Public Health Commons^™

Post-Operative Extended Volume External Beam Radiation Therapy Is Safe For High Risk Esophageal Cancer Patients, Edward Yu, Patricia Tai, Jawaid Younus, Richard Malthaner, Larry Stitt, Pauline Truong, George Rodrigues, Robert Ash, Rashid Dar, Anna Tomiak, Mark Vincent, Walter Kocha, Brian Dingle, Richard Inculet

Oncology Presentations

Post-operative radiation therapy (RT) (1) and post-operative chemoradiation (2) have been used for esophageal cancer patients deemed high risk for recurrence after esophagectomy.

Defining opitmal RT target volume after esophagectomy is difficult due to significant changes in patient anatomy and function.

Some radiationon cologists advocated the inclusion of the anastomotic site within the irradiation volume due to concerns for potential increased relapse risk, while others did not subscribe to this practice due to concerns for increased treatment related toxicity.

We have previously reported patient outcome benefit using extended volume RT In management with high risk esophageal cancer patients underwent esopagectomy(3). …

The Use Of Telehealth For Diabetes Management: A Qualitative Study Of Telehealth Provider Perceptions, Faith P. Hopp, Mary M. Hogan, Peter A. Woodbridge, Julie C. Lowery

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

Monitoring and Messaging Devices (MMDs) are telehealth systems used by patients in their homes, and are designed to promote patient self-management, patient education, and clinical monitoring and follow-up activities. Although these systems have been widely promoted by health care systems, including the Veterans Health Administration, very little information is available on factors that facilitate use of the MMD system, or on barriers to use.

Methods

We conducted in-depth qualitative interviews with clinicians using MMD-based telehealth programs at two Veterans Affairs Medical Centers in the Midwestern United States.

Results

Findings suggest that MMD program enrollment is limited by both …

Inhibition Of Proteasome Activity By The Dietary Flavonoid Apigenin Is Associated With Growth Inhibition In Cultured Breast Cancer Cells And Xenografts, Di Chen, Kristin R. Landis-Piwowar, Marina S. Chen, Q Ping Dou

Wayne State University Associated BioMed Central Scholarship

Abstract

Introduction

Proteasome inhibition is an attractive approach to anticancer therapy and may have relevancy in breast cancer treatment. Natural products, such as dietary flavonoids, have been suggested as natural proteasome inhibitors with potential use for cancer prevention and therapeutics. We previously reported that apigenin, a flavonoid widely distributed in many fruits and vegetables, can inhibit proteasome activity and can induce apoptosis in cultured leukemia Jurkat T cells. Whether apigenin has proteasome-inhibitory activity in the highly metastatic human breast MDA-MB-231 cells and xenografts, however, is unknown.

Methods

MDA-MB-231 breast cancer cell cultures and xenografts were treated with apigenin, followed by …

Paradoxical Antiproliferative Effect By A Murine Mammary Tumor-Derived Epithelial Cell Line, Esteban N. Gurzov, Sanaa M. Nabha, Hamilto Yamamoto, Hong Meng, O Graciela Scharovsky, R Daniel Bonfil

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

Despite significant advancement in breast cancer therapy, there is a great need for a better understanding of the mechanisms involved in breast carcinogenesis and progression, as well as of the role of epigenetic contributions from stromal cells in mammary tumorigenesis. In this study, we isolated and characterized murine mammary tumor-derived epithelial and myofibroblast cell lines, and investigated the in vitro and in vivo effect of cellular soluble factors produced by the epithelial cell line on tumor cells.

