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Walden Dissertations and Doctoral Studies

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Full-Text Articles in Epidemiology

Inflammatory Markers Associated With Disease Progression Of Cardiorenal Syndrome, Srikanta Banerjee Jan 2015

Inflammatory Markers Associated With Disease Progression Of Cardiorenal Syndrome, Srikanta Banerjee

Walden Dissertations and Doctoral Studies

An increase in cellular inflammatory biomarkers directly increases the risk of cardiovascular disease (CVD). Using the social ecological and biomedical theories, the study examined quantitatively how specific inflammatory biomarkers are associated with cardiorenal syndrome (CRS), a potential complication of hypertension and diabetes, and how sociodemographic factors modify this association in the U.S. adult population. A retrospective secondary data analysis of the data collected from National Health and Nutrition Examination Survey (NHANES) 1999-2010 was utilized to evaluate these hypotheses. High sensitivity C-reactive protein, homocysteine (hcy), and fibrinogen had a modifying effect on Type 4 (chronic reno-cardiac etiology), Type 2 CRS (chronic …

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Predictors Of Knowledge Of Stroke And Intent To Call 911 Among African Americans, Hyacinth Idu Hyacinth Jan 2015

Predictors Of Knowledge Of Stroke And Intent To Call 911 Among African Americans, Hyacinth Idu Hyacinth

Walden Dissertations and Doctoral Studies

Stroke is associated with significant health disparity and predominantly affects the elderly. Stroke outcome is significantly improved if an individual is able to get "clot-bursting" medication. A significant predictor of an on-time arrival to the emergency room for treatment in the event of a stroke is the ability to accurately recognize stroke signs and symptoms. The purpose of this study was to determine the factors (demographic, socioeconomic, and educational) that predict the knowledge of stroke signs/symptoms and intent to call 911 in the event of a stroke. The study was grounded in the social ecological theoretical model and analyzed archived …

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Mental Health Professionals' Attitude And Perception Of Their Role In Tackling Substance Abuse And Related Disorders In Nigeria, Olubusayo Ruth Akinola Jan 2015

Mental Health Professionals' Attitude And Perception Of Their Role In Tackling Substance Abuse And Related Disorders In Nigeria, Olubusayo Ruth Akinola

Walden Dissertations and Doctoral Studies

Mental health professionals (MHPs) play a pivotal role in enhancing treatment outcomes for drug-using populations and minimizing their harm to the public. In response to a gap in the literature, this study sought to (a) assess MHPs' attitudes about the use and abuse of substances and their perception of their role in tackling substance abuse and related disorders in Nigeria, (b) identify predictors of perception, and (c) explore regional variations in attitude. Based on the validated drug and drug users' problems perception questionnaire and the substance abuse attitude survey, a cross-sectional survey was conducted in a randomized sample of 292 …

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The Association Of Lead With Cataracts And Vision-Related Problems In Perimenopausal Women, Imogene Drakes Jan 2015

The Association Of Lead With Cataracts And Vision-Related Problems In Perimenopausal Women, Imogene Drakes

Walden Dissertations and Doctoral Studies

Around the world, women are subject to an earlier incidence of cataracts, have a higher risk for cataracts, and also have a higher risk for other vision-related problems than men. Previous research has indicated an association between endogenous lead stored in long bones and cataracts in men over 60 years of age; however, a similar study in women did not reveal an association. This case control study was conducted to investigate whether perimenopausal mobilization of endogenous lead serves as a possible causative factor for women's generalized vision issues and cataract incidence in particular. Secondary data were gathered from 1,416 women …

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Predictors Of Full Childhood Immunization Status In Owerri, Nigeria, Osuala Uzor Kelvin Jan 2015

Predictors Of Full Childhood Immunization Status In Owerri, Nigeria, Osuala Uzor Kelvin

Walden Dissertations and Doctoral Studies

Full (complete) childhood immunization against tuberculosis, poliomyelitis, diphtheria, tetanus, hepatitis B, yellow fever, measles, and the maternal retention of immunization documentation are the most cost-effective interventions against vaccine-preventable childhood diseases. The full childhood immunization rate in Nigeria has not reached the expected target level of compliance at 90%. Using the social ecological model, this study investigated the influence of maternal satisfaction with postnatal services and paternal support on full childhood immunization status; it also examined the association between maternal factors and the maternal retention of immunization documentation in Owerri, Nigeria. The hypotheses were that maternal satisfaction with postnatal services and …

