9 research outputs found
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Neuroscience Subject Guide for the University of Miami
The Neuroscience Subject Guide was developed in 2018 by Maya Lubarsky as part of her Library Research Scholars Program. The Subject Guide aims to aid Neuroscience students in guiding their research and improving their research skills. It also includes a comprehensive background on the development of the Neuroscience program at the University of Miami.</p
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Abstract PO2-09-07: Neighborhood Disadvantage and Social Adversity in Breast Cancer Patients
Abstract Introduction: Neighborhood disadvantage has been shown to independently predict breast cancer specific survival even after considering access to care barriers. This effect may be explained in part by biologic influences of the neighborhood environment on breast tumors. Social genomics literatures posits that this relationship is mediated by chronic stress in the form of social adversity, i.e. disadvantaged neighborhoods may be leading to increased stress for patients which in turn may effect tumor biology. Our objective in this study was to link a measure of patient-reported neighborhood specific stress with an objective and widely used measure of neighborhood disadvantage, the Area Deprivation Index (ADI). Methods: In this prospective cohort study patients with stage I-IV breast cancer completed survey questions from a validated Neighborhood Social Environment Adversity Survey (NSEAS) to measure perceived stress caused by their environment. Questions included both 5-item and 4-item Likert scale answer choices with higher scores indicating higher stress. Responses were standardized into Z-scores and composite and subscale scores were calculated by summation. Subscales included threat to safety, social cohesion, and aesthetic quality. Survey questions demonstrated good reliability with a Cronbach’s α of 0.72. Cohort addresses were used to determine the ADI, a continuous measure from 1-10 with higher scores indicating more disadvantage. Hierarchical linear regression was used to assess the relationship between ADI and NSEAS composite and subscale scores while controlling for covariates. Results: 380 breast cancer patients completed the NSEAS 61.6% were Hispanic, 17.0% were Non-Hispanic White, and 21.4% were Non-Hispanic Black. Mean age (SD) was 56 (12) years. Mean (SD) ADI was 4 (3). On univariate analysis, we found that ADI significantly predicts NSEAS composite and subscale scores (Composite β =0.63, t=5.68, p< 0.001; Threat to Safety β =0.18, t=5.07, p< 0.001; Social Cohesion β =0.19, t=3.35, p< 0.001; Aesthetic Quality β =0.15, t=4.20, p< 0.001). After controlling for age, race, ethnicity, highest education level, patient insurance, and annual household income, we found that ADI continued to significantly predict levels of NSEAS (Composite β =0.48, t=4.02, p< 0.001; Threat to Safety β =0.14, t=3.57, p< 0.001; Social Cohesion β =0.14, t=2.34, p=0.02; Aesthetic Quality β =0.12, t=3.09, p=0.002). Conclusion: In our novel study, we found that higher levels of neighborhood disadvantage independently predict higher levels of perceived neighborhood stress in breast cancer patients. Because of the known detrimental effects of both chronic stress and neighborhood disadvantage on health, understanding the specific factors of stress caused by neighborhood-level social adversity can help define targetable areas of intervention for future studies. These findings contribute to current literature on how and why neighborhood disadvantage leads to worse breast cancer outcomes. Table 1. Hierarchical Regression Illustrating Relationship between Neighborhood Disadvantage and Patient-Reported Neighborhood Social Environment Adversity Survey Scores Citation Format: Alexandra Hernandez, Maya Lubarsky, Susan Kesmodel, Michael Antoni, Neha Goel. Neighborhood Disadvantage and Social Adversity in Breast Cancer Patients [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-09-07
Racial and Ethnic Disparities in Breast Cancer Survival Emergence of a Clinically Distinct Hispanic Black Population
OBJECTIVE: To understand the impact of Black race on breast cancer (BC) presentation, treatment, and survival among Hispanics. SUMMARY BACKGROUND DATA: It is well-documented that non-Hispanic Blacks (NHB) present with late-stage disease, less likely to complete treatment, and have worse survival compared to their non-Hispanic White (NHW) counterparts. However, no data evaluates whether this disparity extends to Hispanic Blacks (HB) and Hispanic Whites (HW). Given our location in Miami, gateway to Latin America and the Caribbean, we have the diversity to evaluate BC outcomes in HB and HW. METHODS: Retrospective cohort study of stage I-IV BC patients treated at our institution from 2005–2017. Kaplan-Meier survival curves were generated and compared using the log-rank test. Multivariable survival models were computed using Cox proportional hazards regression. RESULTS: Race/ethnicity distribution of 5,951 patients: 28% NHW, 51% HW, 3% HB, and 18% NHB. HB were more economically disadvantaged, had more aggressive disease, and less treatment compliant compared to HW. 5-year OS by race/ethnicity was: 85% NHW, 84.8% HW, 79.4% HB, and 72.7% NHB (p<0.001). After adjusting for covariates, NHB was an independent predictor of worse OS [HR:1.25 (95% CI: 1.01–1.52), p< 0.041)]. CONCLUSIONS: In this first comprehensive analysis of HB and HW, HB has worse OS compared to HW, suggesting that race/ethnicity is a complex variable acting as a proxy for tumor and host biology, as well as individual and neighborhood-level factors impacted by structural racism. This study identifies markers of vulnerability associated with Black race and markers of resiliency associated with Hispanic ethnicity to narrow a persistent BC survival gap
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Does structural racism impact receipt of NCCN guideline-concordant breast cancer treatment?
