Identifying Predictors of Racial Disparity in Treatment and Mortality Among Patients Diagnosed with Breast Cancer in South Carolina

Introduction: Despite a lower incidence of breast cancer (BrCA) among Black women in the U.S. compared to White women, Black women experience consistently higher mortality rates. The aims of this study were 1) to assess the relationship between race and diagnosis-to-treatment times 2) to assess racial disparity in mortality among Black and White BrCA patients in SC and 3) assessment of the validity of the Mortality-to- incidence ration (MIR) as a proxy for survival and geospatial investigation of racial disparity among breast cancer (BrCA) patients. Methods: Breast cancer cases diagnosed between 2002-2010 were obtained retrospectively from the SC Central Cancer Registry, linked with administrative data from a private payor source and Medicaid Plan. The main exposure variable for all analyses was patient’s race (White vs Black women). For aim 1, outcome variables were diagnosis-to-treatment time for BrCA-related surgery, radiation, adjuvant hormone treatment (AHT) and chemotherapy; Chi-square tests, logistic regression and generalized linear model analyses were conducted to compare patients’ diagnosis-to-treatment times among Blacks and Whites. For aim 2, the main outcome variable was mortality characterized by vital status and total survival time; Cox proportional hazard analyses were conducted to compare hazard ratios among Blacks and Whites to assess disparities in mortality. For aim 3, MIRs were computed from cancer incidence and mortality data which were obtained from the SC Community Access Network (SCAN). ArcGIS 10.2 was utilized to map BrCA MIRs by race (46 counties and 4 regions). MIR were categorized into seven levels using the national BrCA MIR for White women as reference in county maps; in all other maps, categorizations were based on natural breaks in ArcGIS. Survival percentage, Cox Proportional hazard ratios and survival-MIR correlation analyses were computed for all BrCA cases in each county/region utilizing SAS software and data on BrCA cases which were obtained retrospectively from the SC Central Cancer Registry from 2002 to 2010. Results: A total of 2155 BrCA patients with 1557 White women and 598 Black women were reported in the study period (2002-2010). For aim 1, multivariable linear model regression showed that there was statistically significant increase in adjusted least square means in receipt of AHT by 54 days, 36 days, 63 days and 46 days among unmarried, not being on best chance network and late surgery; multivariable logistic regression showed that the odds of late receipt of surgery was 1.96 (95% CI: 1.38-2.79) among unmarried Black women compared with unmarried White women; 1.89 (95% CI: 1.32-2.71) among Black women who lived Conclusions: Mortality was higher among Blacks who lived in the Low Country region of the state and among Blacks who lived in urban areas. Health region ranking utilizing the MIR correlated with 12-year survival time in the overall population, Whites and Black-White difference. To improve overall timely receipt of AHT, efforts need to be directed at Black BrCA patients that are not married, not on BCN, and those that received late surgery. To improve overall timely receipt of surgery, efforts need to be directed at Black BrCA patients that are not married, lived in urban areas and live

Knowledge and use of emergency contraception among students of public secondary schools in Ilorin, Nigeria

Introduction: Unintended pregnancy and unsafe abortion pose a major reproductive health challenge to adolescents. Emergency contraception is safe and effective in preventing unplanned pregnancy. The objective of this study was to assess the student's knowledge and use of emergency contraception. Methods: This cross-sectional study was carried out in Ilorin, Nigeria, using multi-stage sampling method. Data was collected using pre-tested semi-structured self-administered questionnaire. Knowledge was scored and analysed. SPSS version 21.0 was used for data analysis. A p-value <0.05 was considered statistically significant. Results: 27.8% of the respondents had good knowledge of emergency contraception. Majority of respondents (87.2%) had never used emergency contraception. Majority of those who had ever used emergency contraception (85.7%) used it incorrectly, using it more than 72 hours after sexual intercourse (p=0.928). Conclusion: Knowledge about Emergency contraception and prevalence of use were low. Contraceptive education should be introduced early in the school curriculum for adolescents.Pan African Medical Journal 2016; 2

