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Disparities In Thyroid Cancer Diagnosis Based On Residence And Distance From Medical Facility, Sunita Regmi, Evi A. Farazi, Elizabeth Lyden, Anupam Kotwal, Apar Kishor Ganti, Whitney Goldner

Journal Articles: Epidemiology

CONTEXT: Rural-urban disparities have been reported in cancer care, but data are sparse on the effect of geography and location of residence on access to care in thyroid cancer.

OBJECTIVE: To identify impact of rural or urban residence and distance from treatment center on thyroid cancer stage at diagnosis.

METHODS: We evaluated 800 adults with differentiated thyroid cancer in the iCaRe2 bioinformatics/biospecimen registry at the Fred and Pamela Buffett Cancer Center. Participants were categorized into early and late stage using AJCC staging, and residence/distance from treating facility was categorized as short (≤ 12.5 miles), intermediate (> 12.5 to < 50 miles) or long (≥ 50 miles). Multivariable logistic regression was used to identify factors associated with late-stage diagnosis.

RESULTS: Overall, …

Factors Associated With Delaying Medical Care: Cross-Sectional Study Of Nebraska Adults, Kendra Ratnapradipa, Snehal Jadhav, Josiane Kabayundo, Hongmei Wang, Lisa C. Smith

Journal Articles: Epidemiology

BACKGROUND: Delayed medical care may result in adverse health outcomes and increased cost. Our purpose was to identify factors associated with delayed medical care in a primarily rural state.

METHODS: Using a stratified random sample of 5,300 Nebraska households, we conducted a cross-sectional mailed survey with online response option (27 October 2020 to 8 March 2021) in English and Spanish. Multiple logistic regression models calculated adjusted odds ratios (aOR) and 95% confidence intervals.

RESULTS: The overall response rate was 20.8% (n = 1,101). Approximately 37.8% of Nebraskans ever delayed healthcare (cost-related 29.7%, transportation-related 3.7%), with 22.7% delaying care in the …

Overlooked Sex And Gender Aspects Of Emerging Infectious Disease Outbreaks: Lessons Learned From Covid-19 To Move Towards Health Equity In Pandemic Response, Lynn Lieberman Lawry, Roberta Lugo-Robles, Vicki Mciver

Journal Articles: Epidemiology

Sex and gender issues are especially important in emerging infectious diseases (EIDs) but are routinely overlooked despite data and practice. Each of these have an effect either directly, via the effects on vulnerability to infectious diseases, exposures to infectious pathogens, and responses to illness, and indirectly through effects on disease prevention and control programs. The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the viral agent of coronavirus disease 2019 (COVID-19) has underscored the importance of understanding the sex and gender impacts on pandemics. This review takes a broader looks at how sex and gender impact vulnerability, exposure risk, and treatment and …

Nasal Host Response-Based Screening For Undiagnosed Respiratory Viruses: A Pathogen Surveillance And Detection Study, Nagarjuna R. Cheemarla, Amelia Hanron, Joseph R. Fauver, Jason Bishai, Timothy A. Watkins, Anderson F. Brito, Dejian Zhao, Tara Alpert, Chantal B. F. Vogels, Albert I. Ko, Wade L. Schulz, Marie L. Landry, Nathan D. Grubaugh, David Van Dijk, Ellen F. Foxman

Journal Articles: Epidemiology

BACKGROUND: Symptomatic patients who test negative for common viruses are an important possible source of unrecognised or emerging pathogens, but metagenomic sequencing of all samples is inefficient because of the low likelihood of finding a pathogen in any given sample. We aimed to determine whether nasopharyngeal CXCL10 screening could be used as a strategy to enrich for samples containing undiagnosed viruses.

