Church-Based Breast Cancer Screening Education: Impact of Two Approaches on Latinas Enrolled in Public and Private Health Insurance Plans

Introduction The Tepeyac Project is a church-based health promotion project that was conducted from 1999 through 2005 to increase breast cancer screening rates among Latinas in Colorado. Previous reports evaluated the project among Medicare and Medicaid enrollees in the state. In this report, we evaluate the program among enrollees in the state's five major insurance plans. Methods We compared the Tepeyac Project's two interventions: the Printed Intervention and the Promotora Intervention. In the first, we mailed culturally tailored education packages to 209 Colorado Catholic churches for their use. In the second, promotoras (peer counselors) in four Catholic churches delivered breast-health education messages personally. We compared biennial mammogram claims from the five insurance plans in the analysis at baseline (1998–1999) and during follow-up (2000–2001) for Latinas who had received the interventions. We used generalized estimating equations (GEE) analysis to adjust rates for confounders. Results The mammogram rate for Latinas in the Printed Intervention remained the same from baseline to follow-up (58% [2979/5130] vs 58% [3338/5708]). In the Promotora Intervention, the rate was 59% (316/536) at baseline and 61% (359/590) at follow-up. Rates increased modestly over time and varied widely by insurance type. After adjusting for age, income, urban versus rural location, disability, and insurance type, we found that women exposed to the Promotora Intervention had a significantly higher increase in biennial mammograms than did women exposed to the Printed Intervention (GEE parameter estimate = .24 [±.11], P = .03). Conclusion For insured Latinas, personally delivering church-based education through peer counselors appears to be a better breast-health promotion method than mailing printed educational materials to churches

Premier: The Magazine of the UNLV Harrah College of Hospitality

Of the countless hospitality programs around the world, why does the Harrah College of Hospitality consistently rank at the top? I believe the college\u27s excellence stems from our ability to leverage our strengths with those of our partners to do great things. It\u27s that simple. This approach has certainly been in play as we\u27ve navigated the difficulties of the past two years. We\u27ve worked with our friends in industry and academia to bolster our internship and mentorship programs, research, and interdisciplinary projects, all with the intent of expanding the knowledge base of the hospitality discipline and building a pipeline of much-needed talent for the industry. In the pages that follow, you\u27ll find example after example of these partnerships at work: our catering team\u27s unprecedented collaboration with UNLV Athletics; a new wine and music course that combines the expertise of the Hospitality College with the expertise of the UNLV Music Department; researchers from our college and around the world coming together to address tough industry challenges; and donors, such as Andrew and Peggy Cherng and the San Manuel Band of Mission Indians, helping the college bring innovative hospitality programs into higher ed. Perhaps the college\u27s most impactful partnership over the years has been with the hospitality companies in Las Vegas. We provide the smart and well-prepared student talent; they provide opportunities for students to work and intern in the industry. Our ongoing internship collaboration with Resorts World Las Vegas (pg. 24), which benefits 20+ UNLV students each semester, is but one example of how collaborations can lead to greatness. When the college and our partners share our time, expertise, and resources, there\u27s simply no limit to what we can accomplish. Together, we are stronger and more resilient, and our students are primed to carry the spirit of partnership forward into their lives and careers

Diet and physical activity interventions to improve cardiovascular disease risk factors in liver transplant recipients: Systematic review and meta-analysis

© 2024 The Author(s). Published by Elsevier Inc. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/Background and aims: Cardiovascular disease, associated risk factors and obesity are prevalent after liver transplant and modifiable through lifestyle changes. Understanding what lifestyle interventions and their respective components are effective is essential for translation to clinical practice. We aimed to investigate the effects of diet and physical activity interventions on weight, body mass index and other cardiovascular disease risk factors in liver transplant recipients, and systematically describe the interventions. Methods: We systematically searched Embase, MEDLINE, Psycho Info, CINAHL, Cochrane central register of controlled trials, PeDro, AMED, BNI, Web of Science, OpenGrey, ClinicalTrials.gov and the international clinical trials registry from inception to 31 May 2023. Search results were screened by two independent reviewers: randomised control trials with interventions that targeted diet and physical activity behaviours in liver transplant recipients were considered eligible. Two independent reviewers extracted and synthesised data for study, participant and intervention details and results. We used the Revised Cochrane Risk of Bias Tool for Randomised Trials to assess risk of bias for outcomes and the GRADE approach to rate the quality of the body of evidence. When two or more studies reported findings for an outcome, we pooled data using random-effects meta-analysis. Results: Six studies were included, reporting three physical activity and three combined diet and physical activity interventions. Participants were 2 months-4 years post-transplant. Interventions lasted 12 weeks-10 months and were delivered remotely and/or in-person, most commonly delivered to individual participants by health care or sports professionals. Five studies described individual tailoring, e.g. exercise intensity. Adherence to interventions ranged from 51% to 94%. No studies reported fidelity. Intervention components were not consistently reported. In meta-analysis, diet and physical activity interventions did not significantly reduce weight or body mass index compared to control groups, however no studies targeted participants with obesity. Diet and physical activity interventions reduced percentage body fat and triglycerides compared to control groups but did not reduce total cholesterol or increase activity. The GRADE quality of evidence was low or very low. Conclusion: Diet and physical activity interventions reduced percentage body fat and triglycerides in liver transplant recipients. Further good quality research is needed to evaluate their effect on other cardiovascular disease risk factors, including weight and BMI. Interventions need to be better described and evaluated to improve evidence base and inform patient care.Peer reviewe

