D. Huo

F. Qian

I. Morhason-Bello

N. Hou

O. Ojengbede

O. Olopade

S. Ademola

T.O. Ogundiran

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200 Env i r o nmen t a l an d S o c i a l D e t e rm i nan t s o f H ea l t hdata regarding these biomarkers in relation to dietary patterns fromthe Southern Cone of Latin America. Therefore, the objective of thisstudy is to analyze these biomarkers in relation to our traditionaldietary patterns.Structure/Method/Design: CESCAS I study is an observationalprospective cohort study with a multistage probabilistic sample of7600 participants from general population of four sites in Argentina,Chile and Uruguay. We conducted a cross-sectional analysis in arandomly selected subsample of 988 subjects. Subjects with previouscardiovascular events or under lipid-lowering agents were excluded.Diet was assessed using a previously validated 126-item food fre-quency questionnaire. We used a factor analysis to derive the majordietary patterns by gender. Linear regression models were used toexamine the associations among Apo AI, Apo B, CRP, and otherlipids (dependent variables) and quartiles (Q) of dietary pattern scores(independent variables). Linear trends tests were conducted to assessthe associations with multiple regression analysis.Results (Scientific Abstract)/Collaborative Partners (Program-matic Abstract): The population sample included 418 men and 570women. The “prudent pattern” (PP) was characterized by intake offruits, vegetables, low-fat dairy products, whole cereal, fish, and sea-food. In men, higher scores of PP (Q4) showed a significant reductionin mean adjusted values of Apo B (e9.29 mg/dL), total cholesterol(TC) (e22.4 mg/dL), low-density lipoprotein (LDL) (e19.0 mg/dL),high-density lipoprotein (HDL) (e3.3 mg/dL) compared to the lowestscores (Q1). In normal-weight subjects, higher scores of PP alsoreduced CRP levels (e3.12 g/L). In women, higher scores of PPshowed significant reduction in Apo B (e6.51 mg/dL), TC (e14.4mg/dL) and LDL (e11.3 mg/dL). The “Western-like pattern” (WLP)was characterized by intake of meat, processed foods, pizza, empa-nadas, sweets and desserts, refined grains, vegetable oils, and otherfats. In men, higher scores of WLP showed a trend to increase LDL(+27.1 mg/dL) while in women they showed a trend to increasevalues of triglycerides (+27.1 mg/dL, P ¼ 0.08), LDL (+7.4 mg/dL),and TC (+9.2 mg/dL). Apo AI level was not associated with anydietary pattern.Summary/Conclusion: Prudent dietary pattern was associated witha healthier lipid profile in both genders and better inflammatoryprofile in normal weight men, while the WLP showed a trend toincrease plasma lipids, especially in women.Developing a breast cancer knowledge assessment toolfor health care workers in Ibadan, NigeriaL. Pruitt1, S. Odedina2, I. Anetor2, H. Oduntan3, S. Ademola3,I. Morhason-Bello3, T.O. Ogundiran3, M. Obajimi3, O. Olopade4,O. Ojengbede3; 1University of Chicago, Center for Global Health, Chi-cago, IL/US, 2University of Ibadan, Centre for Population and Repro-ductive Health, Ibadan/NG, 3University of Ibadan, Ibadan/NG, 4TheUniversity of Chicago, Department of Medicine, Chicago, IL/USBackground: Breast cancer is the most common cancer affectingwomen, and in the developing world, late-stage diagnosis contributesto significant morbidity and mortality. Previous research in Ibadan,Nigeria on social factors contributing to late-stage diagnosis revealedthat many patients received inappropriate medical treatment at thecommunity level. Our research sought to assess the level of knowl-edge about breast cancer among a range of medical practitioners.Structure/Method/Design: Many of the established knowledgeassessment instruments from the United States focused onmammography screening, which was not applicable in this setting, sowe conducted focus groups, as we developed our own tool. Ourquestionnaire was designed to assess knowledge of symptoms, riskfactors, treatments, and local cultural beliefs about breast cancer.Focus groups were conducted with health care workers from multipletiers of the health care system to ensure that the topics covered in thequestionnaire were comprehensive. The focus groups were audio-recorded and facilitated by experienced public health researchers.They were analyzed thematically.Results (Scientific Abstract)/Collaborative Partners (Program-matic Abstract): Seven focus groups were conducted each consistingof three to eight participants from a single professional group.Participant groups were tertiary hospital physicians, general hospitalphysicians, primary health care center nurses, general hospital nurses,traditional birth attendants, community pharmacists, and traditionalherbalists. The discussions revealed baseline knowledge of breastcancer symptoms across multiple tiers of the health care system, aswell as a general awareness of the types of treatment available. Vari-ation in knowledge level was seen most strongly in discussion of riskfactors and etiology for breast cancer. All participants regardless