A comparison of smoking cessation efforts in African Americans by resident physicians in a traditional and primary care internal medicine residency

Tobacco use causes significant morbidity and mortality among African Americans. Physicians may inconsistently counsel patients against smoking. This retrospective chart review evaluated smoking cessation efforts in African Americans by internal medicine resident physicians in a traditional and a primary care residency program. One hundred twenty-nine African-American patients were evaluated by resident physicians in the traditional internal medicine residency. A tobacco use history was obtained in 84 patients. Twenty-eight patients smoked and two patients were counseled against smoking. Fifty-two African-American patients were evaluated by resident physicians in the primary care residency. A tobacco use history was obtained in 47 patients. Twenty patients smoked and 12 patients were counseled against smoking. There was a statistically significant difference in the rate at which smoking histories were obtained (p = 0.0011) and frequency of counseling against smoking (p < 0.0001). Gender analysis revealed that African-American women were less frequently asked about their smoking history (p = 0.0058) and counseled against smoking (p = 0.0016) by resident physicians in the traditional residency. African-American men received less counseling against smoking (p = 0.055) by resident physicians in the traditional residency. Resident physicians in the primary care residency program demonstrated greater smoking cessation efforts for African American patients. Smoking cessation should be emphasized in all internal medicine residency training programs.     

Colorectal cancer screening among African Americans: the importance of physician recommendation

INTRODUCTION: African Americans have higher colorectal cancer incidence and mortality rates than whites. They are also more likely to be diagnosed with late-stage disease and less likely to survive for at least five years after diagnosis. Lack of adherence to colorectal cancer screening recommendations has previously been found to be associated with lower income, lower educational level, and racial/ethnic minority status. METHODS: One hundred-fifty African-American patients (aged 50-79 years) of an inner city hospital, were surveyed by mail and telephone in early 2002. Seventy-six patients completed the survey, and data from 74 surveys were analyzed. RESULTS: Approximately one-half (55%) of the respondents reported having received a fecal occult blood test (FOBT) in the last 12 months, sigmoidoscopy in the last five years, or colonoscopy in the last 10 years. Thirty-nine percent of the survey participants reported never having received a physician recommendation for FOBT, 60% reported never having received a recommendation for sigmoidoscopy, and 57% reported never having received a recommendation for colonoscopy. Previous physician recommendation was strongly associated (p < 0.001) with levels of FOBT, sigmoidoscopy, and colonoscopy use. DISCUSSION: Future studies should examine factors that influence primary care physicians' decision-making about ordering colorectal cancer screening tests, as well as patients' decision-making regarding adherence to physician recommendations.     

Attitudes of African Americans regarding screening for prostate cancer.

The purpose of this study was to identify attitudes associated with the willingness of African Americans to participate in prostate cancer screening. Subjects > or = 40 years were recruited from South Central Los Angeles. Fifty-six respondents were divided into low or middle socioeconomic groups based on education and occupation. Focus group discussions were conducted to assess knowledge, attitudes, and beliefs about prostate cancer screening and treatment, willingness to participate in screening, incentives and barriers toward participating in screening, and source of medical care. The middle socioeconomic respondents expressed a greater willingness to participate in prostate screening. This difference was attributed to their greater knowledge about the disease and screening procedures, enhanced access to health promotion activities, being less fearful of discovering abnormal results, exposure to more aggressive behavior on the part of the provider with respect to screening, and receiving medical care in an environment that is more respectful toward the consumer. Efforts to increase minority participation in prostate cancer screening or prevention studies must take these findings into consideration.     

