Fear and loathing in the Caribbean: three studies of fear and cancer screening in Brooklyn's immigrant Caribbean subpopulations

Background: Anxiety, worry, and fear are among the most common emotional responses to the threat of disease and several studies have linked various fears to cancer preventive and detection behaviors. Cancer-related worry and fears about screening or its consequences are also characteristics that vary across ethnic groups and may be differentially linked to screening outcomes 1. Limiting the utility of this growing literature are at least two key considerations. First, little attention has been paid to documenting variation in cancer-related fears among subpopulations of persons of African descent, despite evidence that (a) rates of screening may vary among both male 2 and female 3 immigrants from islands in the Caribbean living in the United States and (b) incidence rates for cancers such as those of the prostate may be very high in men from Jamaica 4, Guadaloupe 5 and Trinidad and Tobago 6, as well as in immigrant groups in both the United Kingdom 7 and United States 8. Second, findings regarding the relations anxiety, cancer worry, and screening fear hold with screening behavior seen thus far have been inconsistent, in our view because anxieties stemming from different sources have different relations with behavior. In the emotions theory view, understanding the role of fear in health behavior in diverse groups is predicated on understanding the object or source of the fear 91011 for the simple reason that anxiety motivates avoidance of particular elicitors 1012. Research conducted within the U54 Comprehensive Cancer Partnership between Long Island University and Columbia University has produced several studies documenting differences in breast and prostate cancer screening frequencies among Caribbean subpopulations living in Brooklyn, New York 11213. A major concentration in this program of behavioral research has investigated whether trait anxiety, cancer worry, and screening-related fears vary across Caribbean subpopulations and whether these highly differentiated emotional responses independently predict screening behavior in multivariate models 12121314. Consistent with theory, we expected that fears pertaining to the screening context (e.g., fear of pain or the psychological implications of certain screens), would predict avoidance of the fear-inducing situation and thus be associated with less frequent screening. Conversely, where fears relate to the disease itself, greater fear should predict more frequent screening. Methods: Because of our overarching interest in the links between cancer and cancer-screening-related fears and cancer screening behaviors among the diverse groups of men and women living in Brooklyn, New York, we combined data from three community-based studies. Although measures and samples varied somewhat across studies, each study investigated the link between emotions and screening outcome in ethnic groups that included immigrants from islands in the Caribbean. Because of our interest in examining differences within traditional racial categories, we used a combination of (a) self-categorization based on a the traditional racial categories offered in the US Census together with (b) information regarding country of origin. Allowing a combination of self-reported racial categorization (tapping aspects of identity and minority status) in concert with shared birthplace to influence groupings increases the likelihood that participants share cultural and developmental characteristics thought to form part of ethnicity 15. We distinguished between Black men born in the United States (hereafter, U.S.-born African Americans), and those originating from countries in the English-speaking Caribbean (e.g., Trinidad & Tobago, Jamaica, Barbados). Immigrant and non-immigrant minority groups were contrasted with men self-identifying as "European or White/Non-Hispanic" who were born in the United States (hereafter, U.S.-born European American). In Study 1, stratified cluster-sampling was used to recruit 1364 women (aged between 50–70 years) from six ethnic groups: US-born African American, US-born European American, immigrants from islands in the English-speaking Caribbean (Jamaica, Barbados, Trinidad and Tobago), the Dominican Republic, Haiti, and Eastern Europe 1. In Study 2, 180 US-born African American, US-born European American and immigrant Jamaican men (aged between 40–70 years) were recruited using convenience sampling 13. In Study 3, 533 men (aged between 45–70 years) from four groups – US-born African American, US-born European American, and immigrant men from Jamaica and from Trinidad and Tobago – were recruited 12. In each study, participants provided background data, reported on screening history for either breast or prostate cancer, and completed a measure of trait anxiety, cancer worry, and/or screening fears. Results: As expected, we found differences among groups of African descent from the United States and the Caribbean. Although women from all groups screened at rates below those recommended, data from Study 1 showed that English-speaking Caribbean, Haitian and Dominican women screened less frequently than US-born African Americans and European Americans and that immigrant Eastern European women were also infrequent screeners (see Figure 1). Conversely, however, there were no differences in rates of self-reported prostate screening among men from the English-speaking Caribbean, US-born African Americans, or US-born European Americans in either Study 2 or Study 3. As expected, cancer-related emotional characteristics also varied across subpopulations (see Figure 2). Cancer worry was generally lower among women from the various Caribbean immigrant groups (Study 1) than it was among US-born African Americans or US-born European Americans. Fears regarding screening, however, varied somewhat differently. Fear of screening was higher among US-born African Americans and immigrant men from the English-speaking Caribbean (Studies 2 and 3) than among US-born European Americans. Consistent with the need to carefully measure fear-related constructs in the context of cancer behavior, however, our data also demonstrated that a specific fear related to concerns regarding threats to masculinity in the context of male screening strongly characterized the attitudes of men from the English-speaking Caribbean compared to the views of US-born European and US-born African Americans (Study 2). Finally, a combination of multiple regression and ANOVAs in each study showed that emotional characteristics independently predicted screening, in most cases even when background characteristics were controlled. Across studies, greater cancer worry predicted more frequent screening while fear of screening predicted less frequent screening. Figure 1 Number of cancer screens in prior 10 years Number of cancer screens in prior 10 years. DRE = digital rectal examination, PSA = prostate specific antigen test, Mamm = mammogram, CBE = clinical breast exam. Figure 2 Emotion characteristics related to screening Emotion characteristics related to screening. Trait = trait anxiety, Worry = cancer worry, Scr. Fr. = screening fear, and Em. Con. = emasculation concern. Conclusion: Data from three large-scale studies in Brooklyn, New York suggest that members of immigrant Caribbean subpopulations screen for breast and prostate cancer at very low rates; in most cases lower than those of either US-born African or US-born European Americans. Groups of Caribbean men and women also vary in the emotions they report regarding cancer and the screening process, generally revealing a pattern that is predictive of poorer screening. Coupled with the fact that emotion characteristics predicted screening outcomes even when controlling for other factors, data from these three studies suggest that the emotional responses Caribbean groups place them at risk for poor screening. Interventions that address these responses may offer the prospect of improving screening frequency in these disadvantaged groups. Competing interests: The authors declare that they have no competing interests. Authors' contributions: NSC and CM was involved in study design, analysis, interpretation/write up and critical revision of the manuscript. BA and DH in the analysis, interpretation and write up. AKJ, TU and LNB were involved in the interpretation and write up. PMR was part of the study design, analysis and interpretation/write up. JMM and AIN had part in the study design, analysis and critical revision whilst JSJ took part in critical revision

