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Articles 3151 - 3180 of 6134
Full-Text Articles in Public Health
Improving Access To Mental Health Care With Nurse Practitioners, Jessica Whelan
Improving Access To Mental Health Care With Nurse Practitioners, Jessica Whelan
Dissertations
Problem: Over 40% of those with mental illness are untreated since the supply of psychiatrists does not meet the demand. The psychiatric mental health nurse practitioner (PMHNP) may be an adjunct in providing those services. The purpose of this quality assurance study was to evaluate outcomes of care between a PMHNP and a psychiatrist (medical doctor [MD]).
Methods: An observational, descriptive design with a retrospective medical record review of adult patients over a six-month period in a suburban, Midwestern, privately owned psychiatric practice.
Results: A total of 787 individual patients encountered at least one visit (N=787) although 3,679 …
Going Behind The Scenes: Understanding And Organizing A Corporate Fitness Center, Rachael Griffith
Going Behind The Scenes: Understanding And Organizing A Corporate Fitness Center, Rachael Griffith
Masters Theses/Capstone Projects
The author learns best practices and how to organize a corporate fitness center. Area companies are explored.
Service-Learning Research For Development: An Option For The Poor In Practice Through Social Analysis And Community Engagement, Thomas M. Kelly, Kate L. Nolt
Service-Learning Research For Development: An Option For The Poor In Practice Through Social Analysis And Community Engagement, Thomas M. Kelly, Kate L. Nolt
Jesuit Higher Education: A Journal
A group of faculty, staff and students from Creighton University conducted a research project using a strengths-based approach to create a community health needs assessment (CNHA) in the fall of 2017. The instruments, including a survey to determine health status, a focus group questionnaire, an environmental scan and an individual interview instrument, were developed to help shift the paradigm from which many international medical missions are conducted with Creighton’s community partner in the Dominican Republic, the Centro de Educación para la Salud Integral (CESI). In the process of creating, developing, implementing, assessing and reformulating this strength-based CHNA, researchers encountered both …
The Effect Of Parent-Infant Swim Classes On Maternal Parenting Competence, Emotional Availability, And Aquatic Handling, Hope Sadowski, Chanele Molano
The Effect Of Parent-Infant Swim Classes On Maternal Parenting Competence, Emotional Availability, And Aquatic Handling, Hope Sadowski, Chanele Molano
Showcase of Graduate Student Scholarship and Creative Activities
Low parenting competence and limited emotional availability decrease the quality of the parent-infant relationship (Young, 2011; Sturge-Apple et al., 2012). However, co-occupations, or reciprocal relationships where the occupations of two or more individuals are interactively shaping each other, have been associated with strengthening parent-infant relationships (Pierce, 2009; Price & Stephenson, 2009). Parent-infant swim classes are co-occupation based interventions that facilitate close bodily contact and teach parents handling skills that can generalize into the home. Numerous websites allude to the benefits of these classes; however, there are currently no evidence-based claims supported by the occupational therapy literature. The researchers hypothesized that …
Effect Of A 24-Week Randomized Trial Of An Organic Produce Intervention On Pyrethroid And Organophosphate Pesticide Exposure Among Pregnant Women, Cynthia L. Curl, Jessica Porter, Ian Penwell, Rachel Phinney, Marai Ospina, Antonia M. Calafat
Effect Of A 24-Week Randomized Trial Of An Organic Produce Intervention On Pyrethroid And Organophosphate Pesticide Exposure Among Pregnant Women, Cynthia L. Curl, Jessica Porter, Ian Penwell, Rachel Phinney, Marai Ospina, Antonia M. Calafat
Public and Population Health Faculty Publications and Presentations
Background: Introduction of an organic diet can significantly reduce exposure to some classes of pesticides in children and adults, but no long-term trials have been conducted. Objectives: To assess the effect of a long-term (24-week) organic produce intervention on pesticide exposure among pregnant women.