Disparities in breast cancer survival remain a challenge. We aimed to analyze the effect of structural racism, as measured by the Index of Concentration at the Extremes (ICE), on receipt of National Cancer Center Network (NCCN) guideline-concordant breast cancer treatment.
We identified patients treated at two institutions from 2005 to 2017 with stage I-IV breast cancer. Census tracts served as neighborhood proxies. Using 5-year estimates from the American Community Survey, 5 ICE variables were computed to create 5 models, controlling for economic segregation, non-Hispanic Black (NHB) segregation, NHB/economic segregation, Hispanic segregation, and Hispanic/economic segregation. Multi-level logistic regression models were used to determine the association between individual and neighborhood-level characteristics on receipt of NCCN guideline-concordant breast cancer treatment.
5173 patients were included: 55.2% were Hispanic, 27.5% were NHW, and 17.3% were NHB. Regardless of economic or residential segregation, a NHB patient was less likely to receive appropriate treatment [(OR)
0.58 (0.45-0.74); OR
0.59 (0.46-0.78); OR
0.62 (0.47-0.81); OR
0.53 (0.40-0.69); OR
0.59(0.46-0.76); p < 0.05].
To our knowledge, this is the first analysis assessing receipt of NCCN guideline-concordant treatment by ICE, a validated measure for structural racism. While much literature emphasizes neighborhood-level barriers to treatment, our results demonstrate that compared to NHW patients, NHB patients are less likely to receive NCCN guideline-concordant breast cancer treatment, independent of economic or residential segregation. Our study suggests that there are potential unaccounted individual or neighborhood barriers to receipt of appropriate care that go beyond economic or residential segregation
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Associations Between Perceived Discrimination, Screening Mammography, and Breast Cancer Stage at Diagnosis: A Prospective Cohort Analysis
Despite higher breast cancer screening rates, black women still are more likely to have late-stage disease diagnosed. This disparity is influenced in part by structural and interpersonal racism. This prospective study sought to determine how interpersonal factors, including perceived discrimination, influence screening and stage of disease at diagnosis.BACKGROUNDDespite higher breast cancer screening rates, black women still are more likely to have late-stage disease diagnosed. This disparity is influenced in part by structural and interpersonal racism. This prospective study sought to determine how interpersonal factors, including perceived discrimination, influence screening and stage of disease at diagnosis.A prospective cohort study analyzed adult women with stages I to IV breast cancer from the Miami Breast Cancer Disparities Study. Perceived discrimination and mistrust of providers were assessed using previously validated questionnaires. Multivariable logistic regression was used to evaluate the odds of screening mammography utilization and late-stage breast cancer at diagnosis.METHODSA prospective cohort study analyzed adult women with stages I to IV breast cancer from the Miami Breast Cancer Disparities Study. Perceived discrimination and mistrust of providers were assessed using previously validated questionnaires. Multivariable logistic regression was used to evaluate the odds of screening mammography utilization and late-stage breast cancer at diagnosis.The study enrolled 342 patients (54.4 % Hispanic, 15.8 % white, and 17.3 % black). Multivariate regression, after control for both individual- and neighborhood-level factors, showed that a higher level of perceived discrimination was associated with greater odds of late-stage disease (adjusted odds ratio [aOR], 1.06; range, 1.01-1.12); p = 0.022) and lower odds of screening mammography (aOR, 0.96; range, 0.92-0.99; p = 0.046). A higher level of perceived discrimination also was negatively correlated with multiple measures of provider trust.RESULTSThe study enrolled 342 patients (54.4 % Hispanic, 15.8 % white, and 17.3 % black). Multivariate regression, after control for both individual- and neighborhood-level factors, showed that a higher level of perceived discrimination was associated with greater odds of late-stage disease (adjusted odds ratio [aOR], 1.06; range, 1.01-1.12); p = 0.022) and lower odds of screening mammography (aOR, 0.96; range, 0.92-0.99; p = 0.046). A higher level of perceived discrimination also was negatively correlated with multiple measures of provider trust.This study identified that high perceived level of