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Vyas, Ami, Shweta Kamat e Junhie Oh. "Rhode Island (RI) Women's Breast Cancer Mammography Use Prior to and After Cancer Diagnosis: Linkage of RI Cancer Registry Data With RI All-Payer Claims Database". Journal of Public Health Management and Practice 30, n.º 2 (março de 2024): E65—E73. http://dx.doi.org/10.1097/phh.0000000000001862.
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Objective: A limitation of the central cancer registries to examine associations between mammography use and cancer diagnosis is their lack of cancer screening history. To fill this measurement gap, Rhode Island Cancer Registry (RICR) breast cancer (BC) records were linked to Rhode Island-all-payer claims database (RI-APCD) to study Rhode Island (RI) women's regular mammography use and identify its predictors. Methods: From the linked 2011-2019 data, we identified 4 study cohorts: (1) women who ever received mammography by Women's Cancer Screening Program (WCSP) and were diagnosed with BC (“WCSP-BC” cohort: n = 149), (2) women diagnosed with BC outside of WCSP (BC-control cohort: n = 4304), (3) women with a history of mammography use at WCSP but no BC diagnosis (n = 6513), and (4) general RI women with no BC diagnosis (n = 15 121). Logistic regressions were conducted to identify predictors of regular mammography use. Results: The linkage for RI-APCD and RICR for our study had a high matching rate of 82%. Mammography use prior to BC diagnosis was not different between the WCSP-BC cohort and the BC-control cohort (58% vs 57%). Women in the BC-control cohort who had mammography in 2 years prior to their cancer diagnosis were more likely of being diagnosed at an early-stage disease. Among BC-control group, women with no anxiety/depression or with no preventive examinations were less likely of regular mammography use. Among women with no BC, a lower proportion of women with a history of screening at WCSP had regular mammography use, compared with the general RI women (38% vs 66%). Conclusion: RI-APCD data linkage with RICR provides excellent opportunities to examine regular mammography use among RI women and compare their outcomes to the general women population in the state. We identified opportunities for improving their mammography use. A measurement gap in the central cancer registries can be effectively reduced by utilizing statewide claims database.
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Fenton, Mary Anne. "Quality improvement outcomes in an academic practice participating in ASCO’s Quality Oncology Practice Initiative (QOPI)." Journal of Clinical Oncology 30, n.º 34_suppl (1 de dezembro de 2012): 206. http://dx.doi.org/10.1200/jco.2012.30.34_suppl.206.
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206 Background: The ASCO QOPI is an instrument for community and academic practices to assess quality and adherence to guidelines in areas of treatment planning and goals, chemotherapy consent documentation, smoking cessation, symptom control, palliative care, and disease specific measures. Following data submission QOPI summary reports for the submitting practice and QOPI aggregate are available for review and comparison. Methods: The academic practice of Rhode Island Hospital Comprehensive Cancer Center has participated in QOPI since the fall of 2008. QOPI measure summary reports for our practice and comparison to the Academic Aggregate are reviewed by our physicians after each round of chart abstraction, measures are identified for improvement. Interventions include education on practice improvement and development of policy and procedures for implementation by our Quality Control Officer in compliance with hospital policies. Results: Presented is a summary of quality improvement interventions implemented. Additional areas of quality improvement have been identified based on QOPI data, and improvement plans are ongoing including treatment summaries for patient and primary care physicians, tools to assess patient emotional well being, documentation of family history and referral for genetic assessment. Conclusions: QOPI provides a platform for collection, analysis and comparison of quality measures. For the measures of formulating a pain plan the intervention was a reminder to document the plan. For the measure hospice enrollment, a reflection on our hospice enrollment has lead to an increase in referral to palliative care. The ASCO QOPI program is a tool for quality improvement, our Quality Control Officer was essential in implementation of our improvement projects. [Table: see text]
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Scott, H. Denman, Barbara A. Debuono, John P. Fulton, Robert A. Smith e Judith P. Feldman. "The Breast Cancer Screening Program in Rhode Island". Journal of Public Health Policy 13, n.º 1 (1992): 52. http://dx.doi.org/10.2307/3343058.
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Glicksman, A. S., L. Tisch e P. Calabresi. "Community cancer control task forces in Rhode Island". Journal of Clinical Oncology 22, n.º 14_suppl (15 de julho de 2004): 1038. http://dx.doi.org/10.1200/jco.2004.22.14_suppl.1038.
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Glicksman, A. S., L. Tisch e P. Calabresi. "Community cancer control task forces in Rhode Island". Journal of Clinical Oncology 22, n.º 14_suppl (15 de julho de 2004): 1038. http://dx.doi.org/10.1200/jco.2004.22.90140.1038.
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Ollila, Thomas, Anthony E. Mega, Boris Martinez, Paula Salisbry, Annabelle Neville, Janell Johnson, Brett Dickens et al. "Evaluation of a summer program for minority high school students in the clinical cancer center: The Future Gen Cancer Scholars program." Journal of Clinical Oncology 42, n.º 16_suppl (1 de junho de 2024): e13703-e13703. http://dx.doi.org/10.1200/jco.2024.42.16_suppl.e13703.
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e13703 Background: Individuals from minoritized communities receive less cancer screening, have higher stage at cancer diagnosis, and experience higher death rates. Helping minority high school students find a pathway to enter college and continue with advanced education and training and become leaders in cancer treatment, research and prevention may help reduce these inequities. Many public high schools in urban centers struggle in STEM education. The Rhode Island Hospital / Legorreta Cancer Center at Brown University partnered with the Papitto Opportunity Connection in Rhode Island to create the Future Gen Cancer Scholars program. Methods: High school students were invited to apply from Providence and surrounding communities. Accepted applicants became paid hospital employees and received training in professional conduct, protected health information and other skills necessary to shadow physicians in inpatient and outpatient settings. The summer curriculum included physician shadowing, radiology, pathology, student run tumor boards, seminars and community outreach. Pre/post-surveys were collected where students rated their experiences and beliefs regarding cancer careers on a 5-point Likert scale. Open-ended questions were added to evaluate interest in pursuing a career in oncology. Results: 20 high school students participated in the program’s first cohort. 70% self-identified as Hispanic/Latinx and 30% as African American, 85% were female, 90% attended a public school. Pre- and post-surveys were completed by 17 students. The 5-point Likert scale showed improvement in an understanding of oncology careers (pre, 3.9; post, 4.5), interest in pursuing a related career (pre, 3.1; post, 3.8), and recognition of available educational resources within their communities (pre, 3.9; post 4.3). Confidence in overcoming educational access barriers slightly decreased (pre-4.1; post-3.8) due to the increased awareness of the length, cost and process of medical training. Most students described the Future Gen Program as helping them identify career goals and a path forward. Conclusions: The Future Gen program helped solidify minority high school students’ desire to become leaders in cancer care and may provide a path forward to achieve this goal. We will track students’ educational and research achievements over time to measure the program’s impact. The establishment of a successful local model can provide a framework for a nationwide program.
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Farghly, Mohamed F. A., Rashed A. Alhotan, Khalid M. Mahrose, Youssef A. Attia, Mostafa Abdelfattah, Mohammed Abougabal, Mossad Taboosha et al. "Intermittent light program impacts on reproductive performance, health and welfare of breeding hens". Archives Animal Breeding 66, n.º 4 (14 de novembro de 2023): 315–24. http://dx.doi.org/10.5194/aab-66-315-2023.
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Abstract. The lighting regime significantly impacts poultry production, reproductive performance, health and welfare. This study aimed to test the effect of the intermittent light (IL) regime on reproductive organs and hormones, semen quality, and behavioral performance. Thus, 270 Rhode Island Red hens aged 20 weeks were distributed among three groups of six replicates and 15 birds each, housed in floor pens. The first group was used as a control (C) and was exposed to constant light for 16 h d−1, while birds in other groups were exposed to IL for 20 min h−1 (T20) and 40 min h−1 (T40) during the 16 h light period. The outcomes were that follicle number was higher for T20 compared to T40 but not the controls, while T40 is different from T20 but not the controls. The same is true for testosterone. The sperm concentration is lower for T40 compared to the controls, with no difference between T20 and the controls. Body temperature was not different among groups. Conversely, differences were not noticed for leg alterations; plumage conditions; and relative ovary, oviduct, and/or testes weight and hatchability. Thus, the IL T20 program should be further investigated as a lighting regimen for managing Rhode Island Red laying hens for stimulating follicle number and testosterone without negatively impacting the physiological response and health traits. From a practical point of view, the IL schedule of 20 min h−1 during 20–36 weeks of age can be economically viable due to saving 66 % of the light cost.
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Nicholson, Charles F., Qingbin Wang e Daniel Lass. "Impacts of the Northeast Interstate Dairy Compact on Supply, Retail Prices and the WIC Program: An Introduction". Agricultural and Resource Economics Review 30, n.º 1 (abril de 2001): 81–82. http://dx.doi.org/10.1017/s1068280500000563.
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The Northeast Interstate Dairy Compact (Compact), the first regional dairy compact in the U.S., has been the focus of a great deal of attention and speculation during the past several years. The Compact was authorized under the Federal Agriculture Improvement and Reform act of 1996 and was enacted into law by each of the six New England states, Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont (U.S. Government). The Compact explicitly recognizes dairy farming as an important component of the New England landscape that provides both cultural and economic benefits to the region. The Compact's stated purposes are to assure the continued viability of dairy farming in the Northeast, as well as its associated support industries, and to provide consumers with an adequate local supply of pure and wholesome milk. The Compact provides a measure of farm fluid milk price control in the New England states in order to help satisfy these goals.
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Mantripragada, Kalyan C., Adam J. Olszewski, Andrew Schumacher, Kimberly Perez, Ariel Birnbaum, John L. Reagan, Anthony Mega et al. "Clinical Trial Accrual Targeting Genomic Alterations After Next-Generation Sequencing at a Non-National Cancer Institute–Designated Cancer Program". Journal of Oncology Practice 12, n.º 4 (abril de 2016): e396-e404. http://dx.doi.org/10.1200/jop.2015.008433.