oftraining were aware of the trend of late-stage diagnosis and had manyinsightful comments as to the causes for it including specific culturalbeliefs. New topics raised in focus group discussions were added tothe questionnaire.Summary/Conclusion: Many existing breast cancer awareness toolshave been developed for an American context with a focus onmammographic screening, and this cannot be applied to a low- ormiddle-income context where such screening is not widespread.Additionally, cultural beliefs may act as significant barriers to care andare location specific. Now that we have developed a relevant ques-tionnaire we will begin recruiting 500 health care workers to completeit. Once we have captured the current level of knowledge we candesign educational programs that fit the specific needs of each pro-fessional level. Greater knowledge among community health careworkers has the potential to reduce time to referral and effective careat a tertiary medical center for Nigerian breast cancer patients.Association of alcohol consumption and breast cancerrisk among women in three sub-Saharan AfricancountriesF. Qian1, T.O. Ogundiran2, N. Hou3, I. Morhason-Bello2, S. Ademola2,O. Ojengbede2, O. Olopade4, D. Huo3; 1University of Chicago, Chicago,IL/US, 2University of Ibadan, Ibadan/NG, 3University of Chicago,Health Studies, Chicago, IL/US, 4University of Chicago, Hematology/Oncology, Chicago, IL/USBackground: Alcohol drinking is linked to a risk of women’s breastcancer. However, there is little knowledge about alcohol consumptionand its relationship to breast cancer among African women.Structure/Method/Design: We conducted a caseecontrol studyamong 2139 women with invasive breast cancer and 2590 controls inCameroon, Nigeria, and Uganda from 1998 to 2013. A structuredquestionnaire was used to collect detailed information on alcoholdrinking. Alcohol consumption was defined as having ever consumedalcoholic beverages at least once a week for a continuous 6 months ormore. Alcohol contents in different types of drinks were quantifiedand converted to amount of pure ethanol. Multivariate logisticregression analysis was used to estimate adjusted odds ratio (aOR)and 95% confidence interval (CI).Results (Scientific Abstract)/Collaborative Partners (Program-matic Abstract): The prevalence of alcohol consumption amongwomen in Cameroon, Nigeria, and Uganda were 42.6%, 6.6%, and46.1%, respectively. Women with breast cancer were more likely thanAnna l s o f G l o b a l He a l t h 201controls to have ever consumed alcohol (aOR, 1.64; 95% CI,1.29e2.07). Both past drinking (aOR, 1.70; 95% CI, 1.24e2.35) orcurrent drinking (aOR, 1.51; 95% CI, 1.10e2.07) were associatedwith breast cancer risk. A doseeresponse relationship was observedfor years of drinking (P trend < 0.001), with each additional yearcontributing to a 2% increase in risk. Among women with familyhistory of breast cancer (aOR, 2.81; 95% CI, 1.09e7.24), the rela-tionship between alcohol drinking and breast cancer was strongerthan that among women without the history (aOR, 1.55; 95% CI,1.21e1.99).Summary/Conclusion: We found a positive relationship betweenalcohol consumption and breast cancer risk among African women,although it was heterogeneous across three countries. Alcoholdrinking may be becoming increasingly common among Africanwomen, and this modifiable risk factor should be addressed in breastcancer prevention programs in Africa.The effect of geography and demography on outcomesof emergency department patients in rural UgandaK. Tiemeier1, M. Bisanzo2, B.A. Dreifuss3, K.C. Ward4; 1University ofWashington Medical Center, Division of Emergency Medicine, Seattle,WA/US, 2University of Massachusetts, Department of Emergency Med-icine, Worcester, MA/US, 3University of Arizona, College of Medicine,Emergency Medicine, Tucson, AZ/US, 4Emory University-Rollins Schoolof Public Health, Georgia Center for Cancer Statistics, Atlanta, GA/USBackground: In Sub-Saharan Africa (SSA) geography represents asignificant challenge to accessing health services. Patients’ ability tonegotiate these challenges is strongly influenced by many de-mographic factors including poverty, urban versus rural householdlocation (urbanicity). Emergency care is a young and developing fieldin SSA, and geographic determinants of emergency patient outcomesin SSA are poorly understood. This study aims to quantify the effectof geographic determinants on the outcomes of patients with acutehealth conditions in SSA, controlling for demographics.Structure/Method/Design: This is a retrospective cohort study ofpatients presenting to an emergency department (ED) of a ruralUganda district hospital. The ED care was managed by non-physicianclinicians with specialized training in emergency care. Logisticregression modeling was utilized to determine if patients’ distance tohospital is associated with mortality within 3 days of presenting to theED, controlling for urbanicity, poverty prevalence, patient age, andpediatric malnutrition cases. Distance categories were <5 km, 5 