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The Role Of Sociodemographic Characteristics And Antiretroviral Prophylaxis On Risky Sexual Behavior Among Men Who Have Sex With Men, Leonard Obodo Jan 2015

The Role Of Sociodemographic Characteristics And Antiretroviral Prophylaxis On Risky Sexual Behavior Among Men Who Have Sex With Men, Leonard Obodo

Walden Dissertations and Doctoral Studies

Recent multicenter, randomized, double blind clinical trials have shown no association between HIV preexposure prophylaxis (PrEP) and increased sexual risk behavior among high-risk men who have sex with men (MSM). However, little research has been conducted under natural conditions devoid of clinical trial controlled environment to confirm the lack of association between PrEP and increased sexual risk behavior. Also, research has shown conflicting associations between sociodemographic characteristics and sexual risk behavior among MSM. In this cross-sectional, web-based, primary data analysis, MSM who reside in United States of America (USA) and who make use of PrEP for HIV prevention were examined …

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Uric Acid Level Is Associated With Postprandial Lipemic Response To A High Saturated Fat Meal, Roy Gail Cutler Jan 2015

Uric Acid Level Is Associated With Postprandial Lipemic Response To A High Saturated Fat Meal, Roy Gail Cutler

Walden Dissertations and Doctoral Studies

Hyperlipidemia caused by a diet high in saturated fat can lead to visceral fat weight gain, obesity, and metabolic syndrome. Being over-weight from visceral fat has been linked to increased risk of developing most age-related diseases and disability, along with a lower income potential and quality of life. However, researchers are just beginning to understand the biological mechanisms that regulate the conversion of excess calories into visceral fat storage rather than glycogen or muscle. Epidemiological studies have repeatedly shown a comorbid association between age-related diseases involving hyperlipemia and circulating levels of uric acid, but not a direct association. This study …

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Psycho-Social Resilience And Risky Hiv Behaviors Among Black Males Who Have Sex With Males, Wilson Osaro Iyokho Jan 2015

Psycho-Social Resilience And Risky Hiv Behaviors Among Black Males Who Have Sex With Males, Wilson Osaro Iyokho

Walden Dissertations and Doctoral Studies

The incidence rate of HIV among Black males having sex with Black males (BMSM) is high compared to that of other racial groups. Researchers have established the association between inappropriate sexual practices, age, income, and environmental determinants and HIV positive status among BMSM. Guided by resilience theory, the purpose of this study was to examine the relationship between HIV risk behavior and resiliency with the goal of identifying a new intervention to mitigate the HIV infection rate in the BMSM community. The theoretical framework used for this study was the resilience theory. This theory is concern with the phenomenon of …

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Glioblastoma Multiforme: Geographic Variations In Tumor Size, Treatment Options, And Survival Rate, Susan Rebecca Nohelty Jan 2015

Glioblastoma Multiforme: Geographic Variations In Tumor Size, Treatment Options, And Survival Rate, Susan Rebecca Nohelty

Walden Dissertations and Doctoral Studies

Glioblastoma multiforme (GBM) is a destructive brain cancer that results in death 12 to 15 months after diagnosis. The purpose of this retrospective study was to determine if variations in tumor size at diagnosis, treatment options, and survival rate occur in GBM patients living in urban and rural areas of the United States. Using the behavior model of health services as the theoretical framework, this study used secondary data sets of GBM cases reported from 1988 to 2011 from the Surveillance, Epidemiology, and End Results program. Tumor size was measured in millimeters; treatment was evaluated by ascertaining the number of …

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The Impact Of Supply Chain Logistics Performance Index On The Control Of Neglected Tropical Diseases In Low- And Middle-Income Countries, Farouk Adams Umaru Jan 2015

The Impact Of Supply Chain Logistics Performance Index On The Control Of Neglected Tropical Diseases In Low- And Middle-Income Countries, Farouk Adams Umaru

Walden Dissertations and Doctoral Studies

Neglected tropical diseases (NTD) in low- and middle-income countries are still not on target per the World Health Organization's (WHO) elimination goal of 2020. Mass drug administration (MDA) is one of the effective strategies supported by the WHO for the control and subsequent elimination of NTD. This quantitative study explored how supply chain logistic capacity may be hampering MDA coverage in countries in which the diseases are endemic. The study examined secondary data from WHO data bank for MDA coverage, to quantify the relationship between supply chain logistics capacity, as measured by the World Bank's logistics performance index (LPIs), and …

