Epidemiology Commons^™

Socioecological Factors Influencing The Anticipated Medical Help-Seeking Time For Breast Cancer Among Women In Togo, A Sub-Saharan Country, Komi Blewussi Aheto

Walden Dissertations and Doctoral Studies

Breast cancer remains a leading cause of death in sub-Saharan Africa (SSA). The burden of the disease in the region is partly attributed to delayed health-seeking, resulting in advanced disease presentation, delayed diagnosis, poor outcomes, and low survival. This quantitative cross-sectional study was conducted to investigate the socioecological factors that influence the anticipated medical health-seeking time for women in SSA experiencing breast cancer symptoms. The socioecological model (SEM) theoretical framework guided this study. A questionnaire was used to collect data from randomly selected (N = 343) women aged 18 years and older with no personal or familial history of breast …

Estimating The Number Of Polygenic Diseases Among Six Mutually Exclusive Entities Of Non-Tumors And Cancer, C I Edvard Smith, Jan A Burger, Rula Zain

Faculty, Staff and Student Publications

In the era of precision medicine with increasing amounts of sequenced cancer and non-cancer genomes of different ancestries, we here enumerate the resulting polygenic disease entities. Based on the cell number status, we first identified six fundamental types of polygenic illnesses, five of which are non-cancerous. Like complex, non-tumor disorders, neoplasms normally carry alterations in multiple genes, including in 'Drivers' and 'Passengers'. However, tumors also lack certain genetic alterations/epigenetic changes, recently named 'Goners', which are toxic for the neoplasm and potentially constitute therapeutic targets. Drivers are considered essential for malignant transformation, whereas environmental influences vary considerably among both types of …

Understanding The Demographic And Health Factors Associated With The Incidence Of Stroke In Jamaica, Zandy Elliott

Walden Dissertations and Doctoral Studies

Stroke, the leading cause of death and disability worldwide, is a significant public health issue in Jamaica, affecting individuals, families, and the healthcare system. This study identified demographic and health factors associated with stroke, enabling medical professionals to better understand high-risk factors and implement preventative care strategies in Jamaica—filling a significant gap in public health knowledge. The quantitative cross-sectional study examined Jamaican demographics, health, and stroke rates. Secondary data from the Office of the Consultant Neurologist (OCN) from 2000-2023 was integrated into the Social Ecological Model (SEM). The study included 291 stroke patients aged 18 and older, excluding those under …

The Effect Of Smoking On Occurrence Of Parotid Gland Tumors In Nineveh: Case-Control Study, Moayad Aziz Alabdaly, Shahbaa Al Bayati, Taha Hassan Taha

BioMed Visions Journal

Background: The parotid gland is the most common site of salivary gland tumors, the majority of these tumors are not malignant, Warthin tumors are the second most common type of cancer after pleomorphic adenomas. At present, tobacco is not classified as carcinogenic for the salivary gland due to inadequate research on the association between smoking and salivary gland tumors. The purpose of this study was to evaluate the connection between smoking and parotid gland tumors (PTG) in a state-scale study.

Materials and Methods: A group of (438) population-based controls that are individually matched and 200 incident PGT patients who were …

Peptide Receptor Radionuclide Therapy And Clinical Associations With Renal And Hematological Toxicities And Survival In Patients With Neuroendocrine Tumors: An Analysis From Two U.S. Medical Centers, Tao Xu, Joseph S. Dillon, Mary A. Maluccio, Dawn E. Quelle, Sarah H. Nash, Hyunkeun Cho, Kristen E. Limbach, Nicholas J. Skill, Yvette Bren-Mattison, Michael A. O’Rorke

School of Medicine Faculty Publications

Purpose: Renal and hematological toxicity are side effects and dose-limiting factors of Peptide Receptor Radionuclide Therapy (PRRT). We aimed to assess the changes in renal and hematological function and associations with survival in neuroendocrine tumor (NET) patients treated with PRRT. Methods: A retrospective cohort of 448 NET patients treated with either 177Lu-DOTATATE or 90Y-DOTATOC were followed for changes of renal and hematological function. Renal function was assessed by monitoring changes in serum creatinine, blood urea nitrogen and estimated glomerular filtration rate. Hematological function was determined by examining changes in white blood cell counts (WBC), platelet counts, and hemoglobin levels over …

