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Green, Andrew. "The African Population and Health Research Center." Lancet 390, no. 10106 (October 2017): 1940. http://dx.doi.org/10.1016/s0140-6736(17)32735-6.
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Odiaka, Emeka, David W. Lounsbury, Mohamed Jalloh, Ben Adusei, Thierno Amadou Diallo, Papa Moussa Sene Kane, Isabella Rockson, et al. "Effective Project Management of a Pan-African Cancer Research Network: Men of African Descent and Carcinoma of the Prostate (MADCaP)." Journal of Global Oncology, no. 4 (December 2018): 1–12. http://dx.doi.org/10.1200/jgo.18.00062.
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Purpose Health research in low- and middle-income countries can generate novel scientific knowledge and improve clinical care, fostering population health improvements to prevent premature death. Project management is a critical part of the success of this research, applying knowledge, skills, tools, and techniques to accomplish required goals. Here, we describe the development and implementation of tools to support a multifaceted study of prostate cancer in Africa, focusing on building strategic and operational capacity. Methods Applying a learning organizational framework, we developed and implemented a project management toolkit (PMT) that includes a management process flowchart, a cyclical center-specific schedule of activities, periodic reporting and communication, and center-specific monitoring and evaluation metrics. Results The PMT was successfully deployed during year one of the project with effective component implementation occurring through periodic cycles of dissemination and feedback to local center project managers. A specific evaluation was conducted 1 year after study initiation to obtain enrollment data, evaluate individual quality control management plans, and undertake risk log assessments and follow-up. Pilot data obtained identified areas in which centers required mentoring, strengthening, and capacity development. Strategies were implemented to improve project goals and operational capacity through local problem solving, conducting quality control checks and following compliancy with study aims. Moving forward, centers will perform quarterly evaluations and initiate strengthening measures as required. Conclusion The PMT has fostered the development of both strategic and operational capacity across project centers. Investment in project management resources is essential to ensuring high-quality, impactful health research in low- and middle-income countries.
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Jiagge, Evelyn, Joseph Kwaku Oppong, Jessica Bensenhaver, Francis Aitpillah, Kofi Gyan, Ishmael Kyei, Ernest Osei-Bonsu, et al. "Breast Cancer and African Ancestry: Lessons Learned at the 10-Year Anniversary of the Ghana-Michigan Research Partnership and International Breast Registry." Journal of Global Oncology 2, no. 5 (October 2016): 302–10. http://dx.doi.org/10.1200/jgo.2015.002881.
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Women with African ancestry in western, sub-Saharan Africa and in the United States represent a population subset facing an increased risk of being diagnosed with biologically aggressive phenotypes of breast cancer that are negative for the estrogen receptor, the progesterone receptor, and the HER2/neu marker. These tumors are commonly referred to as triple-negative breast cancer. Disparities in breast cancer incidence and outcome related to racial or ethnic identity motivated the establishment of the International Breast Registry, on the basis of partnerships between the Komfo Anokye Teaching Hospital in Kumasi, Ghana, the University of Michigan Comprehensive Cancer Center in Ann Arbor, Michigan, and the Henry Ford Health System in Detroit, Michigan. This research collaborative has featured educational training programs as well as scientific investigations related to the comparative biology of breast cancer in Ghanaian African, African American, and white/European American patients. Currently, the International Breast Registry has expanded to include African American patients throughout the United States by partnering with the Sisters Network (a national African American breast cancer survivors’ organization) and additional sites in Ghana (representing West Africa) as well as Ethiopia (representing East Africa). Its activities are now coordinated through the Henry Ford Health System International Center for the Study of Breast Cancer Subtypes. Herein, we review the history and results of this international program at its 10-year anniversary.
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Adebamowo, Sally N., Eileen O. Dareng, Ayotunde O. Famooto, Rasheed A. Bakare, and Clement A. Adebamowo. "Cohort Profile: African Collaborative Center for Microbiome and Genomics Research (ACCME)." Journal of Global Oncology 2, no. 3_suppl (June 2016): 40s. http://dx.doi.org/10.1200/jgo.2016.003822.
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Abstract 65 Background: Cervical cancer is the second most common cancer in Africa. Much remains unknown about the prevalence and pathogenicity of human papillomavirus (HPV) types and the mechanism of disease, and there is a need for new biomarkers for screening programs. Methods: ACCME is a multicenter prospective cohort study of host germline, somatic and HPV genomics and epigenomics, and vaginal microenvironment; and their association with cervical cancer in 10,000 HIV negative women in Nigeria. Data on demographic, lifestyle, medical history, serum, germline DNA, HPV genotype, and vaginal pH are collected at baseline and during follow up visits every 6 months. Samples of exfoliated cervical cells are analyzed for high risk HPV with Roche LINEAR ARRAY and vaginal bacterial composition and abundance are characterized by deep sequencing of barcoded 16S rRNA gene fragments (V4) on a Illumina MiSeq platform. Colposcopies and biopsies are conducted on participants with clinical lesions and those with persistent high risk HPV infections. Results: By December 2015, 10,000 participants had been enrolled in the ACCME cohort. The mean (SD) age of the study participants at baseline was 40 (10) years. Most of the participants were married (76%), attended university (44%), and had professional jobs (37%). All the study participants have had vaginal sex, 17% have had oral sex, and only 2% have ever had anal sex. We found 30% of the study participants were HPV positive and 70% were HPV negative. The mean (SD) vaginal pH in the study population was 5.2 (0.5). Further analyses to characterize high-risk HPV types and determine persistence will be conducted at each follow up visit. Also, characterization of cervical cytokines and vaginal microbiome will be conducted after the follow up visits for all participants have been conducted. Conclusions: ACCME is a paradigm for translational research in biomarker discovery that addresses high impact public health challenges affecting women's health in Africa and the rest of the world. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from the authors.
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Marino, Natascia, Julia McCarty, Guanglong Jiang, Mariah L. Johnson, Teresa Mahin, Nicholas Scherer, and Anna Maria Storniolo. "Genetic ancestry in normal breast tissue donors from the Susan G. Komen tissue bank at the IU Simon Cancer Center (KTB)." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): e13065-e13065. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.e13065.
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e13065 Background: When studying complex diseases with a heritable component, such as breast cancer, chances of finding disease susceptibility genes can be increased by accounting for genetic ancestry within the population investigated. The limitation in using self-reported race to reveal population genetic substructure has been extensively reported. Therefore, we employed a panel of genetic polymorphisms, or Ancestry Informative Markers (AIMs), to genetically determine the racial and ethnic background of the tissue donors in the KTB, the only existing biobank of breast tissue cores taken from healthy women. Methods: 4112 women donated breast tissue between 2006 and 2016, and also provided race and ethnicity information. We used a panel of 41 AIMs to estimate genetic ancestry and to maximize the difference between European/ Middle East (Caucasian, C), East Asia and Central/South Asia (Asian), African, and Hispanic populations. We employed the Bayesian Markov chain Monte Carlo (MCMC) method implemented in the program STRUCTURE 2.2. A reference set was obtained from the Human Genome Diversity Project. Results: In women self-identified as Black/African American (AA),White and Asian, the assigned genetic ancestry proportions were 93.8% African, 95% C and 96.6% Asian respectively, while the racial composition among the 318 self-identified Hispanics (of which only 178 were confirmed by the genetic ancestry) was 45.3% C, 5.3% African, and 14.7% Asian. Interestingly, 46.9% of the Asian population failed to report the racial background. This percentage was lower for C (1.3% ) and AA (0.5%). Women with African ancestry were younger (≤35 yrs) at the time of donation (24%), as compared to the C (32%) and Asian (33.7%) donors. The obesity rate (BMI > 30) is higher in the AA (60.6%) and C (36.6%), as compared to the Asian population (26.6%). Conclusions: A well-characterized genetic background of the normal breast tissue donors in the KTB will allow a more accurate examination of the association of the genetic ancestry with breast cancer events or risk factors with the ultimate goal of more fully understanding breast cancer racial disparities and their possible role in the risks for and outcomes of breast cancer.
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Leader, Amy, Lauren Waldman, Liana Yocavitch, Ayako Shimada, Rebecca Cammy, Gregory D. Garber, and Brooke Worster. "Screening for health literacy at an urban academic cancer center." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e19034-e19034. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e19034.
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e19034 Background: Low health literacy is more prevalent among older adults and minority populations, and it has been linked to excess health care utilization and poor health outcomes in cancer patients. Screening for health literacy may improve communication and care, such that discussions and information can be tailored to patient need. The purpose of this study was to describe health literacy levels and correlates among patients at an urban, NCI-designated cancer center. Methods: In September 2019, we began health literacy screening for each newly diagnosed, English-speaking cancer patient. Patients were categorized as having low, medium, or high health literacy using the BRIEF health literacy screener; results are visible in the EMR. For this analysis, we included patient age, gender, insurance type, race/ethnicity, and socio-economic status (SES), which was calculated using an Area Deprivation Index (ADI) ranging from 0 (no deprivation) to 100 (extreme deprivation). Data was summarized using descriptive statistics; ANOVA and Chi-squared tests investigated associations between patient’s health literacy levels and potential correlates. Results: Among 284 patients, 68%, (n = 195) were Caucasian, 25% (n = 70) were African American and 7%, (n = 19) identified as Hispanic, Asian American or some other race. Seventy-five percent (n = 211) were male; the mean age was 63 years (SD: 12). The mean ADI was 42 (SD: 28), indicating a low to moderate SES. Seventy percent (n = 200) had a high health literacy score, 20% (n = 57) had a medium score, and 10% (n = 27) had a low health literacy score. Only a patient’s race/ethnicity and the ADI were significantly associated with their health literacy score. Seventy-seven percent of Caucasian patients had high health literacy scores compared to 59% of African American patients and 48% patients of Hispanic, Asian or some other origin (P < .001). Patients with low health literacy had an ADI score (65.1) that was almost double the score of patients with high health literacy scores (38.5) (p < .001). Conclusions: Roughly one-third of patients seen at this urban cancer center did not have a high health literacy score. Socio-economic status was a stronger correlate to health literacy than patient age, marital status, or insurance type. EMRs should capture a patient’s SES in some manner, as this is strongly associated with health literacy.
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Wandiga, Steve, Janet Agaya, Ouma S. Gurrion, Ochieng Albert Okumu, Grace Kiringa, Juliana Otieno, Geoffrey Mwai, Videlis Nduba, and Stephen Munga. "PO 8446 COLLABORATIVE TUBERCULOSIS RESEARCH AGENDA AT KEMRI CENTER FOR GLOBAL HEALTH RESEARCH, KISUMU, KENYA." BMJ Global Health 4, Suppl 3 (April 2019): A38.2—A38. http://dx.doi.org/10.1136/bmjgh-2019-edc.100.
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BackgroundDeveloping countries grapple with inadequate funding amidst high burden of diseases. Africa is home to 9 of the 22 countries with a high tuberculosis (TB) burden and to 29 of the 41 countries with a high TB-HIV burden. Kenya is among the high TB and high TB-HIV burden countries. The Western Kenya region has the highest burden of TB and HIV. North-South partnerships are pivotal in ameliorating funding gaps in clinical research.MethodsWhile optimising existing infrastructure and organising programme support (i.e sensitisation and awareness creation, leading to study participant recruitment), from 2005 to date we conducted with multiple North-South collaborators capacity strengthening, TB prevalence survey, observational studies, operational research, and vaccine and drug trials.ResultsTB prevalence survey showed 600 cases per 100,000 population, TB epidemiological studies among adolescents and infants yielded 680 and 900/100,000 population respectively while 2 TB vaccine trials among infants and adults were conducted in Siaya. Three TB drug trials and a TB patient observational cum bio-bank study were concluded in Kisumu. KEMRI TB laboratory was upgraded from BSL2 to BSL3, was ISO-accredited in 2013, renewed in 2015 and 2017 and supports TB programme health facilities with retreatment specimens, supervision and mentorship. Over 25 operational TB studies grouped into community and case detection (increasing case detection), diagnostic and molecular (new diagnostic methods) and epidemiology studies (testing and monitoring cohorts for epidemiological questions) were implemented. Five PhDs, 9 Master’s, 2 Postgraduate Diplomas, 6 Bachelor’s degrees and 10 Diplomas have been supported. Siaya clinical research center was built while in Kisumu an adolescent clinic was constructed. This work involved 18 northern and 26 southern partners. Over 35 publications have been published out of these collaborations.ConclusionNorth-South collaborations provided funding, expertise and resources to harness research capacity of KEMRI; hence the need to foster a global networking culture.