METHODS: In this pathogen surveillance and detection study, we measured CXCL10 concentrations from nasopharyngeal swabs from patients in the Yale New Haven health-care system, which had been tested at the Yale New Haven Hospital Clinical Virology Laboratory (New Haven, …

The Association Between Mediated Deprivation And Ovarian Cancer Survival Among African American Women, Andrew B. Lawson, Joanne Kim, Courtney Johnson, Kendra Ratnapradipa, Anthony J. Alberg, Maxwell Akonde, Theresa Hastert, Elisa V. Bandera, Paul Terry, Hannah Mandle, Michele L. Cote, Melissa Bondy, Jeffrey Marks, Lauren C. Peres, Joellen Schildkraut, Edward S. Peters

Journal Articles: Epidemiology

BACKGROUND: Deprivation indices are often used to adjust for socio-economic disparities in health studies. Their role has been partially evaluated for certain population-level cancer outcomes, but examination of their role in ovarian cancer is limited. In this study, we evaluated a range of well-recognized deprivation indices in relation to cancer survival in a cohort of self-identified Black women diagnosed with ovarian cancer. This study aimed to determine if clinical or diagnostic characteristics lie on a mediating pathway between socioeconomic status (SES) and deprivation and ovarian cancer survival in a minority population that experiences worse survival from ovarian cancer.

METHODS: We …

Evaluation Of Theoretical Frameworks To Detect Correlates Of Hpv Vaccination In The Midwest, Us, Using Structural Equation Modeling, Abraham Degarege, Shinobu Watanabe-Galloway, Kristyne Mansilla, Rahel M. Sileshi, Edward S. Peters

Journal Articles: Epidemiology

Knowledge of a valid, well-designed, and targeted theory-based framework helps better characterize reasons for HPV vaccine hesitancy and identify promising approaches to increase vaccination rates for eligible individuals. This study evaluated health theories in explaining factors affecting HPV vaccination and used a theoretical framework to identify direct and indirect predictors and mediators of HPV vaccination. A cross-sectional survey regarding HPV vaccine uptake and related factors was conducted among 1306 teenagers and young adults in the Midwest, US, in March and April 2023. Structural equation modeling confirmed fit of the framework based on the Integrated Health Theory (IHT) to the HPV …

Exploring Barriers And Promoters Of Crc Screening Use Among Agricultural Operators: A Pilot Study Of An Application Of Concept Mapping, Cheryl Beseler, Jungyoon Kim, Roma Subramanian, Susan Harris, Karen Funkenbusch, Aaron Yoder, Tamara Robinson, Jason M. Foster, Shinobu Watanabe-Galloway

Journal Articles: Epidemiology

INTRODUCTION: The purpose of the study was to identify barriers and facilitators of colorectal cancer (CRC) screening use among agricultural operators in Nebraska, US.

METHODS: The concept mapping approach was used to engage participants and enhance the generation of ideas and opinions regarding CRC screening. Two focus groups (seven women and seven men) were conducted.

RESULTS: Among women, the cost domain was most agreed upon as important, followed by experiencing symptoms, awareness, and family. Among men, the important concepts related to CRC screening were family and friend support, feeling too young to get CRC, family or personal history of CRC, …

Development And Validation Of A Questionnaire To Assess Awareness And Knowledge Of Nonalcoholic Fatty Liver Disease, A Liver Cancer Etiological Factor, Among Chinese Young Adults, Yi Du, Fedja A. Rochling, Dejun Su, Kendra Ratnapradipa, Jianghu James Dong, Evi A. Farazi

Journal Articles: Epidemiology

PURPOSE: Despite the increasing prevalence of nonalcoholic fatty liver disease (NAFLD), a liver cancer etiological factor, among Chinese young adults (CYA), there is a lack of valid, reliable, ready-to-use survey instruments for assessing awareness and knowledge of NAFLD in this population. The aims of this study were to develop, validate, and assess the reliability of a web-based, self-administered questionnaire evaluating awareness and knowledge of NAFLD among CYA.