Adherence to combined Antiretroviral therapy (cART) among people living with HIV/AIDS in a Tertiary Hospital in Ilorin, Nigeria

Introduction: this study aims to assess the treatment adherence rate among People Living With HIV/AIDS (PLWHA) receiving treatment in a Nigerian tertiary Hospital. Methods: this was a cross-sectional study that assessed self-reported treatment adherence among adults aged 18 years and above who were accessing drugs for the treatment of HIV. Systematic random sampling method was used to select 550 participants and data were collected by structured interviewer administered questionnaire. Results: the mean age of respondents was 39.9±10 years. Adherence rate for HIV patients was 92.6%. Factors affecting adherence include lack of money for transportation to the hospital (75%), traveling (68.8%), forgetting (66.7%), avoiding side effects (66.7%), and avoiding being seen (63.6%). Conclusion: the adherence rate was less than optimal despite advancements in treatment programmes. Adherence monitoring plans such as home visit and care should be sustained

Early sexual debut: prevalence and risk factors among secondary school students in Ido-ekiti, Ekiti state, South-West Nigeria

Background: Early adolescent sexual activity remains a recurring problem with negative psychosocial and health outcomes. The age at sexual debut varies from place to place and among different individuals and is associated with varying factors. The aim was to determine the prevalence and risk factors of early sexual debut among secondary school students in Ido-Ekiti, South-West Nigeria.Methodology: This was a cross-sectional study. The respondents were selected using multi-stage sampling technique. Pre-tested, semi-structured, self-administered questionnaire was used to collect data. Data was analyzed using SPSS version 15.Results: More than two-thirds, 40(67.8%), had early sexual debut. The prevalence of early sexual debut was about 11%. The mean age of sexual debut was 13.10±2.82; the mean age for early sexual debutants was 11.68±1.98. The mean number of sexual partners was 2.44±1.99. Male gender, having friends who engaged in sexual activities had association with early sexual exposure (p<0.05). Alcohol intake had the strongest strength of association for early sexual debut among the students.Conclusion: The high prevalence of early sexual exposure among the students calls for urgent interventions to stem the trend. This will help to reduce the devastating negative psycho-social and health sequels.Keywords: Sexual debut, prevalence, risk factors, Nigeri

Early sexual debut: prevalence and risk factors among secondary school students in Ido-ekiti, Ekiti state, South-West Nigeria.

Background: Early adolescent sexual activity remains a recurring problem with negative psychosocial and health outcomes. The age at sexual debut varies from place to place and among different individuals and is associated with varying factors. The aim was to determine the prevalence and risk factors of early sexual debut among secondary school students in Ido-Ekiti, South-West Nigeria. Methodology: This was a cross-sectional study. The respondents were selected using multi-stage sampling technique. Pre-tested, semi-structured, self-administered questionnaire was used to collect data. Data was analyzed using SPSS version 15. Results: More than two-thirds, 40(67.8%), had early sexual debut. The prevalence of early sexual debut was about 11%. The mean age of sexual debut was 13.10\ub12.82; the mean age for early sexual debutants was 11.68\ub11.98. The mean number of sexual partners was 2.44\ub11.99. Male gender, having friends who engaged in sexual activities had association with early sexual exposure (p<0.05). Alcohol intake had the strongest strength of association for early sexual debut among the students. Conclusion: The high prevalence of early sexual exposure among the students calls for urgent interventions to stem the trend. This will help to reduce the devastating negative psycho-social and health sequels

Liver Enzymes and Lipid Profile Among Type 2 Diabetic Patients in Osogbo, Nigeria Liver Enzymes and Lipid Profile Among Type 2 Diabetic Patients in Osogbo, Nigeria

ABSTRACT Background: Type 2 DM has been linked with dyslipideamia and elevation of some liver enzymes, in fact it has been identified as independent risk factor for development of coronary artery disease (CHD). The risk of coronary heart disease in patients with type 2 DM with hepatic involvement was assessed in this study

