Health Sciences Faculty Scholarship

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Normative Data for the BTrackS Balance Test of Postural Sway: Results from 16,357 Community- Dwelling Individuals Who Were 5 to 100 Years Old
(2018-05-17) Goble, Daniel J.; Baweja, Harsimran S.
Background: Postural sway is routinely assessed because increased postural sway is associated with poorer performance of activities of daily living, higher rates of residential care, and increased risk of falling. Force plate technology is one of the most sensitive and objective means of assessing postural sway in the clinic. Objective: The aim of this study was to provide the first set of normative data for the BTrackS Balance Test (BBT) of postural sway. Design: The design was descriptive and population based. Methods: BBT results from 16,357 community-dwelling individuals who were 5 to 100 years old were accumulated and assessed for effects of age, sex, height, and weight. Percentile rankings were calculated for significant groupings. Results: BBT results were dependent on age and sex but not height or weight. Therefore, percentile rankings were determined for male and female individuals in each age category, with no consideration of participant height or weight. Limitations: Data were collected by third-party practitioners with various backgrounds in more than 50 locations across the United States and Canada. There was an imbalance in the sample sizes for age and sex groupings. Conclusions: The findings of this study represent the largest normative dataset ever published for postural sway results. Normative data on the BBT can assist in determining abnormalities in postural sway, which have been linked to negative clinical outcomes.
The impact of different high-intensity interval training protocols on body composition and physical fitness in healthy young adult females
(2018-12-28) Brown, Elise; Hew-Butler, Tamara; Marks, Charles R.C.; Butcher, Scotty J.; Choi, Myung D.
Although traditional high-intensity interval training (HIIT) has been effective in improving body composition and physical fitness, it is unclear how multimodal HIIT affects these variables. This study compared the differences between these two training programs on body composition and physical fitness in apparently healthy, nonobese young adult females. A total of 16 participants (mean age = 23 ± 5.08 years) completed a 12-week HIIT intervention with two treatment groups: rowing and multimodal. Immediately before and after the intervention, the following measures were assessed: body mass index (BMI), total body mass, waist circumference, waist-to-height ratio, total body fat %, visceral adipose tissue, lean mass, bone mineral outcomes, cardiovascular fitness, and muscular fitness. A general linear model with repeated measures was used to assess changes over time for the group as a whole, as well as between-group differences. For the group as a whole, there were significant decrease in total body fat % (p = 0.04) and significant increases in BMI (p = 0.015), total body mass (p = 0.003), lean mass (p < 0.001), bone mineral content (BMC) (p < 0.001), VO2max (p = 0.01), broad jump (p = 0.001), squat endurance (p = 0.006), press (p < 0.001), back squat (p < 0.001), and deadlift (p < 0.001) one repetition maximum (1RM). The multimodal group (p < 0.001) increased deadlift 1RM significantly more than the rowing group (p = 0.002). HIIT can be an effective means for improving cardiovascular and muscular fitness, increasing lean mass and BMC, and thereby improving cardiometabolic as well as musculoskeletal health in nonobese females. Using a multimodal approach may give the added benefit of superior muscular strength increases.