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BINKA, FRED N., PIERRE NGOM, JAMES F. PHILLIPS, KUBAJE ADAZU, and BRUCE B. MacLEOD. "ASSESSING POPULATION DYNAMICS IN A RURAL AFRICAN SOCIETY: THE NAVRONGO DEMOGRAPHIC SURVEILLANCE SYSTEM." Journal of Biosocial Science 31, no. 3 (July 1999): 375–91. http://dx.doi.org/10.1017/s0021932099003752.
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In 1993, the Navrongo Health Research Centre launched a new demographic research system for monitoring the impact of health service interventions in a rural district of northern Ghana. The Navrongo Demographic Surveillance System uses automated software generation procedures that greatly simplify the preparation of complex database management systems. This paper reviews the Navrongo model for data collection, as well as features of the Navrongo system that have led to its replication in other health research projects requiring individual-level longitudinal demographic data. Demographic research results for the first 2 years of system operation are indicative of a pretransitional rural society with high fertility, exceedingly high mortality risks, and pronounced seasonal out-migration.
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Sadarangani, Tina, and Holly Dabelko-Schoeny. "Services That Matter for Aging in Place: Research on the Impact and Promise of Adult Day Centers." Innovation in Aging 4, Supplement_1 (December 1, 2020): 617–18. http://dx.doi.org/10.1093/geroni/igaa057.2098.
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Abstract Adult day service centers (ADCs) in the United States are increasingly recognized as an important source of community-based long-term care for older adults. However, awareness, widespread utilization, reimbursements, and access to ADCs have been limited by a lack of evidence on ADCs’ impact. In this interdisciplinary symposium, we explore current research taking place in the realm of adult day services to understand the reach and impact of ADCs. We begin by examining the most current center-level and user-level data from the National Center for Health Statistics, and demonstrate how these data can be used to inform research and policy. We subsequently evaluate survey data from the National Adult Day Services Association that captures clinical data being collected in ADCs (N=250) surrounding users’ clinical outcomes. We then explore the effectiveness of four interventions on ADC users’ health and functional status: board games, cognitive behavioral therapy, aromatherapy and dance. Finally, we examine the association between adult day services use by African American persons with dementia and depressive symptoms in their caregivers. Our findings suggest that ADCs serve a complex population with high rates of poverty and chronic conditions, but ADCs can have a meaningful impact on users’ health and well-being by leveraging innovative programming. We conclude by discussing how standardization of data collection efforts could enable researchers and policymakers to evaluate ADCs’ impact and target funding towards services that maximizes users’ health and well-being.
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Airhihenbuwa, Collins O., and Leandris Liburd. "Eliminating Health Disparities in the African American Population: The Interface of Culture, Gender, and Power." Health Education & Behavior 33, no. 4 (May 31, 2006): 488–501. http://dx.doi.org/10.1177/1090198106287731.
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Since the release of former Secretary Margaret Heckler’s Secretary’s Task Force Report on Black and Minority Health more than two decades ago, excess death from chronic diseases and other conditions between African Americans and Whites have increased. The conclusion of that report emphasized excess death and thus clinical care, paying little attention to the sociocultural environment and its effects on risk of disease. The authors of this article contend that eliminating health disparities between the African American and White populations in the United States requires a focus on improving the social environment of African Americans. They examine the interface of culture, gender, and power and how those are central to analysis of the root causes of health disparities. The REACH 2010 project of the Centers for Disease Control offers examples on how a coalition of community and research organizations can infuse community interventions with informed considerations of culture, gender, and power to eliminate health disparities
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Lawal, Taoreed O., Bassel F. El-Rayes, and Hyun Sik Kim. "Survival outcomes of patients with unresectable hepatocellular carcinoma in a national population-based study: SEER versus tertiary cancer center." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): e14736-e14736. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.e14736.
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e14736 Background: To evaluate long-term survival in patients with unresectable hepatocellular carcinoma (HCC) in large national population-based database and to assess the impact of subspecialized care on similarly matched patients at a tertiary cancer center. Methods: Using the Surveillance, Epidemiology and End Results (SEER) registry, patients diagnosed between 2004 and 2008 with advanced unresectable HCC not amendable to radiation therapy or cancer-directed surgery were extracted. Additionally, similar matched patients receiving drug eluting bead transarterial chemoembolizaton (DEB TACE) for unresectable HCC were included in the study. Demographic, clinical, and procedural data were collected. Patients were stratified based on Contract Health Service Delivery Areas (CHSDA) and the rural- urban continuum. The Kaplan Meier method was used for survival analysis, and survival curves were compared using the log rank test in SPSS. Results: 14,369 patients were studied and demographics were as follows: mean age at time of diagnosis was 63.97 years (SD 12.5); 76.1% were male; 66.7% were Caucasian; 13.3% were African-American; and 19.4% were Asian or American Indian. The overall median observed survival from diagnosis of the 136 patients receiving DEB TACE was significantly higher when compared to the 404 Atlanta patients and the 12,012 SEER patients (median OS = 22 vs 4 vs 4 months respectively, p< 0.05). When compared to CHSDA, the median overall survival for patients receiving DEB TACE was 5 times longer than all other geographical areas (22 months vs 3, 4, 3, 4, and 4 in Alaska, East, Northern Plains, Pacific Coast, and the Southwest, respectively, p<0.05). Metropolitan, urban, and rural areas demonstrated similar survival outcomes and patients receiving DEB TACE had superior survival (22 vs 3-4 months, p<0.05). Conclusions: This study suggests that DEB TACE is viable treatment option that confers significantly beneficial survival results when compared to similar patients nationwide diagnosed with advanced unresectable HCC in the same 5-year time frame regardless of population demographics and health service delivery area.
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Ofili, Elizabeth, Laura Schanberg, Barbara Hutchinson, Felix Sogade, Icilma Fergus, Phillip Duncan, Joe Hargrove, et al. "The Association of Black Cardiologists (ABC) Cardiovascular Implementation Study (CVIS): A Research Registry Integrating Social Determinants to Support Care for Underserved Patients." International Journal of Environmental Research and Public Health 16, no. 9 (May 10, 2019): 1631. http://dx.doi.org/10.3390/ijerph16091631.
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African Americans, other minorities and underserved populations are consistently under- represented in clinical trials. Such underrepresentation results in a gap in the evidence base, and health disparities. The ABC Cardiovascular Implementation Study (CVIS) is a comprehensive prospective cohort registry that integrates social determinants of health. ABC CVIS uses real world clinical practice data to address critical gaps in care by facilitating robust participation of African Americans and other minorities in clinical trials. ABC CVIS will include diverse patients from collaborating ABC member private practices, as well as patients from academic health centers and Federally Qualified Health Centers (FQHCs). This paper describes the rationale and design of the ABC CVIS Registry. The registry will: (1) prospectively collect socio-demographic, clinical and biospecimen data from enrolled adults, adolescents and children with prioritized cardiovascular diseases; (2) Evaluate the safety and clinical outcomes of new therapeutic agents, including post marketing surveillance and pharmacovigilance; (3) Support National Institutes of Health (NIH) and industry sponsored research; (4) Support Quality Measures standards from the Center for Medicare and Medicaid Services (CMS) and Commercial Health Plans. The registry will utilize novel data and technology tools to facilitate mobile health technology application programming interface (API) to health system or practice electronic health records (EHR). Long term, CVIS will become the most comprehensive patient registry for underserved diverse patients with cardiovascular disease (CVD) and co morbid conditions, providing real world data to address health disparities. At least 10,000 patients will be enrolled from 50 sites across the United States.
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Perez Perez, Ariel, Nawid Mohammad Sarwari, Terra Warner, Liqiang Ni, and Danny Landau. "Enrollment disparities in cancer clinical trials: A single institution experience." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e18128-e18128. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e18128.
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e18128 Background: The importance of population heterogeneity in clinical cancer research is universally recognized. This study aims to identify possible disparities in trial participation at UF Health Cancer Center at Orlando Health. Methods: Data on patients’ enrollment, during the period from 01/01/2016 to 12/31/2016, was obtained from our research C-base. We utilized descriptive statistics to characterize the main demographic variables. Pearson's Chi-squared and Z-tests were utilized to compare percentages of enrolled versus not enrolled patients by ethnicity, race and gender. Results: A total of 3704 cases were established as new patients during the study period, of which 369 (10%) were enrolled in cancer research studies (Table). Our analysis showed statistically significant differences in enrollment by racial category (χ2= 95.09, df = 3, p < 0.0000). American Indian (n = 6) and Native Hawaiian (n = 4), were excluded from the analysis due to small sample sizes and no enrollments. In addition we tested with the Z-stat whether the enrollment in each group was different from the population average (p = 0.10). The Caucasian group did not differ from the average (z = 0.3944; p < 0.6933), whereas both the African American (z = -4.2286; p < 0.0001) and the Asian group (z = -2.3102; p < 0.0209) were under enrolled. The Others group was above the average (z = 8.4632; p < 0.0001). There were also differences in enrollment by gender and ethnicity. Females were under enrolled as compared to Males (z = -7.0716; p < 0.0001). The Hispanic group enrollment was significantly below the population average (z = -4.17; p < 0.0001). Conclusions: We found significant differences in the enrollment of minorities in cancer trials in our institution. African Americans, Asians, Hispanics and Females were all under represented. The group labeled as Others requires further attention. [Table: see text]
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Stefan, Daniela Cristina. "Cancer Care in Africa: An Overview of Resources." Journal of Global Oncology 1, no. 1 (October 2015): 30–36. http://dx.doi.org/10.1200/jgo.2015.000406.
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Purpose According to predictions from the International Agency for Research on Cancer, over the next 5 years, the annual number of new cases of cancer in Africa will grow to more than one million. Together with the immense loss in human life, there is a considerable economic setback attached to this number. However, most African nations are far from adequately scaling up their capacity to control cancer. Methods This study reviews the published data on the existing cancer control resources in Africa. It is, to our knowledge, the first combined effort looking at all resources available on the continent regarding cancer care. Results The total number of 102 cancer treatment centers, including general oncology centers, gynecologic oncology or other single-organ malignancy units, and pediatric oncology and palliative care establishments, is not sufficient to cover the increasing needs of the African population affected by cancer. In addition, the continental average total health expenditure per capita amounts to only US$82. Conclusion This review could serve as a starting point for devising realistic solutions meant to improve the prevention and management of malignant disease on the African continent.
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Keedy, V. L., L. Horn, A. Hayes, B. Spencer, G. Garcia, N. Campbell, A. Sandler, D. Carbone, and D. H. Johnson. "Enrollment of lung cancer patients on clinical trials at an NCI comprehensive cancer center." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): 6633. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.6633.
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6633 Background: Enrollment of cancer patients (pt) in clinical trials is considered essential in order to improve cancer care. However, cancer clinical trials participation remains low. Understanding barriers to pt enrollment is necessary to overcome this problem. Previous reports have identified pt age, race, and ethnicity, disease stage, performance status (PS) and relationship with their health care provider as factors that can influence the enrollment of pts in clinical trials. Methods: We conducted a retrospective review of the charts of all lung cancer pts seen in the Thoracic Oncology Clinic at Vanderbilt Ingram Cancer Center between November 2005 and November 2008. A total of 1075 lung cancer pts were seen. Results: 577 charts (of a planned 1075) have been audited to date. Pt demographics: median age = 64 yrs; male = 54%; Caucasian = 92%, African American = 4%, and Asian = 1%; NSCLC = 80%, SCLC = 17%. Male pts were more likely than females to be eligible for a clinical trial (p = 0.056). A study protocol was available for 57% of pts; 52% of pts proved eligible; 36% were entered into a study (11% total population). Significantly more protocols were available for NSCLC pts compared to pts with SCLC (p ≤ 0.001); there was also a non-significant trend towards higher enrollment of eligible NSCLC pts. There was no difference in eligibility between ethnicity; the percentage of eligible pts enrolling on trials was similar between Caucasian & African American pts (46% and 43%); no Asian pts were enrolled. The most common reasons for not enrolling included a preference for treatment closer to home (29%), patient refusal (19%), PS (19%), and co-morbidities (17%). The distance pts traveled was inversely correlated with likelihood of study participation. Conclusions: A total of 11% of lung cancer pt evaluated in our Thoracic Oncology Clinic were enrolled in clinical trials. Our data suggest additional strategies are needed to attract minority groups, increase enrollment of women and pts with comorbidities and poor PS. Travel distances influence pt willingness to participate in clinical trials. Strategies are needed to overcome this factor. No significant financial relationships to disclose.