5-Fluorouracil-induced cardiotoxicity mimicking myocardial infarction: a case report

BACKGROUND: Severe cardiotoxicity is a documented, but very unusual side-effect of intravenous 5-fluorouracil therapy. The mechanism producing cardiotoxicity is poorly understood. CASE PRESENTATION: A case of 5-fluorouracil-induced cardiotoxicity, possibly due to coronary artery spasm, and mimicking acute anterolateral myocardial infarction is presented and discussed. Electrocardiographs highlighting the severity of the presentation are included in the report along with coronary angiograms demonstrating the absence of significant coronary atherosclerosis. CONCLUSION: Severe 5-fluorouracil-induced cardiotoxicity is rare, but can be severe and may mimic acute myocardial infarction, leading to diagnostic and therapeutic dilemmas. Readministration of 5-fluorouracil is not advised following an episode of cardiotoxicity

Docetaxel-carboplatin as first line chemotherapy for epithelial ovarian cancer

A prospective, non-randomized, multicentre, open, dose-finding study of a carboplatin-docetaxel (C-D) combination as first-line chemotherapy in FIGO stage Ic–IV epithelial ovarian cancer. C-D was given 3-weekly for 6 planned cycles, with a 3-day prophylactic dexamethasone regimen (8 mg b.i.d.). 139 eligible patients (Pts) (median age 56 years, range 28–85) were given a total of 750 cycles of chemotherapy in 5 cohorts: Co1, 32 pts, 169 cycles (C at AUC 5 + D 60 mg/m2); Co2, 22 pts, 122 cycles (5 + 75), Co3, 29 pts, 156 cycles (6 + 75), Co4, 27 pts, 146 cycles (7 + 75), Co5, 30 pts, 157 cycles (6 + 85). 110 patients (79%) completed 6 cycles; 17 (12%) stopped due to toxicity. 104 patients (75%) had CTC grade IV neutropenia, and 5 patients (4%) had this associated with fever. There were 2 probable treatment-related deaths. Only 8 patients (6%) experienced grade II–III neurotoxicity (all sensory; no motor > grade I). The maximum tolerated dose was reached in cohorts 4 and 5, and the dose limiting toxicities were myelosuppression and diarrhoea. The overall response rate for the study was 66% (49/74); CA125 response was 75% (70/93). Median progression-free survival was 16.6 months (95% CI 13.3–19.1). Recommended doses are carboplatin AUC 5 (via51 Cr EDTA) or AUC 6 (if calculated) plus docetaxel 75 mg/m2. A randomized trial comparing this regimen with carboplatin-paclitaxel has just completed recruitment. © 2001 Cancer Research Campaign http://www.bjcancer.co