The antiestrogenic effects of black cohosh on BRCA1 and steroid receptors in breast cancer cells
(2019-02-19) Crone, Michael; Hallman, Kelly; Lloyd, Victoria; Szmyd, Monica; Badamo, Briana; Morse, Mia; Dinda, Sumi
Background: Black cohosh (BC) is an herbal remedy often used by women to treat symptoms associated with menopause. Research has shown that the molecular activity of BC is associated with estrogen receptor alpha (ER-α) regulation. Progesterone receptor (PR) expression is found to be consistent with ER expression and mutations in the BRCA1 gene, a tumor-suppressor gene, are known to be responsible for about 40%–45% of hereditary breast cancers. Purpose: The objective of this study was to determine the effects of BC alone, as well as in combination with hormones and antihormones, on cell viability and expression of ER-α, PR, and BRCA1 in both T-47D and MCF-7 cell lines. Methods: Cells were cultured in charcoal-stripped serum prior to their treatment and subsequent protein extraction. Western blot analyses were performed following a Bio-Rad Bradford protein assay and SDS-PAGE gel electrophoresis, with ECL luminescence and Image Studio Lite software. Cellular viability assays were performed using propidium iodine (PI) staining, and the distribution of fluorescent structures was evaluated through confocal microscopy. RT-qPCR analysis was performed on extracted cellular RNA. All statistical analyses were performed using SPSS software, and data was subjected to Kruskal-Wallis testing, followed by post-hoc analysis using the Mann-Whitney U-test to determine the statistical significance of all findings. Results: Western blot analysis displayed significant alterations of ER-α, PR, and BRCA1 protein levels after 24-hour treatment with 80–500 μM BC. BC displayed a concentration-dependent decrease on ER-α and BRCA1 expression, with an 87% reduction of ER-α expression and a 43% of BRCA1 expression in T-47D cells compared to control. After six days of treatment with 400 μM BC, a 50% decrease in cell proliferation was observed. Following 24 hours of co-treatment with 400 μM BC and 10 nM E2, ER-α was downregulated by 90% and BRCA1 expression was reduced by 70% compared to control. The expression of PR, following the same treatment, exhibited similar effects. The proliferative effect of E2 was reduced in the presence of BC. Conclusion: Black Cohosh demonstrates substantial anti-cancer properties, and this study may significantly aid in the understanding of the molecular effects of BC on ER-α, PR, and BRCA1 in breast cancer cells.
School-Based Physical Therapists' Perceptions about Becoming Effective Practitioners through Professional Development
(2023-01-23) Zousmer, Stacy; Stiller, Christine; Thompson, Kristine; Wilson, Christopher; Kondratek, Melodie
Aims: The aims of this study were to explore perceptions of school-based physical therapists (SBPTs) about professional development and effective practice and to create a conceptual framework to help understand how SBPTs become effective practitioners who continue to learn and grow professionally as clinicians in an educational setting. Methods: Twenty school-based physical therapists completed a demographic questionnaire and a semi-structured interview. Guiding interview questions focused on SBPTs' perceptions of roles and responsibilities, professional development, barriers, and recommendations. Results: Participants identified roles and personal qualities of effective SBPTs. Three concepts for the process of professional development were developed: educational context and culture, barriers to effective practice, and strategies for professional development. Conclusion: The development of effective practice for SBPTs is a multifaceted, iterative process involving a unique set of knowledge, skills, and behaviors that allow them to fulfill their roles. The process takes time and effort to understand the self within the educational context and culture, recognize barriers to effective practice, and develop strategies for success. A conceptual framework was developed to assist SBPTs in implementing a plan for professional development that leads to effectively providing services to students and functioning as essential members of the educational team.
Dataset of mercury levels found in cosmetic skin lightening products from Michigan and North Carolina
(2022-09) Rajaee, Mozhgon; Bassene, Atoysha; Hsu-Kim, Heileen; Jin, Zehao
Ethnic and racial minority populations are at a greater risk of using skin lightening products due to influences from colorism. Elevated levels of mercury in cosmetic skin lightening products have been documented throughout the US despite being banned. Because levels in North Carolina and Southeast Michigan are unknown, skin lightening products were collected from ethnic retailers between February 2019 to February 2020 in neighborhoods with minority ethnic enclaves. Two samples of each product were collected and analyzed for total mercury. Forty-five (n=45) skin lightening products were collected. Most samples (n=38) contained mercury levels that were below the detection limit (0.02 ppm), but two samples containing levels of 5,950 and 2,400 ppm, were well above the US Food and Drug Administration permissible level of 1 ppm. The two samples were from Mexico and purchased from a North Carolina Latin American supermarket.
Literature review of epidemiological studies examining the relationship between calcium and lead levels
(2021) Rajaee, Mozhgon; Dubovitskiy, Ernest; Brown, Victoria C.
Lead has adverse effects on health, society, and the economy. Lead exposure results in increased blood lead levels and storage in bones. Calcium and lead are competitively absorbed and as such calcium can be used to mitigate the body lead burden. Twenty-eight quantitative research studies were reviewed that examined lead exposure (in blood, bone, or breastmilk) and calcium intake or serum calcium to evaluate the efficacy and safety of fortifying potable water supplies with calcium to mitigate lead absorption or resorption. Eighteen of the studies reported a significant inverse relationship between biomarker lead levels and calcium intake or serum calcium. The relationship was most evident with high calcium intake, suggesting a dose-dependent relationship. An intervention with calcium-fortified water could offer an accessible source of supplemental calcium to help meet the recommended dietary allowance (RDA) and mitigate lead absorption. A concentration of 60 mg-Ca/L can supply 22.0 and 16.3% of a 1,000 mg-Ca RDA for men and women, respectively, at the recommended daily water intake.