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Social Determinants Of Health Inequality And Life Expectancy Among Women Of Edo State, Nigeria, Daniel Aromeh Odekina Jan 2015

Social Determinants Of Health Inequality And Life Expectancy Among Women Of Edo State, Nigeria, Daniel Aromeh Odekina

Walden Dissertations and Doctoral Studies

Health inequality conflates a huge number of economic, social, and political issues. These issues, together described as social determinants, determine a population's health through influencing health status and life expectancy. The research purpose of this study was to examine how social determinants affected the life expectancy of the women of Edo State, based on secondary data from Nigeria's 2008 demographic and health survey (NDHS). The theories that guided the study were self-efficacy beliefs of the social cognitive theory and physical self-concept of the health belief model. This quantitative cross-sectional study examined the associations between socioeconomic status, nutritional status, literacy/educational attainment, …

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Crash Risk Associated With Cellular Phone Use While Driving, Tiffani Ann Fordyce Jan 2015

Crash Risk Associated With Cellular Phone Use While Driving, Tiffani Ann Fordyce

Walden Dissertations and Doctoral Studies

There are inconsistencies in the published literature on the effect of cellular phone use while driving. The objective of this study was to estimate an adjusted nationwide crash rate associated with cell phone use while driving and to compare statewide crash rates prior to and following the implementation of legislation banning cell phone use while driving. Crash rates in nationally representative databases were calculated based on imputed values for cell phone use using the propensity score method. The imputed nationwide crash rate for fatal crashes (1.61 per 100 fatal crashes) and all crashes (1.409 per 100 crashes) represented a 2 …

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The Association Between Rheumatoid Arthritis And Type 2 Diabetes Mellitus, Magaly Perez Nieves Jan 2015

The Association Between Rheumatoid Arthritis And Type 2 Diabetes Mellitus, Magaly Perez Nieves

Walden Dissertations and Doctoral Studies

A research report from the Centers for Disease Control and Prevention (CDC) indicated that more than 50% of people with diabetes mellitus (DM) in the United States (U.S.) also have arthritis. The diabetes population is disproportionately affected by arthritis, but there has been limited and inconsistent research to confirm the association between type 2 diabetes mellitus (T2DM) and rheumatoid arthritis (RA). The current study aimed to identify an association between T2DM and RA for noninstitutionalized U.S. adults between 1999 and 2012 using a nationally representative sample from the National Health and Nutrition Examination Survey (NHANES) database (n =31,488 ). A …

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Vitamin D Deficiency And Immune Function In African American, Hiv-Infected Men, Rana H. Ismail Jan 2015

Vitamin D Deficiency And Immune Function In African American, Hiv-Infected Men, Rana H. Ismail

Walden Dissertations and Doctoral Studies

Vitamin D deficiency is common in individuals diagnosed with HIV and is known for its detrimental health effects. Its recognition as a potent immune-modulator with possible immune health implications in HIV disease progression was the main impetus for this study. The association between Vitamin D and CD4 count falls short of being consistent and is too weak to allow conclusions. Similarly, the literature is inconsistent with regard to the impact of Vitamin D supplementation on CD4. This observational, retrospective chart review study aimed to explore the relationship between Vitamin D deficiency and CD4 count/percent, and to evaluate whether changes in …

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Albumin Levels In Hispanic Dialysis Patients With And Without Type Ii Diabetes, Hector Hernandez Jan 2015

Albumin Levels In Hispanic Dialysis Patients With And Without Type Ii Diabetes, Hector Hernandez

Walden Dissertations and Doctoral Studies

Albumin provides the vital scaffolding for growth and tissue repair and supports oncotic blood pressure and hemodynamics. In hemodialysis patients, albumin aids with fluid removal by drawing excess fluid from edematous tissues back into the blood where it can then be removed by a dialyzer. The hyperglycemia seen in dialysis patients with Type II diabetes progressively damages kidney glomeruli, which permits albumin seepage into the urine, thus lowering serum albumin. The conceptual framework underpinning this research is the van't Hoff theory of osmotic pressure. Under this framework, the solute-solvent relationship largely contributes to the osmotic movement of fluid. The purpose …

