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PubMed1995

Effect of outdoor airborne particulate matter on daily death counts.

To investigate the possible relationship between airborne particulate matter and mortality, we developed regression models of daily mortality counts using meteorological covariates and measures of outdoor PM10. Our analyses included data from Cook County, Illinois, and Salt Lake County, Utah. We found no evidence that particulate matter < or = 10 microns (PM10) contributes to excess mortality in Salt Lake County, Utah. In Cook County, Illinois, we found evidence of a positive PM10 effect in spring and autumn, but not in winter and summer. We conclude that the reported effects of particulates on mortality are unconfirmed.

Air Pollutants↗
PubMed2002

InfoFair: an annual computer and information event.

Since 1983, the Spencer S. Eccles Health Sciences Library has presented InfoFair, an annual event featuring presentations, exhibits, demonstrations, and workshops on computer and information topics of interest to health professionals and health information providers at the University of Utah Health Sciences Center and throughout Utah. The first InfoFair was held in response to an increasing number of inquiries from library users on how to search MEDLINE from their home or office computers. The focus of InfoFair has expanded and changed over the past nineteen years to reflect changes in library users' computer and information needs, concerns, and interests. While themes and programs have changed, a definite set of trends, guidelines, and procedures have developed based on the experience gained each year. The purpose of this paper is to review and evaluate the changes in InfoFair from 1983 to 2001 and to present information for use by other libraries for planning and presenting similar events.

Computer User Training↗
PubMedDate not supplied

Successful turnaround of a university-owned, community-based, multidisciplinary practice network.

PURPOSE: The University of Utah purchased a 100-clinician, 9-practice multi-specialty primary care network in 1998. The university projected the network to earn a profit the first year of its ownership in a market with growing capitation; however, capitation declined and the network incurred up to a 21 million dollars operating loss per year. This case study describes the financial turnaround of the network. METHODS: In 2001, the university reconfigured the practices for a fee-for-service environment while preserving the group's multidisciplinary clinical and ancillary services. Changes included reorganization under the existing University of Utah Hospitals and Clinics system, new governance and leadership, closure of practices, creation of a billing office, new financial reporting, implementation of electronic health records, revision of physician compensation, capture of referrals, leadership and staff training, and practice reengineering. RESULTS: The network as a whole became profitable in 2004-2005. Its primary care component is projected to become profitable in 2 to 3 years. The network is opening new sites strategically important to the health system. CONCLUSIONS: This turnaround required commitment from senior university leaders, management with knowledge of primary care practice, retention of ancillary revenues, and management and business services specific to the network with support from other units within the university. Culture change within the group was essential. Our experience suggests that an academic health center can successfully operate a primary care network by attending to the unique needs of this challenging business. Doing so can strengthen the institution's overall financial and clinical performance and provide an important setting for teaching and research.

Community Health Centers↗
PubMed2005

Positive selection of a pre-expansion CAG repeat of the human SCA2 gene.

A region of approximately one megabase of human Chromosome 12 shows extensive linkage disequilibrium in Utah residents with ancestry from northern and western Europe. This strikingly large linkage disequilibrium block was analyzed with statistical and experimental methods to determine whether natural selection could be implicated in shaping the current genome structure. Extended Haplotype Homozygosity and Relative Extended Haplotype Homozygosity analyses on this region mapped a core region of the strongest conserved haplotype to the exon 1 of the Spinocerebellar ataxia type 2 gene (SCA2). Direct DNA sequencing of this region of the SCA2 gene revealed a significant association between a pre-expanded allele [(CAG)8CAA(CAG)4CAA(CAG)8] of CAG repeats within exon 1 and the selected haplotype of the SCA2 gene. A significantly negative Tajima's D value (-2.20, p < 0.01) on this site consistently suggested selection on the CAG repeat. This region was also investigated in the three other populations, none of which showed signs of selection. These results suggest that a recent positive selection of the pre-expansion SCA2 CAG repeat has occurred in Utah residents with European ancestry.

Ataxins↗
PubMed2005

CFH Y402H confers similar risk of soft drusen and both forms of advanced AMD.

