Effects of Acculturation on Quality of Life, Chronic Diseases and Health Behaviors in Persons of African Ancestry

The Black population in Philadelphia comprises of a diverse mix of persons with varied ancestry. We have established a non-cancer control registry (CAP3 study) which involves the collection of bio-specimens, epidemiological, lifestyle, quality of life, chronic conditions, culture and cancer prevention behaviors. Currently there are 707 participants enrolled, 95% from the African diaspora. In this study, the acculturation (the degree to which an individual holds onto their cultural norms) of new and pre-enrolled participants (n = 100) will be assessed and evaluations will be made to determine the relationship between acculturation, chronic conditions, health behaviors and quality of life. Since April 2015, 45 participants have been given the acculturation assessment. The demographics of these participants is largely foreign-born and with a mean age of 45.6. The process of data collection involves administering the health assessment and acculturation tool to eligible, consenting participants via face-to-face interviews, phone interviews, post-mail and electronic mail. Additionally, I will extract DNA from mouthwash and urine samples of participants. Presently, data collection and analysis, is still ongoing and results are not final. The most common chronic diseases and the least common health-impacting behaviors in the African diaspora will be examined and possible differences between persons of US origin and persons of foreign origin will be determined. The study findings will help to inform how quality of life and health behaviors are impacted by acculturation; leading to the development of culturally sensitive interventions to promote health and reduce chronic disease in the Black community

Racial differences in new-onset cardiovascular disease in men with prostate cancer treated with hormone therapy

INTRODUCTION Cardiovascular disease is the leading cause of death in patients with prostate cancer. Despite its efficacy in the treatment of advanced prostate cancer, androgen deprivation therapy (ADT) has been associated with increased cardiovascular disease mortality. Given black men have elevated risk of cardiovascular disease mortality compared to other racial groups, this study sought to evaluate the relationship of race with ADT-associated cardiotoxicity. METHODS We conducted a retrospective chart review of patients with locally advanced and metastatic prostate cancer who received androgen deprivation therapy at a single institution from 2017 to 2022. Methods of ADT included gonadotropin-releasing hormone agonists/antagonists, non-steroidal anti-androgens, and bilateral orchiectomy. Patients were identified using International Classification of Diseases diagnosis and procedure codes. Data was collected on patient demographics, details regarding prostate cancer staging and treatment, as well as cardiovascular diagnoses and events, both proceeding and following hormone treatment initiation. RESULTS A total of 119 patients met inclusion criteria, including 94 black men and 25 white men. Median age at time of diagnosis was 68 and 63, for black and white men respectively. The groups did not differ with respect to stage at diagnosis and treatment history including radical prostatectomy, radiation, and chemotherapy as well as type of ADT administered. Median follow up was 4.0 and 4.7 years in the white and black cohorts. Mean duration of androgen deprivation therapy was similar in white and black men (8.37 v. 7.0 years, p = 0.38, ANOVA). Prevalence of pre-existing cardiovascular diagnoses prior to starting androgen deprivation therapy was similar between the two groups prior to starting ADT treatment (28% v. 35%, p = 0.5, ANOVA). After initiating ADT, black men had greater likelihood of developing new cardiovascular diagnoses (46% v. 24%, p = 0.05, ANOVA), with a trend toward higher rate of coronary angioplasty/bypass procedures in black men (9.5% v. 4%, p 0.12, ANOVA). All recorded 8 deaths were in patients who identified as black; cardiovascular disease was the cause of death in 5 of the 8 patients (3 cerebrovascular accidents, 1 myocardial infarction, 1 pulmonary embolism). 2 of the 3 cerebrovascular accidents occurred in patients with no pre-existing cardiovascular history prior to initiation of ADT. CONCLUSIONS This data suggests a higher incidence of cardiovascular morbidity in black men on androgen deprivation therapy and may translate to a higher risk of cardiovascular mortality

High-risk and multiple human papillomavirus (HPV) infections in cancer-free Jamaican women

