The Chinese and Korean American immigrant experience: a mixed-methods examination of facilitators and barriers of colorectal cancer screening

Objective: Among Asian Americans, colorectal cancer (CRC) is the second leading cause of cancer deaths. Despite strong evidence that screening can reduce CRC-related mortality, fewer Chinese and Koreans receive screening as compared to non-Hispanic whites and blacks. The objective of this study was to examine facilitators and barriers as well as strategies to promote CRC screening in this population.

Design: This study employed a mixed-methods design. We conducted 17 key informant interviews and 12 focus groups in the Washington, D.C. metropolitan area. 120 Chinese and Korean focus group participants, aged 50 to 85, also provided quantitative data through self-administered surveys. All participants were asked to discuss facilitators and barriers of CRC screening, including in relation to culture.

Results: Participants who had a regular physician and doctor’s recommendation for CRC screening were more likely to ever receive a colonoscopy (adjusted odds ratio (aOR)?=?3.51; 95% confidence interval (CI): 1.26, 9.79 and aOR?=?6.61; 95% CI: 2.63, 16.65, respectively). A doctor’s recommendation was also significantly associated with receipt of a fecal occult blood test (FOBT) (aOR?=?4.00; 95% CI: 1.43, 11.15). In terms of barriers, those who reported having no time and not having symptoms were less likely to have a colonoscopy (aOR?=?0.15; 95% CI: 0.03, 0.82 and aOR?=?0.02; 95% CI: 0.002, 0.23, respectively) than those who had time and symptoms. Preventive healthcare was often not viewed as a priority, particularly for those living the‘immigrant life,’ who gave precedence to work. Cultural barriers to CRC screening included language (e.g. limited English proficiency and low health literacy); fear of finding CRC and burdening the family especially children; fatalism; and stigma towards cancer.

Conclusions: Future interventions and programs aiming to increase CRC screening among Chinese and Korean Americans should address both cultural and non-cultural factors that influence CRC screening uptake.     

Prevalence of vitamin B12 deficiency in healthy Indian school‐going adolescents from rural and urban localities and its relationship with various anthropometric indices: a cross‐sectional study

Background

Micronutrient deficiency is a global health burden, especially among developing countries. The present cross‐sectional study aimed to determine the prevalence of vitamin B₁₂ deficiency in healthy Indian school‐going adolescents, based on area of residence, sex and body mass index (BMI) . Furthermore, the relationship of serum B₁₂ concentration with dietary vitamin B₁₂ intake and anthropometric indices was assessed among adolescents from rural and urban India.

Methods

A total of 2403 school‐going adolescents (11–17 years) from National Capital Region and rural areas of Haryana, India were selected. Serum B₁₂ concentrations were estimated using an electrochemiluminescence immunoassay. Dietary assessments were conducted on 65% of total participants (n  = 1556) by two 24‐h diet recalls.

Results

The prevalence of vitamin B₁₂ deficiency in the total study population was 32.4% (rural: 43.9% versus urban: 30.1%, P  < 0.001; male: 34.4% versus female: 31.0%, P  < 0.05; normal weight: 28.1%, versus overweight: 39.8%, versus obese: 51.2%, P  < 0.001). More than half (51.2%) of obese adolescents were vitamin B₁₂ deficient. On multiple linear regression analysis, serum B₁₂ in rural adolescents was associated with age (β = ?0.12, P  < 0.05). Among urban adolescents, serum B₁₂ was associated with BMI (β = ?0.08, P  < 0.05) and adjusted dietary vitamin B₁₂ intake (β = 0.14, P  < 0.001). Serum vitamin B₁₂ levels were found to be lower in rural females (β = ?0.12, P  = 0.030) and urban males (β: 0.11, P  < 0.001) compared to their respective contemporaries.

Conclusions

Vitamin B₁₂ deficiency was higher among rural school‐going adolescents. Boys had a higher B₁₂ deficiency than girls. Inverse associations of serum B₁₂ with adiposity indices were observed. Serum B₁₂ levels were positively associated with dietary vitamin B₁₂ intake.

     

Comparison of the effectiveness of amitriptyline and gabapentin on chronic neuropathic pain in persons with spinal cord injury

Rintala DH, Holmes SA, Courtade D, Fiess RN, Tastard LV, Loubser PG. Comparison of the effectiveness of amitriptyline and gabapentin on chronic neuropathic pain in persons with spinal cord injury.

Objective

To test the hypotheses that both amitriptyline and gabapentin are more effective in relieving neuropathic pain than an active placebo, diphenhydramine.

Design

Randomized, controlled, double blind, triple crossover 8-week trial.

Setting

Veterans Affairs medical center.

Participants

Community dwelling adults with spinal cord injury (N=38) were recruited by telephone, letters, and flyers.

Intervention

Eight-week trial each of amitriptyline, gabapentin, and diphenhydramine.