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Akinyemi, Rufus O., and Olaleye A. Adeniji. "Stroke Care Services in Africa: A Systematic Review." Journal of Stroke Medicine 1, no. 1 (June 2018): 55–64. http://dx.doi.org/10.1177/2516608518775233.
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Background: Stroke is the second leading cause of death and adult-onset disability globally. Although its incidence is reducing in developed countries, low- and middle-income countries, especially African countries, are witnessing an increase in cases of stroke, leading to high morbidity and mortality. Evidently, a new paradigm is needed on the continent to tackle this growing burden of stroke in its preventative and treatment aspects. Aims and Objectives: The aim of this study was to determine the scope of stroke care services, where they exist, and their relationship with currently existing health systems. Methods: A detailed literature search was undertaken referring to PubMed and Google Scholar for articles from January 1960 to March 2018, using a range of search terms. Of 93 publications, 45 papers were shortlisted, and 21 reviewed articles on existing stroke services were included. Results: The literature on models of stroke services in Africa is sparse. We identified focused systems of care delivery in the hyperacute, acute, and rehabilitative phases of stroke in a few African countries. There is a continent-wide paucity of data on the organization of prehospital stroke services. Only 3 African countries (South Africa, Egypt, and Morocco) reported experiences on thrombolysis. Also, the uptake of dedicated stroke units appears limited across the continent. Encouragingly, there are large-scale secondary prevention models on the continent, mostly within the context of experimental research projects, albeit with promising results. We found only 1 article on the interventional aspects of stroke care in our review, and this was a single-center report. Conclusions: The literature on the organization of stroke services is sparse in Africa. Dedicated action at policy, population, community, and hospital-based levels is urgently needed toward the organization of stroke services to tame the burgeoning burden of stroke on the African continent.
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Lee, Yu-Che, Ko-Yun Chang, and Mehdi Mirsaeidi. "State-Level Health Disparity Is Associated with Sarcoidosis Mortality." Journal of Clinical Medicine 10, no. 11 (May 27, 2021): 2366. http://dx.doi.org/10.3390/jcm10112366.
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Background: Sarcoidosis is associated with significant morbidity and rising health care utilization, which contribute to the health care burden and disease outcome. In the United States (US), evaluation of sarcoidosis mortality by individual states has not been investigated. Methods: We examined sarcoidosis mortality data for 1999–2018 from the Centers for Disease Control and Prevention (CDC). America’s Health Rankings (AHR) assesses the nation’s health on a state-by-state basis to determine state health rankings. The numbers of certified Sarcoidosis Clinics within the US were obtained from World Association for Sarcoidosis and Other Granulomatous Disorders (WASOG) and Foundation for Sarcoidosis Research (FSR). The associations between sarcoidosis mortality and state health disparities were calculated by linear regression analyses. Results: From 1999 to 2018, the mean age-adjusted mortality rate (AAMR) in all populations, African Americans and European Americans were 2.9, 14.8, and 1.4 per 1,000,000 population, respectively. South Carolina had the highest AAMR for all populations (6.6/1,000,000) and African Americans (20.8/1,000,000). Both Utah and Vermont had the highest AAMR for European Americans (2.6/1,000,000). New York State and South Atlantic had the largest numbers of FSR-WASOG Sarcoidosis Clinics (6 and 13, respectively). States with better health rankings were significantly associated with lower AAMR in all population (R2 = 0.170, p = 0.003) but with higher AAMR in European Americans (R2 = 0.223, p < 0.001). Conclusions: There are significant variations in sarcoidosis mortality within the US. Sarcoidosis mortality was strongly associated with state health disparities. The current study suggests sarcoidosis mortality could be an indicator to reflect the state-level health care disparities in the US.
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Kurasz, Andrea M., Glenn E. Smith, Maria G. McFarland, and Melissa J. Armstrong. "Ethnoracial Differences in Lewy Body Diseases with Cognitive Impairment." Journal of Alzheimer's Disease 77, no. 1 (September 1, 2020): 165–74. http://dx.doi.org/10.3233/jad-200395.
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Background: Increasing research focuses on ethnic differences in Alzheimer’s disease, but such efforts in other neurodegenerative dementias are lacking. Currently, data on the ethnic profile of cognitively impaired persons with Lewy body disease (LBD) is limited, despite Lewy body dementia being the second most common neurodegenerative dementia. Objective: The study aimed to investigate presenting characteristics among ethnoracially diverse individuals with cognitive impairment secondary to LBD using the National Alzheimer’s Coordinating Center database. Methods: Participants self-identified as African American, Hispanic, or White. We used Kruskal-Wallis and Pearson χ2 analyses to investigate group differences in presenting characteristics and linear regression to compare neuropsychological test performance. Results: Presentation age was similar between groups (median 74–75 years). Compared to Whites (n = 1782), African Americans (n = 130) and Hispanics (n = 122) were more likely to be female and single, have less educational attainment, report more cardiovascular risk factors, describe less medication use, and perform worse on select cognitive tests. Hispanics reported more depressive symptoms. Conclusion: Cohorts differences highlight the need for population-based LBD studies with racial-ethnic diversity. Culturally-sensitive neuropsychological tests are needed to determine whether observed differences relate to cultural, social, testing, or disease-related factors. More research is needed regarding how social and biological factors impact LBD care among diverse populations.
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Antolinez-Domínguez, Inmaculada, and Esperanza Jorge-Barbuzano. "IZAZOVI U IDENTIFICIRANJU RANJIVOSTI MIGRATNTICA NA JUŽNOJ GRANICI EUROPE: DOPRINOSI IZ BIOGRAFSKIH NARATIVA." Annual of Social Work 28, no. 1 (July 29, 2021): 153–80. http://dx.doi.org/10.3935/ljsr.v28i1.328.
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In the 1980s, the Southern Frontier of Spain became one of the southern borders of the European Union after Spain entered into the European Economic Community (EEC). On the African continent, the Spanish cities of Ceuta and Melilla that border with Morocco are physically separated from Spain by the Mediterranean Sea. Those two cities became a privileged enclave for immigration control, but also for the detection of vulnerable conditions of the migrant population. This paper has a double objective: to describe the action research developed in the Center for the Temporary Residence of Immigrants in Ceuta and to analyze 49 biographical interviews with women residents of the Center within the framework of saidaction research. The results show the diversity of situations of vulnerability in which migrant women can find themselves in this border context. Hence, it is important to rethink the intervention to avoid secondary victimization within critical and humanistic models of intervention. This work, precisely, addresses the design of a tool for biographical narratives from the perspectives of integral health and care.
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Stempel, Jessica M., Vinicius Machado Jorge, Djeneba Audrey Djibo, and Claudia M. Dourado. "Disparities in cancer survival in patients with multiple myeloma: A community-based cancer center experience." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e20530-e20530. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e20530.
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e20530 Background: Multiple myeloma (MM) accounts for nearly 17% of all hematological malignancies and 2% of all cancer-related deaths in 2018. Despite new treatment options, survival disparities among African Americans (AA) and other ethnic minorities still exist. Although cytogenetics and advanced age are high-risk features, equal healthcare access may also impact outcomes. We aim to investigate the social and biological factors which affect overall survival in patients with MM in a community setting with a predominantly AA population. Methods: We retrospectively identified MM cases diagnosed from January 1, 2013 and March 30, 2019, from our tumor registry. We collected demographic, clinical, histopathologic and treatment variables. Our primary endpoint was overall survival (OS). Overall and median survival with 95% confidence intervals were obtained using Kaplan Meier estimates. Results: We identified 73 patients with MM. Median age was 70 years (range, 42-88 years), 31 were female (42%) and 58 were AA (79%). Median household income in the AA group was $37,832 and $50,810 in the non-AA group ( p< 0.05). AA had a median overall survival (OS) of 15.9 months (95% CI, 8.2-23.7) compared to non-AA, 21.9 months (95% CI, 2.1-41.7). After a median follow-up of 20 months, the HR for death in AA was 1.32 (95% CI, 0.71-2.5); p= 0.37. None of the variables investigated were independently associated with an increased risk of mortality. Conclusions: Social determinants of health play a major role in community-based cancer centers, including access to care, income and social support. A difference in household income was found between both groups but was not independently associated with a survival advantage. Although, our results show AA patients with MM have a shorter OS compared to non-AA, this failed to reach statistical significance. The size of our sample limited the discovery of potential discrepancies in social determinants of health between both groups and their effect on outcomes. Larger-scale community-based studies are indispensable to investigate these differences further. [Table: see text]
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Mendez, Kyra, and Hae-Ra Han. "Recruiting Racially and Ethnically Diverse Dementia Family Caregivers for Survey Research." Innovation in Aging 4, Supplement_1 (December 1, 2020): 353. http://dx.doi.org/10.1093/geroni/igaa057.1135.
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Abstract Recruiting racially and ethnically diverse dementia family caregivers (FCGs) for research can be challenging. The purposes of this presentation are to describe methods of successfully recruiting racially and ethnically diverse dementia FCGs for survey research and to share lessons learned. This study aimed to recruit dementia FCGs who have a chronic health condition and access to a mobile device. FCGs were primarily recruited from the Baltimore-Washington Metropolitan area to complete an online or phone survey about their technology use. A variety of recruitment methods were used including: posting ads in a local newspaper targeting older adults, partnering with a local Alzheimer’s research center and memory treatment center, attending community events, using online research registries, and posting online advertisements. The most successful method of recruiting minorities was by attending community events for caregivers and talking directly with community members about the research study. Online recruitment methods were less successful, but yielded the greatest diversity of participants, including Asian, Native American, mixed race, and African American FCGs. Some challenges associated with recruiting minority FCGs were working with primarily immigrant communities; recruiting FCGs who do not speak English; and building trust among communities that have been negatively impacted by research. Suggestions for future research include using recruitment strategies that enable researchers to build rapport with FCGs, engaging community stakeholders to understand your source population, and using a variety of recruitment methods. Also, online recruiting through credible sources appears to be a somewhat feasible method of recruiting diverse FCGs for survey research.
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Geisler, Amaris, Dulce M. Barrios M.S, Sarah J. Noor, and Mario E. Lacouture. "Checkpoint inhibitor treatment-related cutaneous adverse events in skin of color patients at Memorial Sloan Kettering Cancer Center." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): 3076. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.3076.
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3076 Background: The advent of immune checkpoint inhibitors (CPIs) for the management of advanced malignancies has led to unintended consequences of nonspecific immune activation. Cutaneous immune related adverse events (irCAEs) are the most common and first to manifest, on average within 3.6 weeks of treatment initiation. irCAEs may require CPI treatment dose reduction or discontinuation and negatively impact patient quality of life. There is substantial variability in the reporting of these toxicities and inadequate reporting in skin of color patients (SOC), who are often underrepresented in oncology clinical trials. The purpose of this study is to characterize irCAEs in SOC cancer patients. Methods: A single center retrospective analysis of electronic medical records from 2009-2020 was conducted. SOC was defined as African American, Hispanic, Native American/Pacific Islander, or Asian. irCAEs were graded using the Common Terminology Criteria for Adverse Events (CTCAE) v5.0. Results: Of 1459 SOC patients that presented to our institution and received CPIs during the study period, 175 (12%) presented to dermatology for irCAEs [African American (56, 32%); Asian (98, 56%); Hispanic (20,11%); Native American (1, 0.5%)]. Patients’ toxicities were stratified by CPI mechanism: anti-PD-1/L1 (139, 79%), combination of anti-PD-1/L1 plus anti-CTLA-4 (29, 17%), and anti-CTLA-4 therapy (7, 4%). Of 376 irCAEs, pruritus (62, 16%), xerosis (42, 11%), maculopapular rash (40, 11%), and cutaneous hyperpigmentation (36, 10%) were most frequently diagnosed. There were 86 (23%) grade 1, 93 (25%) grade 2, and 18 (5%) grade 3 events. Average time from CPI-treatment initiation to irCAE onset was 6.5 months (SD 7.9). Fifteen (9%) patients required CPI dose reduction or discontinuation due to skin toxicity. Topical corticosteroids (133, 76%) were the most frequently used treatment for all irCAEs. Conclusions: Our findings suggest that irCAEs occur frequently in SOC cancer patients. Furthermore, a 6.5-month delay in time to diagnosis highlights a need for increased surveillance of these cutaneous toxicities in darkly pigmented skin. Generally, SOC patients present unique diagnostic and management challenges due to differences in skin biology and propensity toward hyperpigmentation; however, in SOC cancer patients, the mechanisms of oncologic immunotherapy must be considered in developing successful treatment strategies and management of dermatologic health in this population.