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Purpose: Successful clinical trial accrual targeting uncommon genomic alterations will require broad national participation from both National Cancer Institute (NCI)–designated comprehensive cancer centers and community cancer programs. This report describes the initial experience with clinical trial accrual after next-generation sequencing (NGS) from three affiliated non–NCI-designated cancer programs. Materials and Methods: Clinical trial participation was reviewed after enrollment of the first 200 patients undergoing comprehensive genomic profiling by NGS as part of an institutional intuitional review board–approved protocol at three affiliated hospitals in Rhode Island and was compared with published experience from NCI-designated cancer centers. Results: Patient characteristics included a median age of 64 years, a median of two lines of prior therapy, and a predominance of GI carcinomas (58%). One hundred sixty-four of 200 patients (82%) had adequate tumor for NGS, 95% had genomic alterations identified, and 100% had variants of unknown significance. Fifteen of 164 patients (9.2%) enrolled in genotype-directed clinical trials, and three patients (1.8%) received commercially available targeted agents off clinical trials. The reasons for nonreceipt of NGS-directed therapy were no locally available matching trial (48.6%), ineligibility (33.6%) because of comorbidities or interim clinical deterioration, physician's choice of a different therapy (6.8%), or stable disease (11%). Conclusion: This experience demonstrates that a program enrolling patients in specific targeted agent clinical trials after NGS can be implemented successfully outside of the NCI-designated cancer program network, with comparable accrual rates. This is important because targetable genes have rare mutation rates and clinical trial accrual after NGS is low.
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Pressman, Amanda, Joseph DiMase, Seth Asser, Susan Shepardson, John Bui e Lusu Ndawillie. "Screening Colonoscopy in the Underserved Population (SCUP): Results of the First Year of a Colorectal Cancer Screening Program in the Underserved Population of Rhode Island". American Journal of Gastroenterology 105 (outubro de 2010): S547—S548. http://dx.doi.org/10.14309/00000434-201010001-01475.
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DiMase, Joseph, Amanda Pressman e Seth Asser. "Screening Colonoscopy in the Underserved Population: Report of the First Year of a No-Cost Colorectal Cancer Screening Program for the Underserved in Rhode Island". American Journal of Gastroenterology 106, n.º 7 (julho de 2011): 1193–95. http://dx.doi.org/10.1038/ajg.2011.4.
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Khan, Hina, Kristy Ramphal, Morgan Motia, Maria Fhon, Jonathan Mudge, Cristina Pacheco, Howard Safran e Christopher G. Azzoli. "Disparities in lung cancer screening in a diverse urban population and the impact of a community-based navigational program." Journal of Clinical Oncology 41, n.º 16_suppl (1 de junho de 2023): 6555. http://dx.doi.org/10.1200/jco.2023.41.16_suppl.6555.
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6555 Background: Lung cancer (LC) is the leading cause of cancer death in the US in both men and women; causing 25% of all cancer deaths. Annual lung cancer screening (LCS) with a low-dose CT (LDCT) in high-risk individuals (aged 50-80 with a >20 pack-year smoking history) decreases LC deaths by 20% and is recommended by USPSTF. Despite the efficacy, uptake of LDCT remains low at 6% nationally, and 13% in Rhode Island. Patient (pt) and provider perceived barriers, along with racial, ethnic and socioeconomic disparities widen the gap. We evaluated the implementation of a LCS navigation program at an urban community health center (CHC) with a multiethnic, socioeconomically underserved population. Methods: A bilingual (English and Spanish speaking) pt navigator was integrated into routine clinic practice at a large primary care CHC group, across 4 sites, starting in January 2022. The navigator’s role was to assess pt and provider awareness of the LCS process, assess for systemic barriers, and provide navigational support for the LDCT process. Pts eligible for LCS at the CHC from 1/2022 to 12/2022 were retrospective examined; 50 to 80 years and a >20 pack-year smoking history. The navigator administered a questionnaire to assess barriers to LDCT and demographic variables. Results: A total of 360 eligible pts were seen across the CHC practice in 2022, of which 149 (41.4%) agreed to undergo LDCT after counseling and shared decision making and 28% of these (n 101) completed LDCTs. 153 of the eligible pts completed the survey questionnaire. Of these, 50% were females; 40% were Hispanic/Latinx, 40% were non-Hispanic/Latinx and 22% declined to answer. Majority, 61% were white, 10% African American/Black and 28% declined to answer. A sizeable proportion were non-English speaking (34%) and resided in cities with Rhode Island’s lowest per-capita incomes (Pawtucket 48%), Central Falls (32%) and North Providence/Providence (10%). In assessing barriers to LCS, 46% of pts were not aware of the LCS process and 44% were unaware that LCS was covered by health insurance; 58% of eligible pts did not recall their PCP discussing LCS. Of the LDCTs resulted available at the time of analysis, 84% were Lung RADS-1 and 16% Lung RADS-4 category. Conclusions: Our study highlights the unique barriers to LCS in an urban multiethnic community. While access to LCS remains an issue, pt awareness of the lung cancer screening process was the major barrier. A patient navigation program is critical to the success of LCS in a community, by providing education to patients and providers and the necessary logistical support needed in the LDCT process. With a community based navigational program, we demonstrate a significant increase in lung cancer screening rates in our population to 28% as compared to the state LCS rate of 13%. (Supported by the Robert A. Winn Diversity in Clinical Trials Career Development Award).
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Madapati, Raghu Ram, K. Wayne Lee, Francis J. Manning e Colin A. Franco. "Feasibility of Crumb Rubber Use for Asphalt Pavement Construction". Transportation Research Record: Journal of the Transportation Research Board 1530, n.º 1 (janeiro de 1996): 64–71. http://dx.doi.org/10.1177/0361198196153000109.
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There are two processes of adding crumb rubber modifier (CRM) to hot mix asphalt (HMA), that is, the wet process and the dry process; and different technologies are available for each process. On the basis of the results of the binder study and producer's practices, HMA specimens were prepared using two selected AR binders with Producer R and A CRMs for Rhode Island (RI) dense-graded and dense-graded friction course (DGFC) mixtures, respectively. Aggregates procured from four local asphalt contractors were used. In addition, gap-graded HMA specimens were prepared with 3 percent CRM and control AC-20 binder with two typical local aggregates using the dry process. Marshall mix design was performed on all mixtures to determine optimum binder content and Marshall properties. Mechanical properties were evaluated for the mixtures with and without CRM. Superpave Level I mix design was also performed for dense-graded, DGFC, and gap-graded mixtures with aggregates procured from Contractor C. Finally, the performance of pavements with and without CRM was predicted using the computer program VESYS. Results of this study indicated that the use of CRM is feasible for RI dense-graded and DGFC mixtures utilizing the wet process.
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Tran, Phuong Lien, Emmanuel Chirpaz, Malik Boukerrou e Antoine Bertolotti. "PROM SSCOL—Impact of a Papillomavirus Vaccination Promotion Program in Middle Schools to Raise the Vaccinal Coverage on Reunion Island". Vaccines 10, n.º 11 (14 de novembro de 2022): 1923. http://dx.doi.org/10.3390/vaccines10111923.
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Introduction: On Reunion Island, cervical cancer is the third most common cause of cancer in women. Primary prevention is based on the HPV vaccination, yet coverage rate is low (8.1%). The objective of the study was to evaluate the impact of a health promotion program on the proportion of middle school girls who have completed the HPV vaccination schedule. Material and methods: In this prospective, controlled intervention study of superiority, 12 classes were randomly selected in an intervention school where the promotion program took place, and in a control school where no specific intervention was planned. The program combined: information to students during school classes, information to parents by letter and phone calls, information to general practitioners by letter and video conference call, and the free school-based vaccination (in a “health bus” parked in the schoolyard) with the nonavalent HPV vaccine. Results: In the intervention group, the completion was achieved for 26 girls, which was significantly higher than in the control group (three girls, p < 10−3). The initiated vaccination was also higher in the intervention group (31 girls vs. 6 girls in the control group, p < 10−3). The same results were obtained for the boys as for the full or partial scheme (seven boys vs. 0, p = 0.01; 16 boys vs. 1, p < 10−3, respectively). Conclusions: Implementing a health promotion program and offering the free, school-based vaccination raised the vaccination coverage. These results are promising and may be a stepping stone to expanding this program to the whole Reunion Island and hopefully someday decrease the burden of cervical cancer.
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Gudina, Abdi, M. Patricia Rivera, Charles Kamen e AnaPaula Cupertino. "Abstract A086: Disparities in lung cancer screening uptake across the United States". Cancer Epidemiology, Biomarkers & Prevention 32, n.º 1_Supplement (1 de janeiro de 2023): A086. http://dx.doi.org/10.1158/1538-7755.disp22-a086.
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Abstract Background: Despite the efficacy of low-dose computerized tomography (LDCT) to detect lung cancer early, the rate of lung cancer screening among high-risk individuals remains low. The purpose of this study was to assess lung cancer screening rates in contrast with state lung cancer mortality across the United States. Methods: Data for this study were obtained from the Behavioral Risk Factor Surveillance System (BRFSS) from three consecutive years (2018-2020); a population-based survey administered via cell phone and landline and conducted annually by the Centers for Disease Control and Prevention (CDC). Eligibility criteria follow the 2013 U.S. Preventive Services Task Force (USPSTF) recommendation: high-risk individuals aged 55-80 years with a >30 pack-year smoking history who currently smoke or have quit within the past 15 years. After excluding ineligible subjects and those with missing information, 11,297 subjects were included in the final analysis. Multivariable logistic regression models were used to assess the association between the predictor (i.e., state of residence) and the outcome variable (i.e., screening rate). Results: Of the 24 states included in this study, the states with the highest lung cancer screening rates were Rhode Island (24.75%), Vermont (22.51%), New Jersey (21.72%), Minnesota (21.64%), and Delaware (21.39%). The states with the lowest screening uptake were Oklahoma (9.23%), Utah (9.78%), West Virginia (12.23%), South Dakota (12.31%), and Kansas (12.41%). Kentucky has the highest lung cancer mortality and has become the 6th highest in screening rates. Utah has the lowest lung cancer mortality and is the second-lowest state in lung cancer screening rates. After adjusting for sociodemographic (i.e., age, gender, marital status, level of education, income, insurance, and race/ethnicity) and health-related factors (i.e., chronic obstructive pulmonary disease, smoking history, and primary care provider), high-risk individuals in the state of Delaware (OR: 2.85, 95% CI: 1.50 - 5.41), Kentucky (OR: 2.04, 95% CI: 1.03 - 4.04), Minnesota (OR: 2.74, 95% CI: 1.49 - 5.06), Montana (OR: 2.15, 95% CI: 1.09 - 4.25), New Jersey (OR: 2.39, 95% CI: 1.25 - 4.57), Pennsylvania (OR: 2.28, 95% CI: 1.17 - 4.44), Rhode Island (OR: 2.57, 95% CI: 1.33 - 4.98), Texas (OR: 4.51, 95% CI: 2.04 - 9.97) and Vermont (OR: 3.18, 95% CI: 1.61 - 6.28) were significantly more likely to receive lung cancer screening than those in Utah. High-risk individuals in all the remaining states were not significantly different in terms of their lung cancer screening rates compared to Utah. Conclusions: Lung cancer screening rates varied widely across 24 states and did not match with the lung cancer mortality burden in each state. The results from the present study highlights the importance of developing targeted initiatives and policies that enhance the rates of lung cancer screenings in the states that experience a disproportionate burden of lung cancer mortality. Citation Format: Abdi Gudina, M. Patricia Rivera, Charles Kamen, AnaPaula Cupertino. Disparities in lung cancer screening uptake across the United States [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A086.