A Life Course Perspective on Stress and Health Among Caregivers of Children With Asthma in Detroit
(2013-01) Cheezum, Rebecca R.; Sampson, Natalie R.; Parker, Edith A.; Lewis, Toby C.; O’Toole, Ashley; Patton, Jean; Zuniga, Adriana; Robins, Thomas G.; Keirns, Carla C.
Low-income caregivers raising children with asthma experience many obstacles to their own health, including stress. To understand and describe their daily experiences, researchers conducted 40 qualitative interviews supplemented with descriptive quantitative surveys in Detroit, Michigan, as part of a community-based participatory research partnership of Community Action Against Asthma. Prevalence of chronic illness is noticeably higher among participants than the general US population. Caregivers identified stress processes that may influence disproportionate health outcomes and risk-related behaviors over their lifetime. Applying a life course perspective, findings suggest that public health interventions should address family-level comorbidities, increase instrumental social support, and acknowledge practical coping mechanisms.
Using PhotoVoice to understand health determinants of formerly-homeless individuals living in permanent housing in Detroit
(2018-12-14) Cheezum, Rebecca R.; Rosso, Matthew T.; Niewolak, Nick; Cobb, Tia
Housing First is an evidence-based approach to addressing chronic homelessness that provides permanent, low-barrier housing. Previous literature on the health of tenants of Housing First programs has primarily focused on mental health, substance use, and health care. Using the social-ecological model, we conducted a community-based participatory research (CBPR) PhotoVoice study to better understand what Housing First residents in Detroit identify as factors that impact their health. Seventeen participants were provided cameras and photography training and asked to take photos on the theme “What impacts your health and wellness?” Group sessions were held to discuss photos. Results were organized into four themes: (a) loss of jobs hurts people and communities; (b) blight, more than just abandoned buildings; (c) being pushed out by development; and (d) experiencing the “battlefield” versus feeling peaceful. The social-ecological model was used to indicate potential interventions indicated by study findings.
“I wouldn’t look at it as stress”: Conceptualizations of Caregiver Stress among Low-Income Families of Children with Asthma
(2013-02-24) Cheezum, Rebecca R.; Sampson, Natalie R.; Parker, Edith A.; Lewis, Toby C.; O’Toole, Ashley; Zuniga, Adriana; Patton, Jean; Robbins, Thomas G.; Keirns, Carla C.
Low-income caregivers of children with asthma experience multiple stressors, likely worsening family health. As part of Community Action Against Asthma’s community-based participatory research partnership, researchers conducted 40 qualitative semi-structured interviews and quantitative surveys with low-income caregivers of children with asthma in Detroit, Michigan. Participants described daily childhood asthma experiences and completed scales including the Peds Quality of Life Family Impact Module and Zarit Burden Caregiver Scale. Quantitative scale findings suggested participants are moderately stressed or affected by their child’s illness. While there was some accordance between qualitative and quantitative findings, qualitative findings additionally captured many relevant life stressors, seemingly overlooked or conflated in scale responses. Many participants described asthma as part of childrearing, rather than as a stressor or burden. Findings encourage improvement of clinical, psychometric assessments used to measure and address stressors that shape health for many families with children with asthma.
Low birthweight, retention in HIV care, and adherence to ART among postpartum women living with HIV in Ghana
(2018-07-02) Sakyi, Kwame S; Lartey, Margaret Y; Dension, Julie A; Kennedy, Caitlin E; Mullany, Luke C; Gyebi, Prince O; Kwara, Awewura; Surkan, Pamela J
Care for low birthweight (LBW) infants can contribute to psychological difficulties and stigma among mothers living with HIV, creating challenges for antiretroviral therapy (ART) adherence and retention in HIV care. We explored how caring for LBW infants affects maternal ART adherence and retention in care. We conducted 30 in-depth interviews with postpartum women living with HIV in Accra, Ghana: 15 with LBW infants and 15 with normal birthweight (NBW) infants. Compared to mothers with NBW infants, mothers with LBW infants described how caring for their newborns led to increased caregiver burden, prolonged hospital stays, and stigma—contributing to incomplete ART adherence and missed clinical appointments. For a few women, care for LBW infants created opportunities for re-engagement in HIV care and motivation to adhere to ART. Results suggest women living with HIV and LBW babies in Ghana face increased challenges that impact their adherence to care and ART.