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Hussain, S., D. Quispe, D. Quispe, C. Herrington, R. Shi, and A. Sun. "Obesity at diagnosis increases relapse rate and shortens time to relapse in breast cancer patients." Journal of Clinical Oncology 25, no. 18_suppl (June 20, 2007): 21123. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.21123.
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21123 Objective: Breast cancer is the most common cancer in US women. One in eight women will develop breast cancer in their lifetime. Obesity, one of the 10 leading US health indicators, is associated with breast cancer risk and outcome in various studies. Louisiana is one of the three states with obesity prevalence above 30%. Feist-Weiller Cancer Center (FWCC) in Shreveport serves a large area of Louisiana as far as Baton Rouge. There is a large population of African American patients who are followed in FWCC. The objective of this study is to examine the association of obesity with breast cancer in our patient population. Study Design: A retrospective study from single institution. Medical records of the breast cancer patients in FWCC electronic data management system are reviewed. National Institutes of Health criteria are used to stratify patients: normal or underweight (NW, body mass index or BMI < 25kg/m2, overweight (OW, BMI 25–29.9), and obese (OB, BMI > = 30). Relapse and time to relapsed are compared among three groups. Result: In analysis using multivariant Cox proportional regression model, BMI at diagnosis is a statistical significant predictor of time to relapse. In univariant analysis, increased BMI at diagnosis is associated with 3.3% risk of disease relapse per year. The results demonstrates a positive association of obesity and disease course in breast cancer patients treated at FWCC. No significant financial relationships to disclose.
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Cullen, Jennifer, Nathan Oehrlein, Samantha Streicher, Huai-Ching Kuo, Yongmei Chen, Kevin R. Rice, Grace L. Lu-Yao, and Inger L. Rosner. "Longitudinal prostate cancer outcomes in a racially diverse cohort of military heath care beneficiaries: 1990-2017." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e16581-e16581. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e16581.
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e16581 Background: Prostate cancer (PCa) incidence and mortality disproportionately burden African American (AA) men compared to Caucasian American (CA) men. An interplay of biological, social, and health care factors is blamed for this disparity. However, a recent multi-center study of the Veterans Affairs population found no differences in cancer progression, disease specific survival, or overall survival for AA versus CA men. This study examines a large, racially diverse military health care beneficiary cohort, enrolled over 25+ years, to examine the roles of race and comorbidity on metastasis-free and overall survival. Methods: The Center for Prostate Disease Research (CPDR) multi-center national database was the source of study subjects. Eligible patients included all men who underwent radical prostatectomy (RP) as primary treatment for PCa between January 1, 1990 to December 31, 2017. Comprehensive demographic, clinical, treatment, and outcomes data were collected on all enrollees. Unadjusted Kaplan-Meier estimation curves and multivariable Cox proportional hazards analysis with adjustment for key clinical and pathologic factors were used to examine BCR-free, metastasis-free, and overall survival as a function of patient self-reported race (AA vs. CA). Results: There were 7,135 eligible men, among whom 22% self-reported as AA. Median age at RP and follow-up were 62 and 6.9 years, respectively. A total of 1521 BCR events, 210 metastasis events, and 879 deaths occurred. Compared to CA men, AA men were younger at diagnosis (59.4 vs. 62.7 years, p < 0.05) with higher median PSA (5.8 vs. 5.5 ng/mL, p < 0.05); however, NCCN risk strata, as well as clinical and pathologic stage and grade were distributed comparably across race. Despite slightly poorer BCR-free survival for AA men in both unadjusted and adjusted analysis, there were no statistically significant differences in 5-, 10-, and 15-year probabilities for metastasis-free or overall survival. Conclusions: In this racially diverse equal-access health care setting, this longitudinal cohort study revealed no differences in distant metastasis or overall survival between AA and CA men. Future work will examine molecular signatures of metastatic cancer.
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Gillespie, Theresa Wicklin, John Petros, Michael Goodman, Joseph Lipscomb, Laura Britan, Jessica Lauren Rowell, Lindsey Allison Herrel, and Katharina V. Echt. "Factors impacting decision by African American and underserved populations to choose active surveillance in early-stage prostate cancer." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): 5067. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.5067.
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5067 Background: African-American (AA) men have the highest rates of prostate cancer (PCa) incidence and mortality in the U.S. Screening for PCa with prostate specific antigen (PSA) has allowed detection of early stage disease, but side effects of radical prostatectomy and radiation raise concerns about unfavorable risk:benefit ratios of PSA screening and subsequent therapy. Active surveillance (AS) is an option for early-stage PCa (ESPC), but only 10% of men eligible for AS choose this approach. The 2011 NIH State-of-the-Science Conference promoted the need to enhance decision-making (DM) about AS. In 2012, the U.S. Preventive Services Task Force recommended against PSA screening, while encouraging patient DM. Our study examined DM needs by men (N=204; 68% AA; screening PSA within normal limits) and their significant others (SO) (N=181; 65% AA) regarding AS and other ESPC options. Methods: This multi-center, mixed methods study (N=402; 51% rural) included 5 sites nationwide. Subjects completed quantitative questionnaires prior to focus groups (FG); 54 FG were held, with separate groups for men and SO. Results: After adjusting for education, comorbidities, insurance, age, health literacy, distance to treatment center, willingness to travel, income and numeracy score, AA men were significantly more likely to be influenced by convenience (OR: 2.84, 95% CI: 1.42-5.65) compared to Caucasians. Rural residence, however, did not affect DM. In qualitative analysis, numerous themes were identified relevant to choice of AS: physician treatment discussions being limited to their own specialty; confusion due to conflicting sources of information; convenience; worry about untreated cancer remaining and treatment toxicities; and lack of awareness of AS as an option. SO tended to value cure over avoiding side effects. Conclusions: While the impact of new PCa screening guidelines is uncertain, for AS to become a viable treatment option, providers will need to discuss along with other therapeutic alternatives. SO are influential in DM and may be less enthusiastic about AS than men. For AA men, AS may be a particularly attractive option given the relative influence of convenience in DM.
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Carroll, J., R. Epstein, K. Fiscella, P. Jean-Pierre, C. Figueroa-Moseley, and G. Morrow. "Communication about physical activity in an underserved patient population." Journal of Clinical Oncology 25, no. 18_suppl (June 20, 2007): 17012. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.17012.
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17012 Background: Promoting physical activity may help reduce the incidence of several cancers. The 5A model, used to promote other patient behavior changes in clinical practice, may be applicable to physical activity. Our goal was to determine clinicians’ use of the 5A (Ask, Advise, Agree, Assist, Arrange) guidelines when communicating about physical activity and cancer risk with an underserved patient population. Methods: Analysis of 50 audiotaped transcribed office visits with adult patients and their clinicians in two community health centers in Rochester, NY. We conducted post-visit interviews to assess patient recall of communication about physical activity.We used descriptive statistics to assess patient demographics and the frequency of each of the 5As occurring in the audiotaped visits. Analysis of the transcripts of the visits explored other contextual factors related to use of the 5As for communication about physical activity and cancer risk. Results: Patients were predominantly female (70%) and were African American (50%), Caucasian (35%) and other/mixed ethnicity (15%). In the 50 office visits, there were twelve (24%) Ask, twelve (24%) Advise, three (6%) Agree, two (4%) Assist, and one (2%) Arrange statement. Physical activity communication was mostly (92%) clinician-initiated; the only discussion which included all 5As was patient-initiated. No discussion linked physical activity to cancer risk or cancer prevention. Patients recalling the most communication about physical activity with their clinician reported that it was contextualized to their specific health needs, included support and encouragement, and consisted of clear, simple advice. Conclusions: Communication about physical activity incorporating the Agree and Arrange steps of the 5As was infrequent. Cancer prevention interventions should target these steps and prompt the patient to initiate communication to improve physical activity in underserved populations. This project was supported by a grant from the National Cancer Institute, R25- CA102618. No significant financial relationships to disclose.
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Motsuku, L., E. Chokunonga, M. Sengayi, E. Singh, L. Khoali, and M. Borok. "Strengthening African Population-Based Cancer Registration Through Regional Mentorship: UICC Fellowship Experience at Zimbabwe National Cancer Registry." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 65s. http://dx.doi.org/10.1200/jgo.18.68200.
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Background: South Africa (SA) recently established an urban population-based cancer registry in Ekurhuleni metropolitan district in Gauteng Province. The Ekurhuleni Population-Based Cancer Registry (EPBCR) aims to inform cancer policy and comprehensive cancer control programs. The registry covers 3.5 million residents including public/private, rural/urban patients and a mix of the multiethnic SA population. The first complete year's data will be published in April 2018. It is crucial that high-quality data collected by newly established registries are comparable regionally and globally. The Union for International Cancer Control (UICC) fellowship provides a practical opportunity for South African National Cancer Registry staff to learn from the Zimbabwe National Cancer Registry (ZNCR), a well-established population-based registry in the region. Aim: To enhance the SA EPBCR through observation and application of methods for population-based cancer registration used at the ZNCR. Methods: A desktop review of published and unpublished articles/reports of the ZNCR was conducted. Semi-structured informal interviews were conducted with registry staff to understand data processes from case finding to reporting. Representative data sources were visited to understand case-finding processes. Results: The ZNCR was established in 1985 through a collaborative research agreement between the Ministry of Health (MoH) and International Agency for Research on Cancer (IARC). Its activities are overseen by a 17-member constituted multidisciplinary advisory committee. The registry staff comprise one registrar, one executive assistant (EA) and four health information assistants (HIA). The process of ensuring quality data are guided by the African Cancer Registry Network and the International Association of Cancer Registries standards for population-based cancer registries. The ZNCR uses a combination of active and passive case-finding methods where HIAs have unrestricted access to patient information in private and public sectors such as hospitals, pathology laboratories, radiotherapy centers and death registries. HIAs conduct patient interviews for accurate demographics and to complete missing information. Cases are coded according to International Classification of Diseases for Oncology-V3 and Canreg software is used for data entry, quality control and analysis. The hard copies are stored in locked cabinets in offices with restricted access. The data are then used for reporting and research. Conclusion: The support of government, commitment of advisory committee volunteers, highly trained and experienced staff are key elements behind the success of ZNCR. Strict adherence to international practices for population-based cancer registration has enabled ZNCR to produce high-quality data for research and cancer programs. The processes used by ZNCR will be customised and implemented at EPBCR.
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Dickstein, R. J., J. E. Kreshover, J. C. Milose, and G. A. Gignac. "Metastatic prostate cancer at diagnosis: Clinical presentation in the post-PSA era." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): e16159-e16159. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e16159.
