• Alaskan Physicians' Knowledge, Attitudes, And Behaviors Related To Fetal Alcohol Spectrum Disorders

      Dewane, Sarah L.; Brems, Christine; Rivkin, Inna; Johnson, Mark E.; Eldridge, Gloria (2010)
      Fetal alcohol spectrum disorders (FASDs), caused by maternal consumption of alcohol during pregnancy, constitute the leading known preventable birth defects in the US. Given high prevalence rates and lifetime costs of FASDs in Alaska, it is imperative that healthcare providers have an adequate foundation of knowledge related to FASDs, as well as a strong sense of self-efficacy vis-a-vis their personal capacity to engage in primary and secondary prevention activities. The purpose of this study was to examine Alaskan physicians' self-reported levels of knowledge, attitudes, and practice behaviors related to FASDs, and identify effective ways to educate and train physicians about primary and secondary FASD prevention. Study goals were accomplished via an explanatory mixed methods research design involving three distinct phases; namely, a quantitative, qualitative, and application phase. Through study participation, Alaskan physicians shared their perceptions and opinions about systemic and professional barriers that affect educational and training needs related to FASD prevention and clinical intervention, as well as challenges that impede access to care for individuals who are affected by FASDs. Results based on surveys from 243 physicians and interviews with 24 key informants revealed that physicians are generally knowledgeable about the risks of alcohol consumption during pregnancy. However, physicians are in need of support to provide effective services related to FASD prevention and intervention. These needs include: 1) specialized education during medical school and residency; 2) easily accessible continuing education opportunities; 3) development and dissemination of best practice protocols related to FASD care; 4) workforce development to increase referral options for patients; and 5) changes to healthcare systems to support primary and secondary prevention practices. Clearly, many challenges and obstacles identified by physicians are beyond their control and need to be addressed not only as independent practice issues but as larger medical education and healthcare systems issues. Given these realities and findings, the study concludes with suggestions and resources for physicians related to needed changes in FASD-related practice behaviors, as well as recommendations about how universities, medical schools, healthcare systems, and State and federal entities can better support physicians' efforts to reduce and treat these entirely preventable birth defects.
    • Effect of high latitude on the variability of human event-related brain potentials

      Bush, Anita Marie; Geist, Charles R.; Barnes, Brian M.; Connor, William; Ebbesson, Sven O.; Emery, Scott; Murphy, Edward C. (1993)
      European researchers (Anderson, Chambers, Myhre, Nicholson, & Stone, 1984) at 69 degrees north latitude, have reported seasonal changes in the human electroencephalogram, EEG. Other researchers from the North American mid-latitudes (Deldin, Duncan, & Miller, 1989a, 1989b), using event-related brain potentials, ERPs, have reported changes associated with ambient light. Similar changes in the event-related brain potentials of humans have not been reported from the high latitudes nor by longitudinal methods. This dissertation longitudinally investigated ERP variability in normal humans living at high latitude. One hundred and twelve residents of Fairbanks, Alaska participated in single-trial ERP testing, both auditory and visual, to evaluate criteria of validity and reliability. Subsequently, eight normal humans participated in auditory and visual ERP testing every month for twelve consecutive months. The longitudinally-studied subjects were residents of the Alaskan subarctic, where testing occurred, and each experienced naturally-occuring photoperiod variability of 3.31 hours in December to 21.98 hours in June. Dependent variables included P3 amplitude and latency in both sensory modalities. Independent variables included: age, estimated cranial volume, length of last sleep epoch, subjective wakefulness, ambient photoperiod, and ambient geomagnetic field. Distribution of the longitudinal ERP data satisfied Shapiro-Wilke criteria for normality. The GLM-ANOVA for ordered repeated measures was used and a month effect was observed in P3 amplitude and latency, as well as a month-by-sensory mode interaction. The principal components method of factor analysis evaluated the factor weights of the independent variables. Variables unique to each subject (e.g., age, cranial volume, length of last sleep) were more heavily weighted in the first factor. The environmental variables became heavily weighted in the second factor, and descriptors of the earth's natural geomagnetic activity were weighted more heavily than ambient photoperiod. Following PCA analysis, the environmental variables of geomagnetic field and photoperiod were separately investigated. No seasonal variability in the ERP characteristics was detected when using a photoperiod-based definition of season. However, variability in auditory P3 amplitude was observed when groupings were defined based on geomagnetic criteria.
    • Factors Contributing To Weight Gain Among College Freshman And Beyond

