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PubMed2006

Antenatal screening tests: knowledge and practice patterns of obstetricians in Utah.

We sought to assess knowledge and practices of obstetricians regarding antenatal testing and test the efficacy of continuing education via a direct mailing. In June 2004, an educational brochure entitled "New Options for Maternal Serum Screening for Birth Defects" as well as an anonymous survey pertaining to antenatal testing was sent to 241 American College of Obstetricians and Gynecologists (ACOG) Fellows and Junior Fellows residing in Utah. Data from the 85 (35%) respondents were analyzed. The majority of respondents practice obstetrics (81/85, or 95%). Of these, 67% of respondents perform sonograms routinely in their offices. Respondents were distributed evenly across all years of practice. Respondents offer HIV screening routinely (85%), but only 40% follow ACOG cystic fibrosis (CF) screening recommendations. Midtrimester serum screening is offered routinely by 89% of the respondents, but only 54% adequately understood the capabilities and limitations of the test. Questions related to the patient education brochure included in the mailing were answered correctly more often than the other questions. The brochure emphasized the usefulness of combined integrated screening for detecting Down syndrome, and 94% of respondents subsequently understood this concept. We show that in Utah, ACOG recommendations for HIV and maternal serum testing are being followed uniformly, but CF screening is still not being routinely offered. The accurate responses to questions related to an enclosed education brochure suggest that direct mailings may be useful for provider education, especially in regions where many providers practice remote from academic centers.

Cystic Fibrosis↗
PubMed1983

Epidemiology and genetics of neural tube defects: an application of the Utah Genealogical Data Base.

The distribution and prevalence of births with neural tube defects in Utah from 1940 to 1979 are analyzed with regard to prevalence rates, secondary sex ratios, seasonality, yearly rates, and time-space clustering. The overall prevalence rate of 1.00 per thousand live births is comparable to that of other populations in the western United States. Analysis of sex ratios indicates a substantially higher proportion of females than males. No significant secular trends or time-space clustering are observed. No seasonality is seen for spina bifida; however, the anencephaly cases are delivered more frequently in the early spring and fall months. Following linkage of the neural tube defect cases to the Utah Genealogical Data Base, application of the genealogical index method shows substantial familial clustering of the disease. The average inbreeding coefficient of the neural tube defect cases is not elevated over that of matched controls. The empirical recurrence risk for the disease is calculated to be 3%, and the heritability estimate is 70%. Likelihood analysis of pedigrees containing spina bifida occulta and spina bifida cystica indicates that they may segregate as an autosomal dominant trait with a penetrance of 75%.

Anencephaly↗
PubMed1987

Genetic structure of the Utah Mormons: isonymy analysis.

Isonymy analysis is reported for a sample of 188,895 marriages extracted from the Utah Genealogical Database. Inbreeding rates estimated by isonymy are low, ranging from 0.005 for the earliest marriage cohort (1800-1809) to 0.0008 in the most recent cohort (1950-1959). The inbreeding values decrease considerably through time, but they are consistently higher than inbreeding values estimated from pedigrees. Several explanations are offered for this, including polyphyletism of surnames and the presence of Scandinavian patronyms in this population. Random isonymy between subdivisions is also compared with random kinship estimated from migration matrices. In terms of within-subdivision kinship, the two approaches yield similar results. However, the results are quite dissimilar for between-subdivision kinship. This reflects the recent and nonrandom settlement of Utah by different ethnic groups with different surname distributions. In later time periods, the correlations between the two types of kinship estimates increase, showing that migration patterns (which are strongly determined by geographic distance) exert an increasing influence on the distribution of surnames. Logistic regression is performed on a subset of marriages (n = 88,202), using isonymous vs. nonisonymous marriage as the dependent variable. The independent variables are year of marriage, geographic distance between husband's and wife's birthplaces, endogamous vs. exogamous marriage, and population sizes of husband's and wife's birthplaces. Year of marriage and geographic distance are shown to be significant independent predictors of isonymous marriage.