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Loucks, Eric B., Ian M. Kronish, Frances B. Saadeh, Matthew M. Scarpaci, Jeffrey A. Proulx, Roee Gutman, Willoughby B. Britton e Zev Schuman-Olivier. "Adapted Mindfulness Training for Interoception and Adherence to the DASH Diet". JAMA Network Open 6, n.º 11 (2 de novembro de 2023): e2339243. http://dx.doi.org/10.1001/jamanetworkopen.2023.39243.
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ImportanceHypertension is a major cause of cardiovascular disease, and although the Dietary Approaches to Stop Hypertension (DASH) diet lowers blood pressure (BP), adherence is typically low. Mindfulness training adapted to improving health behaviors that lower BP could improve DASH adherence, in part through improved interoceptive awareness relevant to dietary consumption.ObjectiveTo evaluate the effects of the Mindfulness-Based Blood Pressure Reduction (MB-BP) program on interoceptive awareness and DASH adherence.Design, Setting, and ParticipantsParallel-group, phase 2, sequentially preregistered randomized clinical trials were conducted from June 1, 2017, to November 30, 2020. Follow-up was 6 months. Participants with elevated unattended office BP (≥120/80 mm Hg) were recruited from the population near Providence, Rhode Island. Of 348 participants assessed for eligibility, 67 did not meet inclusion criteria, 17 declined, and 63 did not enroll prior to study end date. In total, 201 participants were randomly assigned, 101 to the MB-BP program and 100 to the enhanced usual care control group, with 24 (11.9%) unavailable for follow-up. Outcome assessors and the data analyst were blinded to group allocation. Analyses were performed using intention-to-treat principles from June 1, 2022, to August 30, 2023.InterventionsThe 8-week MB-BP program was adapted for elevated BP, including personalized feedback, education, and mindfulness training directed to hypertension risk factors. Both MB-BP and control groups received home BP monitoring devices with instructions and options for referral to primary care physicians. The control group also received educational brochures on controlling high BP.Main Outcomes and MeasuresThe primary outcome was Multidimensional Assessment of Interoceptive Awareness (MAIA) questionnaire scores (range 0-5, with higher scores indicating greater interoceptive awareness), and the secondary outcome was DASH adherence scores assessed via a 163-item Food Frequency Questionnaire (range 0-11, with higher scores indicating improved DASH adherence), all compared using regression analyses.ResultsAmong 201 participants, 118 (58.7%) were female, 163 (81.1%) were non-Hispanic White, and the mean (SD) age was 60.0 (12.2) years. The MB-BP program increased the MAIA score by 0.54 points (95% CI, 0.35-0.74 points; P &lt; .001; Cohen d = 0.45) at 6 months vs control. In participants with poor baseline DASH adherence, the MB-BP program also significantly increased the DASH score by 0.62 points (95% CI, 0.13-1.11 points; P = .01; Cohen d = 0.71) at 6 months vs controls. The intervention was also associated with a 0.34-point improvement in the DASH diet score in all MB-BP participants from baseline (95% CI, 0.09-0.59 points; P = .01; Cohen d = 0.27), while the control group showed a −0.04 point change in DASH diet score from baseline to 6 months (95% CI, −0.31 to 0.24 points; P = .78; Cohen d = −0.03).Conclusions and RelevanceA mindfulness program adapted to improving health behaviors to lower BP improved interoceptive awareness and DASH adherence. The MB-BP program could support DASH dietary adherence in adults with elevated BP.Clinical Trial RegistrationClinicalTrials.gov Identifiers: NCT03859076 and NCT03256890
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de Kinderen, Maud A. J., Johann Sölkner, Gábor Mészáros, Setegn W. Alemu, Wondmeneh Esatu, John W. M. Bastiaansen, Hans Komen e Tadelle Dessie. "Genotype by Environment Interactions (G*E) of Chickens Tested in Ethiopia Using Body Weight as a Performance Trait". Animals 13, n.º 19 (6 de outubro de 2023): 3121. http://dx.doi.org/10.3390/ani13193121.
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Ethiopia is a developing nation that could highly benefit from securing food via improved smallholder poultry farming. To support farmer and breeding decisions regarding which chicken strain to use in which Ethiopian environment, G*E analyses for body weight (BW) of growing male and female chickens were conducted. Research questions were (1) if a G*E is present for BW and (2) which strain performs best in which environment in terms of predicted BW. Analyses were performed using predicted BW at four different ages (90, 120, 150, and 180 days) of five strains (Horro, Koekoek, Kuroiler, Sasso-Rhode Island Red (S-RIR), and Sasso) tested in five Ethiopian regions (Addis Ababa, Amhara, Oromia, South Region, and Tigray) that are part of three Agro-Ecological Zones (AEZ) (cool humid, cool sub-humid, and warm semi-arid). The indigenous Horro strain was used as a control group to compare four other introduced tropically adapted strains. The dataset consisted of 999 female and 989 male farm-average BW measurements. G*E was strongly present (p < 0.001) for all combinations of strain and region analyzed. In line with previous research, Sasso was shown to have the highest predicted BW, especially at an early age, followed by Kuroiler. Horro had the lowest predicted BW at most ages and in most regions, potentially due to its young breeding program. The highest predicted BW were observed in Tigray, Oromia, and Amhara regions, which are in the main part of the cool sub-humid AEZ.
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Palafox, Neal, James Edilyong e Martina Reichhardt. "Abstract 18: Cervical Cancer Prevention and Control in the Pacific: A Comprehensive Systems Based Approach in Yap State, Federated States of Micronesia". Cancer Epidemiology, Biomarkers & Prevention 32, n.º 6_Supplement (1 de junho de 2023): 18. http://dx.doi.org/10.1158/1538-7755.asgcr23-abstract-18.
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Abstract Purpose: The US Affiliated Pacific Islands, is composed of 3 US Territories (Guam, American Samoa, Commonwealth of the Northern Marianas) and 3 Sovereign Nations (Federated States of Micronesia (FSM), Republic of the Marshall Islands, Republic of Palau. The cervical cancer incidence in several of these island nations are amongst the highest globally. This project is designed to implement a sustainable comprehensive cervical cancer (CC) control program to eliminate CC in the island nations. Yap State, FSM an LMIC is a current project site. Planning, over 7 years, was through the Cancer Council of the Pacific Islands. Funding is primarily through a CDC Prevention and Control Capacity Building Grant, and other grant funds. To eliminate cervical cancer in Yap State, FSM through enhanced evidence based public health practices. The primary objective is to increase sustainable capacity to control cervical cancer. Methods: This non-research project is guided by the principles of community-based participatory development/engagement (CBPE), implementation science, transdisciplinary approach, and capacity building. The team is composed of 4 working cores, coordinated and led by an implementation core. The 4 cores are 1.) medical protocol and laboratory support 2.) community engagement and outreach 3.) data and informatics 4.) medical modeling and micro-costing. Capacity building through training and infrastructure development is a key component. Each core works synergistically and interfaces with the Yap Community Advisory Board, which has decision making authority. Results: Working towards cervical cancer control in a small island LMIC nation, with human resource and health infrastructure limitations, geographic challenges require flexibility and patience. The project processes involve multiple iterations, are culturally/geographically nuanced, and requires constant adjustment to national and international agency and medical regulatory bodies. Strong partnerships with health policy leaders, vaccination programs, clinicians is essential. Modelling projections to understand potential outcomes is necessary. Conclusions: Cervical Cancer Prevention and Control in Yap State, FSM an LMIC can be done with close and trusting community engagement that is participatory and capacity building. Building strong relationships with local, national, and international programs necessary. Citation Format: Neal Palafox, James Edilyong, Martina Reichhardt. Cervical Cancer Prevention and Control in the Pacific: A Comprehensive Systems Based Approach in Yap State, Federated States of Micronesia [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 18.
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García-Navarro Karen, Jazmín, Josefina Gallegos-Martínez e Jaime Reyes-Hernández. "Effect of the nutritional stabilization program “ESNUT” on body composition, stages of change and self-perception of body image in university students". Journal of Nursing Education and Practice 10, n.º 7 (29 de março de 2020): 18. http://dx.doi.org/10.5430/jnep.v10n7p18.
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Background and objective: Adolescents have changes in diet when entering university (leaving out and irregularity in mealtimes, low intake of fruits and vegetables and high intake of junk food and sugary drinks), often body self-perception does not match the actual body composition leading young people to unhealthy practices. Nutritional educational interventions have been successful based on the Transtheoretical Model of Change. To assess the effectiveness of the educational intervention for Nutritional Stabilization “ESNUT” (name in Spanish) in body composition, stages of change, body self-perception and the concordance level with BMI of students newly admitted to a university before and in post-intervention follow-ups.Methods: Quasi-experimental study with control group in students from 17 to 21 years newly admitted to a university who agreed to participate in the study. Independent variable: Educational intervention Nutrition Stabilization Model “ESNUT” and dependent variables: body self-perception, body composition, BMI. Instruments: SECA 274 digital stadiometer, InBody 230 Bioimpedanciometer, body silhouettes test and change assessment scale of the University of Rhode Island (URICA). Analysis. Descriptive statistics, student’s t (comparison of means) and Pearson's r (correlation) with support from the statistical program SPSS version 18.Results: About 50% of the experimental group showed normal nutritional status according to the Real BMI but only 17% according to the fat mass percentage in the third month of follow-up was 50%. A discrepancy was observed with the Perceived BMI, 67% had a self-perception of normal weight. In the experimental precontemplation group, at basal near 50%, it finally reduced 20% and placed in preparation/action.Conclusions: The effectiveness of the “ESNUT” intervention was observed in the experimental group through body composition with a reduction in the percentage of fat mass, therefore Overweight/Obesity. Self-perception of body image in its correlated Perceived Body Mass Index (BMI) versus Real BMI increased their level of concord. The transition from pre-contemplation to contemplation was observed in the stages of change, as well as from this towards preparation/action. The control group made little progress due to relapse to predecessor stages and revealed itself in an increase in the percentage of body fat. Both the experimental and control groups tended to underestimate the perceived BMI versus the actual BMI. Clinical importance: Identifying the stage of change allows feedback in the support of the change and motivates the participants according to the stage in which they are.