Using Causal Diagrams Within The Grading Of Recommendations, Assessment, Development And Evaluation Framework To Evaluate Confounding Adjustment In Observational Studies, Kevin Mcintyre, Karina N Tassiopoulos, Curtis Jeffrey, Saverio Stranges, Janet Martin

Epidemiology and Biostatistics Publications

BACKGROUND AND OBJECTIVES: The current Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system instructs appraisers to evaluate whether individual observational studies have sufficiently adjusted for confounding. However, it does not provide an explicit, transparent, or reproducible method for doing so. This article explores how implementing causal graphs into the GRADE framework can help appraisers and end-users of GRADE products to evaluate the adequacy of confounding control from observational studies.

METHODS: Using modern epidemiological theory, we propose a system for incorporating causal diagrams into the GRADE process to assess confounding control.

RESULTS: Integrating causal graphs into the GRADE framework enables …

A Time-Stratified, Case–Crossover Study Of Heat Exposure And Perinatal Mortality From 16 Hospitals In Sub-Saharan Africa, Claudia Hanson, Jeroen De Bont, Kristi Sidney Annerstedt, Maria Del Rosario Alsina, Federica Nobile, Nathalie Roos, Peter Waiswa, Andrea Pembe, Jean-Paul Dossou, Claudia Hanson, Hussein Kidanto

Brain and Mind Institute

Growing evidence suggests that extreme heat events affect both pregnant women and their infants, but few studies are available from sub-Saharan Africa. Using data from 138,015 singleton births in 16 hospitals in Benin, Malawi, Tanzania and Uganda, we investigated the association between extreme heat and early perinatal deaths, including antepartum and intrapartum stillbirths, and deaths within 24 h after birth using a time-stratified case–crossover design. We observed an association between an increase from the 75th to the 99th percentile in mean temperature 1 week (lag 0–6 d) before childbirth and perinatal mortality (odds ratio (OR) = 1.34 (95% confidence interval …

Dementia Risk Reduction In The African Context: Multi-National Implementation Of Multimodal Strategies To Promote Healthy Brain Aging In Africa (The Africa-Fingers Project), Chinedu Momoh, Rachel Maina, Lukoye Atwoli, Karen Blackmon, Edna Bosire, Gloria Chemutai, Linda Khakali, Sylvia Mbugua, Zul Merali, Olivera Nesic Taylor,, Anthony Ngugi, Cyprian Mostert, Eunice Muthoni, Roselyter Riang’A, Mansoor Saleh, Shahin Sayed, Jasmit Shah

Brain and Mind Institute

Dementia prevention in Africa is critically underexplored, despite the continent's high prevalence of modifiable risk factors. With a predominantly young and middle-aged population, Africa presents a prime opportunity to implement evidence-based strategies that could significantly reduce future dementia cases and mitigate its economic impact. The multinational Africa-FINGERS program offers an innovative solution, pioneering culturally sensitive, multidomain interventions tailored to the unique challenges of the region. Leveraging insights from landmark global studies such as Worldwide-FINGERS and Alzheimer's Disease Neuroimaging Initiative, the program employs a multideterminant precision prevention framework, grounded in community based systems dynamics. Africa-FINGERS further integrates cutting-edge state-of-the-art multimodal biomarker …

Metastatic Recurrence In Women Diagnosed With Non-Metastatic Breast Cancer: A Systematic Review And Meta-Analysis, Eileen Morgan, Colette O’Neill, Richa Shah, Oliver Langselius, Yaqi Su, Clara Frick, Hanna Fink, Aude Bardot, Miriam Mutebi, Paul Walsh

General Surgery, East Africa

Background: To assess proportions of metastatic recurrence in women initially diagnosed with non-metastatic breast cancer by stage at diagnosis, breast cancer subtype, calendar period and age.

