amp;amp;amp;amp;amp;amp;amp;amp;gt;85%, AOR of 3.09 (95% CI: 1.41-6.77). BMI &amp;amp;amp;amp;amp;amp;amp;amp;gt;85% at birth is independently associated with overweight at 4 years. Newborn overweight is perhaps superior to newborn macrosomia in predicting overweight at age 4.

Research paper thumbnail of The science of primary health-care improvement: potential and use of community-based participatory research by practice-based research networks for translation of research into practice

Experimental Biology and Medicine, Mar 1, 2010

There is a need for new approaches to supplement the existing methods of taking research from ben... more There is a need for new approaches to supplement the existing methods of taking research from bench to bedside and from bedside to practice. Community-based participatory research (CBPR) is an emerging model of research that enhances ongoing clinical research by involving key stakeholders, including community members and patients. A practice-based research network (PBRN) is a group of primary care practices devoted principally not only to the primary care of patients, but also with a mission to investigate questions related to community-based practice and to improve the quality of primary care. Traditionally, PBRN research has not included patients or community members, while CBPR has excluded health providers as key stakeholders. Typical overlap topics of PBRN and CBPR research are health-care disparities, prevention, chronic disease management and mental health. The inclusion of CBPR within a PBRN has been identified as an important next step with the potential to significantly enhance the research process. This review focuses on bringing together the ideals of CBPR and PBRNs in order to tackle intractable problems such as disparities in health-care access and outcomes and translate these results into practice. Specifically, the CBPR PBRN approach can: (1) guide the research process so that studies more closely match the needs of all stakeholders (including providers, patients and community members); (2) assist in the development of the research protocol and identification of research methodologies so that the study is more amenable to participants; (3) facilitate recruitment of research participants; (4) enrich the data collection and analysis; and (5) allow rapid translation of results from the study back into clinical practice and the community. Once these mechanisms have been clearly elucidated, their widespread adoption will positively impact overall health at both a local and national level.

Research paper thumbnail of Policosanol is ineffective in the treatment of hypercholesterolemia: A randomized controlled trial

American Journal of Clinical Nutrition

Background: Policosanol is one of the fastest growing over-thecounter supplements sold in the Uni... more Background: Policosanol is one of the fastest growing over-thecounter supplements sold in the United States. The use of policosanol to treat elevated cholesterol is based on clinical trials conducted in Cuba, which showed sugar cane-derived policosanol to be similar in efficacy to statins. Recent studies have challenged these findings, but there have been no trials conducted in North America that have examined the ability of sugar cane-derived policosanol to lower cholesterol. Objectives: This study investigated the efficacy of sugar canederived policosanol in healthy adults with mild hypercholesterolemia. The primary outcome was the percentage change in LDL cholesterol after 8 wk of therapy. Secondary outcome measures included changes in total cholesterol, HDL cholesterol, triacylglycerols, C-reactive protein, and nuclear magnetic resonancedetermined lipoprotein profile. Dietary habits, weight, and blood pressure were also monitored. Design: Ambulatory, community-dwelling healthy adults with mild hypercholesterolemia (n ҃ 40) were assigned to receive oral policosanol (20 mg) or placebo once daily for 8 wk. This was a doubleblind, randomized controlled trial conducted from January through August 2005. Results: No significant differences in the change in LDL cholesterol were observed between the placebo (n ҃ 20) and policosanol (n ҃ 20) groups. Also, no significant changes in secondary outcome measures, including total cholesterol, HDL cholesterol, triacylglycerol, C-reactive protein, and nuclear magnetic resonance spectroscopydetermined profiles were observed. Policosanol was well tolerated, and no significant adverse events were noted. Conclusion: Policosanol does not alter the serum lipid profile over an 8-wk period in adults with mild hypercholesterolemia.

Research paper thumbnail of A Population Based Study Examining Language as a Predictor of Colorectal Cancer Screening Among Overweight and Obese Hispanic Adults in the United States

The Open Epidemiology Journal, 2009

Objective: Colorectal cancer (CRC) is one of the top two leading causes of cancer deaths in Hispa... more Objective: Colorectal cancer (CRC) is one of the top two leading causes of cancer deaths in Hispanic/Latino adults living in the U.S., and CRC risk increases in people who are overweight. As the U.S. Hispanic population increases along with a growing prevalence of overweight and obesity, studies are needed to determine if overweight Hispanic adults suffer from disparities in their rates of CRC screening. Our study was able to examine the correlation between a preference for using the Spanish language and rates of screening for CRC using national survey data.

Research paper thumbnail of Patient engagement and informed decision making regarding medical imaging

North Carolina medical journal

Misuse and overuse of medical imaging have gained widespread attention due to rising costs, radia... more Misuse and overuse of medical imaging have gained widespread attention due to rising costs, radiation exposure risks, and limited comparative effectiveness evidence. Involving patients in shared decision making offers an opportunity to more clearly define risks and benefits, thus allowing patients to consider both personal values and the best available evidence.

