Kentucky has one of the highest mortality rates for colon cancer, despite dramatic improvements in screening. The National Comprehensive Cancer Network (NCCN) guidelines recommend operation and ...adjuvant chemotherapy for locally advanced (stage IIb/c and stage III) colon cancer (LACC). The purpose of this study was to determine the rate of nonadherence with current standard of care (SOC) and associated factors as possible contributors to mortality.
The Kentucky Cancer Registry database linked with administrative health claims was queried for individuals (20 years and older) diagnosed with LACC from 2007 to 2012. Bivariate and logistic regression of nonadherence was performed. Survival analysis was performed with Cox regression and Kaplan-Meier plots.
A total of 1,404 patients with LACC were included. Approximately 42% of patients with LACC were noted to be nonadherent to SOC, with nearly all (95.7%) failing to receive adjuvant chemotherapy. After adjusting for all significant factors, we found the factors associated with nonadherence included the following: age older than 75 years, stage III colon cancer, high Charlson Comorbidity Index (3+), low poverty level, Medicaid coverage, and disability. Adherence to SOC is associated with a significant improvement in the 5-year survival rate compared with nonadherence (63.0% and 27.4%, respectively; p < 0.0001).
Our study identified multiple factors associated with the failure of patients with LACC to receive SOC, particularly adjuvant chemotherapy, suggesting the need to focus on improving adjuvant chemotherapy compliance in specific populations. Nonadherence to LACC SOC is likely a major contributor to the persistently high mortality rates in Kentucky.
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Background Adults are advised to wear sunscreen with a sun protection factor (SPF) of 15 or higher, apply it up to 30 minutes before sun exposure, and reapply it after 2 hours to reduce exposure to ...ultraviolet radiation in sunlight for the prevention of skin cancer. Objective This study investigated the extent to which adults comply with sunscreen advice. Methods A survey was conducted with 4837 adult skiers and snowboarders at 28 high-altitude ski areas in western North America in January through April 2001 through 2002. Respondents self-reported use of sunscreen, its SPF, time of first application, and reapplication. Results Only 4.4% (95% confidence interval CI = ±0.6) of adults were in full compliance with all sunscreen advice. Half (49.8% 95% CI = ±1.4) complied with SPF 15 or higher advice. Of those wearing sunscreen, 73.2% (95% CI = ±1.8) applied the sunscreen 30 minutes before beginning skiing/snowboarding, but only 20.4% (95% CI = ±2.0) complied with advice to reapply it after 2 hours. Total compliance was lowest during inclement weather, on low-ultraviolet days, by men, and among respondents who believed skin cancer was unimportant and with low sun-sensitive skin. It was positively associated with wearing lip balm and hats with a brim. Limitations The sample was predominantly male and of high socioeconomic status; the results apply most to winter recreation when ultraviolet radiation levels are low, and sunscreen use was assessed by self-report. Conclusion Although the recommendation to use SPF 15 or higher sunscreen has reached many adults, the reapplication advice is heeded by few adults and needs to be highlighted in future sun safety promotions.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Abundant studies have associated colorectal cancer (CRC) treatment delay with advanced diagnosis and worse mortality. Delay in seeking specialist is a contributor to CRC treatment delay. The goal of ...this study is to investigate contributing factors to 14-d delay from diagnosis of CRC on colonoscopy to the first specialist visit in the state of Kentucky.
The Kentucky Cancer Registry (KCR) database linked with health administrative claims data was queried to include adult patients diagnosed with stage I-IV CRC from January 2007 to December 2012. The dates of the last colonoscopy and the first specialist visit were identified through the claims. Bivariate and logistic regression analysis was performed to identify factors associated with delay to CRC specialist visit.
A total of 3927 patients from 100 hospitals in Kentucky were included. Approximately, 19% of patients with CRC visited a specialist more than 14 d after CRC detection on colonoscopy. Delay to specialist (DTS) was found more likely in patients with Medicaid insurance (OR 3.1, P < 0.0001), low and moderate education level (OR 1.4 and 1.3, respectively, P = 0.0127), and stage I CRC (OR 1.5, P < 0.0001). There was a higher percentage of delay to specialist among Medicaid patients (44.0%) than Medicare (18.0%) and privately insured patients (18.8%).
