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PubMed2002

Data, network, and application: technical description of the Utah RODS Winter Olympic Biosurveillance System.

Given the post September 11th climate of possible bioterrorist attacks and the high profile 2002 Winter Olympics in the Salt Lake City, Utah, we challenged ourselves to deploy a computer-based real-time automated biosurveillance system for Utah, the Utah Real-time Outbreak and Disease Surveillance system (Utah RODS), in six weeks using our existing Real-time Outbreak and Disease Surveillance (RODS) architecture. During the Olympics, Utah RODS received real-time HL-7 admission messages from 10 emergency departments and 20 walk-in clinics. It collected free-text chief complaints, categorized them into one of seven prodromes classes using natural language processing, and provided a web interface for real-time display of time series graphs, geographic information system output, outbreak algorithm alerts, and details of the cases. The system detected two possible outbreaks that were dismissed as the natural result of increasing rates of Influenza. Utah RODS allowed us to further understand the complexities underlying the rapid deployment of a RODS-like system.

Algorithms↗

PubMed1992

The incidence and prevalence of dermatitis herpetiformis in Utah.

BACKGROUND AND DESIGN: The incidence and prevalence of dermatitis herpetiformis has never been formally evaluated in any area of the United States. Several northern European studies have shown prevalence rates ranging from 1.2 per 100,000 to 39.2 per 100,000. The present study was performed to evaluate the incidence and prevalence of dermatitis herpetiformis in Utah. Information from 240 patients diagnosed with dermatitis herpetiformis was compiled from hospital records throughout Utah, as well as the sole private dermatopathologist in the state, and from the university referral center of the state. Criteria for inclusion in the study were a clinical diagnosis of dermatitis herpetiformis plus granular deposition of IgA in dermal papillae by direct immunofluorescence of uninvolved skin, or histopathologic findings consistent with the disease. Clinical diagnosis and response to dapsone alone was considered insufficient for inclusion in the study. On the basis of these criteria, as well as exclusion of non-Utah residents, 188 of the original 240 patients qualified for the study. RESULTS: The prevalence of dermatitis herpetiformis in Utah in 1987 was 11.2 per 100,000. The mean incidence for the years 1978 through 1987 was 0.98 per 100,000 per year. The mean age at onset of symptoms for male patients was 40.1 years, and that for female patients was 36.2 years. The male-female ratio was 1.44:1. CONCLUSIONS: This represents the first evaluation of the incidence and prevalence of dermatitis herpetiformis in the United States. These results are similar to those of the previous studies, probably because of Utah's largely northern European ancestry. This population base, plus a much smaller than average black and Oriental population, is likely to have produced a higher incidence and prevalence in Utah than would be seen in other areas of the United States.

Adult↗

PubMed2004

Nonfatal injury rates of Utah agricultural producers.

The purposes of this study were to identify the source and frequency of agricultural injuries in Utah, and determine an injury rate for common agricultural activities. Previous studies conducted in Utah examined injury rates by utilizing emergency room logs. This study collected data directly from the source, farmers and ranchers in Utah, and included all modes of treatment. A random sample of Utah Farm Bureau members were mailed questionnaires to assess the number of injuries occurring during the past three years, the mode of treatment for the most recent injury, and the percentage of time spent in hazardous activities. The rate of injuries requiring medical treatment (19.9%) observed in this survey-based study was higher than reported in previous studies at the state and national level. Nearly half (48.7%) of the injuries reported were treated at home or by a family member. As in the previous Utah studies, working with horses was found to be the single most dangerous activity for agriculturalists in Utah in terms of injuries per unit time of exposure, followed by servicing agricultural machinery.

Accidents, Occupational↗

PubMed2005

Utah's Family High Risk Program: bridging the gap between genomics and public health.