BACKGROUND: Age-related macular degeneration (AMD) is the most common cause of irreversible visual impairment in the developed world. The two forms of advanced AMD, geographic atrophy and neovascular AMD, represent different pathological processes in the macula that lead to loss of central vision. Soft drusen, characterized by deposits in the macula without visual loss, are considered to be a precursor of advanced AMD. Recently, it has been proposed that a common missense variant, Y402H, in the Complement Factor H (CFH) gene increases the risk for advanced AMD. However, its impact on soft drusen, GA, or neovascular AMD--or the relationship between them--is unclear. METHODS AND FINDINGS: We genotyped 581 Icelandic patients with advanced AMD (278 neovascular AMD, 203 GA, and 100 with mixed neovascular AMD/GA), and 435 with early AMD (of whom 220 had soft drusen). A second cohort of 431 US patients from Utah, 322 with advanced AMD (244 neovascular AMD and 78 GA) and 109 early-AMD cases with soft drusen, were analyzed. We confirmed that the CFH Y402H variant shows significant association to advanced AMD, with odds ratio of 2.39 in Icelandic patients (p = 5.9 x 10(-12)) and odds ratio of 2.14 in US patients from Utah (p = 2.0 x 10(-9)) with advanced AMD. Furthermore, we show that the Y402H variant confers similar risk of soft drusen and both forms of advanced AMD (GA or neovascular AMD). CONCLUSION: Soft drusen occur prior to progression to advanced AMD and represent a histological feature shared by neovascular AMD and GA. Our results suggest that CFH is a major risk factor of soft drusen, and additional genetic factors and/or environmental factors may be required for progression to advanced AMD.

Complement Factor H↗
PubMed2000

Frequency of subspecialty physician care for elderly patients with community-acquired pneumonia.

STUDY OBJECTIVES: Specialty societies have developed practice guidelines for the treatment of community-acquired pneumonia (CAP). To aid in adapting specialty recommendations for a pneumonia practice guideline at Intermountain Health Care, we investigated which physicians care for pneumonia patients in Utah. We wanted to understand who provides pneumonia care so as to appropriately target the guideline and design tools for implementation. DESIGN: Retrospective observational study. SETTING: Inpatient and outpatient multicenter. PATIENTS: The study population comprised 13,919 (16,420 episodes of pneumonia) Utah resident Medicare beneficiaries > or = 65 years of age who had CAP. Nursing home residents were excluded. MEASUREMENTS: We used Health Care Financing Administration billing records from 1993 through 1995 to identify the physicians involved in the care of pneumonia patients by self-designated specialty. We linked patterns of physician involvement to age, sex, residential zip code, 30-day mortality rate, and whether or not the patient was hospitalized. RESULTS: The involvement of a pneumonia specialist was limited to 11.7% of episodes, with involvement of a pulmonary specialist in 10.6%, an infectious disease (ID) specialist in 0.9%, and the involvement of both specialties in 0.2% of episodes. Greater specialty involvement was observed in episodes resulting in pneumonia hospitalization (20.0% vs 8.6%, respectively; p < 0.0001), death (20.5% vs 11.2%, respectively; p < 0.0001), and episodes among patients with urban county residential zip codes (13.7% vs 7.5%, respectively; p < 0.0001). CONCLUSION: Most episodes of pneumonia, including those with serious consequences, are treated by primary care physicians with little or no involvement from pulmonary or ID specialists. It is not known whether greater or lesser specialty physician involvement would change pneumonia costs or clinical outcomes.

Aged↗
PubMed2006

Improved clinical outcomes with utilization of a community-acquired pneumonia guideline.