Re-thinking patient motivation in clinical rehabilitation encounters: Insights from different theoretical perspectives
(2018-05) Papadimitriou, Christina; Caddick, Nick; Stone, David; Caddick, Nick
We use analytic pluralism to analyze a data excerpt from the medical rehabilitation of an inpatient with spinal cord injury and his physical therapist to examine how the concept of motivation is used in clinical practice. We employ three theoretical perspectives to explore ways of understanding this concept: social determination theory, phenomenology, and narrative inquiry. We present and argue for multiple ontologies as a new forward to understanding complex human phenomena such as motivation.
The effects of black cohosh on the regulation of estrogen receptor (ERα) and progesterone receptor (PR) in breast cancer cells
(2018-01-18) Szmyd, Monica; Lloyd, Victoria; Hallman, Kelly M.; Mladenovik, Viktoria; McKee, Christina; Morse, Mia; Bedgood, Tyler; Dinda, Sumi
The North American plant Cimicifuga racemosa, also known as black cohosh (BC), is a herb that recently has gained attention for its hormonal effects. As the usage of hormone replacement therapy is declining due to its adverse effects in women with cancer, many are turning to herbal remedies like BC to treat menopausal symptoms. It is crucial to determine whether the effects of BC involve estrogen receptor-alpha (ERα). Previous studies from our laboratory have shown ERα to be a possible molecular target for BC. In this study, we examined the effects of BC (8% triterpene glycosides) alone and in combination with hormones and antihormones on the cellular viability, expression of ERα and progesterone receptor (PR)-A/B, and cytolocalization of ERα in ER (+) and PR-A/B (+) T-47D breast cancer cells. Cells were cultured and proteins were extracted and quantified. Western blot analysis revealed alterations in the expression of ERα and PR after treatment with BC (5–100 µM). BC induced a concentration-dependent decrease in ERα and PR protein levels when compared to the control. Image cytometric analysis with propidium iodide staining was used to enumerate changes in T-47D cell number and viability. A decrease in T-47D cell viability was observed upon treatment with 5–100 µM BC. The ideal concentration of BC (100 µM) was used in combination with hormones and antihormones in an effort to further understand the possible similarities between this compound and other known effectors of ERα and PR. After a 24-hour concomitant treatment with and/or in combination of BC, estradiol, ICI 182, 780, and Tamoxifen, downregulation of ERα and PR protein levels was observed. Delineating the role of BC in the regulation of ERα, PR, as well as its mechanisms of action, may be important in understanding the influence of BC on hormone receptors in breast cancer.
Primary school children's health behaviors, attitudes, and body mass index after a 10-week lifestyle intervention with follow-up
(2018-05-09) Brown, Elise C.; Buchan, Duncan S.; Drignei, Dorin; Wyatt, Frank B.; Kilgore, Lon; Cavana, Jonathan; Baker, Julien S.
Background: Given the current global child obesity epidemic, testing the effectiveness of interventions in reducing obesity and its influencers is paramount. The purpose of this study was to determine immediate and long-term changes in body mass index and psychosocial variables following a 10-week lifestyle intervention. Methods: Seven hundred and seventy participants (8.75 ± 0.98 years of age, 379 boys and 391 girls) took part in the study. Participants had height, weight, and psychosocial questionnaires assessed at pre- and post-control, pre- and post-intervention, and 6-months post-intervention. Participants completed a weekly 10-week intervention consisting of healthy eating and physical activity education, physical activity, parental involvement, and behavior change techniques. Regression models were fit with correlated errors where the correlation occurred only between time points, not between subjects, and the nesting effects of school and area deprivation were controlled. Results: Regression models revealed a significant decrease in body mass index from pre- to post-intervention of 0.8512 kg/m2 (P = 0.0182). No Changes in body mass index occurred from post-intervention to 6-month follow-up (P = 0.5446). The psychosocial variables did not significantly change. Conclusions: This lifestyle intervention may be an effective means for improving body mass index in primary school children in the short-term if the duration of the intervention is increased, but these changes may not be sustained without on-going support.