Model-based lamotrigine clearance changes during pregnancy: clinical implication

Objective: The objective of the study was to characterize changes in the oral clearance (CL/F) of lamotrigine (LTG) over the course of pregnancy and the postpartum period through a model-based approach incorporating clinical characteristics that may influence CL/F, in support of developing clinical management guidelines. Methods: Women receiving LTG therapy who were pregnant or planning pregnancy were enrolled. Maternal blood samples were collected at each visit. A pharmacokinetic analysis was performed using a population-based, nonlinear, mixed-effects model. Results: A total of 600 LTG concentrations from 60 women (64 pregnancies) were included. The baseline LTG CL/F was 2.16 L/h with a between-subject variability of 40.6%. The influence of pregnancy on CL/F was described by gestational week. Two subpopulations of women emerged based on the rate of increase in LTG CL/F during pregnancy. The gestational age-associated increase in CL/F displayed a 10-fold higher rate in 77% of the women (0.118 L/h per week) compared to 23% (0.0115 L/h per week). The between-subject variability in these slopes was 43.0%. The increased CL/F at delivery declined to baseline values with a half-life of 0.55 weeks. Interpretation The majority of women had a substantial increase in CL/F from 2.16 to 6.88 L/h by the end of pregnancy, whereas 23% of women had a minimal increase. An increase in CL/F may correspond to decreases in LTG blood concentrations necessitating the need for more frequent dosage adjustments and closer monitoring in some pregnant women with epilepsy. Postpartum doses should be tapered to preconception dose ranges within 3 weeks of delivery

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Diagnostic Work-Up of Breast Cancer in Females

According to American Cancer Society projections, nearly 44,000 women died of breast cancer in 1998. Numerous studies have shown that early detection increases survival and treatment options for breast cancer patients. Through consistent use of an accepted algorithm for diagnosis including self-breast evaluation, clinical breast exams, and regular mammograms many cancers can be detected in early, treatable stages. Attention to supportive data for diagnostic tests and cost effectiveness will assist the practitioner in recommending the appropriate diagnostic plan

Common Threads: Our Community Imagines Together

Common Threads: Our Community Imagines Together Following a divisive election cycle, it\u27s time for us to come together. Join us in using weaving as a metaphor and collaborative activity to celebrate the community we share today and imagine what our best community looks like as we move forward! A US Department of Arts and Culture Imagining Sponsored by University of Northern Iowa and Hawkeye Community College Held at the Waterloo Public Library Saturday, November 12, 2016 2:00-5:00 pm Free and open to the public Participating groups: UNI Printmakers Society - Live t-shirt printing UNI Art Education students - weaving activities for kids Youth Art Team - creating pieces for the large community weaving Performances by: Waterloo Writing Project The Truth Arts to End Violence There will be food provided Round table discussions on creating action plans for strengthening our communities facilitated by community leaders: Shuaib Meacham and Gloria Kirkland Holmes from UNI, Sarah Pauls and Blake Argotsinger from UNI, Kevin Roberts and Alyssa Bruecken from the Waterloo Writing Project, Drew Waseskuk, MJ Idani, and others Timeline 1:00 volunteers arrive for set up 2:00 event doors open, guests can mingle, snack on refreshments, work on the weaving in the main room 2:30-2:45 Waterloo Writing Project 2:45-3:00 The Truth (North End Leadership Academy) 3:00 Invocation, discussion kick-off (arts activities happening simultaneously for those who don\u27t want to participate in the discussion) 3:15-3:45 Round table discussions 3:45-4:00 Share back 4:00-5:00 open time, weaving, t-shirt printing 5:00 event doors close 5:00-6:00 volunteers clean u