American Indian/Alaska Native cancer policy: systemic approaches to reducing cancer disparities

Members of American Indian and Alaska Native (AI/AN) tribes have a unique political status in the United States in terms of citizenship, and that political status determines eligibility for certain unique healthcare services. The AI/AN population has a legal right to healthcare services based on treaties, court decisions, acts of Congress, Executive Orders, and other legal bases. Although the AI/AN population has a right to healthcare services, the Indian Health Service (the federal agency responsible for providing healthcare to AI/ANs) is severely underfunded, limiting access to services (including cancer care). In order to overcome distinct cancer health disparities, policy changes will be needed. This paper reviews the historical pattern of AI/AN healthcare and the challenges of the complex care needed from prevention through end-of-life care for cancer.     

Physical Activity Resources and Changes in Walking in a Cohort of Older Men

Objectives. We evaluated the influence of physical activity resources and neighborhood-level socioeconomic status (SES) on walking among community-dwelling older men.Methods. Participants reported time walked per day at baseline (2000–2002) and follow-up. Residential addresses were linked to a geographic information system database to assess proximity to parks, trails, and recreational facilities. Log-binomial regression analyses were conducted to test the hypothesis that men living near physical activity resources were more likely to increase or maintain time walked.Results. Average time walked per day declined by 6 minutes between baseline and follow-up (P < .05). There was a significant interaction of neighborhood SES and physical activity with walking time (P < .1). Proximity to parks and proximity to trails, respectively, were associated with a 22% (95% confidence interval [CI] = 1.01, 1.47) and 34% (95% CI = 1.16, 1.55) higher likelihood of maintaining or increasing walking time in high-SES neighborhoods, but there was no association in low-SES neighborhoods. Proximity to recreational facilities was not associated with walking.Conclusions. Uncovering reasons that proximity to parks and trails is not associated with maintenance of walking activity among men in low-SES neighborhoods could provide new insight into ways to promote physical activity.Walking is the most common form of exercise among older adults.^1,2 Walking can be integrated into daily routines^3,4 and can be a feature of neighborhood life.^5–7 A physically active lifestyle is linked to disease prevention and risk reduction, as well as to physiological, functional, psychological, and social benefits.^8,9 Despite this widespread knowledge, physical activity declines with age, and the majority of older adults do not meet physical activity recommendations to maintain good health.^10,11 Therefore, identifying factors that encourage elderly adults to maintain physical activities, such as walking, are vital for health promotion.The behavioral ecological model (BEM) of health promotion asserts that both the physical and social environments contribute to an individual''s health behaviors.¹² In the context of physical activity, the BEM theory posits that proximate physical activity resources—such as parks, trails, and recreational facilities—serve as cues for physical activity behaviors. Observing or interacting with people engaging in activities in locations where physical activity occurs provides social and environmental reinforcement for one to do the same.The BEM underlies the hypothesis that physical activity will increase in populations that have access to nearby physical activity resources. To date, cross-sectional studies have generally shown positive associations between proximate physical activity resources and physical activity,^13–21 although some studies have reported no association.^22,23 Despite promising results, cross-sectional studies provide no information on the effects that proximate physical activity resources have on maintenance of physical activities. In addition, few studies have focused specifically on older adults, a population that may be particularly sensitive to the influence of accessibility to physical activity resources.^22,23 Finally, although neighborhood socioeconomic status (SES) affects the availability and quality of physical activity resources,^13,24–27 few studies have evaluated the extent to which neighborhood SES may affect the association between physical activity resources and level of activity.To determine the effects of proximate physical activity resources on maintenance of walking activity, we conducted a prospective study among community-dwelling men 65 years or older from the Portland, Oregon, metropolitan area. Using a novel combination of individual-level and neighborhood-level data, we sought to determine whether older men who live within one eighth, one quarter, or one half mile of physical activity resources, including parks, trails, and recreational facilities, are more likely than men who live further from these resources to maintain or increase the amount of time they spend walking. We also assessed whether relationships between physical activity resources and maintenance of walking activity differ according to neighborhood SES.     