BACKGROUND: We previously reported decreased mortality following implementation of a community-acquired pneumonia guideline derived from specialty society recommendations. However, patients with respiratory failure and sepsis from pneumonia were not included, adjustment for comorbidities was limited, and no guideline compliance data were available. We also questioned whether decreased mortality continued after 1997. METHODS: We utilized Utah data from the Centers for Medicare and Medicaid from 1993 to 2003 to determine if pneumonia guideline implementation was associated with 30-day all-cause mortality, length of hospital stay, and readmission rate. We adjusted outcomes by age, gender, Deyo comorbidity score, prior hospitalizations, and race. Guideline compliance was measured by initial default guideline antibiotic administration. We included patients > or = 66 years old with primary International Classification of Diseases, Ninth Revision, Clinical Modification codes 480.0-483.9, 485.0-486.9, 487.0, 507.0 or 518.81, and 038.x with secondary code pneumonia. We excluded patients with prior hospitalization within 10 days, patients with HIV infection or transplant recipients, and patients not treated by physicians closely affiliated with study hospitals. RESULTS: Mean (+/- SD) age of 17,728 pneumonia patients admitted to the hospital was 72.3 +/- 12.0 years, 55.2% were female, and 96.0% were white. Within Intermountain Healthcare hospitals, a 1-SD increase (10%) in guideline compliance (range, 61 to 100%) was associated with mortality odds ratio (OR) of 0.92 (95% confidence interval[CI], 0.87 to 0.98; p = 0.007). Mortality OR at 16 Intermountain Healthcare hospitals was 0.89 (95% CI, 0.82 to 0.97; p = 0.007) compared with 19 other Utah hospitals. This mortality difference corresponds to approximately 20 lives saved yearly. The readmission rate was also lower. CONCLUSION: Improved clinical outcomes were associated with pneumonia guideline utilization.

Aged↗
PubMed2000

The "muscle-bone unit" in children and adolescents: a 2000 overview.

In former views hormones, calcium, vitamin D and other humoral and nonmechanical agents dominated control of postnatal bone strength (and "mass") in children and adolescents. However later evidence that led to the Utah paradigm of skeletal physiology revealed that this control depends strongly on the largest mechanical loads on bones. Trauma excepted, muscles cause the largest loads and the largest bone strains, and these strains help to control the biological mechanisms that determine whole-bone strength. That makes the strength of children's load-bearing bones depend strongly on growing muscle strength and how bones respond to it. Most hormones and other nonmechanical agents that affect bone strength can help or hinder that "bone strength-muscle strength" relationship but cannot replace it. In addition some agents long thought to exert bone effects by acting directly on bone cells, affect muscle strength too. In that way they could affect bone strength indirectly. Such agents include growth hormone, adrenalcorticosteroid analogs, androgens, calcium, genes, vitamin D and its metabolites, etc. Thus bone and muscle do form a kind of operational unit. It is part of the Utah paradigm that supplements earlier views with later evidence and concepts. The paradigm explains how the "bone strength-muscle strength" relationship works. This article provides an overview of that physiology, and some of its implications for pediatric endocrinologists.

Adolescent↗
PubMed2001

A population-based assessment of pediatric all-terrain vehicle injuries.

OBJECTIVE: To describe the types of injuries sustained by children who ride all-terrain vehicles (ATVs), to estimate the hospital charges associated with these injuries, and to determine adherence to existing rules and regulations governing ATV use. METHODS: Analysis of statewide hospital admissions (1992-1996) and emergency department (ED) visits (1996) in Utah. All patients who were younger than 16 years and had an external cause of injury code for ATV use were included. RESULTS: In 1996, 268 ED visits by children involved an ATV. Boys were twice as commonly injured as girls (male:female ratio: 2.1:1), and skin and orthopedic injuries were most frequent. The median ED charge was $368, and ED charges for these patients totaled $138 000. From 1992 to 1996, 130 children were hospitalized as a result of injuries sustained during ATV use, with median charges of $4240 per admission. Male to female ratio was 2.7:1, and the average age was 11.2 +/- 3.6 years. Mean injury severity score was 8.0 +/- 6.0, and median length of stay was 2 days (range: 0-43 days). Orthopedic injuries were most frequent, but 25% (n = 32) of children sustained head or spinal cord injury. Most children (94%) were discharged from the hospital, but 8 children died as a result of their injuries. Utah regulations prohibit children who are younger than 8 years from driving an ATV and advise against carrying passengers on ATVs. However, 25% (n = 15) of all injured children who were younger than 8 were driving the ATV when injured, and 15% (n = 60) of injured children were passengers on ATVs. Four of the 8 fatally injured children were younger than 8, and all were driving the ATV at the time of the crash. Finally, the estimated injury rate per 100 registered ATVs is significantly higher for children than for adults (3.41 vs 1.71). CONCLUSIONS: ATV use results in significant injuries to children. Efforts to educate parents regarding the risks of ATV use, proper supervision, and use of safety equipment are warranted. Manufacturers of ATVs should continue to improve the safety profile of these inherently unstable vehicles.

