43 research outputs found
Determinants and Disparities of Survival in Triple-Negative Breast Cancer Patients: A Population-Based Retrospective Longitudinal Cohort Design Utilizing the Cox Proportional Hazard Analytical Model
A significant racial disparity in breast cancer mortality exists among women in the United States. Triple-negative breast cancer (TNBC) is a breast cancer phenotype that may explain, in part, this disparity between white and African American women. The objective of this study was to determine the predictors of survival in TNBC and non-triple-negative breast cancer (NTNBC) patients.
Data on 168,756 female patients with a diagnosis of invasive breast cancer in the Surveillance Epidemiology and End Results (SEER) program were stratified based on breast cancer receptor phenotypes in this retrospective longitudinal cohort study design. Multiple logistic regressions were used for exploring predictors of treatment which showed that not receiving surgery as standard treatment was associated (odds ratio: 95% CI) with TNBC (OR 1.151: 1.042, 1.177), uninsured (OR 3.552: 3.206, 3.937) and African American (OR 1.804: 1.702, 1.912) while not receiving radiation was associated with TNBC (OR 1.151: 1.113, 1.190), uninsured (OR 1.318; 1.217, 1.429). Cox’s hazard models were used, regressing age, race, ethnicity, marital status, health insurance status, histological tumor grade, and treatment status on survival time, the outcome measure.
Analysis revealed that the mean survival time is lower for TNBC [15.60 (± 10.29)] months compared with NTNBC [16.01 (± 10.18)] (p \u3c 0.0001), a difference though small is statistically significant. The independent determinants of survival in TNBC were: young age at diagnosis [(β = 0.033, HR 1.033 (1.026, 1.041)]; being African American [(β = 0.182, HR 1.200 (1.117, 1.289)], being married [(β = - 0.362, HR 0.697 (0.658, 0.737)]; higher tumor histological grades [β = 1.034, HR 2.812 (2.159,3.661)]; uninsured [(β = 0.541, HR 1.717 (1.481, 1.992)]; no surgery [(β = 2.156, HR 8.633 (8.152, 9.143)], or no radiation treatment [(β = 0.489, HR 1.630 (1.535,1.73)].
African American race, uninsured status, higher grade at diagnosis, inadequate treatment are independent predictors of poor survival among breast cancer patients; importantly, TNBC had a lower survival than that of NTNBC patients. A higher proportion of TNBC patients had a diagnosis at younger age, with higher tumor grade and was of the African American race. The survival disparity in African American patients may be partially explained by disproportionately higher TNBC cases among them, as well as, rates of not receiving standard treatments
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Targeting medication non-adherence behavior in selected autoimmune diseases: a systematic approach to digital health program development
Background
29 autoimmune diseases, including Rheumatoid Arthritis, gout, Crohn’s Disease, and Systematic Lupus Erythematosus affect 7.6-9.4% of the population. While effective therapy is available, many patients do not follow treatment or use medications as directed. Digital health and Web 2.0 interventions have demonstrated much promise in increasing medication and treatment adherence, but to date many Internet tools have proven disappointing. In fact, most digital interventions continue to suffer from high attrition in patient populations, are burdensome for healthcare professionals, and have relatively short life spans.
Objective
Digital health tools have traditionally centered on the transformation of existing interventions (such as diaries, trackers, stage-based or cognitive behavioral therapy programs, coupons, or symptom checklists) to electronic format. Advanced digital interventions have also incorporated attributes of Web 2.0 such as social networking, text messaging, and the use of video. Despite these efforts, there has not been little measurable impact in non-adherence for illnesses that require medical interventions, and research must look to other strategies or development methodologies. As a first step in investigating the feasibility of developing such a tool, the objective of the current study is to systematically rate factors of non-adherence that have been reported in past research studies.
Methods
Grounded Theory, recognized as a rigorous method that facilitates the emergence of new themes through systematic analysis, data collection and coding, was used to analyze quantitative, qualitative and mixed method studies addressing the following autoimmune diseases: Rheumatoid Arthritis, gout, Crohn’s Disease, Systematic Lupus Erythematosus, and inflammatory bowel disease. Studies were only included if they contained primary data addressing the relationship with non-adherence.
Results
Out of the 27 studies, four non-modifiable and 11 modifiable risk factors were discovered. Over one third of articles identified the following risk factors as common contributors to medication non-adherence (percent of studies reporting): patients not understanding treatment (44%), side effects (41%), age (37%), dose regimen (33%), and perceived medication ineffectiveness (33%). An unanticipated finding that emerged was the need for risk stratification tools (81%) with patient-centric approaches (67%).