Methods: We recruited 20 women from the Idaho Women, Infants, and Children (WIC) program during their first trimester of pregnancy. Eligible women were nonsmokers aged 18–35 years who reported eating exclusively conventionally grown food. We randomly assigned participants to receive weekly deliveries of either organic or conventional fruits and vegetables throughout their second or third trimesters …
Addressing Challenges To The Reliable, Large-Scale Implementation Of Effective School Health Education, Michael J. Mann, David K. Lohrmann
Addressing Challenges To The Reliable, Large-Scale Implementation Of Effective School Health Education, Michael J. Mann, David K. Lohrmann
Public and Population Health Faculty Publications and Presentations
The long-held priority of teaching young people the knowledge and skills needed for healthy living has recently been diminished in many preK-12 schools. Driven by federal and state priorities, laws, and policies associated with high-stakes testing, instruction in untested subjects has been reduced or eliminated in most schools in order to devote more attention to tested subjects, like reading, math, writing, and science. This article proposes a pathway to ensure that all children are able to learn what society knows about health. To that end, four challenges to the reliable, large-scale implementation of effective school health education are identified: (1) …
Kangaroo Mother Care: Opportunities And Implications For Rural Pakistan, Hasan Nawaz Tahir, Zafar Fatmi
Kangaroo Mother Care: Opportunities And Implications For Rural Pakistan, Hasan Nawaz Tahir, Zafar Fatmi
Community Health Sciences
Neonatal mortality comprises 40% of total under-5 mortality, globally. Kangaroo mother care (KMC) is one of the most cost-effective interventions to reduce neonatal mortality. KMC does not require highend equipment, intensive care facilities or technical knowledge. A recent meta-analysis reported that KMC may reduce neonatal mortality in preterm and low birth weight neonates up to 36%. A review of enablers and barriers of KMC suggests that KMC can be integrated in maternal health care system by giving awareness, involving family and giving ownership of the intervention to the community. If supported with minimal incentives it would reduce the cost of …
Community-Acquired Pneumonia Pathogenesis In Patients With Chronic Obstructive Pulmonary Disease, Julio A. Ramirez, Rodrigo Cavallazzi
Community-Acquired Pneumonia Pathogenesis In Patients With Chronic Obstructive Pulmonary Disease, Julio A. Ramirez, Rodrigo Cavallazzi
The University of Louisville Journal of Respiratory Infections
No abstract provided.
Time To Adopt Developmental Origins Of Health And Disease (Dohad) Science In Pakistan, Rozina Nuruddin, Akbar Shoukat Ali, Nuruddin Badruddin Mohammed
Time To Adopt Developmental Origins Of Health And Disease (Dohad) Science In Pakistan, Rozina Nuruddin, Akbar Shoukat Ali, Nuruddin Badruddin Mohammed
Community Health Sciences
No abstract provided.
Public Health Research Priorities To Address Female Genital Mutilation Or Cutting In The United States, Holly G. Atkinson, Deborah Ottenheimer, Ranit Mishori
Public Health Research Priorities To Address Female Genital Mutilation Or Cutting In The United States, Holly G. Atkinson, Deborah Ottenheimer, Ranit Mishori
Publications and Research
Female genital mutilation or cut- ting (FGM/C), an age-old tradition that is still widely practiced around the world, is gaining recognition as an important public health issue in the United States. Increasingly, because of migration, women and girls affected by FGM/C have become members of host communities where the practice is not culturally acceptable.
