A Decision Technology System To Advance the Diagnosis and Treatment of Breast Cancer

Geographical variations in cancer rates have been observed for decades. Described spatial patterns and trends have provided clues for generating hypotheses about the etiology of cancer. For breast cancer, investigators have demonstrated that some variation can be explained by differences in the population distribution of known breast cancer risk factors such as menstrual and reproductive variables (Laden, Spiegelman, and Neas, 1997; Robbins, Bescianini, and Kelsey, 1997; Sturgeon, Schairer, and Gail, 1995). However, regional patterns also may reflect the effects of Workshop on Hormones, Hormone Metabolism, Environment, and Breast Cancer (1995): (a) environmental hazards (such as air and water pollution), (b) demographics and the lifestyle of a mobile population, (c) subgroup susceptibility, (d) changes and advances in medical practice and healthcare management, and (e) other factors. To accurately measure breast cancer risk in individuals and population groups, it is necessary to singly and jointly assess the association between such risk and the hypothesized factors. Various statistical models will be needed to determine the potential relationships between breast cancer development and estimated exposures to environmental contamination. To apply the models, data must be assembled from a variety of sources, converted into the statistical models’ parameters, and delivered effectively to researchers and policy makers. A Web-enabled decision technology system can be developed to provide the needed functionality. This chapter will present a conceptual architecture for such a decision technology system. First, there will be a brief overview of a typical geographical analysis. Next, the chapter will present the conceptual Web-based decision technology system and illustrate how the system can assist users in diagnosing and treating breast cancer. The chapter will conclude with an examination of the potential benefits from system use and the implications for breast cancer research and practice

BCAS: A Web-enabled and GIS-based Decision Support System for the Diagnosis and Treatment of Breast Cancer

For decades, geographical variations in cancer rates have been observed but the precise determinants of such geographic differences in breast cancer development are unclear. Various statistical models have been proposed. Applications of these models, however, require that the data be assembled from a variety of sources, converted into the statistical models’ parameters and delivered effectively to researchers and policy makers. A web-enabled and GIS-based system can be developed to provide the needed functionality. This article overviews the conceptual web-enabled and GIS-based system (BCAS), illustrates the system’s use in diagnosing and treating breast cancer and examines the potential benefits and implications for breast cancer research and practice

Social, environmental and psychological factors associated with objective physical activity levels in the over 65s

Objective: To assess physical activity levels objectively using accelerometers in community dwelling over 65 s and to examine associations with health, social, environmental and psychological factors. Design: Cross sectional survey. Setting: 17 general practices in Scotland, United Kingdom. Participants: Random sampling of over 65 s registered with the practices in four strata young-old (65–80 years), old-old (over 80 years), more affluent and less affluent groups. Main Outcome Measures: Accelerometry counts of activity per day. Associations between activity and Theory of Planned Behaviour variables, the physical environment, health, wellbeing and demographic variables were examined with multiple regression analysis and multilevel modelling. Results: 547 older people (mean (SD) age 79(8) years, 54% female) were analysed representing 94% of those surveyed. Accelerometry counts were highest in the affluent younger group, followed by the deprived younger group, with lowest levels in the deprived over 80 s group. Multiple regression analysis showed that lower age, higher perceived behavioural control, the physical function subscale of SF-36, and having someone nearby to turn to were all independently associated with higher physical activity levels (R2 = 0.32). In addition, hours of sunshine were independently significantly associated with greater physical activity in a multilevel model. Conclusions: Other than age and hours of sunlight, the variables identified are modifiable, and provide a strong basis for the future development of novel multidimensional interventions aimed at increasing activity participation in later life.Publisher PDFPeer reviewe

Neighborhood Typology and Cardiometabolic Pregnancy Outcomes in the Maternal Adiposity Metabolism and Stress Study.

ObjectiveThis study aimed to assess associations between neighborhood typologies classified across multiple neighborhood domains and cardiometabolic pregnancy outcomes and determine variation in effectiveness of a mindfulness-based stress-reduction intervention on outcomes across neighborhood types.MethodsNeighborhoods of participants in the Maternal Adiposity Metabolism and Stress (MAMAS) intervention (n = 208) were classified across dimensions of socioeconomic, food, safety, and service/resource environments using latent class analysis. The study estimated associations between neighborhood type and three cardiometabolic pregnancy outcomes-glucose tolerance (GT) during pregnancy, excessive gestational weight gain, and 6-month postpartum weight retention (PPWR)-using marginal regression models. Interaction between neighborhood type and intervention was assessed.ResultsFive neighborhood types differing across socioeconomic, food, and resource environments were identified. Compared with poor, well-resourced neighborhoods, middle-income neighborhoods with low resources had higher risk of impaired GT (relative risk [RR]: 4.1; 95% confidence Interval [CI]: 1.1, 15.5), and wealthy, well-resourced neighborhoods had higher PPWR (beta: 3.9 kg; 95% CI: 0.3, 7.5). Intervention effectiveness varied across neighborhood type with wealthy, well-resourced and poor, moderately resourced neighborhoods showing improvements in GT scores. PPWR was higher in intervention compared with control groups within wealthy, well-resourced neighborhoods.ConclusionsConsideration of multidimensional neighborhood typologies revealed important nuances in intervention effectiveness on cardiometabolic pregnancy outcomes

