Medullary carcinoma of the breast: a population-based perspective

Prognostic factors specific to medullary carcinoma of the breast (MCB) are unknown. Our objective was to identify patient and tumor factors predictive of overall survival (OS) in a large cohort of MCB patients. The Surveillance, Epidemiology, and End Results database was used to identify patients with MCB diagnosed from 1988 to 2004. Patient, tumor, and treatment factors were compared by univariate analysis via the Kaplan–Meier method and survival differences detected using the log-rank test. A multivariate Cox proportional hazards model controlled for patient age, race, type of surgery, radiotherapy, tumor size, number of lymph node metastases (LNM), lymph node yield (LNY), estrogen receptor (ER) and progesterone receptor (PR) status, and extent of disease. On univariate analysis of 3,348 patients, factors influencing OS included age, race, tumor size, ER status, type of surgery, radiotherapy, LNM, LNY, and extent of disease (P < 0.001). On multivariate analysis, advancing age (P < 0.001), black race (P < 0.001), regional metastases (P < 0.001), distant metastases (P < 0.001), increasing tumor size (P < 0.001), ER positivity (P = 0.003), and increasing LNM (P < 0.001) were associated with decreased OS. An OS benefit was seen in PR-positive patients (P = 0.002) and in those with increasing LNY (P < 0.001). Even among node-negative patients, increasing LNY was associated with improved OS (P < 0.001). Tumor size, LNM, regional and distant metastases, PR status, age, and race are important prognostic factors in MCB. ER positivity was associated with decreased OS, which may reflect inaccuracy in diagnosing MCB or a significant biologic variant. The improved OS seen with increasing LNY in node-negative patients suggests MCB may be currently understaged.     

Physician‐Assisted Suicide Attitudes of Older Mexican‐American and Non‐Hispanic White Adults: Does Ethnicity Make a Difference?

Little is known about attitudes toward physician‐assisted suicide (PAS) in various ethnic groups. This study compares attitudes held by older Mexican Americans and non‐Hispanic whites and examines subject characteristics that may influence their responses. A convenience sample of 100 older Mexican Americans and 108 non‐Hispanic whites (n=208) aged 60 to 89 were recruited from four primary care community‐based practice sites in San Antonio, Texas. Interview items measured attitudes toward PAS, cognitive status, functional status, and religiosity. Older Mexican Americans (52.7%) reported stronger agreement than non‐Hispanic whites (33.7%) with PAS. Male sex (odds ratio (OR)=2.62, 95% confidence interval (CI)=1.09–6.35) predicted agreement with legalization in Mexican Americans, whereas lower religiosity scores (OR=0.84, 95% CI=0.75–0.94) were predictive of agreement in older non‐Hispanic whites. This study is the first to find positive attitudes among community‐dwelling older Mexican Americans toward PAS that are higher than those of older non‐Hispanic white adults. Sex and religious views were important determinants of positive attitudes toward PAS. Larger, more‐generalizable studies should be conducted to confirm the attitudinal patterns that have been identified in this study.     

Use of Sentinel Surveillance and Geographic Information Systems to Monitor Trends in HIV Prevalence,Incidence, and Related Risk Behavior among Women Undergoing Syphilis Screening in a Jail Setting

Innovative methods are needed to systematically track the HIV epidemic and appropriately target prevention and care programs in vulnerable populations of women. We conducted sentinel surveillance among women entering the jail system of San Francisco from 1999 to 2001 to track trends in HIV incidence, HIV prevalence, and related risk behavior. Using geographic information software (GIS), we triangulated findings to examine the spatial distribution of risk and disease. A total of 1,577 female arrestees voluntarily screened for sexually transmitted diseases at intake were included. HIV incidence, estimated using the serologic testing algorithm for recent HIV seroconversion (STARHS), was 0.4% per year (95% confidence interval [95%CI] = 0.1–2.1). HIV prevalence was 1.8% (95%CI = 1.1–2.4). HIV infection was independently associated with age 30 to 39 years compared to all other ages, African-American race/ethnicity vs. non-African-American, and recent injection drug use. Maps showed that the communities in which arrested women reside are also those with the highest concentrations of newly detected female HIV cases, AIDS cases, and clients of substance use programs. The combined strategy of using sentinel surveillance in the jail setting and GIS to map the spatial distribution of disease provides a useful tool to identify patterns of risk in hard-to-reach, vulnerable populations of women.     

Lateral Balance Factors Predict Future Falls in Community-Living Older Adults

Hilliard MJ, Martinez KM, Janssen I, Edwards B, Mille M-L, Zhang Y, Rogers MW. Lateral balance factors predict future falls in community-living older adults.

Objective

To prospectively determine the capacity of measures of mediolateral (ML) protective stepping performance, maximum hip abduction torque, and trunk mobility, in order to predict the risk of falls among community-living older people.

Design

Cross-sectional study.

Setting

A balance and falls research laboratory.

Participants

Medically screened and functionally independent community-living older adult volunteers (N=51).

Interventions

Not applicable.

Main Outcome Measures

Measures included: (1) protective stepping responses: percentage of trials with multiple balance recovery steps and sidestep/crossover step recovery patterns, and first step length following motor-driven waist-pull perturbations of ML standing balance; (2) hip abduction strength and axial mobility: (3) peak isokinetic hip abduction joint torque and trunk functional axial rotation (FAR) range of motion; and (4) fall incidence: monthly mail-in reporting of fall occurrences with follow-up contact for 1 year post-testing. One- and 2-variable logistic regression analysis models determined which single and combined measures optimally predicted fall status.

