Ovarian Cancer Epidemiology, Healthcare Access and Disparities (ORCHiD): Methodology for a Population-Based Study of Black, Hispanic and White Patients with Ovarian Cancer

INTRODUCTION: Less than 40% of patients with ovarian cancer (OC) in the USA receive stage-appropriate guideline-adherent surgery and chemotherapy. Black patients with cancer report greater depression, pain and fatigue than white patients. Lack of access to healthcare likely contributes to low treatment rates and racial differences in outcomes. The Ovarian Cancer Epidemiology, Healthcare Access and Disparities study aims to characterise healthcare access (HCA) across five specific dimensions-Availability, Affordability, Accessibility, Accommodation and Acceptability-among black, Hispanic and white patients with OC, evaluate the impact of HCA on quality of treatment, supportive care and survival, and explore biological mechanisms that may contribute to OC disparities. METHODS AND ANALYSIS: We will use the Surveillance Epidemiology and Ends Results dataset linked with Medicare claims data from 9744 patients with OC ages 65 years and older. We will recruit 1641 patients with OC (413 black, 299 Hispanic and 929 white) from cancer registries in nine US states. We will examine HCA dimensions in relation to three main outcomes: (1) receipt of quality, guideline adherent initial treatment and supportive care, (2) quality of life based on patient-reported outcomes and (3) survival. We will obtain saliva and vaginal microbiome samples to examine prognostic biomarkers. We will use hierarchical regression models to estimate the impact of HCA dimensions across patient, neighbourhood, provider and hospital levels, with random effects to account for clustering. Multilevel structural equation models will estimate the total, direct and indirect effects of race on treatment mediated through HCA dimensions. ETHICS AND DISSEMINATION: Result dissemination will occur through presentations at national meetings and in collaboration with collaborators, community partners and colleagues across othercancer centres. We will disclose findings to key stakeholders, including scientists, providers and community members. This study has been approved by the Duke Institutional Review Board (Pro00101872). Safety considerations include protection of patient privacy. All disseminated data will be deidentified and summarised

Urban Renewal, Gentrification and Food Insecurity in Asheville’s Southside Neighborhood

Asheville, North Carolina is well known as a city packed with fantastic restaurants and local food in the Appalachian region of North Carolina. Yet in this land of apparent abundance, many of its citizens lack consistent, healthy food sources to sustain their lives. Understanding the root causes of this paradox is a major impetus behind this visual ethnographic project. The project focuses on a traditionally African American neighborhood called Southside in Asheville, which underwent significant redevelopment when an urban renewal project was carried out in the neighborhood in the 1970s. Prior to urban renewal, the neighborhood boasted 7 grocery stores. Today it is classified as a food desert. The central inquiry of this research is exploring the long-term impacts of urban renewal on long-time and new residents of Southside, seeking to understand their evolving sense of place as Southside transitions into a new period of gentrification today and their relationship with food as a result of living in a food desert. The research was conducted through interviews with residents and observations of the community while working on various community projects relating to local food access and sustainability issues. This project provides a new understanding of the long-term impacts of urban renewal on the individual lives of residents of the Southside community as they experience daily life within a food desert while simultaneously expanding ideas of Appalachia to include urban and African American realities

Prioritizing Support Offered to Caregivers by Examining the Status Quo and Opportunities for Enhancement When Using Web-Based Self-reported Health Questionnaires: Descriptive Qualitative Study

BackgroundThe Rosalynn Carter Institute for Caregivers (RCI) offers evidence-based interventions to promote caregivers’ health and well-being. Trained coaches regularly meet with caregivers to offer education and instructions to improve caregiver health, build skill sets, and increase resilience. Two of these interventions, RCI Resources for Enhancing Alzheimer's Caregiver Health (REACH) and Operation Family Caregiver (OFC), use a set of caregiver-reported questionnaires to monitor caregivers’ health status and needs. ObjectiveThis study aims to describe how web-based assessment questionnaires are used to identify and monitor caregiver status in the RCI REACH and OFC programs and outlines perceived enhancements to the web-based system that could support caregiver-coach encounters by directing priorities. MethodsThis was a descriptive, qualitative study. Data were collected via semistructured interviews with caregivers and coaches in the RCI REACH and OFC programs from July 2020 to October 2020. During the interviews, participants were asked to describe how the assessment questionnaires were used to inform caregiver-coach encounters, perceived usefulness of enhancements to web-based display, and preference for the structure of score results. The interviews were recorded, transcribed, and coded using structural and interpretive codes from a structured codebook. Qualitative content analysis was used to identify themes and summarize the results. ResultsA total of 25 caregivers (RCI REACH: 13/25, 52%; OFC: 12/25, 48%) and 11 coaches (RCI REACH: 5/11, 45%; OFC: 6/11, 55%) were interviewed. Most caregivers indicated that the assessment questions were relevant to their caregiving experience. Some caregivers and coaches indicated that they thought the assessment should be administered multiple times throughout the program to evaluate the caregiver progress. Overall, caregivers did not want their scores to be compared with those of other caregivers, and there was heterogeneity in how caregivers preferred to view their results at the question or topic level. Coaches were uncertain as to which and how much of the results from the self-reported questionnaires should be shared with caregivers. Overall, the results were very similar, regardless of program affiliation (RCI REACH vs OFC). ConclusionsWeb-based and procedural enhancements were identified to enrich caregiver-coach encounters. New and enhanced strategies for using web-based assessment questionnaires to direct priorities in the caregiver-coach encounters included integrating figures showing caregiver progress at the individual caregiver level, ability to toggle results through different figures focused on individual versus aggregate results, and support for interpreting scores. The results of this qualitative study will drive the next steps for RCI’s web-based platform and expand on current standards for administering self-reported questionnaires in clinical practice settings

