Prevention Strategies for Gynecologic Cancers

This dissertation focused on prevention strategies for ovarian and cervical cancers. Primary prevention of ovarian cancer was explored in Aim 1 using data from the Ovarian Cancer Association Consortium (OCAC; 7,743 cases; 11,882 controls) with the goal of developing a risk stratification model for ovarian cancer. This model was the most comprehensive to date and included body mass index (BMI), height, age at menarche, parity, breastfeeding, incomplete pregnancy, age at last pregnancy, tubal ligation, age at menopause, combined oral contraceptive use, depot-medroxyprogesterone acetate use, menopausal hormone therapy use, first-degree family history of ovarian cancer, endometriosis, and a 36-variant polygenic risk score. We found that associations between ovarian cancer and family history of the disease and endometriosis were modified by menopausal status, but no pairwise interactions between the 15 risk factors themselves were identified. Hence, we developed an ovarian cancer 15-factor multiplicative risk stratification model separately for pre- and post-menopausal women (based on age). Our model stratifies women into finer risk profiles than prior models thereby allowing us to identify people who are candidates for ovarian cancer precision prevention strategies. Tertiary prevention for ovarian cancer was examined in Aim 2 by studying the associations between lifestyle and reproductive factors and residual disease after ovarian cancer primary cytoreductive surgery (PCS). We included 2,169 OCAC participants with advanced stage high-grade serous ovarian cancer who underwent PCS. We found that parous compared to nulliparous women and menopausal estrogen users compared to never users were statistically significantly less likely to have macroscopic residual disease after PCS after adjusting for relevant clinical factors (OR=0.65, 95% CI 0.45-0.93, p=0.018 and OR=0.69, 95% CI 0.48-1.00, p=0.048, respectively). Conversely, women who had ever breastfed compared to those who had not were more likely to have residual disease (adjusted OR=1.41, 95% CI 1.03-1.92, p=0.032). If these findings are replicated, this scope of work has tremendous potential to assist with ovarian cancer precision treatment. These factors could be included in treatment decision tools to help determine whether a patient should undergo PCS or have neoadjuvant chemotherapy followed by interval debulking surgery. Lastly, cervical cancer secondary prevention was studied in Aim 3 where a cross-sectional survey on awareness of, experience with, and attitudes toward cervical cancer screening was carried out among urban (n=202) and rural women (n=196) in Southern Vietnam. Women in both areas reported similarly low awareness of Human papillomavirus (HPV; 37.6% in urban and 34.2% in rural areas had ever heard of it) and low cervical cancer screening (51.8% in urban; 49.1% in rural). Urban participants were statistically significantly more willing to try HPV self-sampling for cervical cancer screening than rural participants (56.2% in urban; 42.2% in rural; OR=2.02, 95% CI 1.26-3.23) adjusting for demographic and socioeconomic factors. Rural women were more likely to have the concern of self-sampling incorrectly (73.4% in urban; 82.5% in rural; adjusted OR=0.49, 95% CI 0.28-0.88) while urban women were more likely to fear HPV testing revealing cancer (59.9% in urban; 47.1% in rural; adjusted OR=1.78, 95% CI 1.11-2.86). Improving health literacy and healthcare access and developing rural-urban tailored health education programs are warranted to reduce the cervical cancer burden in Southern Vietnam. This dissertation has tremendous translational potential to decrease the burden of gynecologic cancers by assisting with prevention, screening, and treatment for ovarian and cervical cancers.PhDEpidemiological ScienceUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/172596/1/phungmt_1.pd

Effect of Ignition Energy and Hydrogen Addition on Laminar Flame Speed, Ignition Delay Time, and Flame Rising Time of Lean Methane/Air Mixtures

A series of experiments were performed to investigate the effect of ignition energy (Eig) and hydrogen addition on the laminar burning velocity (Su0), ignition delay time (tdelay), and flame rising time (trising) of lean methane−air mixtures. The mixtures at three different equivalence ratios (ϕ) of 0.6, 0.7, and 0.8 with varying hydrogen volume fractions from 0 to 50% were centrally ignited in a constant volume combustion chamber by a pair of pin-to-pin electrodes at a spark gap of 2.0 mm. In situ ignition energy (Eig ∼2.4 mJ ÷ 58 mJ) was calculated by integration of the product of current and voltage between positive and negative electrodes. The result revealed that the Su0 value increases non-linearly with increasing hydrogen fraction at three equivalence ratios of 0.6, 0.7, and 0.8, by which the increasing slope of Su0 changes from gradual to drastic when the hydrogen fraction is greater than 20%. tdelay and trising decrease quickly with increasing hydrogen fraction; however, trising drops faster than tdelay at ϕ = 0.6 and 0.7, and the reverse is true at ϕ = 0.8. Furthermore, tdelay transition is observed when Eig > Eig,critical, by which tdelay drastically drops in the pre-transition and gradually decreases in the post-transition. These results may be relevant to spark ignition engines operated under lean-burn conditions