Christianity↗
PubMed2006

Hindlimb adaptations in Ourayia and Chipetaia, relatively large-bodied omomyine primates from the Middle Eocene of Utah.

North American omomyids represent a tremendous Eocene radiation of primates exhibiting a wide range of body sizes and dietary patterns. Despite this adaptive diversity, relatively little is known of the postcranial specializations of the group. Here we describe hindlimb and foot bones of Ourayia uintensis and Chipetaia lamporea that were recovered from the Uinta B member (early Uintan Land Mammal Age), Uinta Formation, Utah. These specimens provide insights into the evolution of postcranial adaptations across different body sizes and dietary guilds within the Eocene primate radiation. Body mass estimates based on talar measurements indicate that Ourayia uintensis and Chipetaia lamporea weighed about 1,500-2,000 g and 500-700 g, respectively. Skeletal elements recovered for Ourayia include the talus, navicular, entocuneiform, first metatarsal, and proximal tibia; bones of Chipetaia include the talus, navicular, entocuneiform, and proximal femur. Both genera had opposable grasping big toes, as indicated by the saddle-shaped joint between the entocuneiform and first metatarsal. Both taxa were arboreal leapers, as indicated by a consistent assemblage of characters in all represented bones, most notably the somewhat elongated naviculars, the high and distinct trochlear crests of the talus, the posteriorly oriented tibial plateau (Ourayia), and the cylindrical head of the femur (Chipetaia). The closest resemblances to Ourayia and Chipetaia are found among the Bridger omomyines, Omomys and Hemiacodon. The results of our comparisons suggest that the later, larger, more herbivorous omomyines from Utah retained a skeletal structure characteristic of earlier, smaller North American omomyids.

Adaptation, Physiological↗
PubMed2005

The methodology of the Utah Birth Defect Network: congenital heart defects as an illustration.

OBJECTIVES: The Utah Birth Defect Network (UBDN) uses a population-based birth defect surveillance system that has evolved from identifying only neural tube defects in 1994 to monitoring all structural malformations since 1999. All pregnancy outcomes are monitored statewide through intensive identification of potential cases using multiple reporting sources. METHODS: The UBDN is a well-established statewide surveillance system that uses a combined approach, active and passive, in case ascertainment. Utah has the distinct advantage of having relatively few points of entry into the health care system both pre- and postnatally. A description of the UBDN methodology is presented and the completeness, validity and timing of reporting sources and diagnoses are illustrated using the example of congenital heart defects (CHD). RESULTS: The UBDN identified a total of 2,115 potential CHD cases, of which 1,082 (51.2%) were determined to be true cases and 1,033 (48.8%) were classified as not a case (NAC). A single source was responsible for reporting 1,038 (49.1%) potential cases:241 (23.2%) were true cases, and the remaining 797 (76.8%) were classified as NAC and considered to be false positives. DISCUSSION: This descriptive analysis of CHD cases collected through the UBDN's surveillance system illustrates the necessity--and benefit--of using multiple sources of ascertainment to ensure completeness of reporting.

Birth Certificates↗
PubMed2005

Lobular breast cancer: excess familiality observed in the Utah Population Database.