BACKGROUND: Family history is a simple yet powerful genomic tool that can identify individuals and entire populations at risk for diseases such as heart disease, cancer, and diabetes. Despite its use for predicting disease, family history has traditionally been underused in the public health setting. CONTEXT: A program for identifying families at risk for a variety of chronic diseases was implemented in Utah. Utah has population characteristics that are unique among the United States. Although the land area is large, most residents live within a relatively small geographic area. The religion of 70% of the residents encourages the recording of detailed family histories, and many families have access to records dating back to the 1800s. METHODS: From 1983 through 1999, the Utah Department of Health, local health departments, school districts, the University of Utah, and the Baylor College of Medicine implemented and conducted the Family High Risk Program, which identified families at risk for chronic diseases using the Health Family Tree Questionnaire in Utah high schools. CONSEQUENCES: The collection of family history is a cost-effective method for identifying and intervening with high-risk populations. More than 80% of eligible families consented to fully participate in the program. A total of 80,611 usable trees were collected. Of the 151,188 Utah families who participated, 8546 families identified as high-risk for disease(s) were offered follow-up interventions. INTERPRETATION: The program was revolutionary in design and demonstrated that family history can bridge the gap between genetic advances and public health practice.

Breast Neoplasms↗

PubMed2005

Increasing prevalence of gastroschisis in Utah.

BACKGROUND: Recent studies provide conflicting information about gastroschisis prevalence trends. The authors proposed that prevalence of gastroschisis in live births has increased in Utah and that characteristics of these infants would provide clinically useful information about treatment and outcomes. METHODS: Primary Children's Medical Center (PCMC) is the sole pediatric surgical referral hospital for Utah. The authors used both pediatric surgical and neonatal databases to identify gastroschisis cases at PCMC from 1971 through 2002. Only infants whose mothers had a primary residence in Utah were included. Individual charts were reviewed for infant characteristics for cases from 1998 through 2002. Utah Vital Statistics Reports were used to determine live birth rates and general infant and maternal characteristics. RESULTS: Gastroschisis prevalence increased from 0.36 to 3.92 cases per 10,000 live births over 31 years (P < .001). Young maternal age, primigravida status, and tobacco use were associated risk factors. Using the time required to achieve full enteric feedings at targeted volume and caloric density as a measurement of outcome, we found no association between delivery mode or surgical closure type (primary or secondary) and time to full feedings. Higher birth weight was associated with decreased time to full feedings (P = .03). CONCLUSIONS: Gastroschisis prevalence has increased 10-fold over the past 3 decades in Utah.

Adolescent↗

PubMed1976

Cancer incidence in Mormons and non-Mormons in Utah, 1966-1970.

Between 1950 and 1969 cancer mortality in white Utah residents was 22 per cent less than that in the entire United States population. The religion of 72 per cent of the State residents (Mormon) proscribes use of tobacco and alcohol. We therefore analyzed the 10,641 cases of cancer identified in Utah from 1966 to 1970 and compared the incidence found in Utah Mormons, in Utah non-Mormons, and in a national survey. Comparison of Utah Mormons with non-Mormons showed that Mormons had a lower incidence of all cancers associated with cigarette smoking (P less than 0.00001). Mormon females had a low incidence of cancer of the breast (P = 0.008), uterine cervix (P less than 0.00001), and ovary (P = 0.04); Mormon males had a lower incidence of stomach cancers (P = 0.003). These findings addevidence to the association between cigarette smoking and certain cancers, but leave unexplained the significant differences between Mormons and non-Mormons for incidence of cancer of the breast, cervix, prostate and nervous system.

Alcohol Drinking↗

PubMed2005

Female breast cancer incidence and survival in Utah according to religious preference, 1985-1999.