Results

The single variable model with the strongest predictive value for falls was the use of multiple steps in all trials (100% multiple steps) (odds ratio, 6.2; P=.005). Two-variable models, including 100% multiple steps and either hip abduction torque or FAR variables, significantly improved fall prediction over 100% multiple steps alone. The hip abduction and FAR logistic regression optimally predicted fall status.

Conclusions

The findings identify new predictor variables for risk of falling that underscore the importance of dynamic balance recovery performance through ML stepping in relation to neuromusculoskeletal factors contributing to lateral balance stability. The results also highlight focused risk factors for falling that are amenable to clinical interventions for enhancing lateral balance function and preventing falls.     

The Nurse’s Role in the Prevention of Cervical Cancer Among Underserved and Minority Populations

Since the implementation of the Papanicolaou test, there has been a significant decline in the incidence of cervical cancer over the last 50 years. Despite this reduction, each year there are approximately 11,000 women in the United States diagnosed with cervical cancer, the second most common type of cancer in women worldwide. Infection with oncogenic human papillomavirus (HPV) is necessary for the development of precancerous lesions and the progression to cervical cancer. For those diagnosed with an HPV infection or cervical cancer, a considerable personal and financial burden often results. Recent analyses estimate that the total direct costs associated with cervical dysplasia and cancer are extensive. Additionally, a patient’s quality of life (social, emotional, and sexual functioning) is adversely affected following a diagnosis with an HPV infection or cervical cancer. The data also show disparities in the incidence of cervical cancer and barriers that may contribute to these phenomena in underserved populations. National programs have been implemented and can help reduce the burden of disease, but vaccination against HPV remains the primary method of prevention. In the healthcare field, nurses play many roles, a prominent one being a patient educator. As a result, there is a need to educate nurses about the risks and impact of HPV and cervical cancer. Nurses can be instrumental in educating the public about vaccination and increasing awareness of HPV and cervical cancer among the underserved.     

A new,rapid, and promising approach to aerosol immunization: Inflatable bags and valved masks

Booster doses of MMR vaccine equal in dosage to injected doses were aerosolized into a 3/4 l bag that inflated in 4 s. The bag was then attached to valved masks, and its contents rapidly inhaled in one or two deep breaths by preschool Mexican children. Antibody responses in the children exposed to the aerosolized measles component were superior to those noted after injection, while responses to the mumps and rubella components were equivalent. The new method appears to be effective, safe, and has several advantages over previously used methods. Further explorations of the approach seem merited.     

Trends of overweight and obesity among children in Tijuana, Mexico

The objectives of this study were to compare the trends of obesity from 2001-02 to 2006-07 in school children of Tijuana, Mexico and to investigate the relationship with the child's gender and type of school attended. Bietapic random sample was selected by cluster of schools and groups. Results of the 1684 children from 6-14 years of age assessed showed an overall prevalence of obesity (> 95(th)) of 28%. An overall increase of overweight and obesity of 7-percentage points (p=0.0003), from 41 to 48%, being higher among boys and younger girls. Prevalence of obesity was higher among boys and children from private schools.     

Influence of extrusion on the bioactive compounds and the antioxidant capacity of the bean/corn mixtures

The aim of this investigation was to examine the influence of extrusion on the bioactive compounds and the antioxidant capacity of bean/corn mixtures. Whole bean flour and nixtamalized corn were mixed in a 60:40 proportion and extrusion was performed in different moisture (14.5%, 15.4%, 17.1% and 18.0%) and temperature (150°C, 160°C, 170°C, 180°C and 190°C) conditions in order to find the optimal extrusion conditions. According to their functional properties and antioxidant status, the mixtures 142°C/16.3% H, 170°C/16.3% H and 198°C/16.3% H were defined as optimal, moderate and bad, respectively. Total polyphenols and flavonoids in the mixture of 142°C/16.3% H (15.09±1.7 mg gallic acid equivalent [GAE]/g dry weight [DW] and 1.57±0.2 mg catechin equivalent [CE]/g DW) were significantly higher (P<0.05) than in the sample 170°C/16.3% H (9.42±1.1 mg GAE/g DW and 1.4±0.1 mg CE/g DW) and the mixture 198°C/16.3% H (6.46±0.8 mg GAE/g DW and 0.78±0.1 mg CE/g DW). The antioxidant activity (37.02±3.8 and 25.01±2.5 μM Trolox equivalent [TE]/g DW) of mixture 142°C/16.3% H, determined by the cupric reducing antioxidant capacity with Trolox equivalent antioxidant capacity and β-carotene-linoleic acid (β-carotene,% of inhibition) assays, was significantly higher (P<0.05) than in 170°C/16.3% H (25.69±2.8 and 17.02±1.8 μM TE/g DW) and in mixture 198°C/16.3% H (13.93±1.5 and 8.94±0.9 μM TE/g DW), respectively. The free polyphenols, flavonoids and the antioxidant activities showed lower results than the hydrolyzed ones. The correlation coefficients between polyphenols, flavonoids, and cupric reducing antioxidant capacity capacities were between 0.93 and 0.99. In cereal proteins extracted and separated by electrophoresis, some differences were found in the sodium dodecyl sulfate-protein bands in the region from 36 to 45 kDa for 142°C/16.3% H, in comparison with other samples. Therefore, there is a need to find such conditions for the extrusion procedures that would take into consideration the contents of the bioactive compounds and the antioxidant capacity in the end product.