Antihypertensive medication adherence and blood pressure control among central Alabama veterans

Medication nonadherence is associated with adverse outcomes. To evaluate antihypertensive medication adherence and its association with blood pressure (BP) control, the authors described population adherence to prescribed antihypertensive medication (proportion of days covered ≥80%) and BP control (mean BP <140/90 mm Hg) among central Alabama veterans during the fiscal year 2015. Overall, 75.1% of patients receiving antihypertensive medication were considered adherent, and 66.1% had adequate BP control. Patients adherent to antihypertensive medication were more likely to have adequate BP control compared with patients classified as nonadherent (67.4% vs 62.0%; adjusted odds ratio 1.33; 95% confidence interval, 1.22–1.44 [P<.0001]). Among patients who had uncontrolled BP, 73.6% were considered adherent to medication. Adherence to antihypertensive medication was associated with adequate BP control; however, a substantial proportion of patients with inadequate BP control were also considered adherent. Interventions to increase BP control could address more aggressive medication management to achieve BP goals.     

Differing Developmental Trajectories in Heart Rate Responses to Speech Stimuli in Infants at High and Low Risk for Autism Spectrum Disorder

We investigated heart rate (HR) in infants at 3, 6, 9, and 12 months of age, at high (HRA) and low (LRC) familial risk for ASD, to identify potential endophenotypes of ASD risk related to attentional responses. HR was extracted from functional near-infrared spectroscopy recordings while infants listened to speech stimuli. Longitudinal analysis revealed that HRA infants and males generally had lower baseline HR than LRC infants and females. HRA infants showed decreased HR responses to early trials over development, while LRC infants showed increased responses. These findings suggest altered developmental trajectories in physiological responses to speech stimuli over the first year of life, with HRA infants showing less social orienting over time.     

The role of glucocorticoids in the uncontrollable stress-induced potentiation of nucleus accumbens shell dopamine and conditioned place preference responses to morphine

Exposure to stressors can impact on the responsiveness to drugs of abuse, and glucocorticoid hormones (CORT) may interact with dopamine (DA) within the nucleus accumbens shell (NAcs) to mediate these responses. We have previously shown that the CORT response to morphine, but not to a previous uncontrollable stressor, is necessary for the stress-induced potentiation of morphine's rewarding effects. Here, we test (1) the necessity of CORT during inescapable stress (IS) and/or morphine for IS potentiation of morphine-induced NAcs DA and (2) the sufficiency of enhanced CORT, in the absence of prior IS, to potentiate morphine-induced NAcs DA as well as morphine conditioned place preference (CPP) in male Sprague-Dawley rats. In the first experiment, we administered the CORT synthesis inhibitors metyrapone and aminoglutethimide (100mg/kg each, sc) to suppress the CORT response to either IS (100 1 mA tailshocks) or subsequent morphine (3 mg/kg, sc) treatment. Twenty-four hour after IS, microdialysis was performed and morphine was administered. In the next experiments, CORT (1 mg/kg, sc) was injected 20 or 30 min before morphine during either microdialysis or CPP testing, respectively, in non-stressed rats. We found that IS potentiated subsequent morphine-induced NAcs DA and this was completely blocked by CORT suppression before morphine, but not before IS. However, elevated levels of CORT concurrent with morphine, but in the absence of a stressor, failed to potentiate NAcs DA or CPP. These results suggest that the CORT response to morphine is necessary, but not sufficient in the absence of prior IS, for sensitized NAcs DA and CPP responding to morphine, and provide further evidence that CORT is involved in the expression, but not the induction, of this sensitization.     