BACKGROUND: Female breast cancer incidence rates in Utah are among the lowest in the U.S. The influence of the Church of Jesus Christ of Latter-day Saint (LDS or Mormon) religion on these rates, as well as on disease-specific survival, will be explored for individuals diagnosed with breast cancer in Utah from 1985 through 1999. METHODS: Population-based records for incident female breast cancer patients were linked with membership records from the LDS Church to determine religious affiliation and, for LDS Church members, level of religiosity. Incidence rates were age-adjusted to the 2000 U.S. standard population using the direct method. Cox proportional hazards model was used to compare survival among religiously active LDS, less religiously active LDS, and non-LDS with simultaneous adjustment for prognostic factors. RESULTS: Age-adjusted breast cancer incidence rates were consistently lower for LDS than non-LDS in Utah from 1985 through 1999. Rates were lower among LDS compared with non-LDS across the age span. In 1995-99, the age-adjusted incidence rates were 107.6 (95% CI: 103.9 - 111.3) for LDS women and 130.5 (123.2 - 137.9) for non-LDS women. If non-LDS women in Utah had the same breast cancer risk profile as LDS women, an estimated 214 (4.8%) fewer malignant breast cancer cases would have occurred during 1995-99. With religiously active LDS serving as the reference group, the adjusted death hazard ratio for religiously less active LDS was 1.09 (0.94 - 1.27) and for non-LDS was 0.86 (0.75 - 0.98). CONCLUSION: In Utah, LDS lifestyle is associated with lower incidence rates of female breast cancer. However, LDS experience poorer survivability from breast cancer than their non-LDS counterparts. Parity and breastfeeding, while protective factors against breast cancer, may contribute to poorer prognosis of female breast cancer in LDS women.

Adult↗

PubMed1993

A comprehensive evaluation of family history and breast cancer risk. The Utah Population Database.

OBJECTIVE: The purpose of this study is to assess the impact of family history on the risk of developing breast cancer. DESIGN: A case-control study design was used. SETTING: To provide a comprehensive assessment of family history risk, we used the Utah Population Database, a linked database compiled of genealogy data of the descendants of Mormon pioneer families, cancer data from the Utah Cancer Registry, and mortality data from the Utah Department of Vital Statistics. PATIENTS: All women diagnosed with breast cancer who were in the genealogy database and the Utah Cancer Registry were included. Controls were women selected from the genealogy, who like cases had no record of previous cancer. They were matched to the cases by age and place of birth. OUTCOME: Several definitions of family history were used. The total familial risk variable, developed to work effectively in the Utah Genealogy Database, accounts for all family members, their degree of relatedness to the case, and the amount of time they were observed for possible cancer diagnosis. RESULTS: A threefold increase in risk, estimated by the odds ratio (OR), of breast cancer among those with the highest family history score (6% of cases) was observed when compared with those with the lowest family history score. The OR for women with a first-degree relative with breast cancer was 2.45 (95% confidence interval [CI], 1.84 to 3.06). If the nearest relative was a second-degree relative, the OR was 1.82 (95% CI, 1.39 to 2.24); if the nearest relative was a third-degree relative, the OR was 1.35 (95% CI, 1.07 to 1.64). A slightly greater risk was observed if the first-degree relative was a woman's mother (OR, 2.44; 95% CI, 1.77 to 3.42) rather than a sister (OR, 2.01; 95% CI, 1.66 to 2.43). Among subjects diagnosed before the age of 50 years, the disease experience of relatives prior to age 50 was most important, while for older subjects the experience of relatives of all ages was of roughly equal importance. Women who developed contralateral breast cancer within 3 years of initial diagnosis were nearly 10 times as likely as women without breast cancer to have a first-degree relative with breast cancer. Based on the risk estimates in this study, we have estimated that approximately 17% to 19% of breast cancer in the population could be attributed to family history. Women who had a first-degree relative with colon cancer had a 30% increased risk of breast cancer. CONCLUSIONS: In this study population, women with a family history of breast cancer, even if the nearest relative with breast cancer is a third-degree relative, are at increased risk of the disease.

Adult↗

PubMed1988

Antithrombin III Utah: proline-407 to leucine mutation in a highly conserved region near the inhibitor reactive site.