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e16159 Background: Prostate cancer (CaP) has varying biologic behavior. Prostate-specific antigen (PSA) screening dramatically diminished the presentation of patients (pts) with metastatic CaP from 5.6% in 1990 to 1.5% in 2003 as evidenced by the CaPSURE database. Our institution has a uniquely diverse demographic and socioeconomic population and we sought to identify pts with metastatic CaP at diagnosis to evaluate contributing factors. Methods: We retrospectively reviewed all pts charts diagnosed with CaP as identified by ICD-9 code (185) between January 1st 2003 and October 31st 2008 after cross referencing with the term metastatic. Pts progressing from localized disease were excluded. Data was collected on pts initially presenting with metastases. Results: Sixty-one pts presented initially with metastatic CaP at a median age of 68 years old (45 –90) and a median PSA of 92 ng/mL (4.4 –3463). Digital rectal exam was normal in 8 pts (13%) and abnormal in 43 (70%). Median body mass index was 27.2 (16.9 –46.7) with 26 pts (42%) being smokers and 20 (32%) non-smokers. Thirty-six pts (59%) had a Charlson Comorbidity Index score of 0, 10 (16%) a score of 1, 10 (16%) a score of 2, and 5 (8%) a score of ≥ 3. Fifteen pts (24%) were Caucasian, 42 (68%) black [24 (39%) African American, 10 (16%) Caribbean, 8 (13%) African], 1 (1%) Hispanic, 1 (1%) Asian, 1 (1%) Albanian, and 1 (1%) Indian. Presenting symptoms were comprised of 32 pts (52%) with lower urinary tract symptoms including hematuria, urinary retention, and hydronephrosis, 21 (34%) with bone pain, 3 (4%) with neurologic deficits, and 17 (27%) were asymptomatic. Forty-seven pts (77%) underwent prostate biopsy of which 33 (70%) had high grade (Gleason ≥ 8) tumor. Conclusions: CaP initially presenting as metastatic disease is a rare event in the post-PSA era, but may result from lacking primary health care screening, poor patient compliance, or inherent predisposing factors of tumor biology. Our analysis identifies a predominantly non-Caucasian population of patients, contrasting the CaPSURE database, who are otherwise healthy. We plan on performing comprehensive analyses on all patients with metastatic CaP at Boston Medical Center. No significant financial relationships to disclose.
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Fiala, Mark A., Sikander Ailawadhi, Mark A. Schroeder, Keith Stockerl-Goldstein, Ravi Vij, and Tanya Marya Wildes. "Racial disparities in NCI Cancer Center (NCI-CC) care for multiple myeloma (MM)." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): e18061-e18061. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.e18061.
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e18061 Background: Despite a favorable genetic profile, African-Americans (AAs) with mm have poorer outcomes secondary to inferior treatment. NCI-CCs provide the highest-quality of care and attendance has been associated with better outcomes in many cancers. AAs have greater access to NCI-CCs proximally; however, they attend these facilities at lower rates than their white peers. The impact of attendance at NCI-CCs on mediating racial disparities in mm outcomes has not been reported on to date. Methods: We reviewed cases of mm the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database from 2000-2011 who were enrolled in Medicare Part A and B > 1 year prior to diagnosis, excluding cases enrolled prior to age 65 and those where mm diagnosis occurred post-mortem. Any center designated a NCI-clinical or -comprehensive center in 2002, 2005, or 2010 was considered a NCI-CC; attendance was defined as 2 or more claims on separate dates (MEDPAR and Outpatient files) from a NCI-CC in the 12 months following mm diagnosis. Logistic regression was performed to determine if race was associated with attendance, Cox regression to determine the association of attendance with survival. Results: 21,843 cases were analyzed; the median age was 77 years; 80% were white, 15% AA/Black. Overall NCI-CC attendance was low, only 11% of the population. Compared to white patients, black patients had a 13% decreased odds (aOR 0.87, 95% CI 0.75-0.99) of NCI-CC attendance after controlling for age, gender, socioeconomic status, geographic, and overall health variables. Attendance was associated with a 28% decrease risk for death (aHR 0.72, 95% CI 0.68-0.76), but had little impact on black-white outcome disparities. Black patients had a 9% increase in risk (aHR 1.09, 95% CI 1.04-1.13) after controlling for NCI-CC attendance. Conclusions: Black patients with mm have lower NCI-CC attendance. This may be related to referral bias and/or patient declining referral. NCI-CC attendance was associated with superior outcomes; however, controlling for attendance did not mediate black-white outcome disparities suggesting that racial treatment disparities pervade beyond access to NCI-CCs.
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Margolis, Rachel H. F., Melissa H. Bellin, Mona Tsoukleris, Jay Unick, Joan E. Kub, and Arlene M. Butz. "Relationship between Caregiver Depressive Symptoms and Child Asthma Medication Adherence: A Multilevel Analysis." Social Work Research 44, no. 3 (September 2020): 196–203. http://dx.doi.org/10.1093/swr/svaa010.
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Abstract Asthma morbidity and mortality are disproportionately higher among African American children. Medication adherence is essential for reducing adverse asthma outcomes in this population. Depressive symptoms, prevalent among mothers of children with asthma, have been linked to medication nonadherence. This longitudinal, multilevel analysis used data from a randomized clinical trial evaluating the efficacy of an environmental control educational intervention to evaluate the relationship between caregiver depressive symptoms (Center for Epidemiologic Studies Depression Scale) and caregiver-reported medication adherence (Medication Adherence Report Scale) in urban African American children with uncontrolled asthma (N = 208) at baseline, in six months, and in 12 months. Nearly a third (31.7%) of caregivers (97% female) had clinically significant depressive symptoms at baseline. A random intercept model showed that the within-caregiver effect of depression predicted lower medication adherence (β = –.079, p = .002) as did time (β = –.413, p < .001); the between-caregiver effect of depression did not (β = –.007, p = .77). Changes in a caregiver’s baseline level of depressive symptoms appear to have a stronger influence on medication adherence than mean level of depressive symptoms. Policy, practice, and further research should address maternal mental health as a key element in the life course of African American children with asthma.
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Gardner, Daniel S., and Nancy Giunta. "MOBILIZING COMMUNITY PARTNERSHIPS TO ENHANCE HEALTH AND REDUCE INEQUITIES IN MULTICULTURAL COMMUNITIES." Innovation in Aging 3, Supplement_1 (November 2019): S746. http://dx.doi.org/10.1093/geroni/igz038.2733.
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Abstract Community-based gerontological research plays an indispensable role in identifying and addressing the strengths, intersectionalities, and socio-structural inequities that shape the lives of older adults in multicultural communities around the world. This symposium highlights the innovative, global scholarship of Silberman Aging: A Hartford Center of Excellence in Diverse Aging, as the Center begins its sixth year. Through community-based research and academic-community collaborations, Center researchers examine challenges affecting the health and wellbeing of diverse and often marginalized aging communities in North America, West Africa, and East Asia. The first paper describes and evaluates a CBPR project that trains community-based natural helping networks to identify and refer older adults with dementia in East Harlem, NY. The second study explores the perceptions and strategies of community-based primary care physicians in Ulaanbaatar, Mongolia in dealing with elder abuse and neglect. The third takes a population health approach to the relationship between social capital and health among older adults in Ghana. Fourth, preliminary results from an evaluation of a nation-wide training initiative that promotes cultural-competencies among aging services providers working with LGBT elders. Finally, we present findings from a CBPR study examining barriers to palliative care among racially and ethnically-diverse community-dwelling older adults with serious illness. Although substantively and methodologically varied, these studies all demonstrate the importance of social networks in health in later life, and underscore the value of community-based research that supports collaboration, empowers communities, and ultimately transforms practice and policy to better meet the diverse needs of older adults around the globe.
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Parry, Charles, Andreas Plüddemann, and Arvin Bhana. "Monitoring Alcohol and Drug Abuse Trends in South Africa (1996–2006): Reflections on Treatment Demand Trends." Contemporary Drug Problems 36, no. 3-4 (September 2009): 685–703. http://dx.doi.org/10.1177/009145090903600319.
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This article describes the South African Community Epidemiology Network on Drug Use project, describes selected trends in treatment demand related to alcohol and other drug (AOD) use for a 10 year period, and reflects on the utility and impact of this initiative on policy and practice. Data are collected using a standardized data collection form from over 70 specialist AOD treatment centers in six sentinel sites in South Africa every 6 months. Data are also collected from police forensic records and community surveys. Treatment demand linked to methamphetamine use has increased substantially in recent years in one site (Cape Town), but not in other sites. Treatment demand for heroin-related problems has increased over time in most sites, with changes in the population group profile of patients being noted. Over time the proportion of adolescents admitted to treatment centers has also increased significantly. The project has informed policy development at provincial and national levels, has guided local training and resource allocation decisions, and has allowed us to engage meaningfully in international forums. It has furthermore strengthened collaboration among researchers and stimulated new research initiatives. Dissemination activities have been intensive.
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McSweeney, Jean, David Robinson, Anthony McGuire, Pamela Christie, Sandra Hatley, Martha Rojo, and Laura James. "2025." Journal of Clinical and Translational Science 1, S1 (September 2017): 67–68. http://dx.doi.org/10.1017/cts.2017.240.
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OBJECTIVES/SPECIFIC AIMS: To establish a state-wide research registry of diverse participants. METHODS/STUDY POPULATION: We garnered broad institutional and community support by involving TRI’s Community Engagement team, its Community Advisory Board (CAB), and 3 UAMS patient CABs in selecting Web site content, images, and colors. Using this feedback, the TRI Recruitment Unit (RU), in conjunction with UAMS Communications and the Center for Health Literacy, developed the materials and crafted comprehensive communication and recruitment strategies. The UAMS Center for Pacific Islander Health, Hispanic faculty, and CAB members translated materials. UAMS IT programmed the user-friendly site to allow registration from smartphones and i-Pads and linked to UAMS patient electronic health messages. RESULTS/ANTICIPATED RESULTS: The RU committee implemented successful innovative strategies, including recruiting at the Arkansas State Fair and ballgames, attended by people of all races, ages, and socio-economic levels. Using i-Pads at the sites, recruitment took <5 minutes/registrant. Within 8 months, >2400 participants from across Arkansas had joined the registry: 14% African-Americans, 8% Pacific Islanders, 5% Hispanic, and 3% Native American. DISCUSSION/SIGNIFICANCE OF IMPACT: Involving CAB multidisciplinary input to design and implement recruitment materials was highly successful. Despite challenges of recruiting under-represented groups, the registry includes 30% minorities. By tracking registrants’ demographics with Lime Survey software, the RU will prioritize future recruitment events to maximize diversity of registrants.
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Moss, Karen O., Anyah Prasad, and Fayron Epps. "ESPO/HEALTH SCIENCES: STRENGTH IN NUMBERS: LEVERAGING THE POWER OF NETWORKS FOR RECRUITING OLDER ADULTS AND CAREGIVERS." Innovation in Aging 3, Supplement_1 (November 2019): S591—S592. http://dx.doi.org/10.1093/geroni/igz038.2196.
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Abstract Recruitment of older adults and/or their family caregivers for participation in research is challenging. This process is further complicated by population or procedure-specific factors that can impede recruitment efforts. The purpose of this symposium is to describe various recruitment challenges and solutions as well as strategies used to engage older adults and family caregivers in research. Dr. Glenna Brewster will present recruitment strategies used for a multisite telehealth intervention for caregivers of persons living with dementia. Dr. Todd Monroe will examine barriers and solutions for recruitment and retention of persons with Alzheimer’s disease for neuroimaging studies. Dr. Karen Moss will share strategies used to recruit family caregivers of African American older adults with dementia for end-of-life research. Dr. Shiva Prasad will share strategies to recruit LGBT older adults to a study on exploring the idea of an LGBT online senior center, and Dr. Karen Rose will describe stigma associated with recruiting persons with Alzheimer’s disease and other dementias, and their family caregivers, including best practices from the literature coupled with lessons learned from experiences. Shared strategies and solutions will assist researchers in identifying and addressing recruitment challenges and help to ensure recruitment of diverse groups of older adults and/or family caregivers for studies that use various research methodologies, including leveraging the power of professional and community-based networks. Increasing research participation will yield the knowledge necessary for improving health outcomes for older adults and their family caregivers living with serious chronic illnesses such as Alzheimer’s disease and related dementias.
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Landgren, Ola, Susan Devesa, Pamela Mink, William F. Anderson, Brendan Weiss, Sigurdur Y. Kristinsson, and Katherine McGlynn. "African-American Multiple Myeloma Patients Have a Better Survival Than Caucasian Patients: a Population-Based Study Including 28,636 Patients." Blood 114, no. 22 (November 20, 2009): 1832. http://dx.doi.org/10.1182/blood.v114.22.1832.1832.