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Hendricks, Sarah A., Julie L. King, Calvin L. Duncan, Winston Vickers, Paul A. Hohenlohe e Brian W. Davis. "Genomic Assessment of Cancer Susceptibility in the Threatened Catalina Island Fox (Urocyon littoralis catalinae)". Genes 13, n.º 8 (22 de agosto de 2022): 1496. http://dx.doi.org/10.3390/genes13081496.
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Small effective population sizes raise the probability of extinction by increasing the frequency of potentially deleterious alleles and reducing fitness. However, the extent to which cancers play a role in the fitness reduction of genetically depauperate wildlife populations is unknown. Santa Catalina island foxes (Urocyon littoralis catalinae) sampled in 2007–2008 have a high prevalence of ceruminous gland tumors, which was not detected in the population prior to a recent bottleneck caused by a canine distemper epidemic. The disease appears to be associated with inflammation from chronic ear mite (Otodectes) infections and secondary elevated levels of Staphyloccus pseudointermedius bacterial infections. However, no other environmental factors to date have been found to be associated with elevated cancer risk in this population. Here, we used whole genome sequencing of the case and control individuals from two islands to identify candidate loci associated with cancer based on genetic divergence, nucleotide diversity, allele frequency spectrum, and runs of homozygosity. We identified several candidate loci based on genomic signatures and putative gene functions, suggesting that cancer susceptibility in this population may be polygenic. Due to the efforts of a recovery program and weak fitness effects of late-onset disease, the population size has increased, which may allow selection to be more effective in removing these presumably slightly deleterious alleles. Long-term monitoring of the disease alleles, as well as overall genetic diversity, will provide crucial information for the long-term persistence of this threatened population.
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Skeffington, Patrick, Robert Aisenberg, Janice Dallacosta, Ian Donaghy, Dani Hackner, Kelly Houde, Kathy Moraes e Annemarie Santos. "896 Fighting the war against COVID-19: administration of bamlanivimab (BAM) or bamlanivimab + etesivimab (BAM + E); a cooperative effort between a community cancer center and an urgent care (UC) facility". Journal for ImmunoTherapy of Cancer 9, Suppl 2 (novembro de 2021): A940. http://dx.doi.org/10.1136/jitc-2021-sitc2021.896.
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BackgroundGoal of the Massachusetts DPH is to ensure equitable distribution of BAM to the most vulnerable at risk of poor outcomes from COVID-19 and to communities with the highest incidences of COVID-19. Hospitals should allocate available doses in a manner consistent with this guidance:1. Patients who meet the EUA criteria; a lottery system will be used if supply is exceeded 2. Patients with comorbidities (high risk) tend to have worse outcomes when infected with SARS-CoV-2 3. BAM was approved under an EUA for the treatment of mild to moderate COVID-19 for those at high risk of progressing to severe disease (revoked 4/16/21). 4. BAM + E combo was approved under an EUA for the same patients and criteria, Southcoast Health entered into this relationship with DPH to provide this service to the southeastern MA population.MethodsPatients identified based on algorithm using Social Vulnerability Index (SVI) and EUA criteriaRNs screened cases for positive criteria using lottery priority and SVIPulmonologists consented appropriate patients, ordered infusions, routed cases for final scheduling within window of treatmentExperienced nursing staff from various Southcoast departments treated up to 6 patients per dayOncology pharmacies are uniquely experienced to prepare monoclonal antibodies (MABS) such as BAM and BAM + EDue to proximity of the Oncology pharmacy to the UC Center, pharmacy reviewed, prepared and delivered infusions to UC once patient was assessed by RNsResultsFirst 152 cases: 7.2% inpatient admissions within 14 days13.8% ED/UC visits within 14 days2% inpatient admissions in 28 days5.9% ED/UC visits within 28 daysTwo deaths during initial 152 cases.ConclusionsCooperative effort between the Cancer Center and Urgent Care led to positive outcomes for local COVID-19 patients. Southcoast demonstrated a 6% hospital admission rate for COVID-19 patients in the MAB program versus 26% admission rate overall for COVID-19 patients.AcknowledgementsThanks to our colleagues at the University of Rhode Island College of Pharmacy for their support with the poster
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Begnoche, Megan, Dana Guyer, Susan F. Korber e Mary Anne Fenton. "Implementing clinic to home telehealth services to promote quality of life for ambulatory oncology palliative care patients." Journal of Clinical Oncology 38, n.º 29_suppl (10 de outubro de 2020): 259. http://dx.doi.org/10.1200/jco.2020.38.29_suppl.259.
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259 Background: The Lifespan Cancer Institute (LCI) identified strategies to improve the palliative care experience and outcomes by providing clinic to home telehealth services. LCI is an integrated academic medical center program combining three hospital programs operating at five outpatient sites. One quality goal is to embed and increase palliative care within the fabric of oncology by providing palliative telehealth in the home to avoid office visits, ED and hospital admissions. Methods: LCI’s multidisciplinary palliative care team, including administrators, physicians, advanced practice providers and community partner physicians assessed telehealth challenges with a vulnerable patient in the home setting. Process development included operations, technology, patient and staff education. The group modified existing Lifespan system workflows, clinic to clinic video for behavioral health and clinic to clinic for providers, to create the clinic to home method. This process benchmarked patient and behavioral health noting video differences with the clinic setting versus the home. Results: Outcome metrics include no show rate, chemotherapy within 14 days of death, ED/ICU within 30 days of death, patient and provider experience. Initial data shows no show rates decreased from 10% (January) to 6% (May) as telehealth increased. Patients marked deceased within 3 months of a LCI visit for January (n = 52) and May ( = 61) unfortunately did not have a negative trend for chemotherapy in the last 14 days of life (Jan: 8%, May 15%). ED and ICU visits both had modest decreases from January (ED 50%, ICU 29%) to May (ED 48%, ICU 21%). In anticipation of future Press Ganey results, patient feedback includes an increase of comfort while at home. Provider satisfaction increased with the ability to assess the patient in their own home instead of the sterile clinic environment. Encountered challenges include insurance restrictions for Rhode Island (not a rural state), technology, and remote trouble shooting. Conclusions: The success of clinic-to-home telehealth services set the foundation for the COVID-19 telehealth insurgence and led to the palliative team acting as role models to medical and radiation oncology. End of life oncology patients stayed home while having their palliative needs addressed remotely. The innovative approach to implementing telehealth services will serve as a model for future LCI telehealth programs including treatment education sessions, oral chemotherapy follow-up, survivorship and post hospital discharge assessments.
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Jafri, Mohammad Ali Syed, Alina Ashraf, Zorays Moazzam e Sara Ashraf. "The impact of food insecurity on county-level colorectal cancer screening rates." Journal of Clinical Oncology 41, n.º 16_suppl (1 de junho de 2023): e22519-e22519. http://dx.doi.org/10.1200/jco.2023.41.16_suppl.e22519.
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e22519 Background: Colorectal cancer screening has been associated with a marked reduction in cancer- related mortality, and the achievement of screening targets has been identified as a national objective by the Healthy People 2030 initiative. Although various social determinants of health (SDoH) have been demonstrated to impact healthcare access, the association between food insecurity (FI) and colorectal screening rates (CSR) remains unexplored. As such, we sought to assess the impact of FI on county-level colorectal screening rates (CSR). Methods: Data on county-level colorectal cancer screening and food insecurity rates in 2018 were extracted from the Centers for Disease Control (CDC) PLACES and County Health Rankings & Roadmaps databases, respectively. Notably, FI and CSR were categorized as low (lowest quartile), intermediate (middle two quartiles) and high (highest quartile). Multivariable logistic regression analyses were used to evaluate the association between FI and CSR. Results: Among 3,106 counties, the median CSR was 62.1% (IQR 58.9%–65.2%) and ranged from 39.8% (Kusilvak, Alaska) to 74.4% (Newport, Rhode Island). A majority of counties were urban (Metropolitan: n = 790, 25.4% vs. Urban: n = 1,671, 53.8% vs. Rural: n = 645, 20.8%). Overall, a fourth of counties had high screening rates (Low CSR : n = 788, 25.4% vs. Intermediate CSR : n = 1,545, 49.7% vs. High CSR : n = 773, 24.9%). Similarly, 25.0% of counties demonstrated high FI (Low FI : n = 777, 25.0% vs. Intermediate FI : n = 1,552, 50.0% vs. High FI: n = 777, 25.0%). Notably, counties with increasing FI were markedly less likely to have High CSR (Low FI : n = 353, 45.4% vs. Intermediate FI: n = 370, 23.8% vs. High FI: n = 50, 6.4%)(p<0.001). After adjusting for county-level rurality, population-to-primary care physician ratio, household income, unemployment, race/ethnicity, education and uninsurance, intermediate and high FI was associated with an incrementally lower likelihood of having High CSR compared with low FI counties (ref: Low FI ; Intermediate FI : OR 0.61, 95%CI 0.47–0.80; High FI : OR 0.31, 95%CI 0.20–0.50). Conclusions: Increasing county-level FI was independently associated with markedly lower colorectal cancer screening rates, indicating that FI may play a key role in driving disparities in access to cancer care. As such, policies targeted at vulnerable communities characterized by high food insecurity and social deprivation are critically needed to ensure equitable access to preventive cancer care measures such as colorectal cancer screening.
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Valencia-Torres, Ileska M., Yara Sánchez-Cabrera, María E. Fernández e Vivian Colón-López. "Abstract A036: The role of multisectoral partnerships in the dissemination of HPV vaccination campaigns in Puerto Rico". Cancer Epidemiology, Biomarkers & Prevention 32, n.º 12_Supplement (1 de dezembro de 2023): A036. http://dx.doi.org/10.1158/1538-7755.disp23-a036.
