bluuebunny/crossref_metadata_2025 huggingface dataset:
Gender Linked Fate, Race/Ethnicity, and the Marriage Gap in American Politics
Authors: Stout Christopher T. , Kretschmer Kelsy , Ruppanner Leah
Published: April 2017

In this study, we explore the predictors of gender linked fate with a focus on marital status for different racial/ethnic groups. We argue that marriage alters women’s perceptions of self-interest by institutionalizing their partnerships with men and consequently leading women to feel less connected to other women. We assess our hypothesis using the 2012 American National Election Study. While we find that married white women and Latinas have significantly lower levels of linked fate than unmarried women of the same race/ethnicity, we find no such relationship for black women. We then explore the implications of these findings by examining the role of gender linked fate in explaining political differences among married and unmarried women using mediation analysis. Ultimately, we find that differences in perceptions of linked fate explain a significant amount of the variation in political ideology and partisanship for white and Latina women.
Remote Ischemic Conditioning for Patients With STEMI
Authors: Schmidt Michael Rahbek , Rasmussen Mathis Ersted , Bøtker Hans Erik
Published: April 2017

ST-segment elevation myocardial infarction (STEMI) remains a leading cause of death and morbidity, despite declining incidence and improved short-term outcome in many countries. Although mortality declines in developed countries with easy and fast access to optimized treatment, development of heart failure often remains a challenge in survivors and still approaches 10% at 1 year. Rapid admission and acute interventional treatment combined with modern antithrombotic pharmacologic therapy frequently establish complete reperfusion and acutely stabilize the patient, but the reperfusion itself adds further to the damage in the myocardium compromising the long-term outcome. Reperfusion injury is believed to be a significant—if not the dominant—contributor to the net injury resulting from STEMI and has become a major focus of research in recent years. Despite a plethora of pharmacological and mechanical interventions showing consistent reduction of reperfusion injury in experimental models, translation into a clinical setting has been challenging. In patients, attempts to modify reperfusion injury by pharmacological strategies have largely been unsuccessful, and focus is increasingly directed toward mechanical modalities. Remote ischemic conditioning of the heart is achieved by repeated brief interruption of the blood supply to a distant part of the body, most frequently the arm. At present, remote ischemic conditioning is the most promising adjuvant therapy to reduce reperfusion injury in patients with STEMI. In this review, we discuss the results of clinical trials investigating the effect of remote ischemic conditioning in patients admitted with STEMI and potential reasons for its apparent superiority to current pharmacologic adjuvant therapies.
ADHD in Tunisian Adolescents: Prevalence and Associated Factors
Authors: Mhalla Ahmed , Guedria Asma , Brahem Takoua , Amamou Badii , Sboui Wiem , Gaddour Naoufel , Gaha Lotfi
Published: April 2017

Objective: The aims of the study were to determine the prevalence of ADHD in a population of high school students and to explore the factors associated with this disorder. Method: This was a cross-sectional study that had included 447 high school students. The diagnosis of ADHD was made by the Adult ADHD Self-Report Scale translated in Arabic language. The sociodemographic and clinical characteristics were evaluated by a preestablished questionnaire. The self-esteem was assessed by the Rosenberg Self-Esteem Scale. Results: The prevalence of ADHD was 18.1%. The logistic regression analysis showed an association between the diagnosis of ADHD and the bad relationships with parents (odds ratio [OR] = 16.43; p < 10-3), the presence of personal psychiatric antecedents (OR = 12.16; p < 10-3), internet misuse (OR = 2.39; p = .014), and maltreatment antecedents (OR = 3.16; p = .009). Conclusion: The prevalence of ADHD in this study was one of the highest prevalence reported. The factors associated with ADHD may have diagnostic and therapeutic implications.
Randomized controlled trial of a home-based palliative approach for people with severe multiple sclerosis
Authors: Solari Alessandra , Giordano Andrea , Patti Francesco , Grasso Maria Grazia , Confalonieri Paolo , Palmisano Lucia , Ponzio Michela , Borreani Claudia , Rosato Rosalba , Veronese Simone , Zaratin Paola , Battaglia Mario Alberto ,   on behalf of the PeNSAMI Project
Published: April 2017

Background:

Evidence on the efficacy of palliative care in persons with severe multiple sclerosis (MS) is scarce.

Objective:

To assess the efficacy of a home-based palliative approach (HPA) for adults with severe MS and their carers.