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Abstract Abstract 1832 Poster Board I-858 Background Multiple myeloma is the most common hematologic malignancy in African-Americans with twice the incidence of Caucasians. Prior single center studies have reported poorer survival among African-American multiple myeloma patients. In contrast, recent data based on multiple myeloma patients who received autologous transplantation in an equal access health care system, showed comparable survival between African-Americans and Caucasians, suggesting that the reportedly poorer outcome for African-Americans may be due to inequalities in access to care. Also, based on publicly available cancer registry data, several publications have reported excess mortality rates for African-American multiple myeloma patients. We conducted a large population-based study including almost 30,000 multiple myeloma patients to evaluate survival patterns by race. Methods. Patient information was obtained from the Surveillance, Epidemiology and End Results (SEER) cancer registries of the National Cancer Institute. Data were drawn from the original nine SEER registries (Atlanta, Connecticut, Detroit, Hawaii, Iowa, New Mexico, San Francisco-Oakland, Seattle-Puget Sound, and Utah), which collectively cover approximately 10% of the U.S. population. Using the SEER*Stat statistical software package, we calculated 1-, 5-, and 10-year relative survival rates (RSR) of multiple myeloma patients diagnosed 1973-2004. We applied four calendar periods (1973-1979, 1980-1986, 1987-1993, and 1994-2004), follow-up through 2005 was included, and age at diagnosis was grouped into three strata (<50, 50-64, and 65+ years). Results We identified a total of 28,636 multiple myeloma patients (4,855 African-American; 23,781 Caucasian); 64% were 65 years or greater at diagnosis. When we included all patients, a comparison of survival rates in African-American and Caucasian males showed that African-American males had significantly better 5-year (32.2% vs. 28.7%) and 10-year (16.4% vs. 11.5%) RSRs (p<0.05). Similarly, African-American females had significantly better 1-year (73.3% vs. 70.2%) and 5-year (31.1% vs. 27.7%) RSRs than Caucasian females (p<0.05). When we examined survival patterns by calendar period (between 1973-1979 and 1994-2004), we found Caucasian patients to have significant improvements in the 1-year (from 67.1 to 72.4%), 5-year (from 24.1% to 31.7%), and 10-year RSR (from 9.9% to 14.9%). African-Americans also showed significantly improved 1-year RSRs (from 68.5% in 1973-1979 to 74.9% in 1994-2004) but the improvements in 5- and 10-year RSRs were not significant. When we examined survival patterns by age group, in the youngest age group (<50 years), both African-Americans and Caucasians improved 5- and 10-year RSRs, while 1-year RSR was improved for Caucasians only (from 80.9% to 84.9%). For patients 50-64 years, Caucasians had significantly improved 1-, 5-, and 10-year RSR; for African-Americans only 1-year RSR improvement was significant. Among patients 65+, there was no significant improved survival for African-Americans while Caucasians had improved 1-year (from 61.4% to 66.9%) and 5-year (from 19.6% to 24.7%) RSRs. Conclusions This large study of almost 30,000 patients found African-American multiple myeloma patients to have a significantly better prognosis than Caucasian patients, suggesting there is disease heterogeneity by race. After the introduction of newer therapies (autologous transplant, IMiDs, and bortezomib), Caucasian multiple myeloma patients showed a more pronounced survival benefit which might reflect inequalities in access to modern care; however, still African-Americans showed similar/better survival compared to Caucasians. Clinicians should be aware that the excess mortality rates for multiple myeloma among African-Americans, to a major degree, is a reflection of the fact that multiple myeloma is 2- to 3-fold more common among African-Americans. Future studies are needed to improve our understanding of the molecular basis for racial disparity patterns in multiple myeloma. Ultimately, such efforts will facilitate an improved understanding regarding disease subtype-specific benefits for individual agents, as well as mechanistic insights into drug sensitivity and resistance. Disclosures Weiss: The Binding Site, Inc.: Research Funding.
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Rubagumya, Fidel, Ainhoa Costas-Chavarri, Achille Manirakiza, Gad Murenzi, Francois Uwinkindi, Christian Ntizimira, Ivan Rukundo, et al. "State of Cancer Control in Rwanda: Past, Present, and Future Opportunities." JCO Global Oncology, no. 6 (September 2020): 1171–77. http://dx.doi.org/10.1200/go.20.00281.
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Rwanda is a densely populated low-income country in East Africa. Previously considered a failed state after the genocide against the Tutsi in 1994, Rwanda has seen remarkable growth over the past 2 decades. Health care in Rwanda is predominantly delivered through public hospitals and is emerging in the private sector. More than 80% of patients are covered by community-based health insurance (Mutuelle de Santé). The cancer unit at the Rwanda Biomedical Center (a branch of the Ministry of Health) is responsible for setting and implementing cancer care policy. Rwanda has made progress with human papillomavirus (HPV) and hepatitis B vaccination. Recently, the cancer unit at the Rwanda Biomedical Center launched the country’s 5-year National Cancer Control Plan. Over the past decade, patients with cancer have been able to receive chemotherapy at Butaro Cancer Center, and recently, the Rwanda Cancer Center was launched with 2 linear accelerator radiotherapy machines, which greatly reduced the number of referrals for treatment abroad. Palliative care services are increasing in Rwanda. A cancer registry has now been strengthened, and more clinicians are becoming active in cancer research. Despite these advances, there is still substantial work to be done and there are many outstanding challenges, including the need to build capacity in cancer awareness among the general population (and shift toward earlier diagnosis), cancer care workforce (more in-country training programs are needed), and research.
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Gross, Tyra Toston, Marsha Davis, Alex K. Anderson, Jori Hall, and Karen Hilyard. "Long-Term Breastfeeding in African American Mothers." Journal of Human Lactation 33, no. 1 (January 6, 2017): 128–39. http://dx.doi.org/10.1177/0890334416680180.
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Background: According to the Centers for Disease Control and Prevention, 39.1% of African American infants are breastfed at 6 months. However, few studies have explored the breastfeeding experiences of African American women who successfully breastfeed to 6 months or longer durations. Research aim: The goal of this qualitative study was to explore the long-term breastfeeding experiences of low-income African American women using the positive deviance approach. Methods: African American women with breastfeeding experience were recruited through Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) breastfeeding peer counselors. Eligibility criteria included being age 18 or older, currently participating in WIC, and having breastfed one child for at least 6 months in the past 2 years. Semistructured, in-depth interviews were conducted with 11 participants. Interviews were audio-recorded and professionally transcribed. Transcripts were then analyzed for emerging themes using thematic analysis in NVivo software. Results: Participants had on average three children each, with an average length of breastfeeding of 10.5 months per child. Four main themes developed: (a) deciding to breastfeed, (b) initiating breastfeeding, (c) breastfeeding long-term, and (d) expanding breastfeeding support. Participants offered culturally tailored suggestions to improve breastfeeding support for other African American women: prenatal discussions of breastfeeding with health care providers, African American lactation support personnel and breastfeeding support groups, and African American breastfeeding promotion in print and digital media. Conclusion: Women who participated in this study breastfed for longer durations than the national average for African Americans. Findings can inform practice and research efforts to improve breastfeeding rates in this population using lessons learned from successful women.
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Ryan, Michael P. "Introduction: Ethical Responsibilities Regarding Drugs, Patents, and Health." Business Ethics Quarterly 15, no. 4 (October 2005): 543–47. http://dx.doi.org/10.5840/beq200515442.
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HIV/AIDS threatens international health on a scale never before seen in human history. Previous plagues and great epidemics, devastating though they were to imperial China, urbanizing Europe, and the colonizing Americas (McNeill 1998), were regionally contained. More than forty million people worldwide are HIV-positive: about half of them live in sub-Saharan Africa, where it apparently originated and where whole tribes and, indeed, most of the adult population of Botswana may very well die of the disease. (Joint UN/WHO 2004). India has another five million people who are HIV-positive, the largest number outside Africa. AIDS is spreading rapidly in China and devastating Thailand, a regional center for prostitution that spreads it further throughout the Asia-Pacific region. No part of the world is spared. The economic, social, and political impacts of this pandemic have only begun to be felt and to be considered.Modern technological and organizational capacities—jet aircraft and globetrotting business and tourist travelers—turned what would have been, in previous eras, an African regional problem into an international crisis and made AIDS exceedingly difficult to contain. Yet, the human technological and organizational capacity to confront the AIDS pandemic also makes this health crisis different from epidemics in earlier times. Medical science applied by pharmacological research has created drug therapies that can control the disease, that can not only stave off death but make productive life possible for many years. The challenge of AIDS could be met, many in the health community say, if it were not that the life-sustaining drugs are owned by private enterprises (Oxfam 2002). The doctors at Médicins Sans Frontières contend, “Patents are not god-given rights. They are tools invented to benefit society as a whole, not to line the pockets of a handful of multinational pharmaceutical companies” (MSF 2003: 2). “[T]he patent monopoly means that a higher price than necessary has to be paid for patented inventions. This is acceptable if this higher price is merely an inconvenience…. However, if the patented invention is essential (say, if it could prevent your untimely death from disease), then the price is more of a dilemma” (MSF 2003: 5). These and other critics declare that drug makers put profits ahead of people and accuse the governments that grant them patent-intellectual property rights, especially the U.S. government, of contributing to this moral bankruptcy.
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Patel, Poras, Yu Yu Thar, Vadim Zarubin, Daniel Castro, Savitha Nagaraj, Aung Lin, and Elizabeth Guevara. "A comprehensive study comparing smokers and non-smokers with lung cancer in an urban minority population." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): e18087-e18087. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.e18087.
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e18087 Background: Cigarette smoking is strongly associated with lung cancer; however, very few studies have been conducted in the urban minority population comparing various parameters between smokers and non-smokers with lung cancer. We investigated epidemiological profiles, histological subtypes, staging at diagnosis, survival after diagnosis and the quality of life. Methods: This retrospective study included urban minority population diagnosed with primary lung cancer at the Brooklyn Hospital Center between 2005-2016. The study population was divided into two groups based on smoking history and various parameters listed below were compared. The health care quality of life (HcQOL) was assessed using parameters of weight loss, cough/hemoptysis, shortness of breath, pain, opioid use and functional capacity. Results: Of the total 576 patients, 432 met inclusion criteria, who were divided into Group A (GA) - Smokers (n = 341 (78.9%)) and Group B (GB) - Non-Smokers (n = 91 (21.1%)). Majority of our study population were African American (GA 71.8%, GB 65.9%) followed by Hispanics. The prevalence of lung cancer was higher in females (GA 56%, GB 52.7%). Patients diagnosed with lung cancer before age 60 were 48.4% in GA versus 5.5% in GB. SCLC pathology was 20% in GA & 0% in GB; NSCLC pathology was 80% in GA & 100% in GB. At the time of diagnosis, 27% in GA had metastatic stage-4 (0% in GB), and 71.4% in GB had stage-1 (27% in GA) NSCLC. Less than 1 year survival was 15.5% in GA and 2.4% in GB; > 3 years survival was 32.3% in GA and 95.2% in GB. HcQOL measure of weight loss of > 10 pounds, hemoptysis, shortness of breath at rest, uncontrolled pain, opioid dependence and functional capacity < 1 block was 67.6%, 17%, 61.9%, 54.1%, 75.1% and 92.2% respectively in GA and 29.1%, 3.5%, 23.2%, 18.5%, 49.4% and 24.3% respectively in GB. A 6-minute walk test was abnormal in 77% of GA and 39.1% of GB. Conclusions: In comparison to non-smokers, smokers were diagnosed with lung cancer at a younger age, had advanced stages of cancer at the time of diagnosis, higher mortality and increased opioid dependence. Smokers had significantly poor HcQOL, which was supported by abnormal six-minute walk test results. Females had overall increased incidence of lung cancer.
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Pritchett, Natalie R., Gwen Murphy, Arash Etemadi, Stephen L. Burgert, Christian C. Abnet, Sanford M. Dawsey, and Michael M. Mwachiro. "High Urinary Polycyclic Aromatic Hydrocarbon Concentrations in Bomet County, Kenya, a Region With a High Incidence of Esophageal Squamous Cell Carcinoma." Journal of Global Oncology 3, no. 2_suppl (April 2017): 9s. http://dx.doi.org/10.1200/jgo.2017.009464.