      Chipp, Cody L.; Brems, Christiane; Johnson, Mark; Metzger, Jesse; Rivkin, Inna (2012)
      Background: Linked with a higher risk of life threatening illnesses, obesity in the United States has become an epidemic, with a prevalence rate of overweight and obese adults of nearly 68%. Obesity rates have accelerated over the past two decades and one crucial developmental period for weight gain is among emerging adults attending college. Using an explanatory mixed-method design, this study examined contributing factors to weight gain among college students, including eliciting university stakeholders' perceptions of supports and barriers to exercising and healthy eating among students. Method: Data collection for the quantitative phase of the study consisted of two waves, baseline and 2-year follow-up. Students completed psychosocial and anthropometric measures (height, weight, and body fat percentage). Data collected for the qualitative phase of the study consisted of key informant interviews with university administrators (n=15) and seven student focus groups (n=34 students). Qualitative analyses were conducted with NVivo software and multiple coders, using a grounded theory approach to elicit major themes. Results: Students gained 1.5lbs (p>.05), with 34% of participants gaining over 5 lbs and 17% over 10 lbs. Participants who gained weight were men, ate more calories from sweets or desserts, and consumed fewer calories from fats. Increase in calories from desserts or sweets increased odds of weight gain (OR=1.075, CI=1.01-1.14) and body fat (OR=1.106, CI=1.036-1.181). Contextualizing the quantitative findings, students and administrators identified several themes that support healthy living, including access to nutritious food and physical amenities. Both groups also identified barriers, including easy access to high-calorie foods, limited recreation facilities, and policy challenges. Administrators spoke of extant health promotion efforts; however, students did not perceive active health promotion initiatives on campus. Conclusions: Dietary habits were identified drivers of weight gain among students. Extant campus supports and barriers to exercise and healthy eating among students were equally identified by students and administrators with great reliability. Implications for future health promotion efforts, food availability, recreation, and physical amenities are discussed in the context of clears sets of recommendations for stakeholder groups. Future research should explore specific dietary foods that are increasing weight and develop targeted preventions/interventions for individuals at risk.
    • The impact of the use of active imagery on labor and delivery

      Ward, Penelope H.; Geist, Charles (1995)
      This clinical investigation assessed the impact of the use of active imagery during labor and delivery to: assist in pain control, facilitate the physiological processes of labor, reduce anxiety, and improve feelings of control and self worth in the parents. Multiple designs including descriptive, Wilcoxon signed-rank test, and ANOVA using the General Linear Model were employed. After approval by monitoring authorities and informed consent, multipara couples responded to the State Trait Anxiety Inventory, the Pregnancy Attitude Index or Levenson's Locus of Control Scales, and the Adjective Checklist. Gender differences in the late third trimester were assessed. Experimental group couples were taught active imagery, given an audiotape for daily practice, and used imagery in labor and delivery. After delivery, tests were readministered, subjective comments recorded, and vividness of imagery assessed in the imagery group mothers. In the 15 couples studied, all were Internally controlled. Men felt more Internally controlled, women more manipulation by Powerful Others. There were no differences on the STAI or ACL. After delivery, no change was found on the STAI, or in Internal control. The eight couples in the Control group and women had greater control by Powerful Others. Control by Chance increased in the Control group, particularly the women. On the ACL, the Experimental group had significant change in Favorable scores with more feelings of internal control, confidence and less need for support and sympathy compared to the Control group. There was no significant difference in time in labor from 7-10 cm. However, Experimental group mothers had shorter labor periods in the hospital. They required less medication, and their babies had higher one minute Apgar scores and significantly higher arterial oxygen concentration in umbilical cord blood gas analysis. Subjectively, mothers voiced greater feelings of control after using imagery, adopting the procedure and generalizing it to other life situations. This study provided an initial look at men's feelings during their wives' pregnancies. The use of active imagery resulted in greater feelings of control and self worth, shorter total labor periods and improved neonatal outcome in this group. Imagery offers a potential for improvement in the birth process which merits further study.