Family history of breast cancer (BC) is a strong predictor for developing female BC. Whether this excess familiality differs within morphological BC subgroups remains unclear. We assessed the risk of lobular breast cancer (LOB) and any BC among relatives of probands with LOB. We used the Utah Population Database (UPDB) to estimate familial relative risks (FRR) as well as average relatedness, using the genealogical index of familiality (GIF) statistic. The UPDB, a population-based resource, links genealogical data from over 2 million individuals to the Utah Cancer Registry. Consistent with other studies, analysis of all BC cases showed significantly increased risk of BC to relatives (first-degree relative [FDR]: FRR = 1.83, 95% confidence interval [CI] = 1.75-1.90). Morphology-specific risks showed that relatives of LOB probands had an increased risk of LOB (FDR: FRR = 4.51, 95% CI = 2.79-6.89) and an increased risk of any BC (FDR: FRR = 2.47, 95% CI = 2.12-2.85); both measures were significantly greater than the all BC FRR estimates, and surpassed even generalized early-onset BC risk. GIF analyses corroborated the FRR results and indicated that the excess relatedness of LOB cases extended to third-degree relatives. Our findings suggest that LOB has a heritable component and may represent a genetically homogeneous form of BC. Pedigrees with excess LOB may be useful in isolating additional BC predisposition genes. Relatives of women with LOB are at higher risk for BC than relatives of other BC subtypes; a more rigorous BC screening regime may be warranted for these individuals.

Age of Onset↗
PubMed1988

Fluid intake and bladder cancer in Utah.

A population-based, incident case-control study was conducted in Utah to assess the relationship between fluid intake and bladder cancer. Cancer cases (n = 419) were identified through the Utah Cancer Registry, and controls (n = 889) were obtained through random digit dialing and the Health Care Financing Administration. After adjustment for cigarette smoking, age, sex, history of diabetes, and history of bladder infections using multiple logistic regression analysis, total fluid intake was not found to be related to bladder cancer development. Specific fluids related to bladder cancer risk were milk intake (OR = 0.64) and caffeinated coffee intake (OR = 1.60). A linear trend for a dose-response protective effect was observed for milk, while coffee increased risk only when 40 or more cups were consumed per week. Alcohol increased risk only when consumed at high levels (over 3.64 ounces or 103 g per week) by people who never smoked cigarettes (OR = 2.37). Likewise, tea consumption in non-cigarette smokers increased bladder cancer risk (OR = 2.25). Results from this study suggest that types of fluids consumed may play a role in the development of bladder cancer. Furthermore, it is hypothesized that the dietary components of these beverages may be related to the development of bladder cancer.

Adult↗
PubMed1980

Congenital malformations in Utah.

The rate of malformed children in Utah of 11.7 per 1,000 liver births, derived from 128,857 birth certificates, ws not high compared with other non-Utah studies. Rates of selected malformations also were not high. The rate of malformed children varied by county of residence. San Juan County reported the highest percentage of mothers receiving late or infrequent prenatal care, the lowest mean level of public education, and the highest rate of malformed children in the state. The rate was not significantly associated with the large population of Indians residing in that county since by controlling for residence, the variation by race was eliminated. The overall rate was positively associated with maternal age rimarily due to an increased frequency of Down's syndrome. The impact of the "maternal age effect" on the state malformation rate, however, was not large. By controlling for maternal age, the slight association between increased rate of malformed children and increasing birth order was eliminated. The rate of malformed children was higher for parents having a low level of education, infrequent prenatal care, or who were not married. There was also a strong negative association of birth weight with the rate of malformation. Analysis of rates of selected malformations suggested that the low birth weight was a sequela to intrauterine growth retardation caused by severe congenital malformation. The validity and etiologic implications of these results await further investigation.

Birth Weight↗
PubMed1995

Hazard assessment of inorganics to three endangered fish in the Green River, Utah.

Acute toxicity tests were conducted with three life stages of Colorado squawfish (Ptychocheilus lucius), razorback sucker (Xyrauchen texanus), and bonytail (Gila elegans) in a reconstituted water quality simulating the middle part of the Green River of Utah. Tests were conducted with boron, lithium, selenate, selenite, uranium, vanadium, and zinc. The overall rank order of toxicity to all species and life stages combined from most to least toxic was vanadium = zinc > selenite > lithium = uranium > selenate > boron. There was no difference between the three species in their sensitivity to the seven inorganics based on a rank-order evaluation at the species level. Colorado squawfish were 2-5 times more sensitive to selenate and selenite at the swimup life stage than older stages, whereas razorback suckers displayed equal sensitivity among life stages. Bonytail exhibited equal sensitivity to selenite, but were five times more sensitive to selenate at the swimup life stage than the older stages. Comparison of 96-hr LC50 values with a limited number of environmental water concentrations in Ashley Creek, Utah, which receives irrigation drainwater, revealed moderate hazard ratios for boron, selenate, selenite, and zinc, low hazard ratios for uranium and vanadium, but unknown ratios for lithium. These inorganic contaminants in drainwaters may adversely affect endangered fish in the Green River.