Methods

Morphology, immunophenotype, cytogenetics, invasiveness, and tumorigenicity of epithelial (LM-234ep) and myofibroblast (LM-234mf) cell lines isolated from two murine mammary adenocarcinomas …

The Status Of Childhood Lead Poisoning And Prevention In Nevada, Usa, Anne Rothweiler, Elena E. Cabb, Shawn Gerstenberger

Environmental & Global Health Faculty Research

One of the first steps in addressing the problem of childhood lead poisoning is to identify the possible sources of exposure in specific communities and target high-risk populations with appropriate interventions. Due to several factors, such as lack of funding and lack of blood lead reporting, little information exists regarding the occurrence of childhood lead poisoning and the prevalence of potential exposure sources in the state of Nevada. Following the recent establishment of a Nevada-based Lead Poisoning Program, we compiled the most current information available on Nevadans, and use this knowledge to suggest future research objectives and outreach activities for …

Factors Associated With Atypical Moles In New Hampshire, Usa, L Titus-Ernstoff, J Ding, A. E. Perry, S. K. Spencer, B. F. Cole, M. S. Ernstoff

Dartmouth Scholarship

Only a few studies, conducted in Sweden, assessed factors associated with the presence of atypical moles in the general population. We conducted a population-based, case-control study in New Hampshire, USA, to identify factors associated with atypical moles. In our study, atypical moles affected 14% of the study population. The adjusted odds ratio (OR) was 0.34 (95% confidence interval (CI)=0.14-0.80) for those with the highest adulthood recreational sun exposure, relative to the lowest. The OR for any freckles, compared to none, was 2.24 (95% CI=1.18-4.25). We found a linear relationship between the number of benign moles and the presence of atypical …

Avances En La Atención Postaborto En América Latina Y El Caribe: Investigando, Aplicando Y Expandiendo, Deborah L. Billings, Ricardo Vernon

Reproductive Health

This work by the Population Council and Ipas documents the intellectual, financial, and managerial effort that many organizations and institutions in Latin America and the Caribbean have made to achieve the objective of improving the quality and effectiveness of postabortion care services. This volume is a contribution to the preparation of directors, owners, and service providers, and to the creation and implementation of policies and programs based on scientific evidence, which will benefit women and the services themselves. Its five sections include an overview; results from country studies, and information about providers and program components; clinical care with various technologies, …

Study Of The Effectiveness Of Training Malian Social And Health Agents In Female Genital Cutting Issues And In Educating Their Clients, Nafissatou J. Diop, Fatoumata Traore, Habibatou Diallo, Ousmane Traore, Aissa Haidara Toure, Youssouf Diallo, Madina Sangare, Fatoumata Tandia, Keita Attaher Toure

Reproductive Health

This report documents findings of a study to assess the education and training of social and healthcare workers in Mali regarding female genital cutting (FGC). After two decades of campaigning against FGC in Mali, the results are not satisfactory when compared to the levels of human and financial investment. The Mali Division of Family and Community Health, with technical support from the Population Council, conducted this research to highlight certain issues related to the practice of FGC in Mali, in particular health consequences and the role health personnel can play in eradicating the practice. The continued prevalence of FGC among …

Contributing Towards Efforts To Abandon Female Genital Mutilation/Cutting In Kenya: A Situation Analysis, Humphres Evelia, Maryam Sheikh Abdi, Carolyne Njue, Ian Askew

Reproductive Health

The Kenyan Ministry of Gender, Sports, Culture and Social Services, with support from UNFPA/Kenya, commissioned the Population Council to conduct a situation analysis of female genital mutilation/cutting (FGM/C) programs in Kenya, with the overall objective of documenting the current status of and trends in FGM/C programming and to help identify crucial elements that need to be prioritized for support. Results show marked declines in prevalence nationally between generations, suggesting a decline in the practice as well as trends toward “medicalization” in recent years. The practice still continues for different reasons, such as rite of passage, for marriageability, controlling sexuality, religious …

Comparative Predictive Value Of Three Prognostic Markers--S-Phase Fraction, Pcna And Mitotic Count On Axillary Lymph Node Metastasis In Carcinoma Breast, Shahid Pervez, Muhammad Nadeem Khan, Muhammad Israr Nasir

Department of Pathology and Laboratory Medicine

Background: Axillary lymph node metastasis is the single most important prognostic factor in carcinoma of the breast. Therefore, prognostic markers that may reliably predict probability of lymph node (LN) metastases are of great value. This study was conducted to compare the predictive value of two novel prognostic / proliferative markers i.e. S-phase fraction (SPF) and proliferating cell nuclear antigen (PCNA) in parallel with mitotic index.