According to recent conservative estimates, more than 513 000 immigrant women and girls living in the United States have undergone or are at risk for FGM/C, a significant increase from the 1990 estimate of 168 000. The arrests of physicians in Michigan in 2017 for performing …
Is There Less Opioid Abuse In States Where Marijuana Has Been Decriminalized, Either For Medicinal Or Recreational Use? A Clin-Iq, Aaron M. Wendelboe, Richard Mathew, Tana Chongsuwat, Elizabeth Rainwater, Mark A. Wendelboe, Elizabeth Wickersham Md, Ann F. Chou
Is There Less Opioid Abuse In States Where Marijuana Has Been Decriminalized, Either For Medicinal Or Recreational Use? A Clin-Iq, Aaron M. Wendelboe, Richard Mathew, Tana Chongsuwat, Elizabeth Rainwater, Mark A. Wendelboe, Elizabeth Wickersham Md, Ann F. Chou
Journal of Patient-Centered Research and Reviews
Opioid use, abuse, and associated mortality have reached an epidemic level. In some states, cannabis is being used to treat chronic pain. To examine the hypothesis that medical marijuana legislation may reduce adverse opioid-related outcomes if patients substitute cannabis for opioids for pain management, we conducted a clinical inquiry (Clin-IQ). We searched Ovid MEDLINE, Ovid MEDLINE In-Process, and Embase for studies using the search terms marijuana, cannabis, legal, marijuana smoking, medical marijuana, opioid-related disorders, cannabis use, medical cannabis, legal aspect, and opiate addiction. We included population-based articles published from January 1, 2012, through December 5, 2018, that assessed the relationship …
I Live Alone But Don't Feel Alone: Social Isolation And Loneliness From The Patient Perspective, Julia Bedard-Thomas, Christian Gausvik, Jonathan Wessels, Saundra Regan, Keesha Goodnow, Anna Goroncy
I Live Alone But Don't Feel Alone: Social Isolation And Loneliness From The Patient Perspective, Julia Bedard-Thomas, Christian Gausvik, Jonathan Wessels, Saundra Regan, Keesha Goodnow, Anna Goroncy
Journal of Patient-Centered Research and Reviews
A growing homebound population may be at risk for social isolation and loneliness. Health-related social needs play a contributing role in these conditions. Research shows social isolation and loneliness are drivers of health outcomes. This pilot feasibility study seeks to explore patient-centered insight into perceptions of social isolation and loneliness in a homebound population. Eight participants were recruited from a home-based primary care practice within a family medicine residency program. One 30-minute semi-structured interview was completed in participants’ homes. The interview focused on loneliness and social isolation, using the 6-item De Jong Gerveld loneliness scale. Three qualitative analysts open-coded transcriptions …
Contraceptive Use Following Unintended Pregnancy Among Ugandan Women Living With Hiv, Jana Jarolimova, Jerome Kabakyenga, Kara Bennett, Winnie R. Muyindike, Annet Kembabazi, Jeffrey N. Martin, Peter W. Hunt, Yap Boum, Jessica E. Haberer, David Bangsberg, Angela Kaida, Lynn T. Matthews
Contraceptive Use Following Unintended Pregnancy Among Ugandan Women Living With Hiv, Jana Jarolimova, Jerome Kabakyenga, Kara Bennett, Winnie R. Muyindike, Annet Kembabazi, Jeffrey N. Martin, Peter W. Hunt, Yap Boum, Jessica E. Haberer, David Bangsberg, Angela Kaida, Lynn T. Matthews
OHSU-PSU School of Public Health Faculty Publications and Presentations
Background: Preventing unintended pregnancy is critical for women living with HIV (WLWH) to safely achieve their reproductive goals. Family planning services should support WLWH at risk of repeat unintended pregnancies. We examined the relationship between unintended pregnancy and subsequent contraception use among WLWH in Uganda.
Study design: This was a retrospective analysis of data from a longitudinal cohort of individuals initiating antiretroviral therapy (ART), restricted to women with pregnancy (confirmed via urine β-hcg testing) between 2011–2013. The exposure of interest was intended vs unintended pregnancy, and the outcome was self-report of modern contraceptive use (hormonal methods, intrauterine device, sterilization, and/or …
Perceptions Of Health Professionals Regarding Minimally Invasive Tissue Sampling (Mits) To Identify The Cause Of Death In Stillbirths And Neonates: Results From A Qualitative Study, Anam Shahil Feroz, Anum Shiraz Ali, Mohsina Noor Ibrahim, Elizabeth M. Mcclure, Shiyam Sunder Tikmani, Sayyeda Reza, Zahid Abbasi, Afia Zafar, Sameen Siddiqi, Sarah Saleem
Perceptions Of Health Professionals Regarding Minimally Invasive Tissue Sampling (Mits) To Identify The Cause Of Death In Stillbirths And Neonates: Results From A Qualitative Study, Anam Shahil Feroz, Anum Shiraz Ali, Mohsina Noor Ibrahim, Elizabeth M. Mcclure, Shiyam Sunder Tikmani, Sayyeda Reza, Zahid Abbasi, Afia Zafar, Sameen Siddiqi, Sarah Saleem
Community Health Sciences