Methods: A systematic search of MEDLINE and Web of Science databases (January 2010–12 May 2022) was conducted. Studies reporting the proportion of distant metastatic recurrence in women with non-metastatic breast cancer were identified and outcomes and characteristics were extracted. Risk of bias was assessed independently by two reviewers. Random-effects meta-analyses of proportions were used to calculate pooled estimates and 95% confidence intervals (CIs).

Results: 193 studies covering over 280,000 patients were included in the …

Prognostic Stratification In Dlbcl Patients With Aberrant Myc Gene, Jian-Rong Li, Vikram R Shaw, Abi Parthasarathy, Yong Li, Christopher I Amos, Chao Cheng

Faculty, Staff and Students Publications

Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous disease characterized by a subset of patients who exhibit treatment resistance and poor prognoses. Genomic assays have been widely employed to identify high-risk individuals characterized by rearrangements in the MYC, BCL2 and BCL6 genes. These patients typically undergo more aggressive therapeutic treatments; however, there remains a significant variation in their treatment outcomes. This study introduces an MYC signature score (MYCSS) derived from gene expression profiles, specifically designed to evaluate MYC overactivation in DLBCL patients. MYCSS was validated across several independent cohorts to assess its ability to stratify patients based on MYC-related genetic …

Identifying High-Risk Multiple Myeloma Patients: A Novel Approach Using A Clonal Gene Signature, Jian-Rong Li, Christiana Wang, Chao Cheng

Faculty, Staff and Students Publications

Multiple myeloma (MM) is a heterogeneous disease with a small subset of high-risk patients having poor prognoses. Identifying these patients is crucial for treatment management and strategic decisions. In this study, we developed a novel computational framework to define prognostic gene signatures by selecting genes with expression driven by clonal copy number alterations. We applied this framework to MM and developed a clonal gene signature (CGS) consisting of 22 genes and evaluated in five independent datasets. The CGS provided significant prognostic values after adjusting for well-established factors including cytogenetic abnormalities, International Staging System (ISS), and Revised ISS (R-ISS). Importantly, CGS …

Residential Proximity To Oil And Gas Developments And Childhood Cancer Survival, Thanh T Hoang, Rutu A Rathod, Omar Rosales, Maria I Castellanos, Jeremy M Schraw, Elyse Burgess, Erin C Peckham-Gregory, Abiodun O Oluyomi, Michael E Scheurer, Amy E Hughes, Philip J Lupo

Faculty, Staff and Students Publications

Background: Environmental toxicants may impact survival in children with cancer, but the literature investigating these associations remains limited. Because oil and gas developments emit several hazardous air pollutants, the authors evaluated the relationship between residential proximity to oil or gas development and survival across 21 different pediatric cancers.

Methods: The Texas Cancer Registry had 29,730 children (≤19 years old) diagnosed with a primary cancer between 1995 to 2017. Geocoded data were available for 285,266 active oil or gas wells and 109,965 horizontal wells. The authors calculated whether each case lived within 1000 m (yes/no) from each type of oil or …

A Phase 1 Study Of Abi-009 (Nab-Sirolimus) In Combination With Temozolomide And Irinotecan In Pediatric Patients With Recurrent Or Refractory Solid Tumors, Including Cns Tumors-A Children's Oncology Group Pediatric Early Phase Clinical Trial Network Study Advl1514, Stuart L Cramer, Alyssa Terry Reddy, Charles Gene Minard, Stephan Voss, Elizabeth Fox, Xiaowei Liu, Kristina Denic, Joel M Reid, Brenda J Weigel

Faculty, Staff and Students Publications

BACKGROUND: Nab-sirolimus (ABI-009, nab-rapamycin; Aadi Bioscience Inc. [Aadi]) is a human albumin-bound form of sirolimus nanoparticles, a potent mTOR inhibitor. This phase I trial was conducted to define dose-limiting toxicities (DLT), maximum tolerated or recommended phase II dose (MTD/RP2D), and pharmacokinetics of Nab-sirolimus in combination with temozolomide and irinotecan.