<p>Abstract</p> <p>Background</p> <p>Vaccines, that target human papillomavirus (HPV) high risk genotypes 16 and 18, have recently been developed. This study was aimed at determining genotypes commonly found in high-risk and multiple-HPV infections in Jamaican women. Two hundred and fifty three (253) women were enrolled in the study. Of these, 120 pregnant women, aged 15–44 years, were recruited from the Ante Natal Clinic at the University Hospital of the West Indies and 116 non-pregnant, aged 19–83, from a family practice in Western Jamaica. Cervical cell samples were collected from the women and HPV DNA was detected using Polymerase Chain Reaction and Reverse Line Hybridization. HPV genotypes were assessed in 236 women. Data were collected from January 2003 to October 2006.</p> <p>Results</p> <p>HPV DNA was detected in 87.7% (207/236) and of these 80.2% were positive for high-risk types. The most common high-risk HPV types were: HPV 45 (21.7%), HPV 58 (18.8%), HPV 16 (18.4%), HPV 35 (15.0%), HPV 18 (14.5%), HPV 52 (12.0%) and HPV 51(11.1%). Other high-risk types were present in frequencies of 1.4% – 7.2%.</p> <p>Multivariate regression analyses showed that bacterial vaginosis predicted the presence of multiple infections (OR 3.51; CI, 1.26–9.82) and that alcohol use (OR 0.31; CI, 0.15–0.85) and age at first sexual encounter (12–15 years: OR 3.56; CI, 1.41–9.12; 16–19 years, OR 3.53, CI, 1.22–10.23) were significantly associated with high risk infections. Cervical cytology was normal in the majority of women despite the presence of high-risk and multiple infections.</p> <p>Conclusion</p> <p>HPV genotype distribution in this group of Jamaican women differs from the patterns found in Europe, North America and some parts of Asia. It may be necessary therefore to consider development of other vaccines which target genotypes found in our and similar populations. HPV genotyping as well as Pap smears should be considered.</p

HPV as a marker for molecular characterization in head and neck oncology: Looking for a standardization of clinical use and of detection method(s) in clinical practice

Background: A consensus about the most appropriate diagnostic method(s) for head and neck human papillomavirus (HPV)\u2010induced carcinogenesis is still lacking because most of the commercially available assays have been designed for the cervix. Methods: This article summarizes current data and trends concerning HPV diagnostic strategies in oropharyngeal squamous cell carcinoma (OPSCC). Six main approaches are described. Results: The diagnostic gold standard for HPV\u2010related OPSCC, focusing on E6/E7 mRNA detection, requires fresh samples. Because most frequently available samples are formalin\u2010fixed paraffin\u2010embedded (FFPE), the pros and cons of the different approaches were analyzed. Conclusions: In the FFPE samples, the immunohistochemistry of p16, which is considered appropriate to assess HPV\u2010driven carcinogenesis in OPSCC according to the 8th American Joint Committee on Cancer TNM classification, may not be specific enough to become the diagnostic standard in the perspective of treatment deintensification. p16 may play a safer role in combination with another highly sensible assay. Other promising approaches are based on DNA detection through real\u2010time polymerase chain reaction and RNAscope

Patient- and delivery-level factors related to acceptance of HIV counseling and testing services among tuberculosis patients in South Africa: a qualitative study with community health workers and program managers

<p>Abstract</p> <p>Background</p> <p>South Africa has a high tuberculosis (TB)-human immunodeficiency virus (HIV) coinfection rate of 73%, yet only 46% of TB patients are tested for HIV. To date, relatively little work has focused on understanding why TB patients may not accept effective services or participate in programs that are readily available in healthcare delivery systems. The objective of the study was to explore barriers to and facilitators of participation in HIV counseling and testing (HCT) among TB patients in the Free State Province, from the perspective of community health workers and program managers who offer services to patients on a daily basis. These two provider groups are positioned to alter the delivery of HCT services in order to improve patient participation and, ultimately, health outcomes.</p> <p>Methods</p> <p>Group discussions and semistructured interviews were conducted with 40 lay counselors, 57 directly observed therapy (DOT) supporters, and 13 TB and HIV/acquired immune deficiency syndrome (AIDS) program managers in the Free State Province between September 2007 and March 2008. Sessions were audio-recorded, transcribed, and thematically analyzed.</p> <p>Results</p> <p>The themes emerging from the focus group discussions and interviews included four main suggested barrier factors: (1) fears of HIV/AIDS, TB-HIV coinfection, death, and stigma; (2) perceived lack of confidentiality of HIV test results; (3) staff shortages and high workload; and (4) poor infrastructure to encourage, monitor, and deliver HCT. The four main facilitating factors emerging from the group and individual interviews were (1) encouragement and motivation by health workers, (2) alleviation of health worker shortages, (3) improved HCT training of professional and lay health workers, and (4) community outreach activities.</p> <p>Conclusions</p> <p>Our findings provide insight into the relatively low acceptance rate of HCT services among TB patients from the perspective of two healthcare workforce groups that play an integral role in the delivery of effective health services and programs. Community health workers and program managers emphasized several patient- and delivery-level factors influencing acceptance of HCT services.</p

