Chronic inflammation and risk of lung cancer in older adults in the health,aging and body composition cohort study

Objectives

We examined the association between three inflammatory markers (Interleukin (IL)-6, C-reactive protein (CRP), tumor necrosis factor (TNF)-α) and incident lung cancer using baseline, updated, and averaged inflammatory measures in older adults.

Health Effects Reported by Adolescent Water Pipe and/or Cigarette Smokers Compared to Nonsmokers

Purpose

The purpose of this study was to determine the prevalence of respiratory and/or physical fitness health problems in adolescent (ages 18–21) water pipe (WP) smokers (with or without cigarette smoking), cigarette-only smokers, and nonsmokers.

Twelve tips for expanding undergraduate clinical teaching capacity

Undergraduate medical education has expanded substantially in recent years, through both establishing new programs and increasing student numbers in existing programs. This expansion has placed pressure on the capacity for training students in clinical placements, raising concerns about the risk of dilution of experience, and reducing work readiness. The concerns have been greatest in more traditional environments, where clinical placements in large academic medical centers are often the “gold standard”. However, there are ways of exposing medical students to patient interactions and clinical supervisors in many other contexts. In this paper, we share our experiences and observations of expanding clinical placements for both existing and new medical programs in several international locations. While this is not necessarily an easy task, a wide range of opportunities can be accessed by asking the right questions of the right people, often with only relatively modest changes in resource allocation.     

Factors associated with provision of depot medroxyprogesterone acetate to adolescents by US health care providers

ObjectiveIdentify factors associated with healthcare providers' frequency of depot medroxyprogesterone acetate (DMPA) provision to adolescents.Study designWe analyzed data from surveys mailed to a nationally representative sample of public-sector providers and office-based physicians (n=1984). We estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of factors associated with frequent DMPA provision to adolescents in the past year.ResultsAlthough most providers (>95%) considered DMPA safe for adolescents, fewer reported frequent provision (89% of public-sector providers; 64% of office-based physicians). Among public-sector providers, factors associated with lower odds of frequent provision included working in settings without Title X funding (aOR 0.44, 95% CI 0.30–0.64), reporting primary care as their primary clinical focus versus reproductive or adolescent health (aOR 0.42, 95% CI 0.28–0.61), and providing fewer patients with family planning services. Among office-based physicians, factors associated with lower odds of frequent provision included specializing in obstetrics/gynecology (aOR 0.50, 95% CI 0.27–0.91) and family medicine (aOR 0.21, 95% CI 0.09–0.47) versus adolescent medicine, completing training ≥15 versus <5 years ago (aOR 0.27, 95% CI 0.09–0.83), and reporting that 0–24% of patients pay with Medicaid or other government healthcare assistance versus ≥50% (aOR 0.23, 95% CI 0.09–0.61). The reason most commonly reported by providers for infrequent DMPA provision was patient preference for another method.ConclusionsWhile most providers reported frequently providing DMPA to adolescents, training on evidence-based recommendations for contraception, focused on subgroups of providers with lower odds of frequent DMPA provision, may increase adolescents' access to contraception.ImplicationsAlthough >95% of providers considered depot medroxyprogesterone (DMPA) a safe contraceptive for adolescents, only 89% of public-sector providers and 64% of office-based physicians reported frequently providing DMPA to adolescents. Provider training on evidence-based recommendations for contraception counseling and provision may increase adolescents' access to DMPA and all methods of contraception.     

Association between Having a Regular Health Provider and Access to Services Linked to Electronic Health Records

Objective: A regular care provider is an important measure of access to health services, but little is known about the association between having a regular provider and patients’ access to services associated with electronic health records (EHR). Furthermore, the composition of the additional electronic services made available to patients is not well studied.

Methods: We analyzed the most recent data from the Health Information National Trends Survey (HINTS5-Cycle1, 2017, n?=?3,285). We estimated a weighted multivariable logistic regression model to assess the association between having a regular provider (65.3%) and access to EHR (29%). Control variables were selected based on Andersen’s Behavioral Model.

Results: In the adjusted model, participants with a regular provider had significantly greater access to an EHR (aOR 2.91, p < .001) compared to participants without a regular provider. Participants were more likely to have access to an EHR if they were females (aOR 1.56, p < .01), had a tablet computer (aOR 1.55, p < .05), smartphone (aOR 2.27, p < .01), a former smoker (aOR 1.67, p < .05) or had two or more chronic medical conditions (aOR 1.79, p < .01).

Discussion: Individuals who have a regular provider are roughly three times as likely to have access to services linked to an EHR. Access to an EHR enhances both potential and realized access to many healthcare services.

Conclusion: The availability of a regular care provider impacts the “digital divide.” The expansion of electronic health services intensifies the importance of a regular care provider.     

Rising Cancer Incidence and Role of the Evolving Diet in Kenya

Kenya has experienced an increase in the incidence of various types of cancers in the last few decades. This article highlights dietary factors as major contributors to this rising trend of cancer incidence in Kenya at the backdrop of an evolving diet. Literature search revealed that diet plays a major role in the etiology of various cancers with highest incidence rates in various categories of people in Kenya. Other than among children (≤15 years) and HIV/AIDs patients, diet-related cancers such as esophageal, colorectal, stomach, prostate and breast appear to predominate among Kenyans in various categories, i.e., young people (15?≤?30 years), adults (31?≤?65 years), and older people (>65 years). In the past few decades, Kenya has been undergoing nutritional transition characterized by departure from potentially cancer-protective traditional diets (mostly rich in dietary fiber, fruits, and vegetables) to “western diet” (rich in charred red/organ meats, fat, cholesterol, sugar, and salt) that poses elevated cancer risks. Other potentially carcinogenic factors that characterize the evolving Kenyan diet include; drinking of illicit and/or excess alcohol, traditional soot-laced sour milk, reuse of frying fats/oils, kerosene-laced meals, aflatoxin and agrochemical contaminated foods. The various plausible mechanisms of carcinogenesis of these dietary factors are discussed.