discrimination is associated with decreased odds of ever having a screening mammogram and increased odds of late-stage disease. Efforts are needed to reach women who experience perceived discrimination and to improve the patient-provider trust relationship because these may be modifiable risk factors for barriers to screening and late-stage disease presentation, which ultimately have an impact on breast cancer survival.DISCUSSIONThis study identified that high perceived level of discrimination is associated with decreased odds of ever having a screening mammogram and increased odds of late-stage disease. Efforts are needed to reach women who experience perceived discrimination and to improve the patient-provider trust relationship because these may be modifiable risk factors for barriers to screening and late-stage disease presentation, which ultimately have an impact on breast cancer survival
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Comparison of procedural outcomes between morning and afternoon colonoscopies performed by colorectal surgeons
Background and objective Colonoscopy is a common procedure performed by colorectal surgeons for screening, diagnosis, and surveillance of various colorectal diseases. Existing literature has conflicting data on quality outcomes of colonoscopies performed in the afternoon and the morning schedules and only includes colonoscopies performed by gastroenterologists. We sought to analyze procedural outcomes between morning and afternoon colonoscopies performed by colorectal surgeons. Data sources and main outcome measures A retrospective chart review of colonoscopies performed by colorectal surgeons at a tertiary care center from October 2018 through July 2020 was performed. Complete colonoscopies with documented times were included. Patients with colonic resection and incomplete colonoscopy were excluded. Main outcome measures adenoma and polyp detection rates and colonoscopy time variables were compared between morning and afternoon colonoscopies. Results A total of 781 patients were analyzed. Colonoscopies were evenly distributed during shifts (49% morning and 51% afternoon). The overall polyp and adenoma detection rates were 46% and 29%, respectively. There were no significant differences in adenoma and polyp detection rates and colonoscopy duration between morning and afternoon colonoscopies. Multivariate analysis demonstrated that history of prior polypectomy was an independent predictor of adenoma detection rate (OR: 2.17, 95% CI 1.33-3.54, p = 0.002) and was associated with significantly increased colonoscopy times in afternoon shift. Conclusion There were no differences in quality outcomes of adenoma and polyp detection rates between morning and afternoon colonoscopies performed by colorectal surgeons. In addition to known predictors, cecal intubation time and history of polypectomy were also independent predictors of adenoma detection rate. Patients with prior polypectomy had increased colonoscopy times in afternoon shift. Since colorectal surgeons perform higher proportion of diagnostic and surveillance colonoscopies, these patients may be better suited for colonoscopies in morning shift
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Unmet Social Needs and Breast Cancer Screening Utilization and Stage at Presentation
Unmet social needs in local populations may hinder the development of targeted cancer control interventions aimed at improving screening utilization and early-stage breast cancer diagnosis to ultimately improve breast cancer survival disparities.
To evaluate if (1) city-funded screening mammography is associated with utilization of screening mammography, (2) unmet social needs are associated with utilization of screening mammography, and (3) unmet social needs are associated with later-stage disease at diagnosis.
This cohort study included patients with stages I-IV invasive ductal or lobular carcinoma treated at an academic medical center (including both an underserved safety-net hospital [SNH] and a National Cancer Institute-designated academic cancer center [ACC]) from 2020 to 2023. Eligible patients were aged 18 years or older and able to consent. Data were analyzed between July 2023 and September 2023.
The Health Leads Social Needs Screening Toolkit, a screening tool that gathers information on the most common social need domains affecting patient health.
Univariable and multivariable logistic regression was utilized to evaluate the following primary outcomes: (1) routine screening mammography and (2) American Joint Committee on Cancer 8th edition clinical stage at presentation.