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Germline Mutations In Chek1 And Chek2 In Women With Ovarian, Peritoneal, Or Fallopian Tube Cancer, Maria Isabel Harrell Jan 2015

Germline Mutations In Chek1 And Chek2 In Women With Ovarian, Peritoneal, Or Fallopian Tube Cancer, Maria Isabel Harrell

Walden Dissertations and Doctoral Studies

Ovarian cancer is the deadliest gynecological malignancy affecting women. Diagnosis often occurs late due to non-specific symptoms, but if detected early, there is excellent chance for survival. One of the most important risk factors is family history. Up to 24% of cases are due to inherited loss-of-function mutations in genes involved in the DNA damage response. The theory underlying hereditary cancers is Knudson's two-hit theory of cancer causation, where two hits are necessary for cancer to occur in an individual: one in the germline and one in the tissue. The genes, CHEK1 and CHEK2, are modulators of the DNA damage …

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Differentiating Demographic Factors In Latino Patients With Type 2 Diabetes, Carol Lynne Manning Jan 2015

Differentiating Demographic Factors In Latino Patients With Type 2 Diabetes, Carol Lynne Manning

Walden Dissertations and Doctoral Studies

The American Diabetes Association (ADA) data suggest that Latinos share a greater burden of disease than do non-Latino Whites with type 2 diabetes. As a result of poor glycemic control, Latinos also suffer consequences such as blindness, kidney disease, and limb amputation more often than do other ethnic groups. The purpose of this study was to compare demographic factors of Latinos with well-controlled type 2 diabetes, as measured by a HgbA1c of 7 or less (n = 118) to Latinos not well controlled (n = 105). This cross sectional study used a secondary data set with a sample selected from …

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U.S. Army Enlisted Soldiers' Adherence To Prescribed Malaria Chemoprophylaxis In Afghanistan, Michael Paul Brisson Jan 2015

U.S. Army Enlisted Soldiers' Adherence To Prescribed Malaria Chemoprophylaxis In Afghanistan, Michael Paul Brisson

Walden Dissertations and Doctoral Studies

Over the past 13 years, the United States Army has been engaged in armed conflict within Afghanistan. Unfortunately, the United States Army has been forced to evacuate soldiers from the battlefield because of malaria, a parasitic disease that is endemic in Afghanistan. Even though the U.S. Army has adopted an effective chemoprophylaxis protocol, soldiers' adherence to their prescribed medication has been historically low. This research addressed a gap in literature regarding the adherence rates of U.S. Army enlisted soldiers to their prescribed oral malaria chemoprophylaxis. In addition, this research investigated self-reported reasons for soldiers' nonadherence to this medication. The study …

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The Influence Of Religion On Attitudes Toward Alcohol Use In Jewish Adolescents, Toby R. Levin Aug 2014

The Influence Of Religion On Attitudes Toward Alcohol Use In Jewish Adolescents, Toby R. Levin

Walden Dissertations and Doctoral Studies

Historically, the Jewish faith has used alcohol in rituals and religious holidays in which adolescents are permitted to fully participate and this exposure to alcohol may influence attitudes and beliefs about underage drinking among Jewish adolescents. The purpose of this study was to determine if there was a relationship between the Jewish religion and attitudes toward alcohol among Jewish adolescents. The theoretical frameworks, on which this study was based, were the social bond theory and the social development theory. Each of these theories indicates that community is important to the individual. Using a cross sectional study design, 160 adolescents participated …

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Factors Associated With Tuberculin Skin Test Positivity Prevalence In U.S. Medical Laboratory Microbiologists, Julie Ann West Feb 2014

Factors Associated With Tuberculin Skin Test Positivity Prevalence In U.S. Medical Laboratory Microbiologists, Julie Ann West

Walden Dissertations and Doctoral Studies

Prior research has indicated that healthcare personnel (HCP) who work in areas where Mycobacterium tuberculosis poses an occupational hazard are at high risk of tuberculin skin test (TST) positivity and subsequent conversion to active tuberculosis (TB). U.S. medical laboratory microbiologists confront similar hazards but have not been studied outside of the HCP aggregate. The purpose of this study was to fill this gap by examining the relationships between the predictor variables of self-reported history of bacille Calmette-Guerin (BCG) immunization, place of birth, and years of laboratory experience and the outcomes of self-reported lifetime TST positivity, preventive treatment noninitiation, and barriers …