Background: Pakistan is considered to be one of the riskiest places in the world for childbirth as measured by its high stillbirth and neonatal mortality rates. Complete diagnostic autopsy remains the gold standard to determine the cause of death (CoD); however, it is not routinely implemented due to religious objections, sociocultural beliefs, limited resources and low demand from physicians and families. Recently, minimally invasive tissue sampling (MITS) using needle biopsies of multiple tissues to obtain tissue for histological examination and organism identification with PCR has been developed and promoted to determine CoD in low-resource areas. To ensure successful implementation of …
The Role Of The Pharmacy Team In Atrial Fibrillation Detection In Nonclinical Settings, Brian C. Hazelrigg, Monica L. Miller, Sotiris Antoniou, Jagjot Chahal, Sadeer Fhadil
The Role Of The Pharmacy Team In Atrial Fibrillation Detection In Nonclinical Settings, Brian C. Hazelrigg, Monica L. Miller, Sotiris Antoniou, Jagjot Chahal, Sadeer Fhadil
Purdue Journal of Service-Learning and International Engagement
Atrial Fibrillation (AF) is a common cardiac/heart disease that increases a person’s risk of death, making early identification significant in overall disease management. Throughout my time in pharmacy school, I [Brian] have developed an interest in cardiology and research. During my last year of pharmacy school, I spent eight weeks at St. Bartholomew’s Hospital, in London, England, one of the largest cardiac centers within Europe, on an experiential training experience. While there, I had the opportunity to study specifics about many cardiac illnesses, with a focus on atrial fibrillation, and provide education to patients living with this disease. In addition …
Population Health Management, Data And Technology, Helena Ladd, Cody Hepp, Anna Mccloud, Hannah Granger, Mary Ellen Hethcox, Samuel Calabrese
Population Health Management, Data And Technology, Helena Ladd, Cody Hepp, Anna Mccloud, Hannah Granger, Mary Ellen Hethcox, Samuel Calabrese
Pharmacy and Wellness Review
No abstract provided.
A Pharmacist's Guide To Vaccinations, Amy Gillman, Jessica Beck, Vincent Wu
A Pharmacist's Guide To Vaccinations, Amy Gillman, Jessica Beck, Vincent Wu
Pharmacy and Wellness Review
No abstract provided.
Health Risks And Emerging Trends With The Use Of Electronic Cigarettes, Lucy Wagala, Austin Hopkins, Natalie Lennartz, Brian Heilbronner, Brittany L. Long, Natalie Dipietro Mager
Health Risks And Emerging Trends With The Use Of Electronic Cigarettes, Lucy Wagala, Austin Hopkins, Natalie Lennartz, Brian Heilbronner, Brittany L. Long, Natalie Dipietro Mager
Pharmacy and Wellness Review
Cigarette smoking is associated with many health risks and complications. Despite smokers' strong desire to quit, most battle with nicotine withdrawal and relapse. Because electronic cigarettes (e-cigarettes) do not contain tobacco, some believe them to be safer than traditional cigarettes and have used them as a replacement or adjunct nicotine source to prevent withdrawal symptoms. Electronic cigarettes are designed to mimic traditional cigarettes and expel a vapor composed of nicotine, water, glycerol, propylene glycol and other flavorings. Many e-cigarette companies use appealing platforms, which promise smoking cessation and harm reduction, to attract consumers; however, several studies have found e-cigarettes actually …
Improving Healthcare Costs And Patient Outcomes Across Healthcare Professions, Hannah Lamb, Jourdan Ujlaki, Paige Torbet, Isabel Cwikla, Rebecca Worden, Michael Rush
Improving Healthcare Costs And Patient Outcomes Across Healthcare Professions, Hannah Lamb, Jourdan Ujlaki, Paige Torbet, Isabel Cwikla, Rebecca Worden, Michael Rush
Pharmacy and Wellness Review
Healthcare professionals must be aware of the importance of preventive medicine and the responsibility they have in contributing to it. There are three levels of preventive medicine that a healthcare professional can provide based on the patient population that is receiving care and the goals of the particular service. Preventive medicine has the ability to improve both overall healthcare costs and have a positive impact on a patient's quality of life. All healthcare professionals have the potential to fulfill a role in each level of preventive medicine, and should understand the role of each member of the healthcare team, to …
Associations Among Knowledge, Attitudes, And Practices Toward Palliative Care Consultation Service In Healthcare Staffs: A Cross-Sectional Study, Li-Chun Huang, Ho-Jui Tung, Pei-Chao Lin
Associations Among Knowledge, Attitudes, And Practices Toward Palliative Care Consultation Service In Healthcare Staffs: A Cross-Sectional Study, Li-Chun Huang, Ho-Jui Tung, Pei-Chao Lin
Health Policy & Community Health: Faculty Publications
Background
The palliative care consultation service (PCCS) of the National Health Insurance payments has been promoted in Taiwan since 2011, although few studies have been conducted on healthcare staffs’ knowledge, attitudes, and practices regarding PCCS in Taiwan; consequently, the main objective of this study was to explore any correlations regarding the above by cross-sectional design using convenience sampling.