Health Promotion in Therapy
(Wolters Kluwer, 2018-01) Arena, Sara
Nightwatch: Sleep disruption of caregivers of children with asthma in Detroit
(2013-10) Cheezum, Rebecca R.; Parker, Edith A.; Sampson, Natalie R.; Lewis, Toby C.; O’Toole, Ashley; Patton, Jean; Robins, Thomas G.; Keirns, Carla C.
Caregiving for ill loved ones can impact sleep quality and quantity. Insufficient sleep has been associated with worse physical and mental health outcomes, as well as an impact on work performance and ability to accomplish necessary tasks. While some research has looked at the sleep of caregivers of loved ones with chronic illness and found that they experience poorer sleep, little is known about the impact of caring for a child with asthma on the caregiver’s sleep and the ways in which their sleep may be affected. Community Action Against Asthma, a community-based participatory research partnership, conducted interviews with semi-structured and open-ended questions with 40 caregivers of children with asthma who live in Detroit. We found that caregivers regularly experience poor quality sleep due to sleeping lightly in order to listen for the child’s symptoms, waking multiple times to check on the child due to worry and providing care for him or her when he or she experiences symptoms in the middle of the night. Results of the Epworth Sleepiness Scale indicate that 12.5% of caregivers received a score of 16 or more, the score on the scale used to indicate likely presence of a sleep disorder, and 42.5% had a score of 10 or more, indicating excessive sleepiness. Sleep disturbance in caregivers is an under-recognized consequence of childhood asthma with implications for providers caring for children with asthma.
Building Community Capacity to Advocate for Policy Change: An Outcome Evaluation of the Neighborhoods Working in Partnership Project in Detroit
(2013-09) Cheezum, Rebecca R.; Coombe, Chris M.; Israel, Barbara A.; McGranaghan, Robert J.; Burris, Akosua N.; Grant-White, Sonya; Weigl, Ashley; Anderson, Michael
This article presents results of the outcome evaluation of Neighborhoods Working in Partnership (NWP), a community-based participatory research project of the Detroit Community–Academic Urban Research Center, designed to enhance policy advocacy skills through training and support, thereby increasing community capacity, engagement, and empowerment of Detroit residents to change policies. Focus groups and conversational interviews were conducted with NWP participants. Results indicate that the workshop empowered participants and enhanced dimensions of community capacity. Participants reported engaging in policy advocacy activities and various policy successes. Participants identified challenges and facilitating factors to their policy campaigns. Recommendations for similar trainings are provided.
Environmental Health Risk Perception of Hydraulic Fracturing in the US
(Cogent Environmental Science, 2016-07-08) Olawoyin, Richard; McGlothlin, Charles; Conserve, Donaldson F.; Ogutu, Jack
The advent of new technologies such as directional drilling (D2) and the hydraulic fracturing technique (HFtech) has made it possible to enhance energy production from petroleum reserves. The procedures involved have however aroused public sentiments and triggered the debate on the economic importance of petroleum recovery processes. Public perceptions of the environmental health consequences of these processes have been fuzzy. Public survey was conducted using the United States as a case study to foster the development of the most effective policy relative to environmental health sustainability and energy independence. Participants (n = 1243) were surveyed on the prevalence and concerns for HFtech in proxy communities in 2015. Key to the perception inquiry was the knowledge of respondents on HFtech and the concerns relative to the exploration processes. Ordinal logistic regression and Poisson regression (Pλ) were used to interpret the responses obtained from the participants. The study determined mixed public view for HFtech based on the analyses conducted. Young men, on average, had the least degree of concerns, while older residents (60+ years old) are more inclined to have friends who support HFtech in the communities (p-value = 0.082). Through this study, a clearer global profile of perceived public risks can be developed in countries using HFtech, in determining risk acceptability and proper governance for shale gas development. The detailed survey carried out is important for the development of effective strategies for managing risky decisions to emerging energy development issues while balancing the need for a sustainable environment.

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