HAART in hand: The change in Kaposi’s sarcoma presentation in KwaZulu-Natal, South Africa

Background. HIV/AIDS-related Kaposi’s sarcoma (HIV-KS) is a public health problem in South Africa (SA). It is AIDS defining. There have been no studies evaluating its prevalence since the national roll-out of highly active antiretroviral therapy (HAART).Objective. To evaluate the effect of HAART on the disease profile of HIV-KS in KwaZulu-Natal Province (KZN), SA.Methods. Charts of patients with histologically confirmed HIV-KS were reviewed at an oncology clinic in KZN. The significance of associations of HAART with age, gender, CD4 count, urban/rural residence, fungating lesions, ulceration and lymphoedema, and treatment delay, was determined by t-tests for normally distributed continuous variables and χ2 tests for categorical variables. Logistic regression models were used to analyse the association of HAART with CD4 count.Results. Of 198 patients, 194 were documented as HIV-positive; 168 (86.6%) were on HAART at the time of their KS diagnosis. The mean CD4 count of 266 cells/μL was higher than that in previous studies at this site. The mean age at presentation was 36.6 (standard deviation 10.1) years. Females presented at a younger mean age than males (p<0.001). The mean age of females on HAART was 34.7 years and that of males 39.0 years (p=0.003). HAART-naive patients were three times more likely than those receiving HAART (15.4% v. 4.8%) to have visceral involvement (p=0.03).Conclusions. HAART use has resulted in outcome improvement. Mean age at presentation has increased in the group as a whole and for females in particular. The trend in mean CD4 counts has shown positive growth. Females no longer shoulder a disproportionate burden of disease

Three Studies of Fathers' Adaptation to Pregnancy and Parenthood: (1) Moving up the ëMagic Momentí: Fathersí Experience of Prenatal Ultrasound; (2) The Longitudinal Development of Paternal-fetal Attachment; (3) Fathering after Military Deployment: Parenting Challenges and Goals of Fathers of Young Children.

Fathers’ positive and negative interactions impact the health and wellness of mothers and children beginning in the prenatal period and extending across the lifecourse, yet little is known regarding opportunities to engage fathers and encourage patterns of supportiveness. In three discrete, but connected, empirical papers, in my dissertation I use a mix of qualitative and quantitative methods to investigate such opportunities. I use a grounded theory approach to analyze data collected in interviews with expectant fathers after attending a routine prenatal ultrasound, and I find that the period of pregnancy, and the moment of ultrasound in particular, may offer a potent teachable moment when men are feeling hopeful about the future, examining their behaviors and life choices, and may be receptive to outreach. I use data from cross-sectional surveys administered three times across pregnancy to men expecting their first child to examine trajectories of development of paternal-fetal attachment, and find that paternal-fetal attachment increases with time, and is consistently higher among fathers who considered the pregnancy both wanted and well-timed. I examine interview data collected from fourteen male service members, each returned from deployment to a combat zone and parent to at least one child under age seven, to identify specific parenting challenges and goals of fathers of young children post-deployment. Collectively, my three dissertation papers expand the knowledge base on men’s thoughts, feelings and behaviors during the transition to fatherhood, and advance understanding of how to support emerging competencies in early fatherhood and promote nurturing father-child relationships.PhDSocial Work and PsychologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/102465/1/tneugut_1.pd

Feasibility and efficacy of pairing fecal immunochemical testing with mammography for increasing colorectal cancer screening among uninsured Latinas in northern Manhattan

Objectives: We evaluated the feasibility and efficacy of a program to promote colorectal cancer screening (CRC) among uninsured Latinas receiving mammography through a cancer screening clinic in northern Manhattan. Methods: Between August 2009 and March 2010, unscreened, average CRC risk, uninsured Latinas, aged 50–64 years, undergoing mammography received a screening recommendation, education, and fecal immunochemical test (FIT). Socio-demographic information and level of acculturation was collected. Screening compliance was assessed. Results: Of 651 Latinas evaluated, 210 were eligible and, of these, 94% (n = 197) consented to participate; 441 were excluded because they were up-to-date with CRC screening (n = 130), less than 50 (n = 285) or greater than 64 (n = 26) years of age. After intervention, 177 (90%) completed FIT. Within 2 weeks, 87% completed the FIT, and 69% did so with no reminder calls. Acculturation was significantly lower among screeners (p = 0.014). Compared with non-screeners, screeners were more likely to be foreign-born (p = 0.009), to speak only Spanish (p = 0.043), and to prefer to read (p = 0.037), and think (p = 0.015) in Spanish. Conclusion: This study suggests that pairing CRC education and screening with mammography is both feasible and efficacious

Clinicopathological features of extranodal lymphomas: Kuwait experience

A total of 935 patients with extranodal non-Hodgkin lymphoma (NHL) diagnosed in the period between January 1985 and December 2000 in Kuwait Cancer Center, serving the whole population of Kuwait, were used to describe the clinicopathological and epidemiological features of extranodal lymphomas in Kuwait. Extranodal lymphomas accounted for 45% of all NHL observed during this time. All NHL cases from Kuwait Cancer registry were analyzed and pathologically reclassified using the latest WHO ( 2000) classification. The most common lymphoma observed was diffuse large B-cell lymphoma (58.60%) followed by Burkitt's lymphoma (BL) (3.80%). In the pediatric group, BL comprises more than two thirds of all patients (77.20%). The most common extranodal sites were stomach (19.70%) and skin (17.80%) in the adult group, large intestine (29.80%) and small intestine (19.30%) in the pediatric age group. The majority (73.40%) of adult extranodal lymphomas was in stage IE - IIE and had a very good prognosis. On the contrary, the majority of pediatric extranodal lymphomas were found to be in stage III and IV. Variations in treatment policies ( single agent or combined chemotherapy, radiotherapy, combined modality treatment) adopted and changed during the time period of 16 years of this retrospective study were documented. Copyright (C) 2004 S. Karger AG, Basel