Accidents, Traffic↗
PubMed2006

Role of multidecadal climate variability in a range extension of pinyon pine.

Evidence from woodrat middens and tree rings at Dutch John Mountain (DJM) in northeastern Utah reveal spatiotemporal patterns of pinyon pine (Pinus edulis Engelm.) colonization and expansion in the past millennium. The DJM population, a northern outpost of pinyon, was established by long-distance dispersal (approximately 40 km). Growth of this isolate was markedly episodic and tracked multidecadal variability in precipitation. Initial colonization occurred by AD 1246, but expansion was forestalled by catastrophic drought (1250-1288), which we speculate produced extensive mortality of Utah Juniper (Juniperus osteosperma (Torr.) Little), the dominant tree at DJM for the previous approximately 8700 years. Pinyon then quickly replaced juniper across DJM during a few wet decades (1330-1339 and 1368-1377). Such alternating decadal-scale droughts and pluvial events play a key role in structuring plant communities at the landscape to regional level. These decadal-length precipitation anomalies tend to be regionally coherent and can synchronize physical and biological processes across large areas. Vegetation forecast models must incorporate these temporal and geographic aspects of climate variability to accurately predict the effects of future climate change.

Climate↗
PubMed1976

The use of utilization review records as a source of data on nursing home care.

Data form the Utah nursing home Utilization Review Program, 1970-73, provide a description of the population of nursing home patients in Utah and changes over time in patient medication and measures of activity. These data are analyzed according to type of care in home: personal, intermediate, or comprehensive. The collection of data in utilization review programs can help to evaluate the quality of care as well as appropriateness of placement, provided the information collected is designed with these ends in mind.

Adult↗
PubMed1988

Correlates of adolescent drug use by gender and geographic location.

We examined the correlates of self-reported lifetime use of alcohol, marijuana, amphetamines, and cocaine within a sample of almost 7,000 high school sophomores in Arizona and Utah. Correlates of drug use (including parental attachment, religious attachment, educational attachment, conventional values, and drug-using friends) showed very similar patterns by gender, with some interesting differences by location. Drug-using friends are by far the best predictor of drug use for both males and females in Arizona and Utah.

Adolescent↗
PubMedDate not supplied

Assessing the risk factors for suicidal thoughts at a nontraditional commuter school.

The sample of students completing the National College Health Assessment (NCHA) Survey at the University of Utah differs from the national reference group for the NCHA 2003 in age, employment, residence, and marital status. The purpose of this study is to determine if the defining characteristics of a commuter school increase the risk for suicidal thoughts. During the fall semester of 2004, the University of Utah implemented a randomized electronic survey assessing the student body's health status in several areas. The authors compared 88 respondents who endorsed seriously considered suicide in the previous 12 months were with the remaining 954 respondents to identify discriminating variables. Those students who seriously considered suicide more likely lived off campus, indicated they were emotionally abused, were in only fair health, experienced being assaulted, experienced unwanted sexual touching, or were not heterosexual. Students who were employed were significantly less likely to consider suicide.

Adolescent↗
PubMed1976

An outbreak of giardiasis in a group of campers.

Thirty-four of 54 campers on a 2 week trip in mountains of Utah had diarrhea during and after their trip. Twenty-two (79%) of 28 symptomatic campers' stools examined contained Giardia lamblia cysts, whereas 4 (29%) of 14 asymptomatic campers' stools had cysts. The temporal distribution of cases and the absence of clustering among food preparation subgroups suggested a common source exposure. Although the epidemiologic data and fecal coliform counts implicated the remote mountain stream used as water source by the group as the vehicle of transmission, Giardia lamblia cysts were not recovered from stream water nor were they found in intestines or feces of sampled mammals living in the drainage area. Twenty-five other campers had stools examined before and after a subsequent hiking trip in another area of Utah; none had Giardia cysts before, but 6 (24%) had them after return. Questionnaires returned by 133 of the campers showed that 5% had an illness compatible with giardiasis within 2 weeks after their trip. These surveys show that campers exposed to mountain stream water are at risk of acquiring giardiasis.