SCAMP:standardised, concentrated, additional macronutrients, parenteral nutrition in very preterm infants: a phase IV randomised, controlled exploratory study of macronutrient intake, growth and other aspects of neonatal care

<p>Abstract</p> <p>Background</p> <p>Infants born <29 weeks gestation are at high risk of neurocognitive disability. Early postnatal growth failure, particularly head growth, is an important and potentially reversible risk factor for impaired neurodevelopmental outcome. Inadequate nutrition is a major factor in this postnatal growth failure, optimal protein and calorie (macronutrient) intakes are rarely achieved, especially in the first week. Infants <29 weeks are dependent on parenteral nutrition for the bulk of their nutrient needs for the first 2-3 weeks of life to allow gut adaptation to milk digestion. The prescription, formulation and administration of neonatal parenteral nutrition is critical to achieving optimal protein and calorie intake but has received little scientific evaluation. Current neonatal parenteral nutrition regimens often rely on individualised prescription to manage the labile, unpredictable biochemical and metabolic control characteristic of the early neonatal period. Individualised prescription frequently fails to translate into optimal macronutrient delivery. We have previously shown that a standardised, concentrated neonatal parenteral nutrition regimen can optimise macronutrient intake.</p> <p>Methods</p> <p>We propose a single centre, randomised controlled exploratory trial of two standardised, concentrated neonatal parenteral nutrition regimens comparing a standard macronutrient content (maximum protein 2.8 g/kg/day; lipid 2.8 g/kg/day, dextrose 10%) with a higher macronutrient content (maximum protein 3.8 g/kg/day; lipid 3.8 g/kg/day, dextrose 12%) over the first 28 days of life. 150 infants 24-28 completed weeks gestation and birthweight <1200 g will be recruited. The primary outcome will be head growth velocity in the first 28 days of life. Secondary outcomes will include a) auxological data between birth and 36 weeks corrected gestational age b) actual macronutrient intake in first 28 days c) biomarkers of biochemical and metabolic tolerance d) infection biomarkers and other intravascular line complications e) incidence of major complications of prematurity including mortality f) neurodevelopmental outcome at 2 years corrected gestational age</p> <p>Trial registration</p> <p>Current controlled trials: <a href="http://www.controlled-trials.com/ISRCTN76597892">ISRCTN76597892</a>; EudraCT Number: 2008-008899-14</p

Evaluating Active U: an Internet-mediated physical activity program.

Background: Engaging in regular physical activity can be challenging, particularly during the winter months. To promote physical activity at the University of Michigan during the winter months, an eight-week Internet-mediated program (Active U) was developed providing participants with an online physical activity log, goal setting, motivational emails, and optional team participation and competition. Methods: This study is a program evaluation of Active U. Approximately 47,000 faculty, staff, and graduate students were invited to participate in the online Active U intervention in the winter of 2007. Participants were assigned a physical activity goal and were asked to record each physical activity episode into the activity log for eight weeks. Statistics for program reach, effectiveness, adoption, and implementation were calculated using the Re-Aim framework. Multilevel regression analyses were used to assess the decline in rates of data entry and goal attainment during the program, to assess the likelihood of joining a team by demographic characteristics, to test the association between various predictors and the number of weeks an individual met his or her goal, and to analyze server load. Results: Overall, 7,483 individuals registered with the Active U website (≈16% of eligible), and 79% participated in the program by logging valid data at least once. Staff members, older participants, and those with a BMI < 25 were more likely to meet their weekly physical activity goals, and average rate of meeting goals was higher among participants who joined a competitive team compared to those who participated individually (IRR = 1.28, P < .001). Conclusion: Internet-mediated physical activity interventions that focus on physical activity logging and goal setting while incorporating team competition may help a significant percentage of the target population maintain their physical activity during the winter months

A Systematic Review of Online Sex Addiction and Clinical Treatments Using CONSORT Evaluation

Researchers have suggested that the advances of the Internet over the past two decades have gradually eliminated traditional offline methods of obtaining sexual material. Additionally, research on cybersex and/or online sex addictions has increased alongside the development of online technology. The present study extended the findings from Griffiths’ (2012) systematic empirical review of online sex addiction by additionally investigating empirical studies that implemented and/or documented clinical treatments for online sex addiction in adults. A total of nine studies were identified and then each underwent a CONSORT evaluation. The main findings of the present review provide some evidence to suggest that some treatments (both psychological and/or pharmacological) provide positive outcomes among those experiencing difficulties with online sex addiction. Similar to Griffiths’ original review, this study recommends that further research is warranted to establish the efficacy of empirically driven treatments for online sex addiction