We identified Medicaid insurance, low education attainment, and early stage CRC diagnosis as independent risk factors associated with 14-d delay in seeking specialist care after CRC detection on colonoscopy.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Background:
Although Hispanic mothers in the United States have slightly higher rates of breastfeeding initiation than the national average, they are more likely to supplement with formula.
...Objectives:
To describe infant feeding decisions in a sample of 72 urban Hispanic mothers and assess whether demographic and personal factors influence exclusive breastfeeding (EBF) status at 4 months postpartum.
Methods:
The study was longitudinal and included assessments during pregnancy, in the hospital following childbirth, and monthly up to 4 months following birth.
Results:
Nearly all of the 72 mothers were breastfeeding at discharge after the birth of their infant (94%); half of these were EBF. By 2 months postpartum, the rate of EBF had declined to 26%, dropping to 22% by 4 months. Significant predictors of EBF status at 4 months included the baseline indicator for mother’s partner as the most important person in life (adjusted odds ratio AOR, 5.42; 95% confidence interval CI, 1.03-28.66) and breastfeeding self-efficacy score at 1 month (AOR, 1.20; 95% CI, 1.07-1.34).
Conclusion:
These findings have particular relevance in this population, given the high rate of breastfeeding initiation coupled with breastfeeding self-efficacy being a modifiable factor. Support during pregnancy and postpartum, including consultation with a lactation consultant, may increase the self-efficacy of EBF in this low-income population, leading to higher rates of extended EBF among Hispanics.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK, VSZLJ
Appalachia is a rural, socioeconomically disadvantaged region with high rates of cancer and obesity. Using community-based participatory research principles, the Appalachia Community Cancer Network ...tested an initiative to reduce weight among overweight and obese participants by partnering with churches, an important community-based institution in Appalachia.
A group randomized trial was conducted with counties or groups of counties in five Appalachian states. These groups were randomly assigned to receive either monthly diet and exercise education sessions ("Walk by Faith"; WbF) or an educational program focused on cancer screening and education ("Ribbons of Faith"; RoF) to examine effects on weight change. Participants completed questionnaires and biometric measurements at baseline and 12 months. The primary outcome of the study was weight change from baseline to 12 months.
The relative difference in weight loss from baseline to 12 months for WbF compared with RoF was 1.4% but was not statistically significant (
= 0.13). However, results varied by sex and marital status. WbF men experienced a significant 2.8% decrease in body weight, married WbF women a 1.5% decrease, and unmarried WbF women a 1.5% increase compared with their respective RoF subgroups (interaction
= 0.016). Among WbF participants, greater participation in monthly educational sessions was associated with greater weight loss (
= 0.002).
WbF facilitated weight loss mainly in male participants. Level of participation in WbF activities correlated with weight loss.
Findings suggest that additional research is needed to better understand factors associated with participation in health promotion programs for underserved rural communities.
Abstract Objective Faith Moves Mountains assessed the effectiveness of a faith-placed lay health advisor (LHA) intervention to increase Papanicolaou (Pap) test use among middle-aged and older women ...in a region disproportionately affected by cervical cancer and low screening rates (regionally, only 68% screened in prior 3 years). Method This community-based RCT was conducted in four Appalachian Kentucky counties (December 2005–June 2008). Women aged 40–64 and overdue for screening were recruited from churches and individually randomized to treatment ( n = 176) or wait-list control ( n = 169). The intervention provided LHA home visits and newsletters addressing barriers to screening. Self-reported Pap test receipt was the primary outcome. Results Intention-to-treat analyses revealed that treatment group participants (17.6% screened) had over twice the odds of wait-list controls (11.2% screened) of reporting Pap test receipt post-intervention, OR = 2.56, 95% CI: 1.03–6.38, p = 0.04. Independent of group, recently screened participants (last Pap > 1 but < 5 years ago) had significantly higher odds of obtaining screening during the study than rarely or never screened participants (last Pap ≥ 5 years ago), OR = 2.50, 95% CI: 1.48–4.25, p = 0.001. Conclusions The intervention was associated with increased cervical cancer screening. The faith-placed LHA addressing barriers comprises a novel approach to reducing cervical cancer disparities among Appalachian women.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Abstract
Background
Informed decision aids provide information in the context of the patient's values and improve informed decision making (IDM). To overcome barriers that interfere with IDM, our ...team developed an innovative iPad-based application (aka “app”) to help patients make informed decisions about colorectal cancer screening. The app assesses patients' eligibility for screening, educates them about their options, and empowers them to request a test via the interactive decision aid.