Methods: Data of consecutive cases of infiltrating ductal carcinoma (IDC) breast diagnosed from July 2003 to July 2004 at the section of the Histopathology, The Aga Khan University Hospital, Karachi, were reviewed. A total of …

Predictability Of Cardiovascular Disease Event Rates By Common Carotid Artery Intima-Media Thickness In The Atherosclerosis Risk In Communties (Aric) Study, Mara Hollander

Loma Linda University Electronic Theses, Dissertations & Projects

Background: Carotid artery intima media thickness (IMT) is a non-invasive reliable predictor of the extent and severity of CVD. There is difficulty acquiring all measurements for validated three-site carotid IMT. More accessible one-site common carotid artery (CCA) IMT has not yet been validated with CVD events.

Purpose: This study will evaluate the diagnostic accuracy of one-site CCA IMT compared to three-site IMT in predicting cardiovascular disease (CVD) events. Assessment of whether the association of incremental one-site CCA IMT to a CVD event is significant with and without adjustment for traditional cardiac risk factors was made.

Methodology: Data from The Atherosclerosis …

Knowledge And Beliefs Of Adolescents Regarding Sexually Transmitted Infections And Hiv/Aids In A Rural District In Pakistan, Hafsa Raheel, Franklin White, Muhammad Masood Kadir, Zafar Fatmi

Community Health Sciences

Objective:

To assess the knowledge and beliefs of adolescents (15-19 years girls and boys) regarding sexually transmitted infections (STIs) and HIV/AIDS.

Methods:

A community based cross-sectional survey was conducted in October 2002 in a rural district (Mirpurkhas) of Sindh province, Pakistan.

Results:

A total of 428 adolescent girls and boys were interviewed. Only 44% correctly named at least one STI, while 55% knew at least two modes of transmission for HIV/AIDS. Adolescents with education greater than or equal to secondary level, those who were able to read the newspaper, possessed electricity in their homes and were allowed to meet their …

Resource Allocation Within The National Aids Control Program Of Pakistan: A Qualitative Assessment Of Decision Maker's Opinions, Sara Husain, Masood Kadir, Zafar Fatmi

Community Health Sciences

Background:

Limited resources, whether public or private, demand prioritisation among competing needs to maximise productivity. With a substantial increase in the number of reported HIV cases, little work has been done to understand how resources have been distributed and what factors may have influenced allocation within the newly introduced Enhanced National AIDS Control Program of Pakistan. The objective of this study was to identify perceptions of decision makers about the process of resource allocation within Pakistan's Enhanced National AIDS Control Program.

Methods:

A qualitative study was undertaken and in-depth interviews of decision makers at provincial and federal levels responsible to …

Episiotomy And Obstetric Trauma In Nevada: Evidence From Linked Hospital Discharge And Birth Data, Gulzar H. Shah, Joseph A. Greenway, Wei Yang

Nevada Journal of Public Health

Based on the perception that episiotomy prevents obstetric trauma, the procedure is liberally performed in U.S. Hospitals. Using linked Nevada Birth Registry and Nevada Impatient Hospital Discharges (2000 to 2005), we applied descriptive analyses and logistic regression to examine the status of Nevada episiotomy practice and its impact on birth trauma for mothers. Of 106,461 vaginal live births, 26,383 (24.8%) episiotomies were conducted. Obstetric trauma rate declined from 5.2% of vaginal deliveries in 2000 to 4.4% in 2005. After statistically controlling for the effect of other risk factors, zero parity, episiotomy, other instrument assisted deliveries, non-MDs as birth attendants, rural …

Planning An Integrated Disease Surveillance And Response System: A Matrix Of Skills And Activities, Helen N. Perry, Sharon M. Mcdonnell, Wondimagegnehu Alemu, Peter Nsubuga

Dartmouth Scholarship

The threat of a global influenza pandemic and the adoption of the World Health Organization (WHO) International Health Regulations (2005) highlight the value of well-coordinated, functional disease surveillance systems. The resulting demand for timely information challenges public health leaders to design, develop and implement efficient, flexible and comprehensive systems that integrate staff, resources, and information systems to conduct infectious disease surveillance and response. To understand what resources an integrated disease surveillance and response system would require, we analyzed surveillance requirements for 19 priority infectious diseases targeted for an integrated disease surveillance and response strategy in the WHO African region.