Conclusions
This study systematically identifies and categorizes medication non-adherence risk factors in select autoimmune diseases. Findings indicate that patients understanding of their disease and the role of medication are paramount. An unexpected finding was that the majority of research articles called for the creation of tailored, patient-centric interventions that dispel personal misconceptions about disease, pharmacotherapy, and how the body responds to treatment. To our knowledge, these interventions do not yet exist in digital format. Rather than adopting a systems level approach, digital health programs should focus on cohorts with heterogeneous needs, and develop tailored interventions based on individual non-adherence patterns
A Limnological Examination of the Southwestern Amazon, Madre de Dios, Peru
<p>This dissertation investigates the limnology of the southwestern Peruvian Amazon centered on the Madre de Dios department by examining first the geomorphology and then the ecology and biogeochemistry of the region's fluvial systems. </p><p>Madre de Dios, Peru is world renowned for its prolific biodiversity and its location within the Andes biodiversity hotspot. It is also a site of study regarding the development of the Fitzcarrald Arch and that feature's geomorphological importance as the drainage center for the headwaters of the Madeira River - the Amazon's largest tributary and as well as its role as a physical divider of genetic evolution in the Amazon. Though each of these has been studied by a variety of prominent researchers, the ability to investigate all the aspects of this unique region is hampered by the lack of a regional geomorphological map. This study aims to fill that gap by using remote sensing techniques on digital elevation models, satellite imagery and soil, geology and geoecological maps already in publication to create a geomorphological map. The resulting map contains ten distinct landform types that exemplify the dominance of fluvial processes in shaping this landscape. The river terraces of the Madre de Dios River are delineated in their entirety as well as the various dissected relief units and previously undefined units. The demarcation of the boundaries of these geomorphic units will provide invaluable assistance to the selection of field sites by future researchers as well as insights into the origin of the high biodiversity indices of this region and aid in planning for biodiversity conservation. </p><p>Secondly this study examines 25 tropical floodplain lakes along 300 km of the Manu River within the Manu National Park in the Madre de Dios department. Alternative stable state and regime shifts in shallow lakes typically have been examined in lakes in temperate and boreal regions and within anthropogenically disturbed basins but have rarely been studied in tropical or in undisturbed regions. In contrast this study focuses on a tropical region of virtually no human disturbance and evaluates the effects of hydrological variability on ecosystem structure and dynamics. Using satellite imagery a 23 yr timeline of ecological regime shifts in Amazon oxbow lakes or "cochas" is reconstructed. The study shows that almost 25% of the river's floodplain lakes experience periodic abrupt vegetative changes with an average 3.4% existing in an alternative stable state in any given year. State changes typically occur from a stable phytoplankton-dominated state to a short lived, <3 yr, floating macrophytic state and often occur independent of regional flooding. We theorize that multiple dynamics, both internal and external, drive vegetative regime shifts in the Manu but insufficient data yet exists in this remote region to identify the key processes. </p><p>To complete the investigation of tropical limnology the third study compares and contrasts the nutrient-productivity ration of floodplain and non-floodplain lakes globally and regionally. For over 70 years a strong positive relationship between sestonic chlorophyll-a (Chl-a) and total phosphorus (TP) has been established with phosphorus generally viewed as the most limiting factor to productivity. Most of these studies, however, have focused on northern, temperate regions where the lakes are typically postglacial, isolated and fed by small streams. Relatively little work has been done on floodplain lakes which are semi or permanently connected to the river. This study examines the relationship between nutrients and productivity in floodplain lakes globally through an extensive literature synthesis. Values for total phosphorus, total nitrogen and chlorophyll-a were collected for 523 floodplain lakes, represented by 288 data points while 551 data points were collected for 5444 non-floodplain lakes. Analysis revealed that globally, floodplain lakes do not show any significant difference in the total phosphorus/chlorophyll-a relationship from that found in non-floodplain lakes but significant differences are seen between tropical and temperate lakes. We propose that the term `floodplain' lake should serve as purely a geographical descriptor and that it is lacking as an ecological indicator. Instead factors such as precipitation seasonality, hydrological connectivity and regional flooding regimes are better indicators of high or low productivity in floodplain lakes.</p>Dissertatio