to<10 km, and 10 km+. At the larger subcounty level, urbanicity wasdichotomized into urban and poverty prevalence was categorized aslow, moderate, and high. Age categories were <1 year, 1 to 4 years, 5to 14 years, 15 to 49 years, and 50 years+. The 3-day mortalityoutcome was determined by follow-up in the hospital or by phone callto family or friends.Results (Scientific Abstract)/Collaborative Partners (Program-matic Abstract): 3767 Rukungiri residents treated in the ED fromNovember 2010 to November 2011 were included, with an observed3-day mortality of 2%. Distance to hospital was positively associated to3-day mortality after controlling for poverty, urbanicity, age, andmalnutrition. Compared to patients living <5 km from the hospital,patients living 5 to <10 km from the hospital had 1.7 times the oddsof 3-day death (95% CI, 0.8-3.7; P ¼ 0.155), and patients living 10km+ from the hospital had 2.2 times the odds of 3-day death (95%CI, 1.0-5.0; P ¼ 0.048). Urbanicity and poverty were significantlyassociated to 3-day mortality on univariate analysis, but not inmultivariate analysis.Summary/Conclusion: Distance to hospital is an independent riskfactor for 3-day mortality of ED patients after controlling for de-mographic factors. This may have implications for future resourceallocation toward emergency care development in Uganda and SSA.Unintentional home poisoning among children in ruralGhana: A community survey of knowledge, attitudes,and practicesJ. Wilkinson1, J. Mayer1, E.L. Warner2, T. Dickerson3, S. Benson3,D. Ansong4; 1University of Utah School of Medicine, Salt Lake City, UT/US, 2Huntsman Cancer Institute, Salt Lake City, UT/US, 3University ofUtah, Medicine, Salt Lake City, UT/US, 4Komfo Anokye TeachingHospital, Kumasi/GHBackground: Unintentional poisonings are a common cause ofemergency department visits. In 2004, an estimated 346,000 deathsoccurred worldwide from unintentional poisonings, 91% of whichoccurred in developing countries. Due to lack of data collectionmechanisms and resources, unintentional poisoning studies have notbeen conducted in most developing countries.Recently, Ghana loosened regulations for the sale and distri-bution of pesticides and herbicides. Pediatricians in Kumasi, Ghanareported an increase in the number of admissions for unintentionalchildhood poisonings.Structure/Method/Design: A cross-sectional, semi-structuredquestionnaire consisting of open- and close-ended questions wasdeveloped to assess knowledge, attitudes, and current practicesregarding unintentional household childhood poisonings in rural,agrarian Ashanti, Ghana. Team members native to the regioncompleted translation of the questionnaire, which was then pilottested and modified based on feedback from trial field interviews. Fiverural and semi-rural areas were sampled to encompass a range ofpopulation characteristics. Cooperation was high with 94% ofhouseholds with children age 0 to 15 years participating (N ¼ 114).We calculated descriptive characteristics using Stata 12.0. Open-ended questions were coded and analyzed in NVivo 9.Results (Scientific Abstract)/Collaborative Partners (Program-matic Abstract): Respondents were mostly primary caregivers (84%)and female (74%). Mean age for primary caregivers was 41 years. Halfof the respondents (53%) had completed junior secondary school orhigher. Nearly all respondents defined a poison as a substance thatwas harmful to health, and could list at least one poisonous sub-stance, namely pesticides, kerosene, rat poison, and chlorine/bleach.The most common causes reported for poisonings were improperstorage of poisons (42%) and ignorance of the child (54%). In-terviewees cited proper storage as a means to prevent poisonings, yetpoisonous substances were often stored in locations that wereaccessible to children. Less than 5% of respondents (4/114) indicatedthat teaching children about potentially poisonous substances wouldhelp reduce poisoning incidents. Furthermore, some respondents didnot believe that medications could be poisonous.Summary/Conclusion: Despite the worldwide burden of uninten-tional childhood poisonings, few in-depth analyses of unintentionalpoisonings have been conducted. While most participants in our studyacknowledged that a poison was a harmful substance, and could identifyat least one poison in their home, few knew that teaching their childrenabout harmful substances could help reduce unintentional poisonings.School education programs and local health clinics may be an effectiveand sustainable avenue for an intervention to teach children aboutpoisonous substances, and prepare caregivers to educate children aboutthe danger of poisonous substances. We suggest including hair products

Association of alcohol consumption and breast cancer risk among women in three sub-Saharan African countries

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Association of alcohol consumption and breast cancer risk among women in three sub-Saharan African countries

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