Assessing Wellness Needs of Breast Cancer Survivors in Vermont

Background: • In Vermont, 500 breast cancer diagnoses are made annually. • As of 2005, epidemiological data suggest that as many as 7,000 breast cancer survivors were living in VT. • Dragonheart Vermont’s “Survivorship NOW”4 initiative aims to bridge the gap between treatment and recovery. • A literature review, including the Taking Charge program and a survivor needs assessment done by Dr. Geller, supported conducting a needs assessment in three areas: exercise, nutrition, and emotional support. • UVM COM paired with Dragonheart Vermont’s “Survivorship NOW” initiative to determine how to best address these needs.https://scholarworks.uvm.edu/comphp_gallery/1073/thumbnail.jp

Risk factors for Coronavirus disease 2019 (Covid-19) death in a population cohort study from the Western Cape province, South Africa

Risk factors for coronavirus disease 2019 (COVID-19) death in sub-Saharan Africa and the effects of human immunodeficiency virus (HIV) and tuberculosis on COVID-19 outcomes are unknown. We conducted a population cohort study using linked data from adults attending public-sector health facilities in the Western Cape, South Africa. We used Cox proportional hazards models, adjusted for age, sex, location, and comorbidities, to examine the associations between HIV, tuberculosis, and COVID-19 death from 1 March to 9 June 2020 among (1) public-sector “active patients” (≥1 visit in the 3 years before March 2020); (2) laboratory-diagnosed COVID-19 cases; and (3) hospitalized COVID-19 cases. We calculated the standardized mortality ratio (SMR) for COVID-19, comparing adults living with and without HIV using modeled population estimates.Among 3 460 932 patients (16% living with HIV), 22 308 were diagnosed with COVID-19, of whom 625 died. COVID19 death was associated with male sex, increasing age, diabetes, hypertension, and chronic kidney disease. HIV was associated with COVID-19 mortality (adjusted hazard ratio [aHR], 2.14; 95% confidence interval [CI], 1.70–2.70), with similar risks across strata of viral loads and immunosuppression. Current and previous diagnoses of tuberculosis were associated with COVID-19 death (aHR, 2.70 [95% CI, 1.81–4.04] and 1.51 [95% CI, 1.18–1.93], respectively). The SMR for COVID-19 death associated with HIV was 2.39 (95% CI, 1.96–2.86); population attributable fraction 8.5% (95% CI, 6.1–11.1)

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015

Forouzanfar MH, Afshin A, Alexander LT, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. LANCET. 2016;388(10053):1659-1724.Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors-the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57.8% (95% CI 56.6-58.8) of global deaths and 41.2% (39.8-42.8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211.8 million [192.7 million to 231.1 million] global DALYs), smoking (148.6 million [134.2 million to 163.1 million]), high fasting plasma glucose (143.1 million [125.1 million to 163.5 million]), high BMI (120.1 million [83.8 million to 158.4 million]), childhood undernutrition (113.3 million [103.9 million to 123.4 million]), ambient particulate matter (103.1 million [90.8 million to 115.1 million]), high total cholesterol (88.7 million [74.6 million to 105.7 million]), household air pollution (85.6 million [66.7 million to 106.1 million]), alcohol use (85.0 million [77.2 million to 93.0 million]), and diets high in sodium (83.0 million [49.3 million to 127.5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Copyright (C) The Author(s). Published by Elsevier Ltd

