Engaging diverse underserved communities to bridge the mammography divide

<p>Abstract</p> <p>Background</p> <p>Breast cancer screening continues to be underutilized by the population in general, but is particularly underutilized by traditionally underserved minority populations. Two of the most at risk female minority groups are American Indians/Alaska Natives (AI/AN) and Latinas. American Indian women have the poorest recorded 5-year cancer survival rates of any ethnic group while breast cancer is the number one cause of cancer mortality among Latina women. Breast cancer screening rates for both minority groups are near or at the lowest among all racial/ethnic groups. As with other health screening behaviors, women may intend to get a mammogram but their intentions may not result in initiation or follow through of the examination process. An accumulating body of research, however, demonstrates the efficacy of developing 'implementation intentions' that define when, where, and how a specific behavior will be performed. The formulation of intended steps in addition to addressing potential barriers to test completion can increase a person's self-efficacy, operationalize and strengthen their intention to act, and close gaps between behavioral intention and completion. To date, an evaluation of the formulation of implementation intentions for breast cancer screening has not been conducted with minority populations.</p> <p>Methods/Design</p> <p>In the proposed program, community health workers will meet with rural-dwelling Latina and American Indian women one-on-one to educate them about breast cancer and screening and guide them through a computerized and culturally tailored "implementation intentions" program, called <it>Healthy Living Kansas - Breast Health</it>, to promote breast cancer screening utilization. We will target Latina and AI/AN women from two distinct rural Kansas communities. Women attending community events will be invited by CHWs to participate and be randomized to either a mammography "implementation intentions" (<b>MI</b>^<b>2</b>) intervention or a comparison general breast cancer prevention informational intervention (<b>C</b>). CHWs will be armed with notebook computers loaded with our Healthy Living Kansas - Breast Health program and guide their peers through the program. Women in the <b>MI</b>^{<b>2 </b>}condition will receive assistance with operationalizing their screening intentions and identifying and addressing their stated screening barriers with the goal of guiding them toward accessing screening services near their community. Outcomes will be evaluated at 120-days post randomization via self-report and will include mammography utilization status, barriers, and movement along a behavioral stages of readiness to screen model.</p> <p>Discussion</p> <p>This highly innovative project will be guided and initiated by AI/AN and Latina community members and will test the practical application of emerging behavioral theory among minority persons living in rural communities.</p> <p>Trial Registration</p> <p>ClinicalTrials (NCT): <a href="http://www.clinicaltrials.gov/ct2/show/NCT01267110">NCT01267110</a></p

Effective anisotropic elastic constants of bimaterial interphases: comparison between experimental and analytical techniques

The effective elastic constants of a bimaterial composite were experimentally measured with the goal of validating the numerical predications of these constants made by homogenization theory. Secondly, solutions predicted by homogenization theory were compared to predictions made with more standard composite theories. Composite specimens consisting of titanium and epoxy were developed to mimic a porous titanium/tissue interphase. Tensile and shear tests (ASTM D3983) measured the stiffness along the porous coating/epoxy interphase ( E L ), across the interphase ( E T ) and in shear ( G LT ). No significant differences in moduli were found between the experimental measurements and predictions made with homogenization theory, nor between the experimental measurements and Hashin-Shtrikman estimates. Homogenization theory predicted results usually within 20% of Hashin-Shtrikman estimates, but typically more than 50% different from what is predicted by the rule of mixtures. However, homogenization theory allows calculation of anisotropic stiffness estimates and local strains, neither of which is possible using Hashin-Shtrikman estimates. With this experimental validation, the accuracy of homogenization theory for use in implant/tissue interface mechanics applications is confirmed. Since the composite interphase is anisotropic and more compliant in the transverse direction, with stiffness an order of magnitude lower across the interphase, local mechanics, tissue ingrowth and remodeling may be strongly directional dependent.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/46748/1/10856_2004_Article_BF00058722.pd

Development and practical use of an international medical writer competency model

In this article, we explain the rationale for developing a competency model for medical writers, describe the international effort to develop the model, and then highlight its main features and practical uses

Association between Social Isolation and Left Ventricular Mass

Social isolation is associated with progression of cardiovascular disease, with the most socially isolated patients being at increased risk. Increased left ventricular mass is a predictor of cardiovascular morbidity and mortality. It is not yet clear whether social isolation is a determinant of increased left ventricular mass. We performed a cross-sectional study of Northern Manhattan Study participants who were free of clinical cardiovascular disease and had obtained transthoracic echocardiograms (n = 2021) and a baseline questionnaire on social habits. Social isolation was defined as the lack of friendship networks (knowing fewer than 3 people well enough to visit within their homes). Echocardiographic left ventricular mass was indexed to height 2.7, analyzed as a continuous variable and compared between exposure groups. The prevalence of social isolation was 13.5%. The average left ventricular mass was significantly higher (50.2 gm/m 2.7) in those who were, as compared with those who were not (47.6 gm/m 2.7), socially isolated ( P < .05). Higher prevalence of social isolation was found among those less educated, uninsured, or unemployed. There were no significant race-ethnic differences in the prevalence of social isolation. In multivariate analysis, there was a trend toward an association between social isolation and increased left ventricular mass in the total cohort ( P = .09). Among Hispanics, social isolation was significantly associated with greater left ventricular mass. Hispanics who were socially isolated averaged 3.9 gm/ht 2.7 higher left ventricular mass compared with those not socially isolated ( P = .002). This relationship was not present among non-Hispanic blacks or whites. In this urban tri-ethnic cohort, social isolation was prevalent and associated with indices of low socioeconomic status. Hispanics who were socially isolated had a greater risk for increased left ventricular mass