Methods:

Adults with severe MS-carer dyads were assigned (2:1 ratio) to either HPA or usual care (UC). At each center, a multi-professional team delivered the 6-month intervention. A blind examiner assessed dyads at baseline, 3 months, and 6 months. Primary outcome measures were Palliative care Outcome Scale-Symptoms-MS (POS-S-MS) and Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW, not assessed in severely cognitively compromised patients).

Results:

Of 78 dyads randomized, 76 (50 HPA, 26 UC) were analyzed. Symptom burden (POS-S-MS) significantly reduced in HPA group compared to UC ( p = 0.047). Effect size was 0.20 at 3 months and 0.32 at 6 months, and statistical significance was borderline in per-protocol analysis ( p = 0.062). Changes in SEIQoL-DW index did not differ in the two groups, as changes in secondary patient and carer outcomes.

Conclusion:

HPA slightly reduced symptoms burden. We found no evidence of HPA efficacy on patient quality of life and on secondary outcomes.
Evaluation of a web-based cognitive behavioral smoking cessation treatment for overweight/obese smokers
Authors: White Marney A , Ivezaj Valentina , Grilo Carlos M
Published: April 2017

This pilot study tested the efficacy of an Internet-administered smoking cessation treatment for overweight/obese smokers. Participants were 54 community volunteers with overweight/obesity who were regular smokers. Treatment consisted of 12 weeks of nicotine replacement therapy and randomization to Internet-administered cognitive behavioral treatment or health education. In-person assessments of key outcomes occurred at baseline, post-treatment, and at 24-week follow-up. Cessation rates did not differ across the two treatments (25.9% vs 18.5%). Participants receiving cognitive behavioral treatment gained less weight when abstinent than those receiving the standard treatment. Larger studies are needed to replicate these findings.
Public health benefits of hair-mercury analysis and dietary advice in lowering methylmercury exposure in pregnant women
Authors: Kirk Line E. , Jørgensen Jan S. , Nielsen Flemming , Grandjean Philippe
Published: April 2017

Aims: To evaluate whether a public health intervention using focused dietary advice combined with a hair-mercury analysis can lower neurotoxic methylmercury exposure among pregnant women without decreasing their overall intake of seafood. Methods: A total of 146 pregnant women were consecutively recruited from the antenatal clinic at a Danish university hospital at their initial ultrasound scan. Dietary advice was provided on avoiding methylmercury exposure from large predatory fish and a hair sample from each participant was analysed for mercury, with the results being communicated shortly thereafter to the women. A dietary questionnaire was filled in. Follow-up three months later included a dietary questionnaire and a repeat hair-mercury analysis. Results: In the follow-up group, 22% of the women had hair-mercury concentrations above a safe limit of 0.58 µg/g at enrolment, decreasing to 8% three months later. Average hair-mercury concentrations decreased by 21%. However, the total seafood intake remained at the same level after three months. Conclusions:Increased exposure to methylmercury among pregnant women is an important public health concern in Denmark. The observed lowering of hair-mercury concentrations associated with dietary advice corresponds to a substantial public health benefit that probably makes such an intervention highly profitable.
The factor structure of the Hopkins Symptoms Checklist (HSCL-25) in a student population: A cautionary tale
Authors: Skogen Jens C. , Øverland Simon , Smith Otto R.F. , Aarø Leif E.
Published: April 2017

Aims: The Hopkins Symptoms Checklist (HSCL-25) is a widely used self-report measurement for mental health problems, but its factor structure is still uncertain, with divergent results in different social or cultural settings. We aimed to investigate the previously suggested factor structures of the HSCL-25, as well as a model including an explicit somatic factor among students in Norway. Methods: The study population is based on data from the Norwegian study of students’ health and wellbeing, SHoT (‘Studentenes Helse- og Trivselsundersøkelse’), and the present study comprises N = 13,525 participants. Using confirmatory factor analyses we investigated previously suggested factor structures, as well as a 3-factor structure, with specific subscales for anxiety, depression and somatic symptoms, suggested by the authors. After identification of the best-fitting model(s), measurement invariance across sexes, as well as associations with self-reported socioeconomic and social factors, use of medication and help-seeking behaviour were examined. Results: Based on the fit indices alone, bi-factor models fitted the data the best. However, upon further scrutiny when exploring the viability of the bi-factor models, we deemed the reliability of the specific subscales as extremely low and not viable as subscales. We therefore suggest that a uni-dimensional model was the most appropriate in our study. Conclusions: Based on considerations of fit indices, viability of subscales and associations with social and socioeconomic factors we suggest that a uni-dimensional model is most appropriate for HSCL-25 in a student population. Future investigations should examine how the revisions could improve the psychometric properties of the scale.
Modeling, characterization and parametric identification of low velocity impact behavior of time-dependent hyper-viscoelastic sandwich panels
Authors: Sadeghnejad Soroush , Taraz Jamshidi Yousef , Mirzaeifar Reza , Sadighi Mojtaba
Published: April 2017