METHODS: Based on review of relevant literature, a draft questionnaire was initially developed. Face and content validity of the questionnaire was evaluated by an expert panel of seven gastroenterologists. The construct validity was …

Severe Acute Respiratory Infection-Preparedness: Protocol For A Multicenter Prospective Cohort Study Of Viral Respiratory Infections, Radu Postelnicu, Avantika Srivastava, Pavan K. Bhatraju, Mark M. Wurfelc, George L. Anesi, Martin Gonzalez, Adair Andrews, Karen Lutrick, Vishakha K. Kumar, Timothy M. Uyeki, Perren J. Cobb, Leopoldo N. Segal, David Brett-Major, Janice M. Liebler, Christopher J. Kratochvil, Vikramjit Mukherjee, M. Jana Broadhurst, Richard Lee, David Wyles, Jonathan E Sevransky, Laura Evans, Douglas Landsittel

Journal Articles: Epidemiology

OBJECTIVES: Respiratory virus infections cause significant morbidity and mortality ranging from mild uncomplicated acute respiratory illness to severe complications, such as acute respiratory distress syndrome, multiple organ failure, and death during epidemics and pandemics. We present a protocol to systematically study patients with severe acute respiratory infection (SARI), including severe acute respiratory syndrome coronavirus 2, due to respiratory viral pathogens to evaluate the natural history, prognostic biomarkers, and characteristics, including hospital stress, associated with clinical outcomes and severity.

DESIGN: Prospective cohort study.

SETTING: Multicenter cohort of patients admitted to an acute care ward or ICU from at least 15 hospitals …

Disparities In Awareness Of And Willingness To Participate In Cancer Clinical Trials Between African American And White Cancer Survivors, Gaurav Kumar, Jungyoon Kim, Paraskevi A. Farazi, Hongmei Wang, Dejun Su

Journal Articles: Epidemiology

BACKGROUND: Cancer clinical trials (CCTs) are essential for cancer care, yet the evidence is scarce when it comes to racial disparities in CCT participation among cancer survivors in the Midwest. This study aimed to 1) assess disparities in the awareness of and willingness to participate in CCTs between African American and White cancer survivors; and 2) compare perceptions about CCTs between the two racial groups.

METHODS: The study was based on cross-sectional data from the survey "Minority Patient Participation in Cancer Clinical Trials" that collected information from 147 Black and White cancer survivors from Nebraska between 2015 and 2016. Chi-square …

Matters Of Trust: A Comparison Of Patient-Provider Trust In Colorectal Cancer Survivors Using The Trust In Oncologist Scale, Krista Brown, Jungyoon Kim, Shinobu Watanabe-Galloway, Lynn Harland, Jason M. Foster

Journal Articles: Epidemiology

Objective: Trust is a vital component of the patient-provider relationship. Higher trust is associated with increased adherence to treatment and improved outcomes. The purpose of this study was to compare colorectal cancer (CRC) survivors' reported trust toward their primary care physician (PCP) and oncologist (ONC).

Methods: CRC survivors (n=62) were surveyed using the Trust in Oncologist (TiOS) instrument that assessed five domains (honesty, fidelity, caring, competence, and global/overall) using a 5-point Likert scale. Social and demographic variables were analyzed using nonparametric tests.

Results: Mean trust was higher toward the ONC compared to the PCP across all TiOS domains (P=0.001-0.023). Trust …

Gut Microbiome Dysbiosis In Antibiotic-Treated Covid-19 Patients Is Associated With Microbial Translocation And Bacteremia, Lucie Bernard-Raichon, Mericien Venzon, Jon Klein, Jordan E. Axelrad, Chenzhen Zhang, Alexis P. Sullivan, Grant A. Hussey, Arnau Casanovas-Massana, Maria G. Noval, Ana M. Valero-Jimenez, Juan Gago, Gregory Putzel, Alejandro Pironti, Evan Wilder, Yale Impact Research Team, Lorna E. Thorpe, Dan R. Littman, Meike Dittmann, Kenneth A. Stapleford, Bo Shopsin, Victor J. Torres, Albert I. Ko, Akiko Iwasaki, Ken Cadwell, Jonas Schluter, Abeer Obaid, Alice Lu-Culligan, Allison Nelson, Anderson Brito, Angela Nunez, Anjelica Martin, Annie Watkins, Bertie Geng, Chaney Kalinich, Christina Harden, Codruta Todeasa, Cole Jensen, Daniel Kim, David Mcdonald, Denise Shepard, Edward Courchaine, Elizabeth B. White, Eric Song, Erin Silva, Eriko Kudo, Giuseppe Deluliis, Harold Rahming, Hong-Jai Park, Irene Matos, Jessica Nouws, Jordan Valdez, Joseph R. Fauver, Joseph Lim, Kadi-Ann Rose, Kelly Anastasio, Kristina Brower, Laura Glick, Lokesh Sharma, Lorenzo Sewanan, Lynda Knaggs, Maksym Minasyan, Maria Batsu, Mary Petrone, Maxine Kuang, Maura Nakahata, Melissa Campbell, Melissa Linehan, Michael H. Askenase, Michael Simonov, Mikhail Smolgovsky, Nicole Sonnert, Nida Naushad