Pathogenic Potential to Humans of Bovine Escherichia coli O26, Scotland

Escherichia coli O26 and O157 have similar overall prevalences in cattle in Scotland, but in humans, Shiga toxin–producing E. coli O26 infections are fewer and clinically less severe than E. coli O157 infections. To investigate this discrepancy, we genotyped E. coli O26 isolates from cattle and humans in Scotland and continental Europe. The genetic background of some strains from Scotland was closely related to that of strains causing severe infections in Europe. Nonmetric multidimensional scaling found an association between hemolytic uremic syndrome (HUS) and multilocus sequence type 21 strains and confirmed the role of stx<sub>2</sub> in severe human disease. Although the prevalences of E. coli O26 and O157 on cattle farms in Scotland are equivalent, prevalence of more virulent strains is low, reducing human infection risk. However, new data on E. coli O26–associated HUS in humans highlight the need for surveillance of non-O157 enterohemorrhagic E. coli and for understanding stx<sub>2</sub> phage acquisition

Maribel Gamon - Multidrug-Resistant Tuberculosis in India: Solving a Problem by Reconstructing the Public Health Infrastructure

Mycobacterium tuberculosis, commonly referred to as TB, is responsible for causing about 630,000 cases per year of infectious diseases worldwide. Recently, multidrug resistant tuberculosis (MDR-TB) has become an alarming public health concern. In addition, many developing countries lack effective treatment programs. India is one of those countries with a high prevalence of TB, seemingly affected by disconnectedness in their public health infrastructure. India, although a developing country, is still burdened with both chronic and infectious diseases, and there is a reactive public health system that must place focus on long-term effects of emerging resistant strains of TB. It is important to develop rapid drug susceptibility testing for quick diagnosis and treatment of monitored TB levels. According to a 2013 article published by Lancet, countries with well-run public health programs, supported by early diagnosis and access to quality drugs, have better treatment outcomes and compliance. Compliance must be maximized in developing countries to prevent the continuing emergence of MDR-TB. India’s public health infrastructure must be reshaped and empowered with implementation of treatment programs and surveillance frameworks similar to those seen in countries with low rates of MDR-TB levels. It is important that India strengthen their framework for combating MDR-TB, with emphasis on increasing health literacy among community leaders, informing government agencies of the necessity of research and surveillance, strengthening rapid TB diagnostic systems, and providing culturally-appropriate TB treatment programs. Using intervention strategies from other communities may help India develop an appropriate solution for decreasing the prevalence of MDR-TB.https://epublications.marquette.edu/mcnair_2013/1012/thumbnail.jp

miRNA contributions to pediatric-onset multiple sclerosis inferred from GWAS.

ObjectiveOnset of multiple sclerosis (MS) occurs in childhood for approximately 5% of cases (pediatric MS, or ped-MS). Epigenetic influences are strongly implicated in MS pathogenesis in adults, including the contribution from microRNAs (miRNAs), small noncoding RNAs that affect gene expression by binding target gene mRNAs. Few studies have specifically examined miRNAs in ped-MS, but individuals developing MS at an early age may carry a relatively high burden of genetic risk factors, and miRNA dysregulation may therefore play a larger role in the development of ped-MS than in adult-onset MS. This study aimed to look for evidence of miRNA involvement in ped-MS pathogenesis.MethodsGWAS results from 486 ped-MS cases and 1362 controls from the U.S. Pediatric MS Network and Kaiser Permanente Northern California membership were investigated for miRNA-specific signals. First, enrichment of miRNA-target gene network signals was evaluated using MIGWAS software. Second, SNPs in miRNA genes and in target gene binding sites (miR-SNPs) were tested for association with ped-MS, and pathway analysis was performed on associated target genes.ResultsMIGWAS analysis showed that miRNA-target gene signals were enriched in GWAS (P = 0.038) and identified 39 candidate biomarker miRNA-target gene pairs, including immune and neuronal signaling genes. The miR-SNP analysis implicated dysregulation of miRNA binding to target genes in five pathways, mainly involved in immune signaling.InterpretationEvidence from GWAS suggests that miRNAs play a role in ped-MS pathogenesis by affecting immune signaling and other pathways. Candidate biomarker miRNA-target gene pairs should be further studied for diagnostic, prognostic, and/or therapeutic utility