Perspectives of African Americans and dentists concerning dentist-patient communication on oral cancer screening

OBJECTIVE: Mortality rates for oral cancer have not improved appreciably in decades, with Blacks less likely than others to survive 5-years post-treatment. Oral cancer is the fifth most common cancer among African American males, representing a pressing public health concern. This study compared how dentists and African American adults view the current state of dentist-patient communication regarding oral cancer and its detection. METHODS: Five focus groups with 56 African American adults and two focus groups with 17 dentists were conducted in order to compare responses regarding oral cancer information needs and dentist-patient communication on oral cancer screening. RESULTS: African American adults showed little knowledge about oral cancer and cancer screening, and great need for information. However, dentists reported rarely engaging in information exchange with their patients even while performing the examination. CONCLUSION: African Americans' request for screening information and dentists' reticence about performing the screening and initiating communication with patients indicate a need for both public education on oral cancer and improved continuing education courses for dentists. PRACTICE IMPLICATIONS: The dental care community should develop clear guidelines for communicating with patients about oral cancer and engage in continuing education on oral cancer screening procedure. Increased public health efforts aimed at increasing oral cancer awareness and knowledge among the public are warranted.     

Apoptosis resistance can be used in screening the markers of cancer stem cells

Cancer stem cells are a small population of tumor cells that possess the stem cell property of self-renewal and spawning proliferation. The small population of cells is the seeds of tumors. Therefore, these cells are also called "Tumorigenic cells". Other cells which were present in majority in the entire tumor cells have only limited proliferation property and they cannot self-renew. So, isolation and identification of the small population of cells is helpful in further studying the difference between the cancer stem cells and non-tumorigenic cells in certain aspects. However, the isolation and identification of the cancer stem cell is still very difficult. It is reported that cancer stem cells can resist apoptosis when they expose to apoptosis inducement factors. Applying this characteristic of cancer stem cells, we put forward a hypothesis that apoptosis resistance of cancer stem cells can be used in screening the markers of the cancer stem cells. In apoptosis inducement model, the proportion of cancer stem cells may increase in surviving cells. The proportion of the cancer stem cell markers may increase accordingly. Through comparing the change of the expression of cell surface molecules on cancer cells, we may primarily screen the cancer stem cell markers.     

Communication preference moderates the effect of a tailored intervention to increase colorectal cancer screening among African Americans

ObjectiveTest the impact of tailoring CRC screening messages for African Americans (AAs) using novel theoretical variables and to examine moderating effect of communication preferences.MethodsParticipants were randomized to receive two minimally tailored or two enhanced tailored print newsletters addressing CRC. The enhanced intervention was tailored on Self-Determination Theory and other novel psychological constructs. Minimal tailoring only used information available in the patient's EHR. The primary outcome was CRC screening based on EHR. Participants were AA members aged 50–74 of an integrated health care delivery system not up to date on CRC screening.ResultsWe enrolled 881 participants. CRC screening participation rates at 1-year follow up were 20.5% and 21.5% in the minimally and enhanced tailored groups, respectively. Communication preferences moderated the impact of the intervention. Specifically, among those with an autonomous communication preference, screening rates in the minimally and enhanced tailored groups were 17.1% and 25.9%, respectively, while no intervention effect was evident among those with a directive preference.ConclusionFuture research is needed to explore the impact of communication preference tailoring for other health behaviors and among other populations.Practice implicationsTailored communications should consider communication style preference to help guide the content and tone of messages.     

Prediction of hip fracture can be significantly improved by a single biomedical indicator

Femoral neck fractures are a relevant clinical and social problem. The aim of this study was to improve the prediction of patients at-risk of femoral neck fracture with respect to the current densitometric-based methods. In particular, finite element models were used to assess the prediction accuracy obtained by combining together data from the bone density distribution, the proximal femur anatomy, and the fall-related loading conditions. Two-dimensional finite element models were developed based on dual energy x-ray absorptiometry data. A population of 93 elder Caucasian women (half of them reporting a femoral neck fracture) were retrospectively classified both using the standard clinical protocol and Bayes' linear classifiers. This study showed that the bone mineral density in the femoral neck region dominated the fracture event (65% accuracy). Adding the subject's height and the neck-shaft angle to the bone density increased the accuracy to 77%. The classification accuracy was further improved to 82% by including the peak principal tensile strain obtained from the finite element analyses. This research demonstrated that adding one single biomechanical indicator to the standard clinical measurements improves the identification of patients at-risk of femoral neck fracture. © 2002 Biomedical Engineering Society. PAC2002: 8759Ls, 8719Rr     