Journal Articles: Epidemiology

Although microbial populations in the gut microbiome are associated with COVID-19 severity, a causal impact on patient health has not been established. Here we provide evidence that gut microbiome dysbiosis is associated with translocation of bacteria into the blood during COVID-19, causing life-threatening secondary infections. We first demonstrate SARS-CoV-2 infection induces gut microbiome dysbiosis in mice, which correlated with alterations to Paneth cells and goblet cells, and markers of barrier permeability. Samples collected from 96 COVID-19 patients at two different clinical sites also revealed substantial gut microbiome dysbiosis, including blooms of opportunistic pathogenic bacterial genera known to include antimicrobial-resistant species. …

Qualitative Analysis Of Cancer Care Experiences Among Rural Cancer Survivors And Caregivers, Kendra L. Ratnapradipa, Jordan Ranta, Krishtee Napit, Lady Beverly Luma, Tamara Robinson, Danae Dinkel, Laura Schabloske, Shinobu Watanabe-Galloway

Journal Articles: Epidemiology

PURPOSE: Rural (vs urban) patients experience poorer cancer outcomes and are less likely to be engaged in cancer prevention, such as screening. As part of a community needs assessment, we explored rural cancer survivors' and caregivers' experiences, perceptions, and attitudes toward cancer care services.

METHODS: We conducted 3 focus groups (N = 20) in Spring 2021 in rural Nebraska.

FINDINGS: Three patterns of cancer diagnosis were regular care/screening without noticeable symptoms, treatment for symptoms not initially identified as cancer related, and symptom self-identification. Most participants, regardless of how diagnosis was made, had positive experiences with timely referral for testing (imaging …

Intestinal Helminth Infection, Anemia, Undernutrition And Academic Performance Among School Children In Northwestern Ethiopia, Abraham Degarege, Berhanu Erko, Yohannes Negash, Abebe Animut

Journal Articles: Epidemiology

This study examined the prevalence and intensity of intestinal helminth infections and their association with anemia, undernutrition, and academic performance among school children in Maksegnit, northwestern Ethiopia. A total of 1205 school children, who attended Maksegnit Number Two Elementary School between May and July 2021, participated in this study. To determine helminth infection status, two thick Kato–Katz slides were examined for each child. Hemoglobin level was measured using a HemoCue machine. Academic performance was assessed using the mean score of all subjects children have taken for the Spring 2020/2021 academic term. Out of 1205 children examined, 45.4% were infected with …

Fielding Vaccines-Challenges And Opportunities In Outbreaks, Complex Emergencies, And Mass Gatherings, Laura J. Fischer, Robert C. Rains, Sherry M. Brett-Major, Mikiko Senga, Debra Holden, David Brett-Major

Journal Articles: Epidemiology

With the recent COVID-19 pandemic, the importance of vaccine development, distribution, and uptake has come to the forefront of the public eye. Effectively fielding vaccines during an emergency-whether that emergency is a result of an infectious disease or not-requires an understanding of usual vaccine-related processes; the impact of outbreak, complex emergencies, mass gatherings, and other events on patients, communities, and health systems; and ways in which diverse resources can be applied to successfully achieve needed vaccine uptake. In this review, both the emergency setting and briefly vaccine product design are discussed in these contexts in order to provide a concise …

Access, Socioeconomic Environment, And Death From Covid-19 In Nebraska, He Bai, Michelle M. Schwedhelm, John-Martin Lowe, Rachel Lookadoo, Daniel R. Anderson, Abigail Lowe, James V. Lawler, M. Jana Broadhurst, David Brett-Major