The Latino Caregiver Experience Among Dementia And Non-Dementia Caregivers : Can Community Based Care Management Improve Caregiver Health?, Catherine Oliveros

Loma Linda University Electronic Theses, Dissertations & Projects

Purpose: This study provides an analysis of the Latino caregiving community in Southeast Texas and the role community based care management plays in influencing caregiver physical and emotional well-being. Design and Methods: A non-random sample of 63 Latino caregivers was interviewed by phone. Caregiver physical and emotional well-being was studied through burden, depression, perceived health status, and resourcefulness. Regression, correlation, and comparison analysis was performed with key variables. Results: Acculturation was positively correlated with care management use. In comparing dementia and non-dementia caregivers both groups had similar levels of depression and burden, however, the dementia group had significantly lower levels …

Women’S Health In Developing Countries, Javed Rizvi, Nadeem F. Zuberi

Department of Obstetrics & Gynaecology

Healthcare priorities are different in developing and developed countries. A more effective resource allocation, complemented by efforts to implement only those practices that are effective, should be a priority for improving reproductive health services in developing countries. A large burden of gynaecological disease exists in developing countries and it is difficult to envisage serious reforms and improvements without an increase in public-sector spending. However, communities themselves could assume some responsibility for women's health in ways that prioritize women's own perceptions and primary needs. In this chapter we have compiled existing evidence regarding various gynaecological problems faced by women in developing …

An In Vitro Model Of Ovarian Cancer: Studying The Effects Of Talc And Pycnogenol®, Amber Renée Buz'zard

Loma Linda University Electronic Theses, Dissertations & Projects

Ovarian cancer is the sixth most common cancer and accounts for more deaths than any other cancer of the female reproductive system. The American Cancer Society has suggested that poor diet, talc and industrial pollutants may increase the risk of developing ovarian cancer. Talc is ubiquitous and concern is raised about its safety, role as a possible carcinogen and known ability to cause irritation and inflammation. Due to the silent nature of ovarian cancer, chemoprevention is a high priority. The most useful chemopreventive compounds will inhibit, delay or reverse carcinogenesis, and can be taken for long periods of time with …

Traditional Practices And Governmental Responsibilities: An Investigation Into The Evolving Partnership Between Indigenous Brazilian Midwives And State-Provided Maternal Healthcare Services, Caitlin Canfield

Independent Study Project (ISP) Collection

Traditional midwives play important roles in the provision of maternal healthcare services in developing countries. Especially in rural, marginalized communities, traditional midwives help to provide obstetric care when local governmental health services fail to do so. The healthcare provision that traditional midwives “should” undertake is a subject debated by public health and development policy makers who seek to reduce maternal mortality rates and improve maternal health in rural communities in developing countries. This study examines the practices of traditional midwives in indigenous Tupinambá communities located in Southern Bahia, Brazil. It seeks to define the contemporary role of traditional midwives within …

Health And Needs Assessment Of Geriatric Patients: Results Of A Survey At A Teaching Hospital In Karachi, Syed Nabeel Zafar, Hammad Ashraf Ganatra, Sarah Tehseen, Waris Qidwai

Department of Family Medicine

Objective: To study the health and needs of geriatric patients

Methods: A questionnaire based survey of patients visiting the out-patient department of Aga Khan University was carried out. Ethical requirements were met and included administration of informed consent and provision of confidentiality to patients. Convenience sampling was used without any randomization for interviews. Epi-info and SPSS software were used for data management.

Results: Four hundred and two (402) subjects above the age of 65 were surveyed. Most of the subjects were retired (40.5%) married (76.4%) men (69.7%). Ages ranged from 65 to 90 years, the mean being 70.57 years and …

Frequency And Characteristics Of Breast Lymphomas Presenting To A Tertiary Care Hospital, Pakistan, Nausheen Yaqoob, Shahid Pervez, Naila Kayani, Rashida Ahmed, Zubair Ahmed, Sheema Hasan

Department of Pathology and Laboratory Medicine

Objective: To assess the relative frequency of (primary and secondary) mammary lymphomas presenting to a tertiary care hospital, Pakistan and its categorization according to WHO classification of lymphoid neoplasms.