Research paper thumbnail of Exercise for management and treatment of Parkinson disease

American family physician, Jan 15, 2009

Research paper thumbnail of Communities matter: the relationship between neighborhoods and health

North Carolina medical journal

Understanding the link between neighborhood conditions (both physical and social) and health outc... more Understanding the link between neighborhood conditions (both physical and social) and health outcomes is an essential step toward ameliorating health disparities in low-income and high-risk minority populations. This commentary discusses the evidence that the neighborhood is a key social determinant of health and describes tools that can be used to help overcome disparities in community health.

Research paper thumbnail of Cost analysis of the use of emergency departments for primary care services in Charlotte, North Carolina

North Carolina medical journal

Patients often inappropriately seek emergency services for ambulatory care-sensitive conditions (... more Patients often inappropriately seek emergency services for ambulatory care-sensitive conditions (ACSCs). The unnecessary use of emergency departments (EDs) is an expensive burden on hospitals and payers. Here, we identify factors influencing ED visits for ACSCs and analyze the costs of such visits for EDs and primary care clinics. Age, race, sex, and insurance data from 2007 for 3 primary care safety net clinics and 4 EDs in Charlotte, North Carolina, were analyzed using the New York University (NYU) algorithm to identify ACSC diagnoses. Cost analyses used hospital charge data and net margins as surrogates for payer and hospital system costs. A total of 113,730 (59.4%) of 191,622 ED visits were for ACSCs. Factors that increased the number of ACSC-related visits included lack of insurance coverage; receipt of Medicaid insurance; age of less than 2 years; African American, Hispanic, or Native American race or ethnicity; and female sex. Charges in the EDs were 320%-728% higher than tho...

Research paper thumbnail of Policosanol is ineffective in the treatment of hypercholesterolemia: a randomized controlled trial

The American journal of clinical nutrition, 2006

Policosanol is one of the fastest growing over-the-counter supplements sold in the United States.... more Policosanol is one of the fastest growing over-the-counter supplements sold in the United States. The use of policosanol to treat elevated cholesterol is based on clinical trials conducted in Cuba, which showed sugar cane-derived policosanol to be similar in efficacy to statins. Recent studies have challenged these findings, but there have been no trials conducted in North America that have examined the ability of sugar cane-derived policosanol to lower cholesterol. This study investigated the efficacy of sugar cane-derived policosanol in healthy adults with mild hypercholesterolemia. The primary outcome was the percentage change in LDL cholesterol after 8 wk of therapy. Secondary outcome measures included changes in total cholesterol, HDL cholesterol, triacylglycerols, C-reactive protein, and nuclear magnetic resonance-determined lipoprotein profile. Dietary habits, weight, and blood pressure were also monitored. Ambulatory, community-dwelling healthy adults with mild hypercholeste...

Research paper thumbnail of Axoplasm enriched in a protein mobilized by nerve injury induces memory-like alterations in Aplysia neurons

The Journal of neuroscience : the official journal of the Society for Neuroscience, 1995

Axon regeneration after injury and long-term alterations associated with learning both require pr... more Axon regeneration after injury and long-term alterations associated with learning both require protein synthesis in the neuronal cell body, but the signals that initiate these changes are largely unknown. Direct evidence that axonal injury activates molecular signals in the axon was obtained by injecting axoplasm from crushed or uncrushed nerves into somata of sensory neurons with uncrushed axons. Those injected with crush axoplasm behaved as if their axons had been crushed, exhibiting increases in both repetitive firing and spike duration, and a decrease in spike afterhyperpolarization 1 d after injection. Because similar changes occur in the same cells after learning, these data suggest that some of the long-lasting adaptive changes that occur after injury and learning may be induced by common axoplasmic signals. Since the signals in axoplasm must be conveyed to the cell soma, we have begun to test the hypothesis that at least some of these signals are proteins containing a nuclea...

Research paper thumbnail of Systolic Blood Pressure Control Among Individuals With Type 2 Diabetes: A Comparative Effectiveness Analysis of Three Interventions

American journal of hypertension, Jan 9, 2015

The relative effectiveness of 3 approaches to blood pressure control-(i) an intensive lifestyle i... more The relative effectiveness of 3 approaches to blood pressure control-(i) an intensive lifestyle intervention (ILI) focused on weight loss, (ii) frequent goal-based monitoring of blood pressure with pharmacological management, and (iii) education and support-has not been established among overweight and obese adults with type 2 diabetes who are appropriate for each intervention. Participants from the Action for Health in Diabetes (Look AHEAD) and the Action to Control Cardiovascular Risk in Diabetes (ACCORD) cohorts who met criteria for both clinical trials were identified. The proportions of these individuals with systolic blood pressure (SBP) <140mm Hg from annual standardized assessments over time were compared with generalized estimating equations. Across 4 years among 480 Look AHEAD and 1,129 ACCORD participants with baseline SBPs between 130 and 159mm Hg, ILI (OR = 1.46; 95% CI = [1.18-1.81]) and frequent goal-based monitoring with pharmacotherapy (OR = 1.51; 95% CI = [1.16-...