Cigarette smoking and large cell carcinoma of the lung

Large cell carcinoma is the fourth most common histological type of lung cancer in the United States. Cigarette smoking causes large cell lung cancer, but it is uncertain whether the effect varies with the amount and duration of smoking. This uncertainty stems from ambiguity in the histopathological classification of large cell cancer, especially before 1971, and the relatively infrequent occurrence of large cell cancer in epidemiological studies. The present case-control investigation demonstrates that the risk of large cell cancer increases with both the frequency and number of years of cigarette smoking. The odds ratio associated with smoking two or more packs/day was 37.0 (95% confidence interval, 16.4-83.2) in men and 72.9 (35.4- 150.2) in women. It is concluded that cigarette smoking is the predominant cause of large cell lung cancer

Cardiovascular Disease Mortality Among Breast Cancer Survivors

Cardiovascular disease (CVD) is of increasing concern among breast cancer survivors. However the burden of this comorbidity in this group relative to the general population, and its temporal pattern, remains unknown

Exposure to fogger trucks and breast cancer incidence in the Long Island Breast Cancer Study Project: a case-control study

Background: Few studies have supported an association between breast cancer and DDT, usually assessed with biomarkers that cannot discern timing of exposure, or differentiate between the accumulation of chronic low-dose versus acute high-dose exposures in the past. Previous studies suggest that an association may be evident only among women exposed to DDT during biologically susceptible windows, or among those diagnosed with estrogen receptor/progesterone receptor-positive (ER+PR+) breast cancer subtypes. Self-reported acute exposure to a fogger truck, which sprayed DDT prior to 1972, was hypothesized to increase the risk of breast cancer, particularly among women exposed at a young age or diagnosed with ER+PR+ breast cancer. Methods: We examined these possibilities in the Long Island Breast Cancer Study Project (LIBCSP) (1,508 cases, 1,556 controls), which included exposure assessment by structured questionnaire and serum samples collected between 1996–1998, using adjusted logistic and polytomous regression to estimate ORs and 95% CIs. Results: Women with ER+PR+ breast cancer had a 44% increased odds of ever seeing a pre-1972 fogger truck compared to other subtypes (OR = 1.44; 95% CI 1.08-1.93). However, there was little variation in the observed increase in breast cancer risk when considering all women who reported seeing a pre-1972 fogger truck at their residence (OR = 1.16; 95% CI 0.98, 1.37), or during hypothesized susceptible windows. Self-reported acute exposure was not correlated with serum concentrations, a biomarker of long-term exposure. Conclusions: These findings support the hypothesis that seeing a fogger truck, a proxy measure for acute DDT exposure, may be associated with ER+PR+ tumors, the most commonly diagnosed breast cancer subtype among American women

Fecal-Based Colorectal Cancer Screening Among the Uninsured in Northern Manhattan

Background Colorectal cancer (CRC) screening reduces CRC mortality; however, for many reasons, uninsured individuals are less likely to utilize CRC screening tests. Purpose To compare CRC screening behaviors and outcomes with guaiac fecal occult blood testing (gFOBT) from 1998 to 2006 and fecal immunochemical testing (FIT) from 2006 to 2010 in a community-based program serving uninsured patients in northern Manhattan. Methods In 2013, we conducted a retrospective record review of individuals aged ≥50 years who received fecal-based CRC screening at the Northern Manhattan Cancer Screening Partnership between 1998 and 2010. Included were those with household income ≤250% of the federal poverty level, no medical insurance coverage, and who were not up to date with CRC screening. We assessed screening positivity rate, positive predictive value, differences in the use of diagnostic colonoscopy, colonoscopic findings, and adenoma detection rates for gFOBT versus FIT. Results In total, 7,710 patients completed CRC screenings (4,951 gFOBT and 2,759 FIT). The majority were female, Hispanic, foreign born, and young at age of first screening. Compared to gFOBT, FIT detected twice as many positive tests (3.2% vs 1.5%, p≤0.001) and had a higher adenoma detection rate (18.2 vs 11.8, p=0.002). Conclusions The improved positivity and adenoma detection rates with greater number of screening tests over time favor the use of FIT over gFOBT for colorectal screening among uninsured populations in northern Manhattan

Context, Challenges, And Tensions In Global Efforts To Engage Men In The Prevention Of Violence Against Women: An Ecological Analysis

As gender-based violence prevention programs around the world increasingly include efforts to engage men and boys as antiviolence allies, both the profound benefits and the inherent complexities of these efforts are emerging. Acknowledging and exploring tensions associated with engaging men is an important element of thoughtfully fostering menÕs antiviolence ally movements so as to both respectfully invite men into antiviolence work and create effective, gender-equitable prevention programming. To this end, this study presents descriptive findings regarding challenges associated with menÕs engagement programming from in-depth interviews with twenty-nine representatives of organizations that engage men and boys in preventing violence against women and girls in Africa, Asia, Europe, Oceania, and North and South America. Programs reported negotiating complex issues related to gender, the intersectional nature of menÕs identities, and establishing legitimacy and sustainability within communities while maintaining ideological focus and consistency. Additionally, programs reported that these tensions manifest across ecological layers of analysis, and impact both the participation of individual men and the programsÕ experiences in community and national contexts