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Prevalence Of Neonatal Tetanus In Northeastern Nigeria, Jalal-Eddeen Abubakar Saleh Jan 2014

Prevalence Of Neonatal Tetanus In Northeastern Nigeria, Jalal-Eddeen Abubakar Saleh

Walden Dissertations and Doctoral Studies

Although efforts have been made towards improving the health of children across the globe with notable results, neonatal tetanus (NNT) remains a major contributor to the neonatal death rates in Nigeria. This problem calls for a concerted effort by the government to achieve the revised global NNT elimination deadline of 2015. The purpose of this cross-sectional quantitative study using secondary data was to establish the prevalence of NNT in Nigeria's northeast region and to ascertain if there was any significant difference in frequency of antenatal care (ANC), trained traditional birth attendants (TBAs), and umbilical cord treatments, using single sample proportions …

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Correlates Of Asthma Among The Minority Population In South Bronx,New York, Veronica Chibumma Uwanaka Jan 2014

Correlates Of Asthma Among The Minority Population In South Bronx,New York, Veronica Chibumma Uwanaka

Walden Dissertations and Doctoral Studies

Asthma among children has become an inherent problem in many communities in the United States, especially among the minority population. The South Bronx has a large minority population and a high prevalence of asthma. However, no study to date has explored the factors associated with this high prevalence rates in this population. Drawing from theories of social ecology and environmental health, the objective of this quantitative cross-sectional study is to investigate the correlates of asthma among children in the South Bronx by studying the sociodemographic and environmental risk factors, including parental occupation; neighborhood and housing characteristics, air quality, and poverty. …

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A Predictive Model For Dementia Risk In Elderly Adults With Prediabetes, Susan Elizabeth Alford Jan 2014

A Predictive Model For Dementia Risk In Elderly Adults With Prediabetes, Susan Elizabeth Alford

Walden Dissertations and Doctoral Studies

Dementia is a serious public health concern in the United States, with a prevalence of 5.2 million. There is currently no effective way to prevent or cure dementia, and the precise etiology is unknown, but it appears there are multiple risk factors. Prediabetes (PD) has been identified as a risk factor although the scientific evidence is conflicting. This study is important to those at high risk for dementia and to healthcare professionals who lack substantiated dementia prevention strategies. The purpose of this case control study was to determine whether PD is associated with dementia in adults aged 65-95 years and …

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The Effect Of Phytoestrogen Chemoprevention Of Prostate Cancer, Ruel Slyfield Michelin Jan 2011

The Effect Of Phytoestrogen Chemoprevention Of Prostate Cancer, Ruel Slyfield Michelin

Walden Dissertations and Doctoral Studies

Prostate cancer (CaP) remains the most commonly diagnosed cancer and second leading cause of cancer mortality among men in several ethnic groups in the United States. Lower CaP incidence among Asian men has been attributed to increased intake of soy derived phytoestrogens (SDPs); however, its association has not been extensively explored in U.S. men. The purpose of this study was to determine the effect size of serum prostate specific antigen (sPSA) and serum estradiol (sE2) following dietary SDP intervention. The study was based on an original conceptual model that aims to avert early prostate tissue damage through identification of critical …

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Perspectives Of Women In Nairobi Kenya Toward Malaria Control, Catherine Kisavi-Atatah Jan 2011

Perspectives Of Women In Nairobi Kenya Toward Malaria Control, Catherine Kisavi-Atatah

Walden Dissertations and Doctoral Studies

Malaria infection has been and continues to be a serious public health concern that has mystified many in the public health care industry. One area in Sub Saharan Africa that continues to feel the devastating effects of malaria is in Nairobi, Kenya. This qualitative research study explored the attitudes of women in Nairobi, Kenya and how they view intervention measures already introduced by public health care experts in fighting malaria. The phenomenological research approach used purposeful sampling to recruit 16 women from Nairobi, Kenya to participate in semi-structured, open-ended interviews. The ecological systems theory was used as a lens of …

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Assessing The Influence Of Socioeconomic Factors, Knowledge Level, Attitudes, And Practices On Malaria Prevention Among The Gusii People Of Kenya, Christopher Nyakundi Arori Jan 2011