Sickness behavior of rats with abdominal sepsis can be improved by antibiotic and G-CSF prophylaxis in clinic modeling randomized trials

Background and aim: In clinical sepsis research nearly all immune-modulators have demonstrated no benefit in regard to the 28-day mortality rate. Other endpoints such as quality of life have become more attractive, but clinically relevant animal models analyzing an equivalent to quality of life by measurement of sickness behavior are extremely rare. The concept of clinic modeling randomized trials was used in an animal trial to model clinical complexity and conditions of a randomized clinical trial.Methods: 80 adult male Wistar rats were randomly assigned to (1) control: anesthesia and sham operation, (2) sepsis: laparotomy and peritoneal infection with human stool bacteria, (3) sepsis with antibiotic prophylaxis: cefuroxime/metronidazole and (4) sepsis with antibiotic plus a cytokine prophylaxis with granulocyte-colony stimulating factor (GCSF). Endpoints were physiological and behavioral parameters.Results: The combination of antibiotics plus G-CSF was most effective in reducing mortality. All infected animals showed reduced open field activity acutely after infection, and recovery was improved during the 9 day follow-up in rats with prophylactic treatments. In the social interaction test, but not in the elevated plus-maze anxiety test, prophylaxis was also efficient, especially with antibiotics and G-CSF.Conclusions: The results show that improving sickness behavior in septic rats with G-CSF plus antibiotics may be a promising approach.Received 23 June 2004; returned for revision 26 July 2004; accepted by M. J. Parnham 30 August 2004     

Intravascular clearance of disseminating Cryptococcus neoformans in the brain can be improved by enhancing neutrophil recruitment in mice

Extrapulmonary dissemination of Cryptococcus neoformans (C. neoformans) is one of the most critical steps in the development of meningoencephalitis. Here, we report that clearance of the disseminating C. neoformans occurs within the brain microvasculature. Interestingly, the efficiency of the intravascular clearance in the brain is reduced compared to that in the lung. Intravascular clearance is mainly mediated by neutrophils, and complement C5a receptor signaling is crucial for mediating neutrophil recruitment in the vasculature. C. neoformans stimulated actin polymerization of neutrophils is critically involved in their recruitment to the lung, which is associated with the unique vascular structure detected in the lung. The relatively lower efficiency of fungal clearance in the brain vasculature correlates with less efficient recruitment of neutrophils. Accordingly, intravascular clearance of C. neoformans in the brain could be remarkably improved by increasing the recruitment of neutrophils. We conclude that neutrophils have the ability to eliminate C. neoformans arrested in the vasculature. However, insufficient recruitment of neutrophils limited the optimal clearance of this microorganism in the brain. These results imply that a therapeutic strategy aimed at enhancing the accumulation of neutrophils could help prevent cryptococcal meningoencephalitis.     

Role of religious involvement and spirituality in functioning among African Americans with cancer: testing a mediational model

The present study tested a mediational model of the role of religious involvement, spirituality, and physical/emotional functioning in a sample of African American men and women with cancer. Several mediators were proposed based on theory and previous research, including sense of meaning, positive and negative affect, and positive and negative religious coping. One hundred patients were recruited through oncologist offices, key community leaders and community organizations, and interviewed by telephone. Participants completed an established measure of religious involvement, the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-SP-12 version 4), the Positive and Negative Affect Schedule (PANAS), the Meaning in Life Scale, the Brief RCOPE, and the SF-12, which assesses physical and emotional functioning. Positive affect completely mediated the relationship between religious behaviors and emotional functioning. Though several other constructs showed relationships with study variables, evidence of mediation was not supported. Mediational models were not significant for the physical functioning outcome, nor were there significant main effects of religious involvement or spirituality for this outcome. Implications for cancer survivorship interventions are discussed.