A comparative study on behavior, awareness and belief about cervical cancer among rural and urban women in Vietnam

Cervical cancer is the second most common gynecologic cancer in Vietnam but based on the literature, only ~25% of Vietnamese women reported ever being screened for cervical cancer. To inform strategies to reduce the cervical cancer burden in Southern Vietnam where disease incidence is higher than the national average, this study examined behaviors, awareness, barriers, and beliefs about cervical cancer screening among rural and urban women in this geographical region. In October-November 2021, we conducted a cross-sectional study among 196 rural and 202 urban women in Southern Vietnam; participants completed a cervical cancer screening questionnaire. Descriptive analyses and rural-urban differences in screening behavior, awareness, barriers, and beliefs are presented. About half of the rural and urban participants reported ever being screened for cervical cancer. Most participants showed high perceived severity of cervical cancer and benefits of screening. Further, they reported that they would screen if it was recommended by doctors and/or friends/family. However, most women showed low awareness and perceived susceptibility to cervical cancer. Logistical and psychosocial barriers to physician-based screening methods were reported. Based on our results, the World Health Organization 2030 goals for cervical cancer screening are not currently met in Southern Vietnam. Increasing health literacy and engaging doctors and family members/social networks emerged as important avenues to improve screening. HPV (Human papillomavirus) self-sampling is also a potential approach to increase uptake of cervical cancer screening given the identified psychosocial and logistical barriers

Pharmacological Properties, Volatile Organic Compounds, and Genome Sequences of Bacterial Endophytes from the Mangrove Plant Rhizophora apiculata Blume

Mangrove plant endophytic bacteria are prolific sources of bioactive secondary metabolites. In the present study, twenty-three endophytic bacteria were isolated from the fresh roots of the mangrove plant Rhizophora apiculata. The identification of isolates by 16S rRNA gene sequences revealed that the isolated endophytic bacteria belonged to nine genera, including Streptomyces, Bacillus, Pseudovibrio, Microbacterium, Brevibacterium, Microbulbifer, Micrococcus, Rossellomorea, and Paracoccus. The ethyl acetate extracts of the endophytic bacteria’s pharmacological properties were evaluated in vitro, including antimicrobial, antioxidant, α-amylase and α-glucosidase inhibitory, xanthine oxidase inhibitory, and cytotoxic activities. Gas chromatography–mass spectrometry (GC-MS) analyses of three high bioactive strains Bacillus sp. RAR_GA_16, Rossellomorea vietnamensis RAR_WA_32, and Bacillus sp. RAR_M1_44 identified major volatile organic compounds (VOCs) in their ethyl acetate extracts. Genome analyses identified biosynthesis gene clusters (BGCs) of secondary metabolites of the bacterial endophytes. The obtained results reveal that the endophytic bacteria from R. apiculata may be a potential source of pharmacological secondary metabolites, and further investigations of the high bioactive strains—such as fermentation and isolation of pure bioactive compounds, and heterologous expression of novel BGCs in appropriate expression hosts—may allow exploring and exploiting the promising bioactive compounds for future drug development

Study of a Strong Luminescent Core Shell Nanocomposite of Europium Complex Coated on Gold Nanoparticles: Synthesis and Properties

International audienc

Determination of drug-related problems among type 2 diabetes outpatients in a hospital in Vietnam: A cross-sectional study.

IntroductionDrug-related problems (DRPs) are common in clinical practice and occur at all stages of the medication process. The major factor contributing to DRPs is prescription, although patients' poor adherence to treatment is also a significant factor. This study evaluated type 2 diabetes outpatients in a hospital in Vietnam for drug-related problems (DRPs) and related variables.MethodsA cross-sectional descriptive study was conducted on 495 outpatients who met the criteria and 157 people agreed to participate in the interview. Medication order review and medication adherence review were used to identify DRPs. The types of DRP were based on the Pharmaceutical Care Network Europe (PCNE) categories version 9.0. The identification and assessment DRPs were carried out by clinical pharmacists and get agreed upon by physicians who had not directly prescribed patients who participated in the study.ResultsA total of 762 DRPs were identified via prescribing review process, the average number of DRP on each prescription was 1.54±1.07, while 412 DRPs were determined through patient interviewing. The most frequent DRPs were "ADR (Adverse Drug Reaction) occurring" (68.8%). The main causes were "patient is unable to understand instructions properly" or "patient is not properly instructed", "patient stores insulin inappropriately", "patient decides to use unnecessary drugs" and "patient intentionally uses/takes less drug than prescribed or does not take the drug at all for whatever reason" which accounted for 65.0%, 41.4%, 38.2%, and 28.7%, respectively. From the prescribing review, the most observed DRPs were "Inappropriate drug according to guidelines/formulary" and "No or incomplete drug treatment in spite of existing indication", accounting for 45.0% and 42.9%, respectively. There was a significant association between age (OR 3.38, 95% CI: 1.01-11.30), duration of diabetes (OR 3.61, 95%CI: 1.11-11.74), presence of comorbidity (OR 5.31, 95%CI: 1.97-14.30), polypharmacy (OR: 2.95, 95%CI: 1.01-8.72) and DRPs. In patients, poor knowledge of antidiabetic agents was the main reason to lack adherence and occurring ADR (OR 2.73, 95%CI: 1.32-5.66, p = 0.007 and OR 2.49, 95%CI: 1.54-4.03, p = 0.001 respectively).ConclusionDRPs occurred in the prescribing stage and relating to patient's behavior of drug administration was high. Clear identification of DRPs and the associated factors are essential for building the intervention process to improve effectiveness and safety in the treatment of type 2 diabetes mellitus patients