Research paper thumbnail of Management of cervical lymphadenitis in children

American family physician, 2008

Research paper thumbnail of Endemic Toxoplasmosis in Pigs on a Farm in Maryland: Isolation and Genetic Characterization of Toxoplasma gondii

Journal of Parasitology, 2008

The prevalence of Toxoplasma gondii was investigated on a poorly managed pig farm in Maryland. Se... more The prevalence of Toxoplasma gondii was investigated on a poorly managed pig farm in Maryland. Serum and tissue samples from 48 of the 100 pigs on the farm were available for T. gondii evaluation. Serological testing was performed using both ELISA and the modified agglutination test (MAT). Antibodies to T. gondii were detected by ELISA in 12 of 48 animals, while antibodies were detected in 34 of 48 pigs by MAT with titers of 1:10 in 1, 1:20 in 4, 1:40 in 7, 1:80 in 3, 1:160 in 8, 1:320 in 3, 1:640 in 4, and 1:1,280 in 4. Hearts of 16 pigs with MAT titers of 1:10 or higher were bioassayed for T. gondii in cats; 11 cats shed T. gondii oocysts. Hearts of 22 pigs were autolyzed and bioassayed only in mice; T. gondii was isolated from 3 of these 22 pigs. Genetic typing of the 14 T. gondii isolates using the SAG1, SAG2, SAG3, BTUB, GRA6, c22-8, c29-2, L358, PK1, and Apico loci revealed 4 genotypes; 10 isolates belonged to type II lineage (genotypes 1 and 2), 3 belonged to genotype 3, and 1 belonged to genotype 4. Genotype 1 and 2 have type II alleles at all genetic loci, except the former has type II allele and the latter has a type I allele at locus Apico. Both genotypes 1 and 2 are considered to belong to the clonal type II lineages. Genotype 3 and 4 are nonclonal isolates. Results document high prevalence of T. gondii in pigs on a farm in Maryland.

Research paper thumbnail of Evidence That Long-Term Hyperexcitability of the Sensory Neuron Soma Induced by Nerve Injury in Aplysia Is Adaptive

Journal of Neurophysiology, 2005

Peripheral axotomy induces long-term hyperexcitability (LTH) of centrally located sensory neuron ... more Peripheral axotomy induces long-term hyperexcitability (LTH) of centrally located sensory neuron (SN) somata in diverse species. In mammals this LTH can promote spontaneous activity of pain-related SNs, and such activity may contribute to neuropathic pain and hyperalgesia. However, few axotomized SN somata begin to fire spontaneously in any species, and why so many SNs display soma LTH after axotomy remains a mystery. Is soma LTH a side effect of injury with pathological but no adaptive consequences, or was this response selected during evolution for particular functions? A hypothesis for one function of soma LTH in nociceptive SNs in Aplysia californica is proposed: after peripheral injury that produces partial axotomy of some SNs, compensation for sensory deficits and protective sensitization are achieved by facilitating afterdischarge near the soma, which amplifies sensory input from injured peripheral fields. Four predictions of this hypothesis were confirmed in SNs that innervate the tail. First, LTH of SN somata was induced by a relatively natural axotomizing event-a small cut across part of the tail in the absence of anesthesia. Second, soma LTH was selectively expressed in SNs having axons in cut or crushed nerves rather than nearby, uninjured nerves. Third, after several weeks soma LTH began to reverse when functional recovery of the interrupted afferent pathway was shown by reestablishment of a centrally mediated siphon reflex. Fourth, axotomized SNs developed central afterdischarge that amplified sensory discharge coming from the periphery, and the after-depolarization underlying this afterdischarge was enhanced by previous axotomy.

Research paper thumbnail of Obesity and asthma: Pathophysiology and implications for diagnosis and management in primary care

Experimental Biology and Medicine, 2014

The effects of obesity on asthma diagnosis, control, and exacerbation severity are increasingly r... more The effects of obesity on asthma diagnosis, control, and exacerbation severity are increasingly recognized; however, the underlying pathophysiology of this association is poorly understood. Mainstream clinical practice has yet to adopt aggressive management of obesity as a modifiable risk factor in asthma care, as is the case with a risk factor like tobacco or allergen exposure. This review summarizes existing data that support the pathophysiologic mechanisms underlying the association between obesity and asthma, as well as the current and future state of treatment for the obese patient with asthma. Our review suggests that evidence of chronic inflammatory response linking obesity and asthma indicates a need to address obesity during asthma management, possibly using patient-centered approaches such as shared decision making. There is a need for research to better understand the mechanisms of asthma in the obese patient and to develop new therapies specifically targeted to this unique patient population.