Angiographic CT with intravenous administration of contrast medium is a noninvasive option for follow-up after intracranial stenting

Intracranial angioplasty and stenting (ICAS) is a therapeutic option in symptomatic intracranial atherosclerotic disease. Adequate follow-up examination is necessary to exclude in-stent restenosis. Conventional intraarterial digital subtraction angiography (ia-DSA) is the current gold standard, but it is an invasive technique and carries the risk of neurological complications. Angiographic CT (ACT) is a new technique that provides a volume dataset of the highest spatial resolution and high contrast resolution derived from a rotational acquisition of a c-arm-mounted flat-panel detector. The feasibility of ACT with intravenous administration of contrast medium (iv-ACT) for follow-up after ICAS is demonstrated. In two patients iv-ACT was performed as a follow-up examination 12 months after ICAS. High-resolution volume data from the rotational acquisitions were processed to provide delineation of the stent lumen as well as imaging of the brain parenchyma and vessels. In both patients the patency of the stent lumen was assessed successfully. In addition, all other brain vessels were displayed in a manner similar to their appearance on CT angiograms. The brain parenchyma was also adequately imaged in a manner similar to its appearance on CT images. We demonstrated the feasibility and diagnostic value of iv-ACT for follow-up imaging after ICAS. This new application has the potential to become the imaging method of choice after ICAS since it not only enables visualization of the patency of the stent lumen but also is minimally invasive and provides additional information about all brain arteries and the brain parenchyma

Formative evaluation of the telecare fall prevention project for older veterans

<p>Abstract</p> <p>Background</p> <p>Fall prevention interventions for community-dwelling older adults have been found to reduce falls in some research studies. However, wider implementation of fall prevention activities in routine care has yielded mixed results. We implemented a theory-driven program to improve care for falls at our Veterans Affairs healthcare facility. The first project arising from this program used a nurse advice telephone line to identify patients' risk factors for falls and to triage patients to appropriate services. Here we report the formative evaluation of this project.</p> <p>Methods</p> <p>To evaluate the intervention we: 1) interviewed patient and employee stakeholders, 2) reviewed participating patients' electronic health record data and 3) abstracted information from meeting minutes. We describe the implementation process, including whether the project was implemented according to plan; identify barriers and facilitators to implementation; and assess the incremental benefit to the quality of health care for fall prevention received by patients in the project. We also estimate the cost of developing the pilot project.</p> <p>Results</p> <p>The project underwent multiple changes over its life span, including the addition of an option to mail patients educational materials about falls. During the project's lifespan, 113 patients were considered for inclusion and 35 participated. Patient and employee interviews suggested support for the project, but revealed that transportation to medical care was a major barrier in following up on fall risks identified by nurse telephone triage. Medical record review showed that the project enhanced usual medical care with respect to home safety counseling. We discontinued the program after 18 months due to staffing limitations and competing priorities. We estimated a cost of $9194 for meeting time to develop the project.</p> <p>Conclusions</p> <p>The project appeared feasible at its outset but could not be sustained past the first cycle of evaluation due to insufficient resources and a waning of local leadership support due to competing national priorities. Future projects will need both front-level staff commitment and prolonged high-level leadership involvement to thrive.</p

Calmodulin-like proteins localized to the conoid regulate motility and cell invasion by Toxoplasma gondii

Toxoplasma gondii contains an expanded number of calmodulin (CaM)-like proteins whose functions are poorly understood. Using a combination of CRISPR/Cas9-mediated gene editing and a plant-like auxin-induced degron (AID) system, we examined the roles of three apically localized CaMs. CaM1 and CaM2 were individually dispensable, but loss of both resulted in a synthetic lethal phenotype. CaM3 was refractory to deletion, suggesting it is essential. Consistent with this prediction auxin-induced degradation of CaM3 blocked growth. Phenotypic analysis revealed that all three CaMs contribute to parasite motility, invasion, and egress from host cells, and that they act downstream of microneme and rhoptry secretion. Super-resolution microscopy localized all three CaMs to the conoid where they overlap with myosin H (MyoH), a motor protein that is required for invasion. Biotinylation using BirA fusions with the CaMs labeled a number of apical proteins including MyoH and its light chain MLC7, suggesting they may interact. Consistent with this hypothesis, disruption of MyoH led to degradation of CaM3, or redistribution of CaM1 and CaM2. Collectively, our findings suggest these CaMs may interact with MyoH to control motility and cell invasion