Objective
The aim of the study is to explore how informed decision aids can be implemented successfully in primary care clinics, including the facilitators and barriers to implementation; strategies for minimizing barriers; adequacy of draft training materials; and any additional support or training desired by clinics.
Design
This work deals with a multicenter qualitative study in rural and urban settings.
Participants
A total of 48 individuals participated including primary care practice managers, clinicians, nurses, and front desk staff.
Approach
Focus groups and semi-structured interviews, with data analysis were guided by thematic analysis.
Key Results
Salient emergent themes were time, workflow, patient age, literacy, and electronic health record (EHR) integration. Saving time was important to most participants. Patient flow was a concern for all clinic staff, and they expressed that any slowdown due to patients using the iPad module or perceived additional work to clinic staff would make staff less motivated to use the program. Participants voiced concern about older patients being unwilling or unable to utilize the iPad and patients with low literacy ability being able to read or comprehend the information.
Conclusion
Integrating new IDM apps into the current clinic workflow with minimal disruptions would increase the probability of long-term adoption and ultimate sustainability.
NIH trial registry number
R01CA218416-A1.
Using data from a longitudinal study of breastfeeding in Hispanics, this study evaluated the influence of early skin-to-skin contact (SSC) on initiation and sustained exclusive breastfeeding (EBF) at ...1 month postpartum. Two-thirds of the women in the sample participated in early SSC. At discharge, over half of the women were EBF; this proportion decreased to one-third at 1 month postpartum. Controlling for demographic and clinical variables in the model, participation in early SSC was associated with a greater than sevenfold increase in the odds of EBF at discharge (p =. 005) but was not predictive of EBF at 1 month post-discharge (p = .7). Younger maternal age and increased prenatal infant feeding intention were associated with an increased likelihood of EBF across both timepoints. Promoting early SSC may help with initiation of EBF, while further breastfeeding support may be needed to maintain EBF following discharge for this vulnerable population.
Exclusive breastfeeding (EBF) is the most efficacious form of infant feeding and nutrition. Hispanic mothers in the US are more likely than mothers of other racial/ethnic groups to supplement with ...formula in the first 2 days of life. The purpose of this study was to explore infant feeding intentions during the prenatal period as a predictor of EBF at postpartum discharge in a sample of Hispanic women (n = 99). At discharge, 51 % of the women were EBF, 44 % were breastfeeding and supplementing with formula, and 5 % were feeding only formula. Intention to breastfeed was found to be a strong and potentially modifiable predictor of breastfeeding behavior, showing a significant association with EBF upon discharge from the hospital after birth when linked with acceptance of pregnancy and method of delivery. Prenatal care offers a unique opportunity to enhance intentions to breastfeed that may lead to improved EBF in this health vulnerable population.
Decades of promotion of the Pap test have fallen short in persuading vulnerable women to get screened for cervical cancer. Human papillomavirus (HPV) testing provides an additional screening tool, ...and the task for cancer control is to promote understanding of the test and encourage its use. Ogden and colleagues investigated the effect of message framing on increasing knowledge and intention to receive HPV testing. Although both messages increased knowledge and intention, no differences were found between gain- and loss-framed messages. We explore implications of this finding and discuss needed research to expand upon and contextualize this important formative research.
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