Methods: All NHLs (nodal and extra nodal) diagnosed in the section of histopathology during 1992-2004 were retrieved and reviewed. All patients (n=30) diagnosed with lymphomatous involvement of the breast were selected. Distinction between primary and secondary breast lymphomas was not made owing to lack of availability of clinical information.

Results: A total of 5637 breast malignancies were diagnosed in our department during the study period of 10 years and the total …

Treatment Evolution In High-Risk Congenital Diaphragmatic Hernia: Ten Years' Experience With Diaphragmatic Agenesis, Kevin P Lally, Pamela A Lally, Krisa P Van Meurs, Desmond J Bohn, Carl F Davis, Bradley Rodgers, Jatinder Bhatia, Golde Dudell

Faculty, Staff and Student Publications

OBJECTIVE: The objective of this study was to evaluate the impact of newer therapies on the highest risk patients with congenital diaphragmatic hernia (CDH), those with agenesis of the diaphragm.

SUMMARY BACKGROUND DATA: CDH remains a significant cause of neonatal mortality. Many novel therapeutic interventions have been used in these infants. Those children with large defects or agenesis of the diaphragm have the highest mortality and morbidity.

METHODS: Twenty centers from 5 countries collected data prospectively on all liveborn infants with CDH over a 10-year period. The treatment and outcomes in these patients were examined. Patients were followed until death …

Don't Bring Me Your Tired, Your Poor: The Crowded State Of America's Emergency Departments, Jessamyn Taylor

National Health Policy Forum

If the time comes, people expect that the emergency department (ED) will have the resources necessary to treat them in a timely, high-quality manner. Increasingly, however, EDs may not be able to meet that expectation. Hospitals in urban areas with large populations, high population growth, and higher-than-average numbers of uninsured are particularly crowded: ambulances are often diverted to other hospitals and patients are frequently forced to “board” in the hallways (while they wait to be transferred to another facility or part of the hospital). This issue brief places EDs in the context of the U.S. health care system and its …

Imaging Breast Adipose And Fibroglandular Tissue Molecular Signatures By Using Hybrid Mri-Guided Near-Infrared Spectral Tomography, Ben Brooksby, Brian W. Pogue, Shudong Jiang, Hamid Dehghani, Subhadra Srinivasan, Christine Kogel, Tor D. Tosteson, John Weaver, Steven P. Poplack, Keith D. Paulsen

Dartmouth Scholarship

Magnetic resonance (MR)-guided near-infrared spectral tomography was developed and used to image adipose and fibroglandular breast tissue of 11 normal female subjects, recruited under an institutional review board-approved protocol. Images of hemoglobin, oxygen saturation, water fraction, and subcellular scattering were reconstructed and show that fibroglandular fractions of both blood and water are higher than in adipose tissue. Variation in adipose and fibroglandular tissue composition between individuals was not significantly different across the scattered and dense breast categories. Combined MR and near-infrared tomography provides fundamental molecular information about these tissue types with resolution governed by MR T1 images.

The Relationship Between High Sensitivity C-Reactive Protein, Metabolic Syndrome And Exercise, Micheline A. Vargas

Loma Linda University Electronic Theses, Dissertations & Projects

Background: It is well known that regular physical activity is associated with lower risk of chronic diseases such as diabetes and cardiovascular disease. Physical activity is also considered an important determinant of metabolic syndrome. All levels of metabolic syndrome, diabetes, and cardiovascular disease are thought to involve inflammation. Physical activity may reduce risk, at least in part, by modifying the inflammatory process. Recent studies have demonstrated an inverse relationship between inflammatory markers, such as high sensitivity C-reactive protein (hs-CRP), and physical activity. Elevated hs-CRP appears to be an independent predictor of both CVD and diabetes. Recent evidence also suggests that …

Using The Outcome Questionnaire 45.2 In Obesity Treatment, Adam L. Arechiga

Loma Linda University Electronic Theses, Dissertations & Projects

Purpose: The purpose of this study was to determine if the Outcome Questionnaire 45.2 (OQ-45) can be used in the treatment of obesity to predict participant dropout and initial treatment success, in terms of weight loss (Lambert et. al, 2002a). The OQ-45 has been used with success to predict dropout from psychotherapy in clinical populations. It was hypothesized that higher pretreatment OQ-45 scores would be associated with less program completion and less weight loss by the end of treatment.