Quantification of the cortical contribution to the NIRS signal over the motor cortex using concurrent NIRS-fMRI measurements

Near-Infrared Spectroscopy (NIRS) measures the functional hemodynamic response occurring at the surface of the cortex. Large pial veins are located above the surface of the cerebral cortex. Following activation, these veins exhibit oxygenation changes but their volume likely stays constant. The back-reflection geometry of the NIRS measurement renders the signal very sensitive to these superficial pial veins. As such, the measured NIRS signal contains contributions from both the cortical region as well as the pial vasculature. In this work, the cortical contribution to the NIRS signal was investigated using (1) Monte Carlo simulations over a realistic geometry constructed from anatomical and vascular MRI and (2) multimodal NIRS-BOLD recordings during motor stimulation. A good agreement was found between the simulations and the modeling analysis of in vivo measurements. Our results suggest that the cortical contribution to the deoxyhemoglobin signal change (ΔHbR) is equal to 16-22% of the cortical contribution to the total hemoglobin signal change (ΔHbT). Similarly, the cortical contribution of the oxyhemoglobin signal change (ΔHbO) is equal to 73-79% of the cortical contribution to the ΔHbT signal. These results suggest that ΔHbT is far less sensitive to pial vein contamination and therefore, it is likely that the ΔHbT signal provides better spatial specificity and should be used instead of ΔHbO or ΔHbR to map cerebral activity with NIRS. While different stimuli will result in different pial vein contributions, our finger tapping results do reveal the importance of considering the pial contribution.     

Impact of pediatric nurses' uniforms on perceptions of nurse professionalism

This study examined the impact of nursing pants uniform color and style on perceptions of professionalism. Pediatric patients 7 to 17 years of age and their adult visitors were surveyed at two midwestern health care centers. Participants viewed eight photographs of the same RN in different uniforms. Adult participants rated each photograph for 10 image traits using a modified nurse image scale (MNIS). Pediatric participants rated each photograph for five image traits using the nurse image scale for children (NISC). Pediatric participant median sum scores for the eight uniforms were similar, despite clear preferences for boldly printed top and pressed blue or white-pant uniforms (22% each). Adult participant median sum scores were similar for six of the eight uniforms, but two had significantly lower scores (p < 0.001). Pediatric patients' and visitors' uniform preferences are not related to perceptions of professionalism.     

Can Unannounced Standardized Patients Assess Professionalism and Communication Skills in the Emergency Department?

Objectives:  The authors piloted unannounced standardized patients (USPs) in an emergency medicine (EM) residency to test feasibility, acceptability, and performance assessment of professionalism and communication skills.
Methods:  Fifteen postgraduate year (PGY)-2 EM residents were scheduled to be visited by two USPs while working in the emergency department (ED). Multidisciplinary support was utilized to ensure successful USP introduction. Scores (% well done) were calculated for communication and professionalism skills using a 26-item, behaviorally anchored checklist. Residents' attitudes toward USPs and USP detection were also surveyed.
Results:  Of 27 USP encounters attempted, 17 (62%) were successfully completed. The detection rate was 44%. Eighty-three percent of residents who encountered a USP felt that the encounter did not hinder daily practice and did not make them uncomfortable (86%) or suspicious of patients (71%). Overall, residents received a mean score of 60% for communication items rated "well done" (SD ± 28%, range = 23%–100%) and 53% of professionalism items "well done" (SD ± 20%, range = 23%-85%). Residents' communication skills were weakest for patient education and counseling (mean = 43%, SD ± 31%), compared with information gathering (68%, SD ± 36% and relationship development (62%, SD ± 32%). Scores of residents who detected USPs did not differ from those who had not.
Conclusions:  Implementing USPs in the ED is feasible and acceptable to staff. The unpredictability of the ED, specifically resident schedules, accounted for most incomplete encounters. USPs may represent a new way to assess real-time resident physician performance without the need for faculty resources or the bias introduced by direct observation.     

Metabolic Repair of Premutational Damage in Paramecium

The problems of experimental analysis of the post-irradiation processes leading to mutation are considered in some detail. In particular, methods for separating the effects of various modifiers on the rate of these processes from the effects on the time available for them to occur are discussed. Data are presented for recessive lethal mutations in Paramecium to show that all metabolic inhibitors tried (caffeine, iodoacetate, chloramphenicol and streptomycin) decrease the rate of loss of premutational damage and decrease mutation only because they increase the time available for loss. The results are shown to fit the hypothesis of metabolic repair of radiation-induced lesions of the chromosomes.