Journal Articles: Epidemiology

Our study assesses whether factors related to healthcare access in the first year of the pandemic affect mortality and length of stay (LOS). Our cohort study examined hospitalized patients at Nebraska Medicine between April and October 2020 who were tested for SARS-CoV-2 and had a charted sepsis related diagnostic code. Multivariate logistic was used to analyze the odds of mortality and linear regression was used to calculate the parameter estimates of LOS associated with COVID-19 status, age, gender, race/ethnicity, median household income, admission month, and residential distance from definitive care. Among 475 admissions, the odds of mortality is greater among …

Covid-19 Vaccine Acceptance: We Need To Start Now, Krutika Kuppalli, David Brett-Major, Tara C. Smith

Journal Articles: Epidemiology

In this perspective, we discuss the importance of developing a vaccine to help curb transmission of severe acute respiratory syndrome coronavirus 2. The question remains: Once a safe and effective vaccine is developed, will the public be willing to get it? We present information from one of the first tracking polls to assess public attitudes and perceptions toward a possible coronavirus disease 2019 vaccine that suggests public hesitancy over a potential vaccine, concern regarding accelerating clinical trials, and unease over the vaccine approval process. Public health experts, government officials, advocates, and others in the scientific community should respect the signals …

Improvements To A Framework For Gender And Emerging Infectious Diseases, Lynn Lieberman Lawry, Roberta Lugo-Robles, Vicki Mciver

Journal Articles: Epidemiology

No abstract provided.

The Relationship Between Social Vulnerability And Covid-19 Incidence Among Louisiana Census Tracts, Erin N. Biggs, Patrick M. Maloney, Ariane L. Rung, Edward S. Peters, William T. Robinson

Journal Articles: Epidemiology

Objective: To examine the association between the Centers for Disease Control and Prevention (CDC)'s Social Vulnerability Index (SVI) and COVID-19 incidence among Louisiana census tracts. Methods: An ecological study comparing the CDC SVI and census tract-level COVID-19 case counts was conducted. Choropleth maps were used to identify census tracts with high levels of both social vulnerability and COVID-19 incidence. Negative binomial regression with random intercepts was used to compare the relationship between overall CDC SVI percentile and its four sub-themes and COVID-19 incidence, adjusting for population density. Results: In a crude stratified analysis, all four CDC SVI sub-themes were significantly …

Molecular Characterization Of Cryptosporidium Spp. From Humans In Ethiopia, Ambachew W. Hailu, Abraham Degarege, Haileeyesus Adamu, Damien Costa, Venceslas Villier, Abdelmounaim Mouhajir, Loic Favennec, Romy Razakandrainibe, Beyene Petros

Journal Articles: Epidemiology

Data on the distribution and genotype of Cryptosporidium species is limited in Ethiopia. This study examined the presence and genetic diversity of Cryptosporidium species circulating in Ethiopian human population. Stool samples collected from patients who visited rural (n = 94) and urban (n = 93) health centers in Wurgissa and Hawassa district, respectively, were examined for the presence of Cryptosporidium spp. using microscopy, nested PCR and real-time PCR. To detect infection with PCR, analysis of 18S ribosomal RNA was performed. Subtyping was performed by sequencing a fragment of GP60 gene. The overall prevalence of infection was 46% (n = 86) …

Structural Equation Modeling To Detect Correlates Of Childhood Vaccination: A Moderated Mediation Analysis, Abraham Degarege, Karl Krupp, Vijaya Srinivas, Boubakari Ibrahimou, Purnima Madhivanan

Journal Articles: Epidemiology

OBJECTIVES: This study used a health belief theory derived framework and structural equation model to examine moderators, mediators, and direct and indirect predictors of childhood vaccination.