Acceptance and User Experiences of a Wearable Device for the Management of Hospitalized Patients in COVID-19–Designated Wards in Ho Chi Minh City, Vietnam: Action Learning Project

BackgroundWearable devices have been used extensively both inside and outside of the hospital setting. During the COVID-19 pandemic, in some contexts, there was an increased need to remotely monitor pulse and saturated oxygen for patients due to the lack of staff and bedside monitors. ObjectiveA prototype of a remote monitoring system using wearable pulse oximeter devices was implemented at the Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam, from August to December 2021. The aim of this work was to support the ongoing implementation of the remote monitoring system. MethodsWe used an action learning approach with rapid pragmatic methods, including informal discussions and observations as well as a feedback survey form designed based on the technology acceptance model to assess the use and acceptability of the system. Based on these results, we facilitated a meeting using user-centered design principles to explore user needs and ideas about its development in more detail. ResultsIn total, 21 users filled in the feedback form. The mean technology acceptance model scores ranged from 3.5 (for perceived ease of use) to 4.4 (for attitude) with behavioral intention (3.8) and perceived usefulness (4.2) scoring in between. Those working as nurses scored higher on perceived usefulness, attitude, and behavioral intention than did physicians. Based on informal discussions, we realized there was a mismatch between how we (ie, the research team) and the ward teams perceived the use and wider purpose of the technology. ConclusionsDesigning and implementing the devices to be more nurse-centric from their introduction could have helped to increase their efficiency and use during the complex pandemic period

Effects of risk factors for ovarian cancer in women with and without endometriosis.

ObjectiveTo evaluate the associations between 10 well-established ovarian cancer risk factors and risk of ovarian cancer among women with vs. without endometriosis.DesignPooled analysis of 9 case-control studies in the Ovarian Cancer Association Consortium.SettingPopulation-based.Patient(s)We included 8,500 women with ovarian cancer, 13,592 control women.Intervention(s)Ten well-established ovarian cancer risk factors.Main outcome measure(s)Risk of ovarian cancer for women with and without endometriosis.Result(s)Most risk factor-ovarian cancer associations were similar when comparing women with and without endometriosis, and no interactions were statistically significant. However, body mass index (BMI) 25-<30 kg/m2 was associated with increased ovarian cancer risk among women with endometriosis (odds ratio [OR] = 1.27, 95% confidence interval [CI] 1.00-1.60), but not associated with the risk among women without endometriosis (OR = 0.97; 95% CI, 0.91-1.05) when compared with BMI 18.5-<25 kg/m2; an increased risk was observed for a BMI ≥30 kg/m2, although there was little difference comparing women with endometriosis (OR = 1.21; 95% CI, 0.94-1.57) to women without (OR = 1.13; 95% CI, 1.04-1.22) (P-interaction = .51). Genital talcum powder use and long-term menopausal estrogen-only therapy use showed increased ovarian cancer risk, but risk appeared greater for those with endometriosis vs. those without (genital talcum powder: OR = 1.38; 95% CI, 1.04-1.84 vs. OR = 1.12; 95% CI, 1.01-1.25, respectively; ≥10 years of estrogen-only therapy: OR = 1.88; 95% CI, 1.09-3.24 vs. OR = 1.42; 95% CI, 1.14-1.76, respectively); neither of these interactions were statistically significant (P-interaction = .65 and P-interaction = .96, respectively).Conclusion(s)The associations between ovarian cancer and most risk factors were similar among women with and without endometriosis. However, there was some suggestion of differences by endometriosis status for BMI, menopausal hormone therapy use, and genital talcum powder use, highlighting the complexity of ovarian cancer etiology