METHODS: Using a rolling 6 design, Nab-sirolimus was administered intravenously (IV) on days (D) 1 and 8 of cycle (C) 1. In subsequent cycles, Nab-sirolimus was administered D1 and D8 in combination with temozolomide (125 mg/m

RESULTS: Thirty-three patients were enrolled, 32 were eligible. Dose determination included 17 evaluable patients, median …

Adverse Childhood Experiences And Hiv-Related Stigma: A Quantitative Survey Of Tanzanian Men, June 2019, Amandeep Kaur, Monique J. Brown Ph.D., Mph, Geoffrey K. Kangogo, Xiaoming Li Ph.D., Ivan E. Teri, Gaspar Mbita, Aima A. Ahonkhai, Donaldson F. Conserve

Faculty Publications

Experiencing adverse childhood experiences (ACEs) may impact personal opinions, attitudes, and judgments, which can further result in HIV-related stigma. HIV-related stigma consequentially may impact HIV preventive measures such as HIV testing, pre-exposure prophylaxis uptake, and condom use. The extent to which ACEs influence HIV-related stigma perception has not been well studied. Therefore, the study aimed to examine the association between ACEs and perceived and interpersonal HIV-related stigma among Tanzanian HIV-negative men. Quantitative survey data were obtained from the Tanzania STEP (Self-Testing Education and Promotion) project established in four wards: Mabibo, Manzese, Tandale, and Mwanyanamala. A total of 507 men responded …

Sexual Behavior Among Emerging Adults In Africa: A Systematic Review And Meta-Analysis, Stevenson Chea, Vincent A. Kagonya, Osman Abdullahi, Amina Abubakar, Souheila Abbeddou, Kristien Michielsen, Amin Hassan

Institute for Human Development, East Africa

Background: Estimates on sexual behavior (SB) among emerging adults (EmA) is varied in literature, which presents a challenge when designing targeted interventions. We aimed to summarize literature on prevalence and risk factors of SB among EmA in Africa.

Methods: A search for studies published in PubMed, Embase, and Psych Info by March 2023 was done. Studies involving EmA (18–25 years), conducted in Africa, and reporting 1 or more of 7 SBs were reviewed. Pooled prevalence estimates were summarized using forest plots. Heterogeneity in SB was explored. Risk factors were synthesized using a modified socioecological model.

Results: Overall, …

Postnatal Growth Of Etiologically Characterized Preterm Newborns According To Gestational Age At Birth, Paola Roggero, Irina Ryumina, Robert Gunier, Adele Winsey, Stephen Rauch, Irma Alejandra Coronado Zarco, Shabina Ariff, Maria Albertina Rego, Constanza Soto Conti, R. Ochieng

Obstetrics and Gynaecology, East Africa

Objective: To examine the relationship between etiologically-based preterm birth sub-groups and early postnatal growth according to gestational age at birth.

Methods: Prospective, multinational, cohort study involving 15 hospitals that monitored preterm newborns to hospital discharge. Measures/exposures: maternal demographics; etiologically-based preterm birth sub-groups; very, moderate and late preterm categories, and feeding. Primary outcomes: serial anthropometric measures expressed as z-scores of the INTERGROWTH-21st preterm postnatal growth standards.

Results: We included 2320 singletons and 1180 twins: very=24.4% (n = 856, including 178 < 28 weeks’ gestation); moderate=16.9% (n = 592) and late preterm=58.6% (n = 2052). The median (interquartile range) postmenstrual age at the last measure was 37 (36–38) weeks. The ‘no main condition’ sub-group percentage increased from early to late preterm; the ‘perinatal sepsis’ sub-group percentage decreased. ‘Perinatal sepsis’, ‘suspected IUGR’ and ‘fetal distress’ very and late preterm infants had lower postnatal growth patterns than the ‘no main condition’ reference sub-group. This pattern persisted in late but not very preterm infants when postnatal growth was corrected for weight z-score at birth.