Oral HPV Infection and Sexuality: A Cross-Sectional Study in Women

Human Papillomavirus (HPV) is the main risk factor for cervical cancers and is associated with close to 36% of oropharyngeal cancers. There is increasing evidence that oral HPV transmission is related to sexual behavior but to our knowledge studies that involve women who have sex with women have not been performed. We examined the prevalence of oral HPV according to sexual behavior among a population-based sample of 118 women and have made some inferences of possible predictors of oral HPV infection. Women were categorized as heterosexual (history of vaginal sex and/or oral sex with males only, n = 75), bisexual (history of vaginal sex and oral sex with females, n = 32) and other (no history of vaginal sex but oral sex with females [homosexuals], virgins and women with incomplete sexual exposure data, n = 11) The prevalence of oral HPV infection was 12/118 (10.2%) for the overall study population and was not significantly different between heterosexual and bisexual women (10.7% (8/75) vs. 12.5% (4/32), p = 0.784). There was no oral HPV detected among homosexual women, virgins or among women where sexual exposure was unknown. Never smokers were more likely to be oral HPV+ compared to former smokers (Adjusted Odds Ratio (Adj OR) = 0.1, 95% CI, 0.0–1.1) and there was no difference in risk between never smokers and current smokers (Adj OR = 0.7, 95% CI, 0.1–4.6). Twenty-five percent (3/12) of oral HPV+ women had a history of HPV and/or genital warts compared to 9% (10/106) of oral HPV-women (p = 0.104). For the women with a history of vaginal sex (n = 110), oral HPV status was statistically significantly different according to oral sex exposure (p = 0.039). A higher proportion of oral HPV-positive women reported that they had no history of oral sex exposure compared to oral HPV-negative women (4/12, 33% vs. 7/98, 8%). The prevalence of cervical HPV infection did not vary between heterosexuals and bisexuals (35.7% (25/70) vs. 35.5% (11/31), p-value 0.411) and for all other women the cervical HPV prevalence was significantly lower (11.1%, 1/9). Our study suggests that smoking and sexual behavior involving males rather than female partners may be possible predictors of oral HPV infection in women. Further studies with larger sample size are needed to confirm these findings

Perceptions of Prostate Cancer Fatalism and Screening Behavior Between United States-Born and Caribbean-Born Black Males

Cancer fatalism is believed to be a major barrier for cancer screening in Black males. Therefore, the purpose of this study was to compare perceptions of prostate cancer (CaP) fatalism and predictors of CaP screening with Prostate Specific Antigen (PSA) testing between U.S.-born and Caribbean-born Black males. The Powe Fatalism Inventory and the Personal Integrative Model of CaP Disparity Survey were used to collect the following data from males in South Florida. Multivariate logistic regression models were constructed to examine the statistically significant predictors of CaP screening. A total of 211 U.S.-born and Caribbean-born Black males between ages 39–75 were recruited. Nativity was not a significant predictor of CaP screening with PSA testing within the last year (Odds ratio [OR] = 0.80, 95 % confidence interval [CI] = 0.26, 2.48, p = 0.70). Overall, higher levels of CaP fatalism were not a significant predictor of CaP screening with PSA testing within the last year (OR = 1.37, 95 % CI = 0.48, 3.91, p = 0.56). The study results suggest that nativity did not influence CaP screening with PSA testing. However, further studies are needed to evaluate the association between CaP screening behavior and levels of CaP fatalism