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Abstract 43 Background: Polycyclic aromatic hydrocarbons (PAHs) are a group of more than 100 compounds that are formed during incomplete combustion of organic materials, many of which have been classified as known carcinogens. Exposure to PAHs has been suggested as an important risk factor for developing esophageal squamous cell carcinoma (ESCC) in several high-incidence areas, such as China and Iran, but corresponding PAH assessments have not been conducted in East Africa, another ESCC hot spot. To assess the internal uptake of PAH as a result of external exposures, body fluids and tissues can be monitored for PAHs or their metabolites. The primary aim of this study was to quantify the concentration of seven PAH urine metabolites in a cross-section of participants from Bomet, Kenya, an endemic area for ESCC. An additional aim was to assess demographic and lifestyle factors that may be associated with PAH metabolites. Methods: A community-based sample of 294 asymptomatic adults were recruited. Participants collected spot urine specimens and completed a questionnaire. Urine specimens were analyzed at the National Center for Environmental Health at the Centers for Disease Control—the same lab has performed similar analyses on urine samples from the US National Health and Nutrition Examination Survey (NHANES). The seven PAH analytes were hydroxylated metabolites of naphthalene, fluorene, phenanthrene, and pyrene. Median creatinine-adjusted PAH metabolite concentrations (nanogram per gram of creatinine) were compared by all relevant questionnaire items. Results: All seven measured PAH metabolites in the study population were markedly elevated compared with the US population. For example, the median value for 1-hydroxypyrene in Bomet was 1,190 ng/g in males versus 106 ng/g in NHANES, and 2,840 ng/g in females versus 133 ng/g in NHANES. Age (< 50 years), sex (female), and performing indoor cooking were significantly ( P < .01) associated with higher PAH concentrations for all measured metabolites. Regular tobacco use was not reported by many participants (19%) and was not associated with PAH concentrations. Conclusion: PAH metabolite concentrations in Bomet were high compared with the US population. Elevated PAH concentrations were associated with age, sex, and indoor cooking. Additional studies are needed to define the association between high PAH exposure and the risk of developing ESCC as well as to determine the sources of PAH exposure in this high-risk population. Funding: The African Organization for Research and Training in Cancer’s Beginning Investigator Grant for Catalytic Research (BIG Cat) Program, in collaboration with the US National Institutes of Health’s National Cancer Institute, Office of International Affairs. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.
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Shum, Elaine, Christopher Su, Changcheng Zhu, Rasim A. Gucalp, Missak Haigentz, Stuart H. Packer, Cheryl Baker, et al. "PD-L1 expression profile and immunotherapy (IO) experience in African American (AA) and Hispanic (H) lung cancer (LC) patients: Addressing disparities at a minority-based academic cancer center." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): e18073-e18073. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.e18073.
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e18073 Background: Immune checkpoint inhibitors have changed the treatment paradigm for metastatic LC. Minority populations are under-represented in large IO clinical trials. Among 989 pts with newly diagnosed LC at Montefiore Medical Center - a community-based academic center from 2014-2015, 330 (33%) were AA and 195 (20%) were H. In line with practice-changing clinical studies, PD-L1 expression testing and IO have been incorporated into LC treatment. Methods: Pts receiving IO and/or had PD-L1 testing between 1/1/14-12/31/16 were identified from records obtained from pathology, pharmacy, oncology clinics and Clinical Looking Glass. Retrospective chart review was conducted. PD-L1 testing was performed using 22C3pharmDx IHC. Results: We identified 111 pts with LC who received IO and/or had PD-L1 testing, with a median age of 66. 55% were female. Based on race, 52 (47%) were AA, 24 (22%) were White, 26 (24%) were Other, and 9 (8%) were race unknown. Based on ethnicity, 30 (27%) were H, 73 (66%) were non-H and 8 (7%) were ethnicity unknown. 82% were former/current smokers. Adenocarcinoma was the dominant histology (60%). The majority were EGFR WT (91%) and ALK neg (98%). PD-L1 testing was performed in 67 (60%), including 32 (29%) AAs and 20 (18%) Hs. Archival tissue was used in 63%. PD-L1 TPS > 50% was found in 30%, 1-49% in 24%, < 1% in 37%. 62 pts received IO, including 26 (42%) AAs and 18 (29%) Hs. Nivolumab was the most commonly used agent (77%). In AAs, 8 (31%) received IO as 1st line, 13 (50%) as 2nd line, 5 (19%) as 3rd line and above. In Hs, 1 (5%) received IO as 1st line, 10 (56%) as 2nd line, 7 (39%) as 3rd line and above. Immune-related adverse events (IRAEs) were reported in 31% of AAs and 39% of Hs. Data analysis on survival is ongoing. Conclusions: Unlike the low numbers of minority pts in large clinical trials, we found no significant difference in PD-L1 testing and IO across racial and ethnic groups treated at our center. Compared to large clinical trials, we observed lower rates of IRAEs in our cohort. Our current and ongoing observations in these populations may have future implications in narrowing health disparities based on race/ethnicity.
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Gary-Webb, Tiffany L., Elizabeth A. Walker, Lindsey Realmuto, Alexandra Kamler, Jennifer Lukin, William Tyson, Olveen Carrasquillo, and Linda Weiss. "Translation of the National Diabetes Prevention Program to Engage Men in Disadvantaged Neighborhoods in New York City: A Description of Power Up for Health." American Journal of Men's Health 12, no. 4 (March 15, 2018): 998–1006. http://dx.doi.org/10.1177/1557988318758788.
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The Diabetes Prevention Program (DPP) landmark randomized trial demonstrated that participants with prediabetes could reduce their risk for type 2 diabetes by 58% if they achieved 5%–7% weight loss through healthy eating and increasing physical activity. The National DPP (NDPP) is a group intervention based on the DPP and has been widely disseminated by the Centers for Disease Control and Prevention (CDC) and many healthcare institutions. While data show that the program is effective in diverse populations, enrollment among men from low-income and minority communities is low. Thus, the study piloted a novel adaptation focused on men living in disadvantaged neighborhoods. The study approach to adaptation and implementation used characteristics of participatory research, including input from an expert panel of African American and Latino leaders, ongoing consultation with an Advisory Panel, and focus groups with members of the target population. Discussions with these groups focused on male perspectives regarding health promotion and barriers and facilitators to participation in health programming for men. There was general agreement when reviewing ongoing pilot program implementation that the adapted program should have male-only groups with male coaches, as the Advisory Panel had originally suggested. The pilot programs were implemented at five New York City Department of Parks and Recreation sites in Harlem, the Bronx, and Brooklyn in 2015–2016.
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Kohli, Maulika, Elizabeth C. Pasipanodya, Jessica L. Montoya, Maria Marquine, Martin Hoenigl, Vanessa Serrano, Clint Cushman, et al. "A Culturally Adapted SMS Text Messaging Intervention to Promote Antiretroviral Therapy Adherence Among African Americans: Protocol for a Single-Arm Trial." JMIR Research Protocols 9, no. 12 (December 10, 2020): e21592. http://dx.doi.org/10.2196/21592.
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Background African Americans are disproportionally affected by HIV and have poorer rates of antiretroviral therapy (ART) adherence compared to other racial or ethnic groups in the United States. Factors associated with poor HIV disease outcomes are commonly associated with sociostructural barriers that prevent engagement with and retention in HIV care. SMS text messaging interventions to promote ART adherence among predominantly non-Hispanic White persons with HIV (PWH) have been shown to be efficacious; however, limited research has been devoted to culturally tailoring interventions for underrepresented racial/ethnic groups. Considering African Americans show poorer engagement along the HIV care continuum, we developed an individualized and culturally tailored two-way SMS text messaging intervention to improve ART adherence and associated virologic suppression among African American PWH. Objective In this paper we describe the protocol of a culturally tailored individualized Texting for Adherence Building (iTAB) intervention in a 24- to 48-week, single-arm study. Methods We developed a culturally tailored iTAB intervention, which we are implementing in a 24- to 48-week, single-arm study. Participants were recruited from the Family Health Centers of San Diego (FHCSD), a federally qualified health center. Patient inclusion criteria were (1) receiving care at the FHCSD, (2) living with HIV, (3) self-identification as Black, African American, or of African ancestry, (4) English speaking, (5) age 18 or older, (6) currently on ART, and (7) able to provide informed consent. Study enrollment began in November 2017 and closed in July 2019. A total of 90 participants from the FHCSD enrolled in the iTAB intervention, and we anticipate completing data collection in July 2020. Participants were assisted in individualizing and customizing their SMS text message preferences at the baseline study visit. Self-assessment measures are collected at baseline, interim, and final study visits. Problems related to sending/receiving SMS text messages and barriers to ART adherence are assessed at each interim study visit. The FHCSD staff monitors and tracks participants’ daily SMS text message responses to ART adherence reminders using a clinical dashboard. Results We hypothesize that the proportion of individuals achieving HIV virologic suppression (viral load <40 copies/mL) will be greater at the end of the intervention period compared to the proportion prior to study implementation. Additionally, we anticipate that rates of virologic suppression at the end of the intervention among participants receiving iTAB will be comparable to those among the general FHCSD non-African American population who did not receive iTAB. Finally, we anticipate a high response rate to iTAB SMS text messages as well as positive participant feedback at the end of the intervention with regard to the acceptability of, satisfaction with, and perceived efficacy of iTAB. Conclusions The iTAB intervention is a novel individualized two-way SMS text messaging intervention that has been culturally tailored for use among African Americans with HIV. We anticipate that iTAB will demonstrate efficacy in future randomized control trials and will be supportive of medication adherence among other populations facing health disparities. International Registered Report Identifier (IRRID) DERR1-10.2196/21592
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Rocco, Nicholas R., Michael G. Santomauro, Audry H. Robertson, Huai-Ching Kuo, Timothy C. Brand, Yongmei Chen, John E. Musser, et al. "27-year patterns in high-risk prostate cancer treatment in a racially diverse, equal-access health care setting." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e16583-e16583. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e16583.
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e16583 Background: Despite the significant stage migration of prostate cancer (CaP), a large proportion of patients harbor high-risk disease. Few CaP series provide long term outcomes with the ability to assess disparities in diverse populations. We examined 27-year outcomes among men treated for high risk CaP in a large, racially diverse, equal access system. Methods: A retrospective cohort study was conducted of patients enrolled into the Center for Prostate Disease Research (CPDR) Multi-Center National Database from 1990-2017. There were 2,241 CaP patients who were NCCN-defined high risk, had a self-reported race of Caucasian (CA) or African American (AA), and had a primary treatment of hormonal therapy (HT), radical prostatectomy (RP), radiation therapy (RT) or no treatment (NoTX). Demographic and clinico-pathological variables were evaluated and stratified by race and treatment. Primary study outcomes included temporal patterns in race-specific treatment intensity and type(s). Secondary outcomes included biochemical recurrence (BCR)-free survival (BRFS) and distant metastasis-free survival (DMFS). Unadjusted Kaplan-Meier estimation curves and multivariable Cox proportional hazards analysis were used. Results: Mean patient age at CaP diagnosis and follow-up time were 68.1 years and 7.8 years, respectively. AAs made up 26.9% of the study cohort. Median prostate specific antigen level was 20.9 ng/mL (IQR: 7.8 - 35.0). 52% of patients had a biopsy Gleason score of 8 or greater. 714 (31.9%) underwent RP, 966 (43.1%) underwent RT, 288 (12.9%) received primary HT, and 273 (12.2%) had NoTX. A decreasing trend of HT, with stable rates of RP and RT, was observed. Median time to BCR after RP and RT was 1.3 and 3.1 years, respectively. After RP and RT, 51.2% and 39.3% experienced BCR while 10.9% and 12.7% experienced distant metastasis, respectively. There were no significant racial differences in treatment intensity, treatment type, BRFS or DMFS. Conclusions: In this longitudinal series, there was racial comparability for all study outcomes. Moreover, in this high-risk patient series with long-term follow up (median = 6.9 years), nearly 50% did not experience BCR, and only 1 in 10 men developed metastasis.
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Asrijun, Asrijun. "Pengaruh Kondisi Fisik Rumah dengan Kejadian Penderita Tuberkulosis (TB) Paru." UNM Environmental Journals 2, no. 1 (May 16, 2019): 6. http://dx.doi.org/10.26858/uej.v2i1.9157.