Conclusion: The proportional contribution of etiologically-based preterm sub-groups and their postnatal growth trajectories vary by preterm category. Postnatal growth is partially …

Prevalence Trends Of Foodborne Pathogens Bacillus Cereus, Non-Stec Escherichia Coli And Staphylococcus Aureus In Ready-To-Eat Foods Sourced From Restaurants, Cafés, Catering And Takeaway Food Premises, Nicole Foxcroft, Edmore Masaka, Jacques Oosthuizen

Research outputs 2022 to 2026

Foodborne pathogens of Bacillus cereus (B. cereus), non-STEC Escherichia coli (non-STEC E. coli) and Staphylococcus aureus (S. aureus) are currently non-notifiable in Australia unless attributed to a food poisoning outbreak. Due to the lack of data around individual cases and isolations in foods, any changes in prevalence may go undetected. The aim of this study was to determine any changes in the prevalence of B. cereus, non-STEC E. coli and S. aureus in ready-to-eat (RTE) foods sampled from Western Australian restaurants, cafés, catering facilities and takeaway food premises from July 2009 to June 2022. A total of 21,822 microbiological test …

Functional Measures In Non-Copd Chronic Respiratory Diseases: A Systematic Review, Camile Ludovico Zamboti, Heloise Angélico Pimpão, Larissa Dragonetti Bertin, Gabriela Garcia Krinski, Tathielle Garcia, Sandro Laerth Souza Dos Santos Filho, Vinicius Cavalheri, Fabio Pitta, Carlos Augusto Camillo

Research outputs 2022 to 2026

Background/Objectives: The extensive range of instruments designed for evaluating functional performance (FP) in chronic respiratory diseases (CRD) other than chronic obstructive pulmonary disease (COPD) presents a challenge in selecting the most appropriate one. Therefore, this systematic review aimed to summarise FP instruments, their measurement properties, their minimum clinically important differences, and their associations with CRD course-related events or prognosis in non-COPD CRD. Methods: Studies employing patient-reported or performance-based instruments to assess FP in non-COPD CRD were systematically identified in the PubMed, PEDro, Embase, and Cochrane Library databases. COPD-exclusive studies or those solely reporting exercise capacity tests were excluded. Examination focused …

Evaluation And Lessons Learned From The Dissemination And Implementation Science Scholars Program In The National Cancer Prevention And Control Research Network, Daniela B. Friedman, Cam Escoffery, Elaine H. Morrato, Cynthia A. Thomson, Courtney N. Petagna, Freda Allyson Hucek, Mary Wangen, Aubrey Villalobos, James R. Hébert Scd, Samuel Noblet, Mayank Sakhuja, David O. Garcia, Jennifer L. Cruz, Stephanie B. Wheeler

Faculty Publications

Background:

The Centers for Disease Control and Prevention (CDC)-funded Cancer Prevention and Control Research Network (CPCRN) has been a leader in cancer-related dissemination & implementation (D&I) science. Given increased demand for D&I research, the CPCRN Scholars Program launched in 2021 to expand the number of practitioners, researchers, and trainees proficient in cancer D&I science methods. Methods:

The evaluation was informed by a logic model and data collected through electronic surveys. Through an application process (baseline survey), we assessed scholars’ competencies in D&I science domains/subdomains, collected demographic data, and asked scholars to share proposed project ideas. We distributed an exit survey …

Using Geographic Momentary Assessment To Explore Spatial Environment Influences On Wellbeing In People With Hiv, Rayna E. Gasik, Ethan A. Smith, Simone J. Skeen, Stephanie Tokarz, Gretchen Clum, Erica Felker-Kantor, Katherine P. Theall

School of Public Health Faculty Publications

Place-based socio-economic and racial inequities contribute to health disparities among people with HIV (PWH). We used geographic ecological momentary assessment (GEMA) methodologies to explore the interplay between psychosocial outcomes in daily diaries and community spatial measures among PWH in New Orleans. PWH (N = 69) were recruited from a clinic-based cohort study. Micro-longitudinal data were collected via smartphone-based daily diaries and geospatial tracking over 14 days. First, correlations were run between diary derived outcomes (e.g., feeling safe in current location, stress), and spatial measures (e.g., violent crime, alcohol outlets, and vacant lots) within a half-mile buffer around each diary point …