METHODS: A secondary analysis was conducted using data collected from a cross-sectional survey of a random sample of 1599 parents living in urban and rural areas of Mysore district, India. Applying two-stage probability proportionate-to-size sampling, adolescent girls attending 7th through 10th grades in 23 schools were selected to take home a questionnaire to be answered by their parents to primarily assess HPV vaccine intentions. Parents were also asked whether their children had received one …

Deployment And Travel Medicine Knowledge, Attitudes, Practices, And Outcomes Study (Kapos): Malaria Chemoprophylaxis Prescription Patterns In The Military Health System, Patrick W. Hickey, Indrani Mitra, Jamie Fraser, David Brett-Major, Mark S. Riddle, David R. Tribble

Journal Articles: Epidemiology

The Deployment and Travel Medicine Knowledge, Attitudes, Practices, and Outcomes Study (KAPOS) examines the integrated relationship between provider and patient inputs and health outcomes associated with travel and deployments. This study describes malaria chemoprophylaxis prescribing patterns by medical providers within the U.S. Department of Defense's Military Health System and its network of civilian healthcare providers during a 5-year period. Chemoprophylaxis varied by practice setting, beneficiary status, and providers' travel medicine expertise. Whereas both civilian and military facilities prescribe an increasing proportion of atovaquone-proguanil, doxycycline remains the most prevalent antimalarial at military facility based practices. Civilian providers dispense higher rates of …

Colorectal Cancer Screening Uptake: Differences Between Rural And Urban Privately-Insured Population, Mesnad Alyabsi, Jane L. Meza, K. M. Monirul Islam, Amr Soliman, Shinobu Watanabe-Galloway

Journal Articles: Epidemiology

Earlier studies investigated rural-urban colorectal cancer (CRC) screening disparities among older adults or used surveys. The objective was to compare screening uptake between rural and urban individuals 50-64 years of age using private health insurance. Data were analyzed from 58,774 Blue Cross Blue Shield of Nebraska beneficiaries. Logistic regression was used to assess the association between rural-urban and CRC screening use. Results indicate that rural individuals were 56% more likely to use the Fecal Occult Blood Test (FOBT) compared with urban residents, but rural females were 68% less likely to use FOBT. Individuals with few Primary Care Physician (PCP) visits …

Parasitic Infections Represent A Significant Health Threat Among Recent Immigrants In Chicago, Jesica A. Herrick, Monica Nordstrom, Patrick M. Maloney, Miguel Rodriguez, Kevin Naceanceno, Gloria Gallo, Rojelio Mejia, Ron Hershow

Journal Articles: Epidemiology

Parasitic infections are likely under-recognized among immigrant populations in the USA. We conducted a cross-sectional study to evaluate if such infections have health impacts among recent immigrants in Chicago and to identify predictive factors for parasitic infections. A total of 133 recent immigrants were enrolled, filling out a standardized medical questionnaire and providing blood and stool samples. Appriximately 12% of subjects (15/125) who provided a blood or stool sample for testing were found to have evidence of current or prior infection with a pathogenic parasite, of which Toxocara spp. (8 subjects, 6.4%) and Strongyloides stercoralis (5 subjects, 4%) were most …

The Impact Of Travel Time On Colorectal Cancer Stage At Diagnosis In A Privately Insured Population, Mesnad Alyabsi, Mary Charlton, Jane L. Meza, K. M. Monirul Islam, Amr Soliman, Shinobu Watanabe-Galloway

Journal Articles: Epidemiology

BACKGROUND: Rural residents are less likely to receive screening for colorectal cancer (CRC) than urban residents. However, the mechanisms underlying this disparity, especially among people aged 50-64 years old with private health insurance, are not well understood. We examined the impact of travel time on stage at CRC diagnosis.

METHODS: This retrospective cohort study used data from the Blue Cross and Blue Shield of Nebraska. Members of this private insurance company aged 50-64 years, diagnosed with CRC during the period 2012-2016, and continuously enrolled in the insurance plan for at least 6 months prior to CRC diagnosis, were selected for …

Effect Of Abo Blood Group On Asymptomatic, Uncomplicated And Placental Plasmodium Falciparum Infection: Systematic Review And Meta-Analysis, Abraham Degarege, Merhawi T. Gebrezgi, Consuelo M. Beck-Sague, Mats Wahlgren, Luiz Carlos De Mattos, Purnima Madhivanan

Journal Articles: Epidemiology

BACKGROUND: Malaria clinical outcomes vary by erythrocyte characteristics, including ABO blood group, but the effect of ABO blood group on asymptomatic, uncomplicated and placental Plasmodium falciparum (P. falciparum) infection remains unclear. We explored effects of ABO blood group on asymptomatic, uncomplicated and placental falciparum infection in the published literature.