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Abstract INTRODUCTION: The Human Papillomavirus (HPV) is the most common sexually transmitted infection worldwide. Despite the availability of an effective vaccine, HPV vaccination uptake is suboptimal in Puerto Rico (PR). Knowledge and understanding of the benefits of HPV vaccination can influence the intention to vaccinate. The Puerto Rico Community Cancer Control Outreach Program (PRCCCOP) and our network of multisectoral partners disseminated an HPV vaccination educational campaign tailored to promote HPV vaccination among kids and adolescents aged 9-26. OBJECTIVE: To effectively disseminate Human Papillomavirus (HPV) prevention educational campaigns through a network of multisectoral collaborators to increase HPV vaccination uptake in PR. METHODS: The PRCCCOP trained collaborators on basic HPV, HPV-caused cancers, and HPV vaccine knowledge and the use of educational materials. Collaborators distributed educational materials to their clientele who visited in person, participated in sponsored events, and accessed their virtual platforms or via email. In addition to printable educational materials, PRCCOP public service announcement videos about HPV vaccination were transmitted at our participating Federally Qualified Health Centers (FQHC). The PRCCOP provided all collaborators with continued training, assistance, and educational materials. RESULTS: Our program impacted 65 municipalities (83.3% of the island). Electronic and printed versions of our educational materials were disseminated in 40 clinics and vaccination centers across the island, including all 22 FQHCs in Puerto Rico (PR). Over 2,000 people were reached via in-person events and health fairs. Additionally, 18 workshops were imparted in clinical and academic settings. CONCLUSION: Community outreach can be an expensive and labor-intensive task. By establishing partnerships and sharing resources, the PRCCCOP has lowered costs while widely disseminating its educational campaigns and expanding its network outside the traditional academic/health services arena. Collaborating with multisectoral organizations allowed us to increase our presence throughout the island, diversify the types of dissemination mediums, and reach vulnerable and hard-to-reach populations. Citation Format: Ileska M. Valencia-Torres, Yara Sánchez-Cabrera, María E. Fernández, Vivian Colón-López. The role of multisectoral partnerships in the dissemination of HPV vaccination campaigns in Puerto Rico [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A036.
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Hoskin, M. G., R. A. Coleman, E. von Carlshausen e C. M. Davis. "Variable population responses by large decapod crustaceans to the establishment of a temperate marine no-take zone". Canadian Journal of Fisheries and Aquatic Sciences 68, n.º 2 (fevereiro de 2011): 185–200. http://dx.doi.org/10.1139/f10-143.
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In 2003, an area adjacent to Lundy Island was designated as the United Kingdom’s first no-take zone (NTZ) for nature conservation. The only significant fishery at Lundy was for lobster ( Homarus gammarus L.) and various crabs. The Lundy NTZ provided an opportunity to test hypotheses about the recovery of crustacean populations from fishing. Using an experimental potting program, we simultaneously compared changes in the crustacean populations within the NTZ with those in proximal control (Near Control) locations and two distant control (Far Control) locations. Comparisons were replicated over 4 years, and the results analysed using asymmetrical analysis of variance. There was evidence of a rapid, large increase in the abundance and sizes of legal-sized lobsters within the NTZ, and evidence of spillover of sublegal lobsters from the NTZ to adjacent areas. The NTZ also appeared to cause a small, but significant increase in the size of brown crab ( Cancer pagurus L.) and a decrease in the abundance of velvet crabs ( Necora puber L.) (the latter potentially owing to predation and (or) competition from lobsters). Unlike many previous studies, these results are unambiguous, owing to a robust asymmetrical experimental design. We suggest that regulatory and conservation agencies use this approach, which we have demonstrated to be relatively straightforward, whenever the NTZ requiring evaluation cannot be replicated.
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Meijerink, Janine FJ, Marieke Pronk, Birgit I. Lissenberg-Witte, Vera Jansen e Sophia E. Kramer. "Effectiveness of a Web-Based SUpport PRogram (SUPR) for Hearing Aid Users Aged 50+: Two-Arm, Cluster Randomized Controlled Trial". Journal of Medical Internet Research 22, n.º 9 (22 de setembro de 2020): e17927. http://dx.doi.org/10.2196/17927.
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Background Hearing aid (HA) use is known to improve health outcomes for people with hearing loss. Despite that, HA use is suboptimal, and communication issues and hearing-related activity limitations and participation restrictions often remain. Web-based self-management communication programs may support people with hearing loss to effectively self-manage the impact of hearing loss in their daily lives. Objective The goal of the research is to examine the short- and long-term effects of a web-based self-management SUpport PRogram (SUPR) on communication strategy use (primary outcome) and a range of secondary outcomes for HA users aged 50 years and older. Methods Clients of 36 HA dispensing practices were randomized to SUPR (SUPR recipients; n=180 HA users) and 34 to care as usual (controls; n=163 HA users). SUPR recipients received a practical support booklet and online materials delivered via email over the course of their 6-month HA rehabilitation trajectory. They were encouraged to appoint a communication partner and were offered optional email contact with the HA dispensing practice. The online materials included 3 instruction videos on HA handling, 5 videos on communication strategies, and 3 testimonial videos. Care as usual included a HA fitting rehabilitation trajectory only. Measurements were carried out at baseline, immediately postintervention, 6 months postintervention, and 12 months postintervention. The primary outcome measure was self-reported use of communication strategies (3 subscales of the Communication Profile for the Hearing Impaired [CPHI]). Secondary outcome measures included self-reported personal adjustment to hearing loss (CPHI); use, satisfaction and benefit of HAs and SUPR (use questionnaire; International Outcome Inventory for Hearing Aids [IOI-HA], Alternative Interventions [IOI-AI]); recommendation of HA dispensing services; self-efficacy for HA handling (Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids [MARS-HA]); readiness to act on hearing loss (University of Rhode Island Change Assessment adapted for hearing loss [URICA-HL]); and hearing disability (Amsterdam Inventory for Auditory Disability and Handicap [AIADH]). Results Linear mixed model analyses (intention to treat) showed no significant differences between the SUPR and control group in the course of communication strategy use (CPHI). Immediately postintervention, SUPR recipients showed significantly higher self-efficacy for advanced HA handling than the controls, which was sustained at 12 months (MARS-HA; mean difference immediately postintervention: 5.3, 95% CI 0.3 to 10.4; P=.04). Also, SUPR recipients showed significantly greater HA satisfaction than controls immediately postintervention (IOI-HA; 0.3, 95% CI 0.09 to 0.5; P=.006), which was sustained at 12 months, and significantly greater HA use than the controls immediately postintervention (IOI-HA; 0.3, 95% CI 0.02 to 0.5; P=.03), which was not sustained at 12 months. Conclusions This study provides ground to recommend adding SUPR to standard HA dispensing care, as long-term, modest improvements in HA outcomes were observed. Further research is needed to evaluate what adjustments to SUPR are needed to establish long-term effectiveness on outcomes in the psychosocial domain. Trial Registration ISRCTN77340339; http://www.isrctn.com/ISRCTN77340339 International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2016-015012
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Sánchez-Cabrera, Yara, Ileska M. Valencia-Torres, Maria E. Fernandez e Vivian Colón-López. "Abstract A028: Development of multisectoral partnerships in the quest to target effective HPV vaccination strategies in Puerto Rico". Cancer Epidemiology, Biomarkers & Prevention 32, n.º 12_Supplement (1 de dezembro de 2023): A028. http://dx.doi.org/10.1158/1538-7755.disp23-a028.
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Abstract Introduction: Human Papilloma Virus (HPV) is the most common sexually transmitted infection worldwide. HPV accounts for 79% of related cancers in the United States (US). Puerto Rico has the highest incidence (12.1) of cervical cancer among the US and territories, for which HPV infections cause 91%. The Puerto Rico Community Cancer Control Outreach Program (PRCCCOP) and our long-term partner, UTHealth, have developed HPV vaccination educational materials tailored to be used by clinical and public health workers or as a standalone. Since 2019, PRCCCOP has been promoting HPV vaccine to prevent related cancers. Objective: To develop a network of multisectoral collaborators to facilitate the dissemination of Human Papillomavirus (HPV) prevention educational campaigns and HPV vaccination uptake in Puerto Rico (PR). Methods: From 2019 to March 2023, the Puerto Rico Community Cancer Control Outreach Program (PRCCCOP) has established a network of islandwide collaborators, which has developed alliances for the participation of several community activities in which our educational materials have been distributed. Collaborators were offered workshops on HPV, HPV- prevention, and the HPV vaccine, received educational materials, and continued assistance in their community activities. The collaborators were categorized by the type of organization or services they offered. Results: A descriptive assessment of collaborators was documented and categorized into 5 groups. A total of 44 new collaborations have been established, (1) academic (11.3%), (2) health services/FQHCs (36.5%), (3) community-based (7%), (4) private sector (25%), and (5) government (20.4%). Our team has participated in 129 community events in 39 (50%) municipalities. Moreover, our HPV educational campaigns have been distributed in 54 (69.2%) municipalities, including Vieques and Culebra Island municipalities. Conclusion: The PRCCCOP has effectively expanded its reach by developing partnerships with diverse organizations across PR. Most activities are from FQHCs, allowing us to reach the most vulnerable populations effectively. These partnerships helped increase the visibility of the program and the availability of our workshops and educational materials to different organizations in Puerto Rico. By establishing these collaborations, we aim to increase knowledge, raise awareness about HPV prevention, and increase vaccination uptake to eradicate HPV-caused cancers. We will keep growing our network in the next year to reach all municipalities in Puerto Rico. Citation Format: Yara Sánchez-Cabrera, Ileska M. Valencia-Torres, Maria E. Fernandez, Vivian Colón-López. Development of multisectoral partnerships in the quest to target effective HPV vaccination strategies in Puerto Rico [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A028.
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Salgado-Cruz, Omayra, Nelybeth Santiago-Yance, Mirza Rivera-Lugo e Guillermo Tortolero-Luna. "Abstract B060: Increasing breast and cervical cancer knowledge in the COVID-19 pandemic in the health system". Cancer Epidemiology, Biomarkers & Prevention 32, n.º 1_Supplement (1 de janeiro de 2023): B060. http://dx.doi.org/10.1158/1538-7755.disp22-b060.
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Abstract The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) of the Centers for Disease Control and Prevention (CDC) reported that for the month of In April 2020, screening tests for breast cancer decreased by 87% and for cervical cancer by 84% compared to the previous 5-year averages for that month. In response to this finding, the Puerto Rico Breast and Cervical Cancer Prevention and Early Detection Program (PR-BCCPEDP) in collaboration with the insurer Triple S-Salud, implemented a virtual educational intervention and/or face-to-face for breast and cervical cancer in the health centers where Triple-S Salud insurer provides services. The purpose of this initiative was aimed at strengthen knowledge in the early detection of breast and cervical cancer, increase the use of screening tests in the population of interest, and increase the reach of women who do not have health insurance who can qualify for the Program. Methodology: The PR-BCCPEDP entered into a collaborative agreement with the insurer Triple-S Salud to implement an educational intervention for breast and cervical cancer in 12 primary health centers around the island. In the period from October to December 2020, 12 health educators from the Triple-S Salud insurer carried out 131 educational activities with the participation of 875 participants. The educational activities were carried out in person through educational flip charts and virtually using an educational PowerPoint on both types of cancer. The educational materials included topics related to breast and cervical cancer such as: statistics, risk factors, signs and symptoms, early detection guidelines, myths and facts, and barriers to not having early detection tests. Results: The educational intervention in breast and cervical cancer obtained the following results: A total of 875 participated in the intervention, where 100% were women, with an average age of 50 years and the majority (97%) had coverage from the government health plan. The towns with the most registered participants were Bayamón with 18% and Mayagüez with 16% respectively. The virtual form was the most used by the participants (58%) compared to the face-to-face form. Regarding screening tests for breast and cervical cancer, of 75 women who had overdue the breast cancer guidelines, 20% had a mammogram after the intervention. Similarly, 142 women had overdue the cervical cancer guidelines, and 22.6% were carried out the tests after the intervention. Other hand, of the women, referred to the PR-BCCPEDP, 3% indicated not having health insurance, of which 29.6% were recruited and cared for by the Program. Conclusion: Despite security restrictions as a result of the pandemic, collaborations with a health system helped reach a greater number of women to provide education and awareness about breast and cervical cancer. In addition, it can be inferred that the virtual form allowed for increasing the scope of participation in times of pandemic. Lastly, I also helped reach women without health insurance who were recruited into the Program. Citation Format: Omayra Salgado-Cruz, Nelybeth Santiago-Yance, Mirza Rivera-Lugo, Guillermo Tortolero-Luna. Increasing breast and cervical cancer knowledge in the COVID-19 pandemic in the health system [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B060.