Animals↗
PubMed1993

Smoking, alcohol, coffee, tea, caffeine, and theobromine: risk of prostate cancer in Utah (United States).

Data from a population-based study of newly diagnosed cases of prostate cancer (n = 362) and age-matched controls (n = 685) conducted in Utah (United States) between 1983 and 1986 were used to determine if cigarette smoking, alcohol, coffee, tea, caffeine, and theobromine were associated with prostate cancer risk. These factors were examined since their use differs in the Utah population, which is comprised predominantly of members of the Church of Jesus Christ of Latter-day Saints (LDS or Mormon), from most other populations. Pack-years of cigarettes smoked, alcohol intake, and consumption of alcohol, coffee, tea, and caffeine were not associated with prostate cancer risk. Compared with men with very low levels of theobromine intake, older men consuming 11 to 20 and over 20 mg of theobromine per day were at increased risk of prostate cancer (odds ratio [OR] for all tumors = 2.06, 95 percent confidence interval [CI] = 1.33-3.20, and OR = 1.47, CI = 0.99-2.19, respectively; OR for aggressive tumors = 1.90, CI = 0.90-3.97, and OR = 1.74, CI = 0.91-3.32, respectively). We present biological mechanisms for a possible association between prostate cancer and theobromine. This finding needs further exploration in studies with a wider range of theobromine exposures and more men with aggressive tumors.

Aged↗
PubMed1984

The use of asbestos-cement pipe for public water supply and the incidence of cancer in selected communities in Utah.

We tested the hypothesis that there is an association between the use of asbestos-cement piping for drinking water supplies and the incidence of gastrointestinal and kidney cancer. Cancer incidence in 14 Utah communities that had used predominantly asbestos-cement piping for transporting their drinking water supplies for 20 years or more were compared to 27 Utah communities that had never used asbestos-cement piping. Cancer incidence was tabulated for 11 cancer sites for the years 1967-1976. Increased Standard Incidence Ratios (SIRs) were found for cancer of the kidney in men (SIR 192) and leukemia (a control site) in women (SIR 203). No increased SIRs were found for the opposite sex at these sites or for the other gastrointestinal sites singly or in combination. There was no increase in age-adjusted cancer incidence for the 11 sites in 4 of the 14 study communities that had used asbestos-cement piping for 30 years or more. Limitations of the study were that the water supplies were nonaggressive, and leaching from the pipes was minimal if at all. Furthermore, the latent period for observation was very short, suggesting that these results should be considered preliminary.

Adult↗
PubMed1999

The process of converting to a near filmless operation at the University of Utah, Department of Radiology.

The Department of Radiology at the University of Utah Health Sciences Center has made the transition from a traditional film-based department to a near filmless operation. The University of Utah is a large teaching hospital and the transition from film in an educational facility will be discussed. This transition has had its difficulties and its success is dependent on the support of departmental leadership and hospital administration. We have had more than 100 years of experience with film, and current procedures were efficient given the limitations of the medium. While motivated by the traditional reasons for moving to a picture archival and communications system (PACS), such as film savings, unavailable films, and faster reports, we found the intangibles to be the larger issue, as well as a source for the largest benefits. This report will discuss the implementation process and the affect it had on all areas of the hospital, including its impact on hospital physicians, radiologists, file room personnel, and technologists. Procedure changes to the flow of patients, film, and electronic images will also be described. This process cannot be viewed as a one-time change, but must be viewed as a continuous process as areas of improvement are identified and new and improved technologies are developed.