METHODS: A systematic review and meta-analysis was performed using the preferred reporting items for systematic reviews and meta-analyses guidelines. Articles in Pubmed, Embase, Web of Science, CINAHL and Cochrane Library published before February 04, 2017 were searched without restriction. Studies were included if they reported P. falciparum infection incidence or prevalence, …

Temporal And Geospatial Trends Of Pediatric Cancer Incidence In Nebraska Over A 24-Year Period, Evi A. Farazi, Shinobu Watanabe-Galloway, L. Westman, B. Rettig, P. Hunt, R. Cammack, John W. Sparks, Don W. Coulter

Journal Articles: Epidemiology

BACKGROUND: Data from the Surveillance, Epidemiology, and End Results (SEER) revealed that the incidence of pediatric cancer in Nebraska exceeded the national average during 2009-2013. Further investigation could help understand these patterns.

METHODS: This retrospective cohort study investigated pediatric cancer (0-19 years old) age adjusted incidence rates (AAR) in Nebraska using the Nebraska Cancer Registry. SEER AARs were also calculated as a proxy for pediatric cancer incidence in the United States (1990-2013) and compared to the Nebraska data. Geographic Information System (GIS) mapping was also used to display the spatial distribution of cancer in Nebraska at the county level. Finally, …

Adherence And Perceived Barriers To Oral Antiviral Therapy For Chronic Hepatitis B, Kerui Xu, Li-Ming Liu, Evi A. Farazi, Hongmei Wang, Fedja A. Rochling, Shinobu Watanabe-Galloway, Jian-Jun Zhang

Journal Articles: Epidemiology

BACKGROUND: Globally, of the 248 million people chronically infected with the hepatitis B virus (HBV), 74 million reside in China. Five oral nucleot(s)ide analogs (NUCs) have been approved for the treatment of chronic hepatitis B (CHB) in China.

OBJECTIVES: The aims of this study were to determine rates of adherence to NUC therapy in patients with CHB, to identify the self-perceived barriers to adherence, and to examine the factors associated with adherence.

METHODS: Questionnaire-based interviews were administered among Chinese patients with CHB at hepatology clinics of a tertiary hospital in the city of Wuhan, China. Adults aged 18 years or …

A Needs Assessment For Simulation-Based Training Of Emergency Medical Providers In Nebraska, Usa, Nizar K. Wehbi, Rajvi Wani, Yangyuna Yang, Fernando A. Wilson, Sharon J. Medcalf, Brian Monaghan, Jennifer Adams, Paul Paulman

Journal Articles: Epidemiology

Background: Training emergency medical services (EMS) workforce is challenging in rural and remote settings. Moreover, critical access hospitals (CAHs) struggle to ensure continuing medical education for their emergency department (ED) staff. This project collected information from EMS and ED providers across Nebraska to identify gaps in their skills, knowledge, and abilities and thus inform curriculum development for the mobile simulation-based training program.

Methods: The needs assessment used a three-step process: (1) four facilitated focus group sessions were conducted in distinct geographical locations across Nebraska to identify participants' perceived training gaps; (2) based on the findings from the focus group, a …

Coming Out Of "Retirement"-Predictors Of Driving Resumption Among Older Drivers, Kendra Ratnapradipa, Jing Wang, Marla Berg-Weger, Mario Schootman

Journal Articles: Epidemiology

Background and Objectives: Predictors and consequences of driving cessation in older adults have been studied extensively. This study sought to establish the extent to which former drivers resume driving and identify associated factors.

Research Design and Methods: Descriptive analysis of the 2011-2015 National Health and Aging Trends Study data (Round 1:

Results: Among drivers who stopped driving during the study, 17%-28% resumed driving. Age, vehicle ownership, stroke, hospitalization, memory, and perceived transportation barriers were associated with resumption in regression analysis. In multilevel analysis stratified by baseline driving status, poor word recall (OR = 0.62; 95% CI = 0.40, 0.95) and …