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Piras, G., P. Fancello, M. Monne, M. Santona, G. Landriscina e A. Gabbas. "BRCA1 and BRCA2 germline mutations in Sardinian breast cancer families". Journal of Clinical Oncology 24, n.º 18_suppl (20 de junho de 2006): 20118. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.20118.
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20118 Background: Germline alterations in the BRCA1 and BRCA2 genes highly predispose to breast and ovarian cancer. In families with BRCA1/2 mutations, identification of mutation carriers is clinically rilevant in view of the options for surveillance and prevention. The general aim of the present research is to contribute to the molecular epidemiology of BRCA1/2 genes in the italian region of Sardinia as a prerequisite for a prevention program based on DNA analysis. Methods: Fifty-two of 172 patients diagnosed with primary invasive breast carcinomas (n = 150) or ovarian cancer (n = 18) and 4 male with breast cancer referring to our departments between 2003 and 2005, had a positive family history for breast and/or ovarian cancer and were selected for BRCA1/2 mutation screening by denaturing high-performance liquid chromatography and DNA sequencing. Onehundred DNAs from healthy women originating from the same geographical area were used as population controls. Results: We identified 7 BRCA sequence alterations: 3 were already described polymorphisms while 4 novel BRCA variants were found in 11 out of 52 (21%) probands. The BRCA23951del3insAT is a novel deleterious mutation which leads to protein truncation at codon 1258 and co-occurred with the missense BRCA2S2546P in 6 probands originating from the same village and in none of the controls. Segregation analysis suggested the cis-position of the two mutations. All mutation carriers shared a common disease-associated BRCA2 haplotype indicating the presence of a founder effect. The BRCA2N272I was first observed in our population and was found in 3 unrelated probands and in none of 200 control chromosomes. The missense BRCA1E1352K mutation was present in 3 patients from two unrelated families with breast and ovarian cancer cases in three generations. Conclusions: In the present study, BRCA2 are more recurrent than BRCA1 mutations as reported for the northern part of the island. Our findings provide new epidemiological data that may be useful in defining the prevalence, mutational spectrum and penetrance of BRCA1/2 in the genetically homogeneous population of Sardinia. A comprehensive map of the BRCA mutations may facilitate screening/testing for inherited risk of breast cancer. No significant financial relationships to disclose.
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Nickels, Eric M., Shaobo Li, Katti Arroyo, Swe Swe Myint, Adam J. de Smith e Joseph L. Wiemels. "Evaluation of DNA Methylation at Birth in Monozygotic Twin Pairs Discordant for Acute Lymphoblastic Leukemia". Blood 138, Supplement 1 (5 de novembro de 2021): 2278. http://dx.doi.org/10.1182/blood-2021-152795.
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Abstract Background: Aberrant patterns of DNA methylation constitute a key feature of pediatric acute lymphoblastic leukemia (ALL) at diagnosis, however its role as a predisposing or early contributor to the development of ALL remains unknown. We employed a discordant monozygotic twin model to identify epigenetic variation associated with future development of pediatric ALL through evaluation of DNA methylation at birth. Methods: Twin pairs discordant for the development of pediatric ALL were identified using linked data from the California Cancer Registry and California Birth Statistical Master File spanning from 1989 to 2015. Archived dried neonatal blood spots were obtained from 86 same-gender twin pairs with available materials from the California Biobank Program. Following isolation of genomic DNA from DBS samples, monozygosity was confirmed in 43 of 86 twin pairs through an identity-by-descent analysis from a genome-wide SNP-array. Epigenome-wide DNA methylation assessment of the 43 discordant monozygotic twin pairs was conducted using the Illumina Infinium MethylationEPIC BeadChip kit (Illumina, San Diego, CA, USA). Data preprocessing and quality control measures were conducted in R, using SeSAMe for data normalization. Two twin pairs were omitted due to failure to pass quality control measures. Within-pair analysis was conducted through identification of array probes with absolute differences in methylation beta values greater than 15% between case and control siblings of a twin pair unit. Differentially methylated probes (DMP) were identified using a conditional logistic regression model accounting for array-specific variation, nucleated cell proportions, and appropriate control for the paired nature of the dataset. Differentially methylated regions (DMR) were defined by regional correlation of p-values from the conditional logistic regression model. Gene set enrichment analysis was conducted on significant probes identified through the within pair and regression analysis. Results: The discordant twin cohort (n = 41 pairs) included 24 female and 17 male pairs. Median gestational age was 258 days, ranging from 184 to 306 days. Age of diagnosis in the case twin ranged from <1 to 23 years (median = 5). There was no significant association between birthweight and case status (paired Wilcoxon signed rank test p = 0.22). No significant differences in nucleated cell proportions were identified in deconvolution analysis. Within-pair analysis identified a total of 18,001 probes with absolute methylation variation greater than 15% across the 41 twin pairs, with 3,984 recurrently variable across more than one pair. Gene ontology analysis of these recurrently variable sites revealed an enrichment of immune-related processes in 7 of the top 15 terms with nominal p-value <0.05, though no terms were significant after correction for multiple comparisons. Conditional logistic regression was conducted on 37 twin pairs, with T-cell cases (n=4) omitted to improve data resolution. This resulted in 240 significant DMPs with p-values below an FDR threshold of 0.05. Of these significant probes, 20 associate with genes previously reported to have altered DNA methylation in ALL at diagnosis. Regional analysis identified 10 significant DMRs with adjusted p-values below 0.05, with the top association encompassing a 454bp region on chromosome 6 located near TRIM39-RPP21 (adjusted p-value 2.39e-05). Notably, conditional regression analysis revealed a significant negative bias in coefficients (409,812 of 710,010 probes, binomial exact test p <2.2e-16), indicating a global tendency toward hypomethylation in cases compared to unaffected siblings (Figure 1). The strength of this bias was greater in probes associated with open sea regions compared to those in island regions, as well as promoter-associated probes. Conclusions: This novel analysis of DNA methylation at birth in ALL-discordant monozygotic twins identified sites of differential methylation associated with immune regulation. In addition, these results provide evidence of an association between global DNA hypomethylation and future development of ALL in one member of a genetically identical twin pair. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.
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Tangka, Florence K. L., Sujha Subramanian, Sonja Hoover, Charlene Cariou, Becky Creighton, Libby Hobbs, Amanda Marzano et al. "Improving the efficiency of integrated cancer screening delivery across multiple cancers: case studies from Idaho, Rhode Island, and Nebraska". Implementation Science Communications 3, n.º 1 (16 de dezembro de 2022). http://dx.doi.org/10.1186/s43058-022-00381-4.
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Abstract Background Three current and former awardees of the Centers for Disease Control and Prevention’s Colorectal Cancer Control Program launched integrated cancer screening strategies to better coordinate multiple cancer screenings (e.g., breast, cervical, colorectal). By integrating the strategies, efficiencies of administration and provision of screenings can be increased and costs can be reduced. This paper shares findings from these strategies and describes their effects. Methods The Idaho Department of Health and Welfare developed a Baseline Assessment Checklist for six health systems to assess the current state of policies regarding cancer screening. We analyzed the checklist and reported the percentage of checklist components completed. In Rhode Island, we collaborated with a nurse-patient navigator, who promoted cancer screening, to collect details on patient navigation activities and program costs. We then described the program and reported total costs and cost per activity. In Nebraska, we described the experience of the state in administering an integrated contracts payment model across colorectal, breast, and cervical cancer screening and reported cost per person screened. Across all awardees, we interviewed key stakeholders. Results In Idaho, results from the checklist offered guidance on areas for enhancement before integrated cancer screening strategies, but identified challenges, including lack of capacity, limited staff availability, and staff turnover. In Rhode Island, 76.1% of 1023 patient navigation activities were for colorectal cancer screening only, with a much smaller proportion devoted to breast and cervical cancer screening. Although the patient navigator found the discussions around multiple cancer screening efficient, patients were not always willing to discuss all cancer screenings. Nebraska changed its payment system from fee-for-service to fixed cost subawards with its local health departments, which integrated cancer screening funding. Screening uptake improved for breast and cervical cancer but was mixed for colorectal cancer screening. Conclusions The results from the case studies show that there are barriers and facilitators to integrating approaches to increasing cancer screening among primary care facilities. However, more research could further elucidate the viability and practicality of integrated cancer screening programs.
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"Cervical Cancer Control—Rhode Island". JAMA: The Journal of the American Medical Association 262, n.º 15 (20 de outubro de 1989): 2075. http://dx.doi.org/10.1001/jama.1989.03430150035008.
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"From the Centers for Disease Control. Cervical cancer control--Rhode Island". JAMA: The Journal of the American Medical Association 262, n.º 15 (20 de outubro de 1989): 2075–76. http://dx.doi.org/10.1001/jama.262.15.2075.
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Schilke, Randolph, Karen Card, Junwei Jiang, Joshua Sturms, Steve McCoy e Leah Colston. "Validating Syndromic Data for Opioid Overdose Surveillance in Florida". Online Journal of Public Health Informatics 11, n.º 1 (30 de maio de 2019). http://dx.doi.org/10.5210/ojphi.v11i1.9779.