Methods
A total of 210 healthcare staff members were enrolled from a regional hospital from June 1, 2018, to September 30, 2018. Questionnaire items on the Palliative Care Consultation Service Inventory (KAP-PCCSI) were used to measure healthcare staff’s knowledge, attitudes, and practices …
Association Of Urine Levels Of C-Reactive Protein With Clinical Outcomes In Patients With Pneumonia: A Pilot Study, Subathra Marimuthu, Vidyulata Salunkhe, Stephen P. Furmanek, Leslie A Wolf
Association Of Urine Levels Of C-Reactive Protein With Clinical Outcomes In Patients With Pneumonia: A Pilot Study, Subathra Marimuthu, Vidyulata Salunkhe, Stephen P. Furmanek, Leslie A Wolf
The University of Louisville Journal of Respiratory Infections
Finding relevant biomarkers as a potential predictor of severity for patients hospitalized with community acquired pneumonia (CAP), in addition to the clinical scoring system, could advance progress towards more effective patient management. The inflammatory marker, C-reactive protein (CRP), which is elevated in the pathogenesis of many infectious diseases, may be a key biomarker target for CAP. Previous studies have shown that serum CRP may be a useful diagnostic marker for pneumonia in hospitalized patients with acute respiratory symptoms. The main aims of this study were to determine the correlation between serum and urine CRP levels in hospitalized patients with CAP, …
Modeling Resilience In Resettled Syrian Refugees With Disabilities, Nicholas Sherwood
Modeling Resilience In Resettled Syrian Refugees With Disabilities, Nicholas Sherwood
Biennial Conference: The Social Practice of Human Rights
Since 2011, the ongoing conflict in Syria has displaced millions of individuals, many of whom are now resettled across foreign borders. The US currently hosts 21,000 Syrian refugees, and of these, at least 5,000 have a form of disability. Furthermore, many US-based resettlement agencies currently experience strain providing the specialized care required by many of these resettled Syrian refugees with disabilities (RSRD) in large part due to austerity measures imposed by the US Federal government. This research project asks of RSRD themselves: given the limitations placed on your care providers, what personal sources of strength do you utilize when you …
Implementing Screening To Assess Readiness To Change In Overweight And Obese Patients At A Patient-Centered Medical Home, Jarrod Gant
Doctoral Projects
Obesity is at epidemic levels within the United States (U.S.), but the Southern U.S. has some of the most obese states. Mississippi (MS) is the most obese state in the country (Robert Wood Johnson Foundation, 2018). Factors such as diet, sedentary lifestyle, cultural influences, and socioeconomic status contribute to the state’s citizens being overweight and obese.
Contributing to the state’s obesity is the fact that MS has more people living in poverty than any other state (Center for American Progress [CAP], 2018). Lacking the ability to afford healthy foods and the ability to afford quality healthcare adds to the state’s …
Salud Mental Comunitaria: Implementación En Chile Actual, Emma Baker
Salud Mental Comunitaria: Implementación En Chile Actual, Emma Baker
Independent Study Project (ISP) Collection
This study explores how familiar community mental health organizations in Valparaíso follow an established model of community mental health, derived from a variety of essays, books, and reports on the topic. Additionally, it serves to present the effect of this relationship on the contemporary social revolution in Chile. The present social and political unrest, manifesting itself in massive protests throughout the country, presents a unique moment in which these themes can be examined. Additionally, Chile encounters high rates of psychological disorders among its population, a lack of protection for the mental health of children and adolescents, and a lack of …
Leveraging Technology To Address Patient-Centered Outcomes In Sickle Cell Disease, Tilicia Mayo-Gamble, Delores P. Quasie-Woode
Leveraging Technology To Address Patient-Centered Outcomes In Sickle Cell Disease, Tilicia Mayo-Gamble, Delores P. Quasie-Woode
Health Policy & Community Health: Faculty Publications
Work published by Georgia Southern University Press.