Of the 322 women who completed the Health Leads Social Needs Screening Toolkit, 201 (62%) self-identified as Hispanic, 63 (19%) as non-Hispanic Black, and 63 (19%) as non-Hispanic White. Two hundred fifty-five (76%) patients with access to city-funded screening mammography completed a screening mammogram. Patients who presented to the SNH were more likely to present with late-stage disease compared with early-stage disease (15 of 48 [31%] vs 50 of 274 [18%]; P = .04). On multivariable logistic regression, not completing a screening mammography was associated with having an increasing number of unmet social needs (OR, 0.74; 95% CI, 0.55-0.99; P = .047) and an increasing age at diagnosis (OR, 0.92; 95% CI, 0.89-0.96; P < .001). Moreover, increasing unmet social needs was significantly associated with late-stage diagnosis above and beyond screening mammography (OR, 1.38; 95% CI, 1.01-1.89; P = .04).
In this cohort study, access to screening mammography did not translate to utilization of screening mammography, increasing unmet social needs were significantly associated with lower rates of screening mammography, and those with increasing unmet social needs were more likely to present with late-stage disease. This association transcended recruitment site (SNH vs ACC), indicating that patients in either hospital setting may benefit from unmet social needs screening to overcome access to care barriers associated with late-stage disease at diagnosis
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Post-Mastectomy Implant Complications in the Hispanic Breast Cancer Patient Population
BACKGROUND/AIMThe purpose was to analyze the impact of post-mastectomy radiation therapy (PMRT) on implant-based breast reconstruction (IBR) in self-identified Hispanic patients compared to non-Hispanic counterparts.PATIENTS AND METHODSWe retrospectively reviewed patients who underwent IBR between January 1, 2017 and December 31, 2019 at a single hospital system. Patients were cisgender women, assigned female at birth, 18 years or older, and underwent mastectomy with immediate IBR +/- PMRT. We compared characteristics between Hispanic and non-Hispanic patients, assessing capsular contracture and implant loss rates. Multivariable analysis was performed to identify factors associated with complications.RESULTSA total of 317 patients underwent mastectomy and reconstruction. Of these patients, 302 underwent a total of 467 mastectomies with IBR, and these 467 procedures were included in the analysis of complications. Complications occurred in 175 breasts (37.5%), regardless of PMRT. Seventy-two of the 302 patients (24%) received PMRT to one breast. The overall rates of capsular contracture, implant loss, and overall complications did not vary significantly between Hispanic and non-Hispanic patients (p=0.866, 0.974, and 0.761, respectively). When comparing only irradiated patients, there was a trend towards increased implant loss and overall complication rates in Hispanic versus non-Hispanic patients (p=0.107 and 0.113, respectively). Following PMRT the rate of any complication was 71% in Hispanic women and 53% in non-Hispanic women.CONCLUSIONOur study illuminates a trend towards higher complication rates after PMRT in Hispanic versus non-Hispanic patients. Further studies are needed to understand why Hispanic patients may have more side effects from radiation therapy
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Real-world impact of vaccination on coronavirus disease 2019 (COVID-19) incidence in healthcare personnel at an academic medical center.
ObjectiveCoronavirus disease 2019 (COVID-19) vaccination effectiveness in healthcare personnel (HCP) has been established. However, questions remain regarding its performance in high-risk healthcare occupations and work locations. We describe the effect of a COVID-19 HCP vaccination campaign on SARS-CoV-2 infection by timing of vaccination, job type, and work location.MethodsWe conducted a retrospective review of COVID-19 vaccination acceptance, incidence of postvaccination COVID-19, hospitalization, and mortality among 16,156 faculty, students, and staff at a large academic medical center. Data were collected 8 weeks prior to the start of phase 1a vaccination of frontline employees and ended 11 weeks after campaign onset.ResultsThe COVID-19 incidence rate among HCP at our institution decreased from 3.2% during the 8 weeks prior to the start of vaccinations to 0.38% by 4 weeks after campaign initiation. COVID-19 risk was reduced among individuals who received a single vaccination (hazard ratio [HR], 0.52; 95% confidence interval [CI], 0.40-0.68; P < .0001) and was further reduced with 2 doses of vaccine (HR, 0.17; 95% CI, 0.09-0.32; P < .0001). By 2 weeks after the second dose, the observed case positivity rate was 0.04%. Among phase 1a HCP, we observed a lower risk of COVID-19 among physicians and a trend toward higher risk for respiratory therapists independent of vaccination status. Rates of infection were similar in a subgroup of nurses when examined by work location.ConclusionsOur findings show the real-world effectiveness of COVID-19 vaccination in HCP. Despite these encouraging results, unvaccinated HCP remain at an elevated risk of infection, highlighting the need for targeted outreach to combat vaccine hesitancy