Smoking and survival after breast cancer diagnosis: a prospective observational study and systematic review

BACKGROUND: The association of smoking with outcomes following breast cancer prognosis is not well understood. METHOD: In a cohort study called Life After Cancer Epidemiology (LACE), 2265 women diagnosed with breast cancer were followed for a median of twelve years. We used multivariable proportional-hazards models to determine whether smoking, assessed approximately two years post-diagnosis, was associated with risk of death among these women. We also undertook a systematic review of all cohort studies to date that have examined the association between smoking and breast cancer mortality. RESULTS: Compared with never smokers, women who were current smokers had a two-fold higher rate of dying from breast cancer [hazard ratio (HR)=2.01, 95% confidence interval (CI) 1.27–3.18] and an approximately four-fold higher rate of dying from competing (non-breast cancer) causes (HR=3.84, 95%CI 2.50–5.89). Among seven studies that met the inclusion criteria in the systematic review, three studies and our own reported significantly increased risk of breast cancer death with current smoking. We found little evidence of an association between former smoking and breast cancer mortality (HR=1.24, 95% CI 0.94–1.64). CONCLUSIONS: Consistent with findings from our prospective observational study, the systematic review of seven additional studies indicates positive association of current smoking with breast cancer mortality, but weak association with former smoking. IMPACT: Women who smoke following breast cancer diagnosis and treatment are at higher risk of death both from breast cancer and other causes

Predictors of Long-Term Opioid Use Among Patients With Painful Lumbar Spine Conditions

Our objective was to assess predictors of self-reported opioid use among patients with back pain due to lumbar disc herniation or spinal stenosis. Data was from the Spine Patient Outcomes Research Trial (SPORT), a multi-site observational study and randomized trial. We examined characteristics shown or hypothesized to be associated with opioid use. Using generalized estimating equations, we modeled associations of each potential predictor with opioid use at 12 and 24 months. At baseline, 42% of participants reported opioid use. Of these participants, 25% reported continued use at 12 months and 21% reported use at 24 months. In adjusted models, smoking (RR=1.9, p<0.001 at 12 months; RR=1.5, p=0.043 at 24 months) and non-surgical treatment (RR=1.7, p<0.001 at 12 months; RR=1.8, p=0.003 at 24 months) predicted long-term opioid continuation. Among participants not using opioids at baseline, incident use was reported by 8% at 12 and 7% at 24 months. We found no significant predictors of incident use at 12 or 24 months in the main models. In conclusion, nonsurgical treatment and smoking independently predicted long-term continued opioid use. To our knowledge, this is the first longitudinal study to assess predictors of long-term and incident opioid use among patients with lumbar spine conditions

Economics vs. Physical-based Metrics for Relative Greenhouse Gas Valuations

A range of alternatives to the Global Warming Potential (GWP) have been suggested in the scientific literature. One of these alternative metrics that has received significant attention is the cost-effective relative valuation of greenhouse gases. However, this metric is based on complex optimising integrated assessment models that are far from transparent to the general scientist or policymaker. Here we present a new analytic metric, the Cost-Effective Temperature Potential (CETP) which is based on an approximation of the cost-effective relative valuation. We show that this metric shares many similarities with the purely physical metric, Global Temperature change Potential (GTP), but that the CETP performs much better as an approximation to the cost-effective relative valuation

El acontecimiento Chejfec

Bajo la dirección de Julio Premat, en colaboración con Benoît Coquil y Salomé Daha

“Sacred to the Hart”*: Identity and dignity as reflected in the memorial landscapes of postemancipation African Americans in Pensacola, Florida

This article broadens the discussion of 19th century monuments associated with the Lost Cause by exploring the monument landscapes of post-emancipation African American cemeteries and the people who are associated with them. Method. Exemplars from several cemeteries in Pensacola, Florida, are used to examine how the post-emancipation population maintained deep ties to their cultural roots while assimilating into society as free people. Results. The built environment of postemancipation African American cemeteries contains monuments reflecting black identity and dignity in life and in death. Conclusions. Examining a broader sample of memorial landscapes can be a starting point in expanding the national dialogue on our country’s history in a more inclusive fashion. Historic cemeteries, especially African American cemeteries established post-Civil War, offer an excellent means of doing this in a manner that almost all citizens can understand and respectJournal ArticlePublishe