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ObjectiveAssess the validity of Florida (FL) Enhanced State Opioid Overdose Surveillance (ESOOS) non-fatal syndromic case definitions.IntroductionIn 2017, FL Department of Health (DOH) became one of thirty-two states plus Washington, D.C funded by the Center for Disease Control and Prevention (CDC) under the ESOOS program. One of the objectives of this funding was to increase the timeliness of reporting on non-fatal opioid overdoses through syndromic surveillance utilizing either the emergency department (ED) or Emergency Medical Services (EMS) data systems. Syndromic case validation is an essential requirement under ESOOS for non-fatal opioid-involved overdose (OIOD). FL’s ESOOS program conducted OIOD validation and quality monitoring of EMS case definitions, using data from FL’s Emergency Medical Services Tracking and Reporting System (EMSTARS). We examined measurement validity with OIOD cases identified from FL’s statewide hospital billing database, FL Agency for Health Care Administration (AHCA).MethodsFrom FL-EMSTARS, we extracted EMS data where the type of service requested was a 911 response, the patient was treated then transported by EMS to a hospital facility in Florida and was 11 years of age or older. Additionally, all incident-patient encounters excluded those who were dead at the scene. We included all responses with dispatch dates between January 1, 2016, and December 31, 2016. From FL-AHCA, we extracted ED and inpatient discharge information with admission dates and patient age covering the same ranges as our EMS encounters. We classified FL-EMSTARS cases based on combinations, like that of Rhode Island,1 using providers primary impression (PPI), providers secondary impression (PSI) and response to the administration of naloxone. FL-AHCA cases were defined by the following T and F codes from the International Classification of Diseases 10: T40.0-T40.4, T40.60, T40.69, F11.12, F11.120, F11.121, F11.122, F11.129, F11.22, F11.220, F11.221, F11.222, F11.229, F11.92, F11.920, F11.921, F11.922, F11.929. For all “T” codes, the 6th character was either a “1” or “4,” because ESOOS is focused on unintentional and undetermined drug overdoses, ergo we excluded ED visits that are related to intentional self-harm (i.e., “2”) or assault (i.e., “3”). Lastly, for all “T” codes, the 7th character we included was the initial ED encounter (i.e., “A”) because the purpose of the system is to capture increases or decreases in acute overdoses. To improve our match rate, account for typographical errors, and account for the discriminatory power some values may contain, we employed probabilistic linkage using Link Plus software developed by the CDC Cancer Division. Blocking occurred among social security number (SSN), event date, patient age in years, and date of birth (DOB). Next, we matched both datasets on ten variables: event date, age, sex, DOB, ethnicity, facility code, hospital zip code, race, SSN, and patient’s residence zip code. Further pruning was performed to ensure all matches were within a 24-hour time interval. Data management and statistical analyses were performed using SAS® statistical software, version 9.4 (SAS Institute Inc., Cary, NC, USA). We assessed EMS measurement validity by sensitivity, specificity, and positive predictive value (PPV). Next, risk factors were identified by stepwise multivariable logistic regression to improve the accuracy of the FL-ESOOS definition. Significant risk factors from the parsimonious multivariable model were used to simulate unique combinations to estimate the maximum sensitivity and PPV for OIOD.ResultsPrior to merging, FL-EMSTARS contained 1,308,825 unique incident-patient records, where FL-AHCA contained 8,862,566 unique incident-patient records. Of these, we conservatively linked 892,593 (68.2%) of the FL-EMSTARS dataset with FL-AHCA. Our probabilistic linkage represents an 18.2% linkage improvement over previous FL-DOH deterministic strategies (J Jiang, unpublished CSTE presentation, 2018). Among the matched pairs we estimated 8,526 OIOD, 0.96% prevalence, using the FL-AHCA case definition. Whereas the FL-ESOOS syndromic case definition estimated 6,188 OIOD, 0.69% prevalence. The FL-ESOOS OIOD syndromic case definition demonstrated 31.64% sensitivity, 99.61% specificity, and 43.60% PPV. Among false negatives, the response to administrated naloxone among OIOD was 39.37% “not known,” 37.95% “unchanged,” and 0.28% “worse.” We altered the FL-ESOOS EMSTARS case definition for OIOD to include those who were administered naloxone regardless of their response to the medication. We observed 12.37% sensitivity increase to 44.01%, 0.56% specificity decrease to 99.05%, and 12.78% PPV decrease to 30.82%.Are final multivariable model is as follows: lnOdds(Opioid Overdose)= 12.66 – 0.5459(Med Albuterol) – 0.9568(Med Aspirin) – 0.5765(Med Midazolam Hydrochloride) – 0.8690(Med Morphine Sulfate) + 1.4103 (Med Naloxone) – 0.7694(Med Nitroglycerine) + 0.3622(Med Oxygen) – 0.3702(Med Phenergan) – 0.8820(Med Epinephrine 1:10000) – 0.7397(Med Fentanyl) – 0.6376(Med Sodium Bicarbonate) – 0.2725(Med Normal Saline) + 0.3935(Med Other-Not Listed) + 0.6300(PPI General Malaise) + 0.8476(PPI Other, Non-Traumatic Pain) + 0.8725(PPI Airway Obstruction) + 0.4808(PPI Allergic reaction) + 1.4948(PPI Altered level of consciousness) + 1.5481(PPI Behavioral/psychiatric disorder) + 1.3843(PPI Cardiac arrest) + 2.3913(PPI Poisoning/drug ingestion) + 2.2418(PPI Intentional Drug Use; Related Problems) + 0.2783(PPI Respiratory distress) + 2.0305(PPI Respiratory arrest) + 0.4292(PPI Stroke/CVA) + 0.5402(PPI Syncope/fainting) + 0.5219(PSI Other, Non-Traumatic Pain) + 0.9355(PSI Allergic reaction) + 0.3521(PSI Altered level of consciousness) + 0.9036(PSI Poisoning/drug ingestion) + 0.9661(PSI Intentional Drug Use; Related Problems) + 0.3766(PSI Respiratory Distress) + 1.1802(PSI Respiratory Arrest).We plotted the multivariable sensitivity and PPV by probaiblity cutoff value to determine which would produce the best discrimination (see Figure 1). By incorporating a probability cutoff value ≥ 0.22, we can inprove both sensitivity and PPV. Specifically, we can achieve 45.48% sensitivity, 99.32% specificity, and 45.48% PPV.ConclusionsThe sensitivity of the FL-ESOOS surveillance system is not generally high but could still be useful if subsequent validation shows sensitivity stability. Regarding maximizing FL-ESOOS sensitivity and PPV, we deomonstrated that our mulitvariable model with an appropriate probability cutoff value performes better than the current case definition. This study contributes to the limited literature on Florida non-fatal opioid overdoses with a specific emphasis on validating EMS records. New unique indicator combinations are possible to increase sensitivity and PPV but should be thoroughly investigated to balance the tradeoffs to optimize the system’s ability to detect non-fatal overdoses and to discriminate true cases.References1. Rhode Island Department of Health. Rhode Island Enhanced State Opioid Overdose Surveillance (ESOOS) Case Definition For Emergency Medical Services (EMS).; 2017.2. Jiang J, Mai A, Card K, Sturms J, McCoy S. EMS Naloxone Administration for Implication of Opioid Overdose. Presentation presented at the: 2018; CSTE Annual Conference.
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Rogala, Britny G., Alexandria Jarvais, Taylor Ng e Jeffrey Bratberg. "Prescriber and pharmacist understanding of revised Rhode Island pain management regulations". Journal of Oncology Pharmacy Practice, 9 de junho de 2020, 107815522092905. http://dx.doi.org/10.1177/1078155220929057.
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Introduction Federal agencies and national associations have implemented action plans in response to the opioid crisis. Furthermore, over 30 states have enacted legislation with opioid-related restrictions, guidance, or requirements. Following recommendations from the governor-appointed Overdose Prevention and Intervention Task Force, the Rhode Island Department of Health developed an original and updated version of Pain Management Regulations in March 2017 and July 2018, respectively. Our study aimed to identify disparities in interpretation and misconceptions of the updated Rhode Island Department of Health new Pain Management Regulations. Methods Our 29-question survey evaluated pharmacist and prescriber knowledge of regulations, with special attention given to pain management in patients with cancer. Results Thirty-two prescribers and 33 pharmacists completed the survey. The survey identified significant variance in regulation knowledge. Pharmacists correctly identified diagnosis exclusions 13–84% of the time, with a much greater understanding when diagnosis language was used instead of ICD-10 codes. Prescribers correctly identified exclusions 24–46% of the time, with little difference noted when using diagnosis language versus ICD-10 codes. The majority (59.3%) of pharmacists misclassified patients with no prescription dispensed in 30 days as patients who would be considered opioid-naïve. Both prescribers and pharmacists commonly misidentified the frequency with which the prescription drug monitoring program needs to be checked, although in both scenarios were stricter than the regulations themselves. In addition, there were significant differences in interpretation regarding naloxone co-prescribing requirements and patient awareness of naloxone co-prescribing between prescribers and pharmacists. Conclusion Our findings outline several misinterpretations that affect access to chronic and cancer-related pain opioid prescriptions, despite several Rhode Island Department of Health-initiated interventions. When adopting regulations, states should proactively develop educational initiatives to avoid access challenges for patients with diagnoses of exclusion.
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Thomas, J. Graham, Emily Panza, Carly M. Goldstein, Jacqueline F. Hayes, Noah Benedict, Kevin O’Leary e Rena R. Wing. "Pragmatic Implementation of Online Obesity Treatment and Maintenance Interventions in Primary Care". JAMA Internal Medicine, 11 de março de 2024. http://dx.doi.org/10.1001/jamainternmed.2023.8438.