El intento de suicidio y la desesperanza en la adolescencia

Introducción: El suicidio se puede dividir en tres categorías: suicidio consumado, intento suicida e ideación suicida. La situación actual de los y las adolescentes y las condiciones que inciden negativamente sobre su calidad de vida, se hacen evidentes cuando se analizan las estadísticas sobre el intento de suicidio, que representa situaciones límites y que hace referencia al fracaso social como proceso individual de vida. Objetivo: Identificar la frecuencia de intentos de suicidio y el estado de desesperanza presentes en los adolescentes. Metodología: Se trabajó con una población de 1469 adolescentes, matriculados en dos Instituciones Educativas de la ciudad de Cuenca: Colegio Nacional "Benigno Malo" y la Unidad Educativa Particular "Corazón de María". Para la recogida de datos se utilizaron el Cuestionario de Conducta Suicida (SBQ), que indaga sobre la frecuencia de ideas suicidas e intentos de suicidio y la Escala de desesperanza de Beck. Los datos fueron procesados mediante el programa estadístico SPSS. Resultados: Del total de adolescentes un 11.95% ha intentado suicidarse al menos una vez; de éstos, un 22.3% tiene dieciséis años. Respecto a la desesperanza se obtuvo que el 11.26% y 2,39% manifiestan niveles moderados y severos de desesperanza, respectivamente. Conclusiones: La desesperanza y la conducta suicida exhiben comportamientos que deben ser contemplados desde la intervención psicológica en adolescentes de Unidades Educativas Colegio Nacional "Benigno Malo" y "Corazón de María".Introduction: Suicide can be divided into three categories: completed suicide, suicide attempt and suicidal ideation. The current situation of adolescents and the conditions that negatively affect their quality of life, are evident when analyzing the statistics on the suicide attempt, which represents extreme situations and which refers to social failure as an individual life process. Objective: To identify the frequency of suicide attemps and the state of despair present in adolescents. Methodology: The instrument used was the Suicide Behavior Questionary (SBQ) by Lilian Salvo and Roberto Melipillán that investigates the frequency of suicidal ideation and suicide attemps and the scale of Beck's despair that allows us to orient the state of despair experienced by the person, including in the study 1469 adolescents, enrolled in the Educational Institutions of the city of Cuenca: National School "Benigno Malo". and the Particular Educational Unit Corazón de María". Results: The results of this research were obtained throug the SPSS program showing that 11.95% of adolescents have attempted suicide once; of these, 22.3% turn out to be adolescents of sixteen years of age. In turn, 11.26% and 2.39% manifest a moderate despair and a severe despair, respectively. Conclusiones: Although the adolescent lives with both parents, there is the presence of suicide attempts more in women and the presence of states of despair, between mild and moderate

The Effect of Tobacco Use on the Expression of Placental Transporters in Alaska Native Women

Prenatal tobacco use among Alaska Native (AN) women has decreased substantially over the past two decades. Previous research suggests that providing AN women with feedback regarding fetal exposure to tobacco may further promote cessation. Transporters in the placenta regulate fetal exposure to nutrients and xenobiotics, including compounds associated with tobacco use. We examined whether prenatal tobacco use impacts transporter expression in the placenta, and whether this is influenced by fetal sex, degree of tobacco exposure, or transporter genotype. At delivery, we obtained placental samples from AN research participants who smoked cigarettes, used commercial chew or iqmik (oral tobacco), or did not use tobacco during pregnancy. Transporter expression was evaluated using qRT-PCR and Western blotting and tested for correlations between transcript levels and urinary biomarkers of tobacco use. The impact of BCRP/ABCG2 and OATP2B1/SLCO2B1 genotypes on protein expression was also examined. Oral tobacco use was associated with decreased P-gp and increased MRP1, MRP3, LAT1, and PMAT mRNA expression. Transcript levels of multiple transporters significantly correlated with tobacco biomarkers in maternal and fetal urine. In women carrying male fetuses, both smoking and oral tobacco were associated with decreased P-gp. Oral tobacco was also associated with decreased LAT1 in women carrying female fetuses. BCRP and OATP2B1 genotypes did not appear to impact protein expression. In conclusion, prenatal tobacco use is associated with altered expression of multiple placental transporters which differs by fetal sex. As transcript levels of multiple transporters were significantly correlated with tobacco use biomarkers, eliminating prenatal tobacco use should alleviate these changes

Biomarker feedback intervention for smoking cessation among Alaska Native pregnant women: Randomized pilot study.

ObjectiveThere is some evidence for biomarker feedback when combined with cessation counseling for reducing smoking in pregnancy. This randomized controlled pilot study evaluated feasibility and potential efficacy of a social-cognitive theory (SCT)-based biomarker feedback intervention among pregnant Alaska Native (AN) smokers.MethodsParticipants were randomly assigned to receive three study calls (10-20 min each): (1) biomarker feedback intervention (n = 30) including personalized cotinine results and feedback on their baby's likely exposure to carcinogen metabolite NNAL, or (2) contact control usual care condition based on the 5As (n = 30). Assessments were conducted at baseline, post-treatment, and delivery.ResultsHigh rates of treatment compliance, study retention, and treatment acceptability were observed in both groups. 7-day point prevalence smoking abstinence rates at delivery verified with urinary cotinine were the same in both study groups (20% intent-to-treat analysis, 26% per-protocol). SCT-based measures did not change differentially from baseline by study group.ConclusionThis trial supports the feasibility and acceptability of providing biomarker feedback within the clinical care delivery system, but the intervention did not promote increased smoking cessation during pregnancy compared to usual care.Practice implicationsEfforts are needed to promote the usual care and to develop alternative biomarker feedback messaging for pregnant AN women