Diagnostic Imaging↗
PubMed2004

Confirmation of the HPCX prostate cancer predisposition locus in large Utah prostate cancer pedigrees.

Several genetic predisposition loci for prostate cancer have been identified through linkage analysis, and it is now generally recognized that no single gene is responsible for more than a small proportion of prostate cancers. However, published confirmations of these loci have been few, and failures to confirm have been frequent. The genetic etiology of prostate cancer is clearly complex and includes significant genetic heterogeneity, phenocopies, and reduced penetrance. Powerful analyses that involve robust statistics and methods to reduce genetic heterogeneity are therefore necessary. We have performed linkage analysis on 143 Utah pedigrees for the previously published Xq27-28 (HPCX) prostate cancer susceptibility locus. We employed a robust multipoint statistic (TLOD) and a novel splitting algorithm to reduce intra-familial heterogeneity by iteratively removing the top generation from the large Utah pedigrees. In a dataset containing pedigrees having no more than five generations, we observed a multipoint TLOD of 2.74 (P=0.0002), which is statistically significant after correction for multiple testing. For both the full-structure pedigrees (up to seven generations) and the smaller sub-pedigrees, the linkage evidence was much reduced. This study thus represents the first significant confirmation of HPCX (Xq27-28) and argues for the continued utility of large pedigrees in linkage analyses for complex diseases.

Chromosome Mapping↗
PubMed1995

Risk factors and mechanisms of occurrence in motor vehicle-related spinal cord injuries: Utah.

The purpose of this paper is to describe the incidence, risk factors, and crash factors of motor-vehicle-related spinal cord injuries in Utah. The Utah Department of Health established a statewide registry of spinal cord injuries (SCIs) occurring in 1989-1991, analyzing data from hospital medical records and police reports. Forty-nine percent of all SCIs involved motor vehicles, including injuries arising from motor vehicle collisions with bicyclists and pedestrians. Adolescent and young adult males were at highest risk of injury. Among occupants of automobiles and trucks with SCI, 70% were involved in a vehicle rollover, while 39% were ejected from the vehicle. Only 25% reported using seatbelts. SCIs were much more likely to be associated with rollover compared with other types of motor vehicle-occupant injuries. These findings suggest areas in which SCI prevention programs and research should be focused.

Accidents, Traffic↗
PubMed1987

Recruitment of members of high-risk Utah pedigrees.

Cardiovascular Genetics Research Projects in Utah are designed to investigate genetic and environmental determinants of early coronary disease, stroke, and hypertension in population-based pedigrees. Early coronary disease is defined as the occurrence of documented coronary death or myocardial infarction before age 55. Detailed recruitment experience is reported for 2500 persons age 3-83 years in 98 high-risk pedigrees from three ascertainment groups: 1. Descendants of sibships with two or more stroke deaths before age 75. 2. Descendants of sibships with two or more coronary deaths before age 55. 3. First- and second-degree relatives of hypertensive and normotensive probands randomly selected from the Utah Hypertension Detection and Follow-up Program. A response rate of 94% of invited adults attending the first 4-hour clinic visit for detailed screening in 1980-1983 was achieved by multiple telephone, mail, and personal contacts and rescheduling of missed clinic appointments. For the same participants, a second screening cycle in 1983-1986 showed a 91% response of invited adults. Second visit response rates were examined within subgroups according to data collected at the first clinic visit. Below average response rates included 79% of persons with fewer than 12 years of education, 84% of current smokers, and 86% of divorced persons. Above average response rates included 93% of persons attending college and 95% of persons with total family income above $25,000. There were no differences in response according to sex or age. The average cost of recruitment was $59 per person and represented about 10% of the total budget for the High-Risk Pedigree Project.