Camping↗
PubMed2003

Diagnostic and molecular evaluation of three iridovirus-associated salamander mortality events.

In 1998 viruses were isolated from tiger salamander larvae (Ambystoma tigrinum diaboli and A. tigrinum melanostictum) involved in North Dakota and Utah (USA) mortality events and spotted salamander (A. maculatum) larvae in a third event in Maine (USA). Although sympatric caudates and anurans were present at all three sites only ambystomid larvae appeared to be affected. Mortality at the North Dakota site was in the thousands while at the Utah and Maine sites mortality was in the hundreds. Sick larvae were lethargic and slow moving. They swam in circles with obvious buoyancy problems and were unable to remain upright. On the ventral surface, near the gills and hind limbs, red spots or swollen areas were noted. Necropsy findings included: hemorrhages and ulceration of the skin, subcutaneous and intramuscular edema, swollen and pale livers with multifocal hemorrhage, and distended fluid-filled intestines with areas of hemorrhage. Light microscopy revealed intracytoplasmic inclusions, suggestive of a viral infection, in a variety of organs. Electron microscopy of ultra thin sections of the same tissues revealed iridovirus-like particles within the inclusions. These viruses were isolated from a variety of organs, indicating a systemic infection. Representative viral isolates from the three mortality events were characterized using molecular assays. Characterization confirmed that the viral isolates were iridoviruses and that the two tiger salamander isolates were similar and could be distinguished from the spotted salamander isolate. The spotted salamander isolate was similar to frog virus 3, the type species of the genus Ranavirus, while the tiger salamander isolates were not. These data indicate that different species of salamanders can become infected and die in association with different iridoviruses. Challenge assays are required to determine the fish and amphibian host range of these isolates and to assess the susceptibility of tiger and spotted salamanders to heterologous virus isolates.

Amino Acid Sequence↗
PubMedDate not supplied

Lower anxiety in today's high 'sue-ciety'.

Physician malpractice claims are part of the reason for the increased level of health care costs in the United States, according to authors Susan A. Chesteen, Ph.D., Fikry S. Gahin, Ph.D., and Joan M. Lally, Ph.D., of the University of Utah David Eccles School of Business. They present the results of a survey conducted on the residents of Utah on malpractice and discuss the implications for health care providers.

Adult↗
PubMedDate not supplied

Religious hiring exemption upheld: anatomy of a Supreme Court ruling.

In 1980 the Church of Jesus Christ of the Latter-day Saints (LDS Church) notified five employees that they could no longer continue in church employment because they would not or could not attend the temple as members in good standing. Together, the five filed suit in federal district court in Utah, alleging that the LDS Church discriminated against them on religious grounds in violation of Title VII of the federal Civil Rights Act of 1964, which generally prohibits discrimination in employment on the basis of religion. The plaintiffs said the statutory exemption for religious organizations in Section 702 operated as a religious preference and penalized their personal choices of religion in violation of the First Amendment. The case ended up in the Supreme Court, which upheld the provision exempting religious organizations from Title VII with respect to employing people of a particular religion for all not-for-profit activities. Evidence in the case included: Legislative history. As first enacted in 1964, Section 702 provided a limited exemption to religious corporations. In 1972 Congress enacted a broader exemption, effectively exempting from the sweep of Title VII employment decisions made by religious employers with respect to members of that religion in any work connected with the religious corporation. District court proceedings. The Utah court borrowed from several earlier cases, including one that avoided the constitutional issue by deciding that the function challenged was uniquely religious and, thus, exempted. Briefs amicus curiae. Four religious organizations filed briefs amicus curiae.

Civil Rights↗
PubMed1989

Property tax exemption for nonprofit hospitals.

This article discusses management practices that hospital administrators can use to minimize the exposure to property taxation. First, the results of a national survey on the extensiveness of property tax exemption are reviewed. Next, a review of the history of recent developments in Utah is presented, including the recent ruling of the Utah State Supreme Court that "nonprofit" status does not necessarily qualify a hospital for property tax exemption. Finally, a series of suggestions for nonprofit hospitals to consider in an effort to minimize the probability of a challenge to their tax-exempt status is offered.

Community-Institutional Relations↗