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Pulmonary TB patients in Indonesia are ranked fourth in the world after India, China, South Africa with a prevalence of 285 TB per 100,000 population or as many as 302,861 cases in 2010(Lienhardt dkk. 2012).This research is analytic observation, with case control design. Case control studies were conducted by identifying case groups and control groups. This study aims to determine the risk of physical condition of the house with the incidence of pulmonary TB in the working area of Pattingalloang Health Center, Makassar City. After conducting research, it can be concluded that; (1) There is the influence of the stage house fikik condition with the incidence of pulmonary TB with the risk of transmission 10 times from a healthy stage house. (2) There is an influence of fiksik conditions in semi-permanent homes with the incidence of pulmonary TB but not a significant risk factor. (3) There is an influence of the condition of permanent home fiksik conditions with the incidence of pulmonary TB with risk factors for transmission 6 times from a healthy permanent home..
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Tarawally, J. Bundor. "Education in Supportive Care at the United Methodist Church Nursing School Kiss, the Eastern Part of Freetown, Sierra Leone." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 27s. http://dx.doi.org/10.1200/jgo.18.27100.
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Background: Sierra Leone situated in west Africa. It lies between Guinea and Liberia. The country has a population of about seven million people. The country is divided into four regions, they are as follows-western area with Freetown being the capital city, southern province with Bo being the headquarter, northern province with Makeni being the headquarter and eastern province with Kenema being the headquarter. The country is divided into twelve district. Kissy is situated in the eastern part of Freetown. The population of Kissy is about four hundred and fifty thousand people. There are five public hospitals and small health centers. United Methodist Church Hospital is located at the heart of Kissy. Education on supportive care is very important in all hospitals and health centers so that health care workers can apply it when necessary. Supportive care are given to improve the quality of life of patients who have serious or life threatening disease. The goal of supportive care is prevention, treats as early as possible the symptoms of the disease, side effects caused by treatment of a disease, psychological, social and spiritual problems related to a disease or its treatment also called comfort care, palliative care and symptom management. Aim: 1. To raise public education on supportive care. 2. To help the participants understand the importance of supportive care to patients with life threatening disease. Methods: This study was based on interviewing forty health care workers comprises of the following people nurses, caregiver, social workers, community health officers, chaplain and volunteers from the three institutions and community. United Methodist church Nursing School, Kissy Nicole Terrace Health Center Kissy, Kissy Health Center and Kissy Mess-Mess: nurses (3); social workers (2); care givers (2); and community health officers (3). Nicole Terrace Health Center: nurses (3); social workers (2); care givers (2); and community health officers (3). Kissy Health Center: nurses (3); social workers (2); care givers (2); and community health officers (3). Kissy Mess-Mess: volunteers (5) and chaplains (5). Results: During my interview with the different categories of people in the different health institutions and community, I discussed with them supportive care its importance and the impact it creates in the life of a patient with life threatening disease. It was a one-to-one interview and information received was recorded. According to my evaluation, I observed that, none of them have knowledge about supportive care and the impact it creates in the life of patients with life threatening disease. The findings of my research indicate that all the people in the different institutions and community have no knowledge about supportive care. Conclusion: Since supportive care helps to improve the quality of life of patients who have serious life threatening disease, education on the issue of empowering the following people involved in providing supportive care, namely, nurses, care givers/volunteers, chaplain and social workers, will help to prolong the lives of patients with life threatening diseases.
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Bateman, Lori Brand, LaToya J. O'Neal, Theolishia Smith, Yufeng Li, Theresa A. Wynn, Chen Dai, and Mona N. Fouad. "Policy, System and Environmental Correlates of Fruit and Vegetable Consumption in a Low-Income African American Population in the Southeast." Ethnicity & Disease 27, Suppl 1 (November 9, 2017): 355. http://dx.doi.org/10.18865/ed.27.s1.355.
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<p class="Pa7"> <strong>Objective: </strong>The current study seeks to identify policy, system and environmental (PSE) correlates of fruit and vegetable consumption among a sample of low-income African Americans in two counties in Alabama (Jefferson and Mobile) and one county in Mississippi (Forrest).</p><p class="Pa7"><strong>Design: </strong>A modified Behavioral Risk Factor Surveillance System (BRFFS) survey, which included multi-level ecological factors, was used to evaluate nutritional habits at the pre-intervention stage of a multi-state research study. We surveyed a total of 256 participants between May and August 2015. Local community coalitions established in each of the counties were instrumental in the planning and administration of the baseline survey.</p><p class="Pa7"><strong>Results: </strong>Univariate analyses revealed that whether participants met the daily recommendation for fruit/vegetable consumption may be correlated with whether participants had children who attended schools/day care centers with health policies in place, received food assistance, and observed media campaigns related to nutrition. Further, results of multivariate analysis indicated that meeting fruit/vegetable recommendations was correlated with personally participating or having a family member who participated in a health policy meeting in the past two years.</p><p><strong>Conclusion: </strong>These findings suggest that policy-based interventions have the potential to improve health outcomes among priority populations, such as low-income African Americans, who are at high risk of developing chronic diseases.</p><p><em>Ethn Dis</em>. 2017;27(Suppl 1):355-362; doi:10.18865/ed.27.S1.355.</p>
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Georgescu, Anca, Cesar Egurrola, Spencer Schaff, Julia Fisher, Shannon Smith, Catalin Florita, Alyssa Guido, and Stephen Klotz. "PrEP Uptake and Emergent HIV infections in Southern Arizona: Is There A Disconnect?" Open Forum Infectious Diseases 4, suppl_1 (2017): S438—S439. http://dx.doi.org/10.1093/ofid/ofx163.1111.
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Abstract Background Despite expansion of antiretroviral therapy in recent years and growing evidence for PrEP (pre exposure prophylaxis) efficacy, HIV incidence has continued to rise while PrEP uptake has remained low, particularly in populations at risk. Our goal is to compare these populations and further identify discrepancies in populations at risk in Southern Arizona. Methods We retroactively reviewed health records for patients evaluated at Banner University Medical Center Tucson outpatient clinics between January 2014 and September 2016, either with a new HIV diagnosis or prescribed tenofovir/emtricitabine for PrEP. Results We identified 147 patients with new HIV diagnoses and 65 patients evaluated for PrEp. 63% of the newly diagnosed HIV were of Hispanic, African American or American Indian descend (46%, 14% and 3% respectively) while the majority of PrEP patients were White (58%) with a statistically significant difference between the groups (P = 0.006). There was no significant difference between the age groups [28 (19%) of the HIV and 13 (20%) of the PrEP were 18–24] or gender (88% of people accessing HIV care were men, vs. 91% men seen for PrEP). Insurance information at the time of presentation was available for 145 HIV and 64 PrEP patients with statistically significant differences between the groups. 31(21%) newly diagnosed HIV had no insurance and 71 (49%) had a Medicaid plan while 45 (70%) of PrEP patients has a private insurance plan (P < 0.001). None of the people accessing PrEP reported iv drug use as a risk factor compared with 16 (11%) of the newly diagnosed (P = 0.003). Retention in care at 3 months was similar (76% of HIV and 75% of PrEP). The predominant risk categories were MSM with multiple partners and/or condomless anal sex for both groups. Conclusion To our knowledge this is the first study evaluating HIV and PrEP health care disparities in a border region of the Southwestern US, which is home to a large Hispanic minority population. Our findings suggest that low income minority populations, such as Hispanic, African American and American Indian in this region continue to have a higher risk for HIV acquisition and highlights the ongoing need to expand research on how these populations perceive their risk for HIV and navigate complex systems, such as health insurance, when seeking clinical services for PreP. Disclosures All authors: No reported disclosures.
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Essman, Michael, Fernanda Mediano Stoltze, Francesca Dillman Carpentier, Rina Swart, and Lindsey Smith Taillie. "Examining the News Media Reaction to a National Sugary Beverage Tax in South Africa: A Quantitative Content Analysis." Current Developments in Nutrition 4, Supplement_2 (May 29, 2020): 1713. http://dx.doi.org/10.1093/cdn/nzaa064_003.
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Abstract Objectives South Africa was the first sub-Saharan African country to implement a sugar-sweetened beverage (SSB) tax called the Health Promotion Levy (HPL) in April 2018. Given news media can increase public awareness and sway opinions, this study analyzed how the media represented the HPL, including expressions of support or challenge, topics associated with the levy, and stakeholder views of the HPL. Methods We performed a quantitative content analysis of online South African news articles related to the HPL published between January 1, 2017 and June 30, 2019. We coded the presence or absence of mentions related to health and economic effects of the HPL and HPL support or opposition. Prevalence of these mentions, overall and by source (industry, government, academics, other), were analyzed with Pearson χ2 and post-hoc Fisher exact tests. Results Across all articles, 81% mentioned health, and 65% mentioned economics topics. 54% of articles expressed support, 26% opposition, and 20% a balanced view of the HPL. All sources except industry expressed majority support for the HPL. Health reasons were the most common justifications for support, and economic harms were the most common justifications for opposition. Statements that sugar intake is not related to obesity, the HPL will not reduce SSB intake, and the HPL will cause industry or economic harm were all disproportionately high in industry sources (92%, 80%, and 81% vs 25% prevalence in total sample) (P < 0.001). Statements that sugar intake is related to obesity and non-communicable diseases were disproportionately high in both government (46% and 54% vs 31% prevalence in total sample) (P < 0.001) and academics (33% and 38% vs 25% prevalence in total sample) (P < 0.05). Statements that the HPL will improve health and the HPL will reduce health care costs were disproportionately high in government (47% vs 31% prevalence in total sample) (P < 0.001) and academics (44% vs 25% prevalence in total sample) (P < 0.05), respectively. Conclusions Industry expressed no support for the HPL, whereas academics, government, and other sources mainly expressed support. Future studies would be improved by linking news media exposure to SSB intake data to better understand the effects news media may have on individual behavior change. Funding Sources This research was supported by Bloomberg Philanthropies and the Carolina Population Center.
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Lee, Anna, Kanan Shah, Junzo P. Chino, and Fumiko Chino. "Changes in cancer mortality rates after the adoption of the Affordable Care Act." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): 2003. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.2003.
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2003 Background: The Affordable Care Act (ACA) was designed to improve health status in the US primarily through improving access to health insurance. As adoption of Medicaid expansion varied at the state level, this study aims to compare cancer mortality rates over time between states who did (EXP) and did not adopt (NonEXP) Medicaid expansion. Methods: Age-adjusted mortality rates per 100,000 were gathered from the National Center for Health Statistics from 1999-2017 to establish trends. Only deaths due to cancer in patients less than 65 were included. Absolute change in cancer mortality was calculated from 2011-2013 and then from 2015-2017 with 2014 as washout year. Changes within subpopulations (gender, race, ethnicity) were also assessed. Mortality changes between EXP and NonEXP groups were via “difference in differences” analysis. Results: Overall age-adjusted cancer mortality in the US fell from 1999-2017 from 66.9 to 48.8 per 100,000. EXP states had higher population (157 vs 118 million) with less black/African Americans (19.2 vs 21.8 million) and more Hispanics (33.0 vs 21.7 million) than NonEXP states (all examples from 2017). The overall age-adjusted cancer mortality was consistently worse in NonEXP states, cancer mortality fell from 64.7 to 46.0 per 100,000 in EXP states and from 69.0 to 51.9 per 100,000 in NonEXP states from 1999-2017 (both trends p < 0.001, comparison p < 0.001). Comparing the mortality changes in the peri-ACA years (2011-2013 vs 2015-2017) between the 2 cohorts, the difference in differences between EXP and NonEXP states was -1.1 and -0.6 per 100,000 respectively (p = 0.006 EXP, p = 0.14 NonEXP). The estimated overall cancer mortality benefit gained in EXP states after Medicaid expansion (∆∆∆) is -0.5 per 100,000 (p = NS). In EXP states, this translates to an estimated 785 less cancer deaths in 2017. Age-adjusted cancer mortality per 100,000 was worse in NonEXP states for black patients (58.5 EXP vs 63.4 NonEXP in 2017) however there was no differential mortality benefit after ACA expansion when comparing between the peri-ACA years. Of the subpopulations assessed, Hispanics in EXP states had the highest differential cancer mortality benefit at -2.1 per 100,000 (p = 0.07). Conclusions: This is the first study to show a directly measured cancer survival benefit from the ACA on a national scale using a comprehensive database. Hispanic populations appear to have the highest differential cancer mortality benefit after Medicaid expansion. Further study is needed to elucidate why other populations like black patients did not appear to reap the same mortality decrease.