Adolescent↗
PubMed2006

Factors associated with nonanomalous stillbirths: the Utah Stillbirth Database 1992-2002.

OBJECTIVE: This study was undertaken to characterize risk factors associated with nonanomalous stillborn (SB) infants and to ascribe the probability of fetal survival by gestational age among high-risk pregnancies. STUDY DESIGN: We compiled a database of all SB infants and an equivalent number of controls using information obtained from Utah Birth and Fetal Death Certificates during the years 1992 through 2002. Adjusted and unadjusted odds ratios for risk factors associated with SB were generated. Cox proportional hazard models were used to generate survival curves comparing pregnancies complicated by chronic hypertension or gestational hypertension with those of controls. RESULTS: Infants with major anomalies were eliminated from both cases and controls, to generate 1566 nonanomalous SBs and 2720 nonanomalous controls. In a logistic regression model controlling for multiple maternal and fetal factors, placental abruption, hydramnios, cord prolapse, and essential hypertension were associated with an increased risk of SB. In pregnancies complicated by essential hypertension, the survival curve diverged from that of controls at those gestational ages approaching term (hazard ratio 2.24; 95% CI 1.52-3.32). CONCLUSION: SB in nonanomalous infants in Utah is more common among pregnancies complicated by placental abruption, hydramnios, cord prolapse, and essential hypertension.

Databases, Factual↗
PubMed2005

Cancer incidence among Mormons and non-Mormons in Utah (United States) 1995-1999.

BACKGROUND: Population-based Utah Cancer Registry data were linked with Latter-day Saint (LDS or Mormon) Church membership records to obtain site-specific cancer incidence for LDS and non-LDS populations in Utah during 1995-1999. METHODS: Analyses were based on 27,631 incident cases of cancer identified among whites. Restriction to whites was made because of the small number of nonwhites, approximately 5%, in the state during the study period. The direct method was used to age-adjust the rates to the 2000 U.S. standard population. RESULTS: Significantly lower cancer incidence rates per 100,000 were observed among LDS compared with non-LDS males (287.2 vs. 321.1) and females (247.7 vs. 341.0). The lower rates are primarily explained by smoking-related cancers and female breast cancer. If the overall cancer incidence rate in LDS had occurred in the non-LDS population, 2.9% or 421 fewer cases would have occurred among males and 7.9% or 1,025 fewer cases would have occurred among females during the study period. CONCLUSIONS: Given our current knowledge of risk factors for cancer, differences between LDS and non-LDS in smoking for males and smoking and sexual and reproductive behaviors in females primarily explain the lower risk of cancer in LDS populations.

Church of Jesus Christ of Latter-day Saints↗
PubMed1998

Institutional influences on the primary cesarean section rate in Utah, 1992 to 1995.

OBJECTIVES: Our purpose was to evaluate institutional and organizational influences on cesarean section rates in Utah and to adjust such rates for differences in patient acuity. STUDY DESIGN: Data on cesarean section rates were derived from the Utah Hospital Discharge Database and adjusted for patient acuity by correcting raw cesarean rates for those patients undergoing cesarean section meeting regional gestational age transport criteria. RESULTS: When analyzed by means of 1-way analysis of variance, the following factors had a significant negative correlation (P < .05) with cesarean section rate: presence of a newborn intensive care unit and maternal-fetal medicine subspecialists, presence on the medical staff of obstetrician-gynecologist(s) as opposed to family physicians only, delivery volume >1500/y, urban location, and 24-hour in-house anesthesiology. When cesarean rates were corrected for acuity, facilities with maternal-fetal medicine specialists and a newborn intensive care unit had significantly lower rates (P < .001) and more uniform rates than otherwise similar institutions. CONCLUSIONS: More medically sophisticated physicians and institutions have lower cesarean rates when patient acuity is taken into account.

Cesarean Section↗