A dysfunctional antithrombin III (ATIII) gene encoding a qualitatively and quantitatively abnormal anticoagulant molecule is responsible for hereditary thrombosis in a Utah kindred [Bock et al. (1985) Am. J. Hum. Genet. 37, 32-41]. Nucleotide sequencing of the entire protein-encoding portion of the cloned ATIII-Utah gene revealed a C to T transitional mutation which converts proline-407 to leucine. Proline-407 is located 14 amino acids C-terminal to the reactive site arginine of ATIII in a core region of the molecule that has been highly conserved during evolution of the serine protease inhibitor (serpin) gene family. The location of this proline in the crystal structure of the homologous serpin alpha 1-antitrypsin suggests that the leucine substitution in ATIII-Utah may interfere with correct folding of the mutant gene product, leading to its rapid turnover and the low antithrombin levels observed in patient plasmas. The Pro-407 to Leu mutation does not interfere with binding of antithrombin III to heparin. Patient antithrombin III, isolated by affinity chromatography on heparin-Sepharose, was reacted with purified thrombin. ATIII encoded by the patient's normal gene formed protease-inhibitor complexes with thrombin, whereas the product of the ATIII-Utah gene did not. The Pro-407 to Leu mutation destroys a restriction site for the enzyme StuI, permitting rapid diagnosis of affected members of the Utah kindred by Southern blotting of genomic DNA.

Amino Acid Sequence↗

PubMedDate not supplied

Animal implantation results with the Utah-100 total artificial heart.

The Utah-100 total artificial heart was designed to have increased reliability over the Jarvik-7 total artificial heart, achieve better fit, and minimize device associated thrombus formation, without decreasing the function. The Utah-100 heart was tested in 28 calves and 3 sheep. The smallest animal at the time of implantation weighted 54 kg. Mean survival duration was 78 days (range, 1-331 days), with 14 animals surviving longer than 60 days. Multiple organ function was maintained satisfactorily with the Utah-100 artificial heart, and mean plasma free hemoglobin values in the calves that survived longer than 100 days were less than 10 mg/dl. Hemorrhage was the main cause of death in animals dying within 30 days after implantation (5/13, 38%); infection was another primary cause of death or termination (4/31, 13%). Deaths due to mechanical failure occurred from valve or diaphragm failure in two cases, yielding a 91% reliability at a 90% confidence level for 60 days' support. No animal died because of driver or other technical failure. Utah-100 hearts showed superior antithrombogenicity in the connector and valve-related areas when compared with the results of the Jarvik-7 heart, which was also fabricated and implanted in our laboratory (p less than 0.01). With these test results, the authors anticipate that the Utah-100 heart will be a safe and effective device for interim use as a bridge to heart transplantation.

Animals↗

PubMed1995

Intracellular events determine the fate of antithrombin Utah.

We sought to determine whether intracellular or extracellular events contribute to the decrease in circulating antithrombin (AT) levels that is seen in subjects with the Utah mutation (Pro 407 to Leu). Site-directed mutagenesis was used to recreate this mutation within a previously characterized rabbit AT cDNA. Cell-free expression of the mutated cDNA yielded an AT protein that failed to react with thrombin. Expression of the rabbit AT-Utah protein in transiently transfected Cos cells resulted in a 10-fold decrease in the amount of AT antigen detected in the conditioned media, as compared with that seen with the wild-type recombinant AT. This effect was not caused by variations in transfection efficiency, because AT levels were normalized to the product of a cotransfected plasmid, chloramphenicol acetyl transferase. Moreover, on Northern blot analysis, AT mRNA levels were comparable in cells expressing either the rabbit AT-Utah or wild-type recombinant rabbit AT. Immunoblots of conditioned media from the two populations of transfected cells showed that the recombinant AT-Utah protein was intact. The results obtained with Cos cells were reproduced using permanently transfected Chinese hamster ovary (CHO) cells. Pulse-chase experiments with the CHO lines showed that both initial levels of rabbit AT-Utah after the pulse labeling and the rate of subsequent secretion during the chase period were reduced compared with that seen with cells expressing the wild-type AT. The observed reduction in AT secretion was also observed for the AT-Oslo mutation (Ala 404 to Thr) when recreated in the rabbit AT background, and expressed in Cos cells. In these experiments, the media levels of mutant AT were reduced by 50%, compared with wild-type. These results show that intracellular events, as opposed to accelerated clearance or other extracellular causes, contribute to the paucity of AT secretion seen in these strand 1C AT mutants.

Amino Acid Sequence↗

PubMed2005

Identification and study of Utah pseudo-isolate populations-prospects for gene identification.