Method: The study employed a non-experimental time series design. Seventy-eight participants were recruited from the three local obesity treatment programs, which …

Hepatitis B And C: Prevalence And Risk Factors Associated With Seropositivity Among Children In Karachi, Pakistan, Wasim Jafri, Nadim Jafri, Javed Yakoob, Muhammad Islam, Syed Farhan Ali Tirmizi, Tazeen Jafar, Saeed Akhtar, Saeed Hamid, Hasnain Ali Shah, Sheikh Qamaruddin Nizami

Section of Gastroenterology

Background

Infections with hepatitis B virus (HBV) and hepatitis C virus (HCV) can lead to chronic liver disease and hepato-cellular carcinoma (HCC). This cross-sectional study estimated the prevalence and identified risk factors associated with Hepatitis B surface antigen (HBsAg) and HCV antibody (anti-HCV) sero-positivity among children 1 to 15 years of age.

Methods

The study targeted the low to middle socioeconomic population that comprises 80% to 85% of the population. Consent was obtained from parents of the eligible children before administering questionnaire and collected a blood sample for anti-HCV and HBsAg serology.

Results

3533 children were screened for HBsAg and …

Socio-Demographic Correlates Of Betel, Areca And Smokeless Tobacco Use As A High Risk Behavior For Head And Neck Cancers In A Squatter Settlement Of Karachi, Pakistan, Samia Mazahir, Rabia Malik, Maria Maqsood, Kanwal Aliraza Merchant, Farida Malik, Atif Majeed, Zafar Fatmi, Muhammad Rizwanulhaq Khawaja, Shehzad Ghaffar

Community Health Sciences

Background

Head and neck cancers are a major cancer burden in Pakistan. They share a common risk factor profile including regular consumption of products of betel, areca and tobacco. Use of paan, chaalia, gutka, niswar and tumbaku is acceptable in Pakistan and is considered a normal cultural practice. This cross-sectional study was carried out to understand the relation of socio-demographic factors for the consumption of paan, chaalia, gutka, niswar and tumbaku in Pakistani population. Through systematic sampling, 425 subjects from a squatter settlement in Karachi were interviewed using a structured questionnaire. High risk behavior was defined as Daily use of …

Racial Disparity And Socioeconomic Status In Association With Survival In Older Men With Local/Regional Stage Prostate Cancer: Findings From A Large Community-Based Cohort, Xianglin L. Du, Shenying Fang, Ann L. Coker, Corinne Aragaki, Janice N. Cormier, Yan Xing, Beverly J. Gor, Wenyaw Chan

CRVAW Faculty Journal Articles

BACKGROUND

Few studies have examined the outcomes for Hispanic men with prostate carcinoma and incorporated socioeconomic factors in association with race/ethnicity in affecting survival, adjusting for factors on cancer stage, grade, comorbidity, and treatment.

METHODS

We studied a population-based cohort of 61,228 men diagnosed with local or regional stage prostate carcinoma at age 65 years or older between 1992 and 1999 in the 11 SEER (Surveillance, Epidemiology, and End Results) areas, identified from the SEER-Medicare linked data with up to 11 years of followup.

RESULTS

Low socioeconomic status was significantly associated with decreasing survival in all men with prostate carcinoma. …

Pakistan - Country Profile Of Cancer And Cancer Control 1995-2004, Yasmin Bhurgri, Asif Bhurgri, Sania Nishter, Ashfaq Ahmed, Ahmed Usman, Shahid Pervez, Naila Kayani, Rashida Ahmed, Sheema H. Hassan, Ahmed Riaz, Hadi Bhurgri, Imtiaz Bashir

Department of Pathology and Laboratory Medicine

No abstract provided.