Main Outcome Measures

Pain intensity measured with a 10-cm visual analog scale (VAS) and an 11-point (0-10) numeric rating scale (NRS) and depressive symptomatology measured with the Center for Epidemiologic Studies Depression Scale−Short Form (CESD-SF).

Results

Baseline VAS scores for participants with low (<10) CESD-SF scores was 4.61 and for those with high scores (≥10) it was 7.41. At week 8, in participants with high baseline CESD-SF scores, amitriptyline (mean, 4.21) was more effective than diphenhydramine (mean, 6.67; P=.035), and there was a nonsignificant trend suggesting that amitriptyline may be more effective than gabapentin (mean, 6.68; P=.061). Gabapentin was no more effective than diphenhydramine (P=.97). There was no significant difference among the medications for those with lower CESD-SF scores. Results could not be attributed to dropout rates, order or dose of medications, amount of medication taken for breakthrough pain, or side effects.

Conclusions

Amitriptyline is more efficacious in relieving neuropathic pain than diphenhydramine at or below the level of spinal cord injury in people who have considerable depressive symptomatology.     

Genotoxicity of corrosion eluates obtained from endosseous implants

PURPOSE: Commercially pure titanium alloys are currently used as metallic biomaterials in implantology. Corrosion phenomena appear to play a decisive role in metallic implant long-term behavior. Thus, the goal of this study was to examine the genotoxic potential of corrosion eluates obtained from dental implants using Chinese ovary hamster cells in vitro by the single-cell gel (comet) assay. This technique detects deoxyribonucleic acid strand breaks in individual cells in alkaline conditions. MATERIALS AND METHODS: The materials tested included 3 dental implants commercially available. Each of the tested materials was corroded in a solution consisting of equal amounts of acetic acid and sodium chloride (0.1 M) for 1, 3, 7, 14, and 21 days. The Chinese ovary hamster cultures were then exposed to all corrosion eluates obtained from endosseous dental implants for 30 minutes at 37 degrees C. RESULTS: None of the eluates was found to exhibit genotoxicity, regardless of the type of dental implant used. CONCLUSION: The results suggest that all dental implants tested in this study did not induce deoxyribonucleic acid breakage as depicted by the single-cell gel (comet) assay.     

Noncirrhotic portal fibrosis/idiopathic portal hypertension: APASL recommendations for diagnosis and treatment

The Asian Pacific Association for the Study of the Liver (APASL) Working Party on Portal Hypertension has developed consensus guidelines on the disease profile, diagnosis, and management of noncirrhotic portal fibrosis and idiopathic portal hypertension. The consensus statements, prepared and deliberated at length by the experts in this field, were presented at the annual meeting of the APASL at Kyoto in March 2007. This article includes the statements approved by the APASL along with brief backgrounds of various aspects of the disease.     

Secondary Creep Analysis of FG Rotating Cylinder with Exponential,Linear and Quadratic Volume Reinforcement

Creep is an irreversible time-dependent deformation in which a material under constant mechanical stress and elevated temperature for a considerably prolonged period of time, starts to undergo permanent deformation. Creep deformation occurs in three stages namely, primary, secondary and tertiary. Out of these three stages, secondary or steady state creep is particularly an area of engineering interest as it has almost a constant creep rate. Creep deformation plays a significant role in understanding effective service life of an engineering component working under high temperature conditions as such components such as super-heater and re-heater tubes and headers in a boiler, jet engines operating at temperature as high as 1200 ∘C, usually experience a failure or rupture due to creep phenomenon. Design engineers keep a close attention on working stress conditions and elevated temperature under which an engineering component is expected to work as these conditions determine the onset of creep behavior in an engineering component. By recognizing the parameters of material response to creep behavior, engineers can analyse the useful service life and hazardous working conditions for an engineering components. Recognizing the creep phenomenon as high temperature design limitation, ASME Boiler and Pressure Vessel Code have provided guidelines on maximum allowable stresses for materials to be used in creep range. One of the criteria for determination of allowable stresses is 1% creep deformation of material in 100,000 h of service. Thus, the study of creep behavior in engineering components pertaining to high stress and temperature working conditions is very important as it affects the reliability and performance of the engineering components. The aim of our study is to understand the behavior of secondary creep deformation so that an advanced reinforced functionally graded material with better creep resistance, can be designed. In this paper, a secondary creep analysis of functionally graded (FG) thick-walled rotating cylinder under internal and external pressure is conducted. The novelty of the model intends to specify secondary creep stresses and strains by employing exponential, linear and quadratic volume reinforcement for SiCp ceramic in Al metal matrix in radial direction. This will help us to understand the effect of volume reinforcement in FG cylinder under internal/external pressure and rotating centrifugal body force by obtaining secondary creep stresses and strains. The response of the FG cylinder with isotropic material is analyzed and the solution for stress–strain rates in radial and tangential directions are obtained in closed form. Comparison of steady state creep stresses and strains under exponential, linear and quadratic volume reinforcement profiles are discussed and presented graphically.