Isolate populations of varied types have proven powerful for gene identification for rare Mendelian disorders, and continue to show such promise for more complex phenotypes. Existing isolate populations are limited in the phenotypes available for study, and new population isolates are unlikely to arise. We utilize genealogical data available for the state of Utah, dating back to its European founders, to retrospectively define and examine pseudo-isolate subpopulations. These pseudo-isolate populations are defined by selection of a set of "founders" from the genealogical data, and then limitation of "immigration" by censoring of matings and offspring that do not match the isolate population design. A wide variety of pseudo isolate and other study designs are possible by varying the number and type of founders and the extent of immigration allowed. We present several different example Birth-Country pseudo-isolate populations defined within the Utah Population Database (UPDB). We utilize linked cancer phenotype data available for the Utah population to show the utility of this pseudo-isolate approach for identification of more genetically homogeneous prostate cancer pedigrees for predisposition gene identification. In conclusion, we present a unique approach to retrospective "creation" of isolate populations using existing genealogical data. We use the UPDB to exhibit the utility of this approach for the highly heterogeneous Utah population, and suggest the approach is feasible for any population for which high quality genealogy and phenotype data are available.

Databases as Topic↗

PubMed2004

Attitudes toward wilderness study areas: a survey of six southeastern Utah counties.

Southeastern Utah is a region of world-renowned red-rock sandstone formations, large tracts of federal public land, rural communities centered on agriculture and extractive industries, and is often at the epicenter of environmental protection efforts in the western United States. Environmental groups have proposed formal Wilderness designations for much of the region's public land--proposals that have been actively fought by rural community leaders who do not want large areas "locked-up" from traditional livelihood and recreational uses. The debate over wilderness designation in the region has been characterized in the media as one that is particularly contentious and polarizing. A survey of southeastern Utah residents was conducted in order to better understand this conflict. The survey focused on attitudes toward wilderness designation and management. We found that residents of southeastern Utah have negative attitudes towards the designation and management of Wilderness Study Areas. We propose that these attitudes should be carefully considered and engaged in future policy and management decisions. We suggest that negative opinions expressed by residents of southeastern Utah are not directed primarily at the concept of environmental protection but rather at the strong perception that these programs and initiatives have been carried out in a heavy-handed manner and dominated by outside influences that have overwhelmed local "voices."

Adult↗

PubMed1976

A mathematical model of aging processes. IV. A multivariate analysis of blood pressure in a Montreal and a Utah population.

Two populations, one Montreal- and one Utah-based, were studied with respect to heart disease risk factors on a cross-sectional basis. The Utah population afforded consistently lower mean blood pressures than the Montreal population, although there was not evidence that the Utah population was less obese, or had a lower pulse rate. Also, in the Utah population, it was found that the proportion of persons with a family history of heart disease did not differ significantly in the hyper- and normo-tensive groups. Fourteen parameters were investigated in the Montreal population, and the analyses indicated that, when other variables are controlled, age, pulse rate, some measure of serum lipid levels, and a family history of heart disease generally assist in the discrimination between the hyper- and normo-tensive groups, but the obesity measurement did not. In that sense, obesity, on its own, may not be considered a risk factor for hypertension.

Aging↗

PubMed1984

Epidemiology of neural tube defects in Utah, 1940-1979.

The prevalence and distribution of 991 cases of neural tube defects who were born in Utah in 1940-1979 are analyzed. The average prevalence at birth is 1.00 per 1000 births (live and stillbirths), which is similar to other states in the western United States. A decline in prevalence is observed during the past 10 years, although there is not a long-term secular trend for the whole time period. Examination of hospital records shows that 17.9% of neural tube defects were not reported on birth or fetal death certificates. The male/female sex ratio is 0.67. No seasonality is found for spina bifida cases; however, a bimodal distribution, with a substantial deficit in May, is observed for anencephaly. A significant negative correlation is found between neural tube defect prevalence and the percentage of individuals in each Utah county who are members of the Mormon Church. No association is found between levels of fallout exposure in Utah and regional variation in neural tube defects, and time-space clustering analysis demonstrates no significant clusters of neural tube defects in Utah.

Anencephaly↗

PubMed1994

Factors affecting recruitment of physical therapy personnel in Utah.