Self-medication among health workers in a tertiary institution in South-West Nigeria

Introduction: inappropriate self-medication results in wastage of resources, resistance to pathogen and generally entails serious health hazard. This study was undertaken to determine the knowledge, practice and reasons for practice of self-medication among health workers in a Nigerian tertiary institution. Methods: this was a cross-sectional descriptive study conducted among staff of Federal Medical Center Ido-Ekiti, Nigeria. Simple random sampling technique was used to select 305 respondents that were interviewed via a pretested semi-structured questionnaire. Analysis was done using SPSS version 15 and while chi-square test was used to test significance between variables, significant (p value set<0.05). Results: among the 305 respondents interviewed, the age range was 18-52yrs with greater proportion being males (51.8%). Majority of respondents were aware of self-medication (94.8%), but only 47.2% had good knowledge of it. Reasons for practicing self-medication were financial problem (10.8%), mild sickness (10.8%), lack of time (13.4%), knowledge of diagnosis (5.6%), convenience (2.3%) and non-availability of doctors (3.0%). The drugs used by respondents without prescription included analgesics (38.2%), antibiotics (19.0%) anti-malaria drugs (13.3%), and others (29.4%). Conditions for which respondents self-medicated were body pains (14.9%), catarrh (14.9%), headache (14.3%), sore throat (11.5%), diarrhea (11.2%), fever (9.0%) and toothache (5.6%). Conclusion: the study demonstrates that the prevalence of self-medication is relatively high. There is need for health education on the implication and danger of self-medication. There is also need for government to pass and enforce law to restrict free access to drugs.The Pan African Medical Journal 2016;2

WORKERS WILLINGNESS TO DONATE HUMAN BIOLOGICAL SAMPLE FOR FUTURE RESEARCH IN A SOUTH WESTERN NIGERIAN TERTIARY HEALTH CENTER

ABSTRACT Introduction: Human biological material is recognized as an important tool in research, an

Racial Distribution of Neighborhood-Level Social Deprivation in a Retrospective Cohort of Prostate Cancer Survivors

Background: A better understanding of neighborhood-level factors’ contribution is needed in order to increase the precision of cancer control interventions that target geographic determinants of cancer health disparities. This study characterized the distribution of neighborhood deprivation in a racially diverse cohort of prostate cancer survivors. Methods: A retrospective cohort of 253 prostate cancer patients who were treated with radical prostatectomy from 2011 to 2019 was established at the Medical University of South Carolina. Individual-level data on clinical variables (e.g., stage, grade) and race were abstracted. Social Deprivation Index (SDI) and Healthcare Professional Shortage (HPS) status was obtained from the Robert Graham Center and assigned to participants based on their residential census tract. Data were analyzed with descriptive statistics and multivariable logistic regression. Results: The cohort of 253 men consisted of 168 white, 81 African American, 1 Hispanic and 3 multiracial men. Approximately 49% of 249 men lived in areas with high SDI (e.g., SDI score of 48 to 98). The mean for SDI was 44.5 (+27.4), and the range was 97 (1–98) for all study participants. African American men had a significantly greater likelihood of living in a socially deprived neighborhood compared to white men (OR = 3.7, 95% C.I. 2.1–6.7, p p < 0.01). African Americans had a higher likelihood of developing biochemical reoccurrence (OR = 3.7, 95% C.I. = 1.7–8.0) compared with white men. There were no significant association between SDI and clinical characteristics of prostate cancer. Conclusions: This study demonstrates that SDI varies considerably by race among men with prostate cancer treated with radical prostatectomy. Using SDI to understand the social environment could be -particularly useful as part of precision medicine and precision public health approaches and could be used by cancer centers, public health providers, and other health care specialists to inform operational decisions about how to target health promotion and disease prevention efforts in catchment areas and patient populations