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ImportanceBehavioral weight loss interventions have achieved success in primary care; however, to our knowledge, pragmatic implementation of a fully automated treatment that requires little researcher oversight has not been tested. Moreover, weight loss maintenance remains a challenge.ObjectiveTo evaluate the long-term effectiveness of an automated, online, behavioral obesity treatment program (Rx Weight Loss [RxWL]) at 12 months (primary end point) and 24 months when delivered pragmatically in primary care and to compare the effectiveness of 3 weight loss maintenance approaches.Design, Setting, and ParticipantsThis randomized clinical trial of RxWL, an online weight loss program, recruited patients from a Rhode Island primary care network with approximately 60 practices and 100 physicians. Eligible participants were primary care patients aged 18 to 75 years with overweight or obesity who were referred by their nurse care manager and enrolled between 2018 and 2020. All participants were included in the intention-to-treat analysis, whereas only those who engaged with maintenance intervention were included in the per-protocol analysis. Data were analyzed from August 2022 to September 2023.InterventionsAll participants were offered the same 3-month weight loss program, with randomization to one of three 9-month maintenance programs: control intervention (monthly online newsletters), monthly intervention (9 monthly video lessons and 1 week of self-monitoring per month), or refresher intervention (an introductory session and two 4-week periods of lessons and self-monitoring at 7 and 10 months).Main Outcomes and MeasuresThe primary outcome was weight change at 12 months using height and weight data collected from electronic medical records through 24 months.ResultsAmong the 540 participants (mean [SD] age, 52.8 [13.4] years; 384 females [71.1%]) in the intention-to-treat analysis, mean estimated 3-month weight loss was 3.60 (95% CI, −4.32 to −2.88) kg. At the 12-month primary end point, the amount of weight regained in the monthly (0.37 [95% CI, −0.06 to 0.81] kg) and refresher (0.45 [95% CI, 0.27 to 0.87] kg) maintenance groups was significantly less than that in the newsletter control maintenance group (1.28 [95% CI, 0.85 to 1.71] kg; P = .004). The difference in weight regain between the monthly and refresher maintenance groups was not statistically significant. This pattern persisted at 24 months. In the per-protocol analysis of 253 participants, mean weight loss at the end of the initial 3-month intervention was 6.19 (95% CI, −7.25 to −5.13) kg. Similarly, at 12 months there was less weight regain in the monthly (0.61 kg) and refresher (0.96 kg) maintenance groups than in the newsletter control maintenance group (1.86 kg).Conclusions and RelevanceResults of this randomized clinical trial indicate that pragmatic implementation of a 12-month automated, online, behavioral obesity treatment that includes 9 months of active maintenance produces clinically significant weight loss over 2 years in primary care patients with overweight or obesity. These findings underscore the importance of providing ongoing maintenance intervention to prevent weight regain.Trial RegistrationClinicalTrials.gov Identifier: NCT03488212
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Melo Herrera, Yarisbel, Maya Vadiveloo, Brietta M. Oaks, Nekehia T. Quashie, Sarah Blau e Alison Tovar. "Abstract P473: WIC-Tailored, Pre-Filled Online Shopping Carts Influence WIC Food Benefit Redemption". Circulation 149, Suppl_1 (19 de março de 2024). http://dx.doi.org/10.1161/circ.149.suppl_1.p473.
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Introduction: Most participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) do not fully redeem their benefits, due to barriers like transportation, unclear labeling, and category-specific limits. Online food shopping enables the use of choice architecture to promote benefit redemption. Using a mixed-methods pilot randomized-controlled trial, we evaluated whether a WIC-tailored, modifiable pre-filled online grocery shopping cart (intervention group, I) compared to individually selecting items (control group, C) increased WIC benefit redemption. Hypothesis: The I vs. C will have higher change in benefit redemption. Methods: We enrolled Rhode Island WIC participants (n=24) who were ≥18 years and primary food shoppers, spoke English or Spanish, had internet, and no special dietary needs. At baseline, participants completed a sociodemographic questionnaire and a simulated shopping episode (SSE) conducted in Gorilla Shop Builder. They were told to shop as if using all monthly food benefits and to buy WIC and non-WIC items to last 10 days. After a week, we randomized participants to the I or C to complete the second SSE. The I had a modifiable cart pre-filled with WIC items providing 100% of the benefits proposed on the 2022 food package revision, except for fruits/vegetables (33%) and milk (25%) and was personalized with items selected in the first SSE. The C selected their items individually. Both groups had a list of their assigned benefits, and WIC labels for approved items. WIC benefit redemption was expressed as % of the maximum allotted amounts for each food group, per person. Between-group t-tests examined differences in redemption rates. Results: Women were primarily Hispanic (75%), White (50%), postpartum (63%), and had never shopped online (54%). Redemption increased up to 65% more in the I vs. the C for most WIC categories. Conclusions: Results from this pilot trial suggest that a WIC-tailored, pre-filled online shopping cart may be a promising tool to improve WIC benefit redemption.
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Jayarajah, Umesh, e Anuruddha M. Abeygunasekera. "Cancer services in Sri Lanka: current status and future directions". Journal of the Egyptian National Cancer Institute 33, n.º 1 (3 de junho de 2021). http://dx.doi.org/10.1186/s43046-021-00070-8.
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Abstract Background The burden of cancer in Sri Lanka is on the rise. The overall incidence of cancer in Sri Lanka has doubled over the past 25 years with a parallel rise in cancer-related mortality. Cancer has become the second commonest cause of hospital mortality in Sri Lanka. In this review, we aim to provide an overview of the current status and future direction of cancer care in Sri Lanka. Main body In Sri Lanka, cancer services are predominantly provided by the state sector free of charge to the general public. With the establishment of national cancer policy on cancer prevention and control, there has been a commendable improvement in the cancer services provided island-wide. An increasing number of breast, oropharyngeal, thyroid, oesophageal, colorectal, lung, and gastric cancers are being diagnosed and treated annually. Primary prevention measures include restrictions in tobacco and HPV vaccination. Screening programs for selected cancers such as breast, oral and cervical cancers are delivered. Medical oncology units with facilities for systemic therapy and adequately supported by surgical, pathology, and radiology departments have been established in each district general hospital island-wide. Although the current progress is commendable, future changes are necessary to overcome the current limitations and to cater the ever increasing burden of cancer. Measures are necessary to enhance the coverage of Sri Lanka Cancer Registry. Timely high-quality research and audits are essential. Community participation in planning strategies for cancer prevention and treatment is minimal. Community-based palliative care facilities and radiation and other systemic therapy should be made available in all provinces. A culture of multi-disciplinary care with proper referral pathways would help to improve the current setting. Conclusion In conclusion, Sri Lanka has a reasonably balanced and continuously expanding program for prevention, screening, and treatment of cancers. Emphasis on preventive strategies related to reducing tobacco smoking, chewing betel, and obesity, making cancers a notifiable disease, involving the community in planning cancer care and prevention strategies, conducting research to evaluate cost-effectiveness of existing treatment and increasing radiotherapy facilities would further improve the cancer services in Sri Lanka.
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Singleton, Michael D., e Peter J. Rock. "Assessment of a Surveillance Case Definition for Heroin Overdose in Emergency Medical Services Data". Online Journal of Public Health Informatics 10, n.º 1 (22 de maio de 2018). http://dx.doi.org/10.5210/ojphi.v10i1.8353.
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ObjectiveThe aims of this project were 1) to assess the validity of a surveillance case definition for identifying heroin overdoses (HOD) in a NEMSIS 3–compliant, state ambulance reporting system; and 2) to develop an approach that can be applied to assess the validity of case definitions for other types of drug overdose events in similar data state data systems.IntroductionIn 2016, the Centers for Disease Control and Prevention funded 12 states, under the Enhanced State Opioid Overdose Surveillance (ESOOS) program, to utilize state Emergency Medical Services (EMS) and emergency department (ED) syndromic surveillance (SyS) data systems to increase timeliness of state data on drug overdoses. A key aspect of the ESOOS program is the development and validation of case definitions for drug overdoses for EMS and ED SyS data systems. Kentucky’s ESOOS team conducted a pilot validation study of a candidate EMS case definition for HOD, using data from the Kentucky State Ambulance Reporting System (KStARS). We examined internal, face validity of the EMS HOD case definition by reviewing pertinent information captured in KStARS data elements; and we examined external agreement with HOD cases identified Kentucky’s statewide hospital billing database.MethodsFrom KStARS, we extracted EMS emergent transports by any ambulance service to hospitals in a single, large health care system in Kentucky. We included responses with dispatch dates between January 1, 2017 and March 31, 2017. From Kentucky’s statewide hospital claims data system, we extracted inpatient discharges, ED visits and observational stays at the destination hospitals, with admit dates in the same range. We classified EMS cases as HOD based on specific combinations of the following criteria for EMS data elements: primary or secondary provider impression of heroin poisoning (T40.1X4), heroin-related keywords in the patient care narrative or chief complaint, and patient’s response to naloxone as indicated in the medications list1. We used standard drug overdose case definitions for ICD-10-CM-coded hospital billing data2 to classify hospital records from the destination facilities to the same categories. We produced descriptive analyses of the heroin overdose cases detected in both data sources, EMS and hospital. To assess the degree of overlap in the HOD cases identified by the two data systems, we matched the identified EMS HOD cases against the entire set of UKHC hospital cases. Finally, we assessed the validity of the classification of EMS cases as heroin overdoses by reviewing the EMS patient care narratives and related EMS data elements, as well as the ICD-10-CM hospital diagnostic codes for cases that matched to a hospital record.ResultsWe identified 5,517 emergent EMS transports to the destination hospitals in the first quarter of 2017. Of these, 94 (17/1,000) were identified by our case definition as a HOD. We identified 29,631 unduplicated, emergent encounters at the destination hospitals (including inpatient discharges, ED visits, and observational stays; and excluding elective and newborn encounters). Of these, 105 (3.5/1,000) included a diagnostic code for HOD. Linkage of EMS and hospital cases indicated that 141 unique HOD cases were identified in the two files combined. Of these, 58 (41%) were identified as HOD in both systems. 23 HOD cases identified in EMS were matched to a hospital record that had no mention of a HOD; and 13 could not be matched to a hospital record. Additionally, 47 HOD cases identified in the destination hospitals were not matched to an EMS transport to those destination facilities. Overall, 76 out of the 94 (81%) EMS cases identified as heroin overdoses were judged likely to be true heroin overdoses, as indicated by either 1) positive response to naloxone and patient admission of recent heroin use, or 2) hospital diagnosis of heroin overdose, or both. For 2% of identified cases, there was evidence of a false positive finding. The remaining 17% of identified heroin cases were inconclusive: there was information suggestive of opioid overdose, but no clear evidence to suggest, nor to rule out, that the opioid was heroin. Generally, inconclusive cases were identified as heroin overdoses due to positive response to naloxone, combined with mention of the word “heroin” in the narrative that did not indicate an HOD. Examples of the latter include negations (patient denies heroin use) or a bystander who stated that the patient had a history of heroin use.ConclusionsWe assessed the performance of a straightforward case definition for heroin overdose for EMS data. Face validity of 81% of identified heroin overdoses was supported by clerical review of EMS records and/or hospital ICD-10-CM diagnostic codes. Some proportion of the other 19% of cases that were identified as heroin overdoses may have been overdoses involving opioids other than heroin, but we could not quantify that proportion based on the available information.Future work will consider sensitivity (true heroin overdoses that may fail to be captured by this case definition) and refinements to the basic definition that may yield improved results. Lessons learned from this pilot project will inform subsequent, larger-scale validation studies for EMS drug overdose case definitions.References1. Rhode Island Enhanced State Opioid Overdose Surveillance (ESOOS). Case Definition for Emergency Medical Services. Aug 2017.2. Injury Surveillance Workgroup 7. Consensus Recommendations for National and State Poisoning Surveillance. The Safe States Alliance. Atlanta, GA. April 2012.