Assessing The Influence Of Socioeconomic Factors, Knowledge Level, Attitudes, And Practices On Malaria Prevention Among The Gusii People Of Kenya, Christopher Nyakundi Arori

Walden Dissertations and Doctoral Studies

Global morbidity and mortality associated with malaria is rampant, and most of the clinical malaria cases are found in sub Saharan Africa. Previous and current research show that malaria is both preventable and treatable and that socioeconomic variables have a profound influence on how persons in rural Africa respond to malaria infections and the associated preventive strategies. This study assessed two key research questions for malaria cases in the Gusii region of Kenya regarding: First, whether a community education program on malaria has an impact in changing malaria preventive behaviors; and, second, if a relationship exists between socioeconomic factors and …

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Analysis Of Risk Factors Associated With Asymptomatic Colonization Of Methicillin Resistant Staphylococcus Aureus (Mrsa) Among Community College Students, Marilynn Kish-Molina Jan 2011

Analysis Of Risk Factors Associated With Asymptomatic Colonization Of Methicillin Resistant Staphylococcus Aureus (Mrsa) Among Community College Students, Marilynn Kish-Molina

Walden Dissertations and Doctoral Studies

The bacterium Staphylococcus aureus has been an important human ailment for centuries, and with the overuse of antibiotics, methicillin resistant Staphylococcus aureus (MRSA) has emerged as a deadly, costly pathogen worldwide. Healthy carriers can become sick or can spread MRSA without symptoms. The amount of asymptomatic colonization among healthy college students and risk factors for colonization by MRSA are not well understood. According to the epidemiologic triangle model, the host (students who take antibiotics or have a history of skin infections), the infectious agent (MRSA) and the environment (direct contact with people, animals, or objects that may harbor MRSA) all …

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A Sibling Case-Control Study Of Maternal Prenatal Body Mass Index As A Risk Factor For Autism Spectrum Disorder, Ruth Ann Hendrix Jan 2011

A Sibling Case-Control Study Of Maternal Prenatal Body Mass Index As A Risk Factor For Autism Spectrum Disorder, Ruth Ann Hendrix

Walden Dissertations and Doctoral Studies

The prevalence of autism spectrum disorder (ASD) is estimated to be one in every 150 births. While both genetic and postpartum environmental exposure have been linked to ASD, prenatal maternal weight has not been investigated. The objective of the study is to assess whether overweight or obesity at pregnancy is an important risk factor for the diagnosis of ASD in offspring. A case-control study was designed to answer this question using the public health ecosocial theory. The study population consisted of 70 mothers, who were recruited via the Internet using the viral expansion loop. Multiple logistic regression analysis was used …

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The Relationship Between Daily Snowfall Accumulation And Pattern And Severity Of Traumatic Injuries At A U.S. Ski Resort, S. Jason Moore Jan 2011

The Relationship Between Daily Snowfall Accumulation And Pattern And Severity Of Traumatic Injuries At A U.S. Ski Resort, S. Jason Moore

Walden Dissertations and Doctoral Studies

Throughout the relevant literature, research addressing the impact of a specific environmental factor, such as snowfall, on injury patterns or severity among alpine skiers and snowboarders is sparse. The foundation for inquiry into this relationship was developed based on principles of physics and traumatology coupled with findings in the available literature. Secondary analysis of trauma registry data coupled with daily snowfall measurements from one of the largest ski areas in North America illustrated a negative correlation between daily snowfall amount and injury severity (r = -.08). Concordant findings demonstrated an increased odds of sustaining an injury defined as severe or …

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Differences In Breast Cancer Tumor Size, Stage, And Survival By Socioeconomic Position In Young Women, Julie Maureen Tomaska Jan 2011

Differences In Breast Cancer Tumor Size, Stage, And Survival By Socioeconomic Position In Young Women, Julie Maureen Tomaska

Walden Dissertations and Doctoral Studies

Although the incidence of breast cancer in women under 40 years of age is somewhat rare, young women tend to present with cancer that is more advanced and with poorer prognostic characteristics. This research will be important to providers, women and their families and those seeking to clarify screening guidelines. The purpose of this quantitative, retrospective, cohort study was to evaluate differences in prognostic characteristics by socioeconomic position (SIP). The cohort was comprised of females aged 18 to 39 with a primary diagnosis of breast cancer. Data were obtained from the Surveillance, Epidemiology and End Results registry for all primary …

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