Examining The Effect Of A Hypothetical Safe Injection Facility On Hiv And Hcv Transmission Rates In Kent County, Michigan, Trevor Ditmar
Examining The Effect Of A Hypothetical Safe Injection Facility On Hiv And Hcv Transmission Rates In Kent County, Michigan, Trevor Ditmar
McNair Scholars Manuscripts
Previous literature has established that increases in prescription opioid misuse has resulted in similar increases in injection drug use (IDU), collectively referred to as the “opioid epidemic” in the US. Due to this surge in IDU, incidence of Hepatitis C (HCV) and Human Immunodeficiency Virus (HIV) are on the rise in many regions. Research conducted in Canada and elsewhere has supported the use of Safe Injection Facilities (SIFs) and Needle Syringe Programs (NSPs) to mollify disease incidence, but only NSPs are operating in the US despite SIFs having been in use in Canada for several decades. As little research has …
Bridging The Gap On Schistosomiasis: A Cross-Sectional Study Examining The Knowledge Gap And Common Attitudes And Practices Regarding S. Mansoni Infections Among Varying Education Levels In Luanda K’Otieno, Western Kenya, Kathy Zhang
Independent Study Project (ISP) Collection
Background: Schistosomiasis is considered one of the most prevalent neglected tropical diseases in the world. According to the World Health Organization (WHO), the most effective strategy for schistosomiasis control is through preventive chemotherapy with praziquantel (PZQ). In order to successfully control morbidity rates, the WHO recommends mass treatment targeting high risk groups, such as school-age children and adults considered to be at risk.
Methods: This cross-sectional study examined the effects of the National School-Based Deworming Programme (NSBDP) on knowledge of schistosomiasis and subsequent prevalence rates and intensity. A total of 43 residents in Luanda K’Otieno were interviewed, and 34 of …
Integrative Pharmacotherapeutic Approaches To Treating Depression, Charlotte Tse
Integrative Pharmacotherapeutic Approaches To Treating Depression, Charlotte Tse
Independent Study Project (ISP) Collection
Traditional Chinese Medicine (TCM), based in the philosophy-religions of Buddhism, Confucianism, and Daoism, is more than a purely prescriptive medical system; it is a way of life focused primarily on the principles of prevention rather than the more reactionary direction that pharmacotherapy in the US has taken. Mental illness is expected to account for a quarter of China’s overall health burden by 2020, with depression affecting around 100 million people and nearly 30 percent of young Chinese adults. Conventional antidepressants have a delayed onset and unpredictable therapeutic efficacy in this condition, especially in mild to moderate cases of depression. In …
An Analysis Of The Rajasthan Public Health System’S Response To The 2019 Dengue Insurgence, Luke Bryan
An Analysis Of The Rajasthan Public Health System’S Response To The 2019 Dengue Insurgence, Luke Bryan
Independent Study Project (ISP) Collection
Dengue virus is in a pandemic status and is a major public health issue in the modern world. The mosquito-borne disease is largely prevalent in Asia and specifically India, where more than half of the states are considered to have complete presence of the dengue virus. The intricate infrastructure of the Indian public health system looks for dengue cases at all levels and reports to the integrated disease surveillance programme (IDSP).
Analyses of the IDSP and trends of dengue cases was done in response to dengue outbreaks throughout the state. Geographic information system (GIS) maps were created to evaluate a …
Understanding Young Adult Survivors Of Childhood Cancers’ Participation In Late Effects Screening: A Mixed Methods Approach, Kristen Trost Mantlo
Understanding Young Adult Survivors Of Childhood Cancers’ Participation In Late Effects Screening: A Mixed Methods Approach, Kristen Trost Mantlo
Health Services Research Dissertations
Significant advancements in the treatment of childhood cancers have helped to increase the 5-year survival rate from 56% in the early 1970s to approximately 80-85% in the early 2000s (Greenlee, Murray, Bolden, & Wingo, 2000; Hampton, 2005). Treatment modalities such as chemotherapy and radiation have led to many serious long-term side effects, known as late effects. Between 60% and 90% of survivors develop some form of long-term chronic condition due to their treatment and up to 40% of those conditions will be life-threatening (Howlader, N. et al., 2013). While the majority of young adult survivors of childhood cancer are at …