BACKGROUND AND PURPOSE: This study assessed the current and future needs of physical therapy personnel in Utah, including both physical therapists and physical therapist assistants. SUBJECTS: Three hundred twenty-two health care facilities selected from four major employer groups in Utah and a total of 590 physical therapy personnel were surveyed. Two hundred forty-four health care facilities (76%) and 198 physical therapy personnel (33.6%) responded. METHODS: Two survey instruments were developed: one to assess the current and future supply and demand of physical therapy personnel in Utah, and the other to determine recruitment and retention factors. RESULTS: Utah health care facilities projected a need for 46 additional physical therapists and 28 additional physical therapist assistants in 1992. Surveyed physical therapy personnel reported feeling satisfied with the profession and had chosen the profession through a person of influence. Freedom on the job and development of skills were the most often mentioned determinants of job satisfaction, and pay and benefits were the major determinants of retention. CONCLUSION AND DISCUSSION: Physical therapy personnel should have a role in recruitment efforts. Physical therapy personnel have many options for employment and often choose to seek a diversity of opportunities for better compensation.

Job Satisfaction↗

PubMed2000

Incidence and types of adverse events and negligent care in Utah and Colorado.

BACKGROUND: The ongoing debate on the incidence and types of iatrogenic injuries in American hospitals has been informed primarily by the Harvard Medical Practice Study, which analyzed hospitalizations in New York in 1984. The generalizability of these findings is unknown and has been questioned by other studies. OBJECTIVE: We used methods similar to the Harvard Medical Practice Study to estimate the incidence and types of adverse events and negligent adverse events in Utah and Colorado in 1992. DESIGN AND SUBJECTS: We selected a representative sample of hospitals from Utah and Colorado and then randomly sampled 15,000 nonpsychiatric 1992 discharges. Each record was screened by a trained nurse-reviewer for 1 of 18 criteria associated with adverse events. If > or =1 criteria were present, the record was reviewed by a trained physician to determine whether an adverse event or negligent adverse event occurred and to classify the type of adverse event. MEASURES: The measures were adverse events and negligent adverse events. RESULTS: Adverse events occurred in 2.9+/-0.2% (mean+/-SD) of hospitalizations in each state. In Utah, 32.6+/-4% of adverse events were due to negligence; in Colorado, 27.4+/-2.4%. Death occurred in 6.6+/-1.2% of adverse events and 8.8+/-2.5% of negligent adverse events. Operative adverse events comprised 44.9% of all adverse events; 16.9% were negligent, and 16.6% resulted in permanent disability. Adverse drug events were the leading cause of nonoperative adverse events (19.3% of all adverse events; 35.1% were negligent, and 9.7% caused permanent disability). Most adverse events were attributed to surgeons (46.1%, 22.3% negligent) and internists (23.2%, 44.9% negligent). CONCLUSIONS: The incidence and types of adverse events in Utah and Colorado in 1992 were similar to those in New York State in 1984. Iatrogenic injury continues to be a significant public health problem. Improving systems of surgical care and drug delivery could substantially reduce the burden of iatrogenic injury.

Adolescent↗

PubMed1998

Family nursing practice in public health: Finland and Utah.

This exploratory study of family nursing practice in public health care was conducted in Finland and Utah. Staff nurses were interviewed in focus groups and asked to describe their practice of family nursing, the factors promoting and restraining practice, and the impact of the changes in health care delivery on practice. Thirty-six Finnish and 30 Utah nurses participated. Pressure to do more activities with fewer nurses and resources, changes in family problems, and skill level of the nurses were common themes. However, differences were evident. Finnish public health nurses used emotional support and information to help families empower themselves to use resources and to strengthen their family unit. Utah nurses focused first on individual level goals and then family cohesion and health. Nurse-initiated referrals and direct physical care were the primary intervention strategies of Utah nurses. Unlike the U.S. health care system, access for all in maternal and child health care and school health allowed Finnish nurses to develop long-term relationships with families, thus advancing family nursing practice. This study identifies several potential variables for further study particularly related to the organization of health care and nurse-family relationships.

Adult↗