Accurate and deep understanding of the mechanical and physical behavior of sandwich panels with soft elastomeric foams, e.g. cellular solids, such as ethylene vinyl acetate is a key task in designing these structures, and also optimizing their mechanical behavior. The main objective of the present research is to present an applicable method to determine the non-linear hyper-viscoelastic response of elastomeric sandwich panels to low velocity impact loadings, by presenting an applied method. A combination of experimental results and finite element analysis, in conjunction with optimization method is used to determine the hyper-viscoelastic behavior of the studied sandwich panels. The suggested combinational approach can replace the time-consuming and expensive creep and/or relaxation experiments. A relatively simple approach is proposed to identify time-dependent viscoelastic material behavior of elastomeric foams. The calibrated finite element model is utilized to perform a set of parametric studies and the effect of various material properties is studied on the low velocity impact response of sandwich plates.
Compressive sensing of phased array ultrasonic signal in defect detection: Simulation study and experimental verification
Authors: Bai Zhiliang , Chen Shili , Xiao Qiyang , Jia Lecheng , Zhao Yanbo , Zeng Zhoumo
Published: April 2017

Ultrasonic phased array techniques are widely used for defect detection in structural health monitoring field. The increase in the element number, however, leads to larger amounts of data acquired and processed. Recently developed compressive sensing states that sparse signals may be accurately recovered from far fewer measurements, suggesting the possibility of breaking through the sampling limit of the Nyquist theorem. In light of this significant advantage, the novel use of the compressive sensing methodology for ultrasonic phased array in defect detection is proposed in this work. Based on CIVA software, we first present a simulated study on the effectiveness of the compressive sensing applied in ultrasonic phased array in defect detection through the average mean percent residual difference at varying compression rates. The results particularly show that the compressive sensing yields a breakthrough of the sampling limitation. We then experimentally demonstrate comparative analyses on the signals extracted from three types of artificial flaws (through-hole, flat-bottom hole, and electrical discharge machining notches) on two different specimens (made of aluminum and 20# steel). To find the optimal algorithm combination, the best sparse representation basis is chosen among fast Fourier transform, discrete cosine transform, and 34 wavelet kernels; the reconstruction performance is compared between five greedy algorithms; and the recovery accuracy is further improved via four sensing matrices selection. We also evaluate the influence of the sampling rate, and our results are comparable with the gold standard of signal compression, namely, the discrete wavelet transform.
Four-Corner Arthrodesis: Description of Surgical Technique Using Headless Retrograde Crossed Screws
Authors: Mamede João , Castro Adeodato Sandro , Aquino Leal Rafael
Published: April 2017

Background: Four-corner fusion has been shown to be a reliable option of treatment of wrist arthritis, but there is no consensus about which implant and surgical procedure should be used in the arthrodesis. The present study aimed to describe a surgical technique using 2 crossed screws as implants, inserted in a retrograde manner, and to demonstrate preliminary results of the use of the technique. Methods: A retrospective study was conducted using medical records and imaging tests (radiographs and computed tomography) of all 15 patients who underwent a standardized 4-corner fusion technique, between December 2011 and July 2015, in the Department of Hand Surgery of Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, Brazil. We collected data on the following variables: fusion rate, time to fusion, and percentage of patients who had any complications or needed another surgical procedure on the same wrist. Results: All but one patient achieved fusion of arthrodesis. The average time to union was 5.54 months (SD = 3.84). Only the patient who developed nonunion of the 4-corner fusion required another surgery on the same wrist. Conclusions: The procedure described in this study demonstrated a low complication rate and high fusion rate, and can therefore be considered a reliable surgical technique for 4-corner fusion.
Brachial Artery Transection After a Closed Traumatic Isolated Medial Epicondyle Fracture in a Pediatric Patient: A Case Report
Authors: Schwartz Brandon S. , Paryavi Ebrahim , Eglseder W. Andrew , Pensy Raymond A. , Abzug Joshua M.
Published: April 2017

Background: Medial epicondyle fractures in pediatric patients might be associated with an occult elbow dislocation and neurovascular damage. Methods: A single case of a medial epicondyle fracture presenting with brachial artery transection was reviewed. Presentation, clinical course, and early outcome are reported. Results: A 14-year-old patient presenting with an apparently isolated medial epicondyle fracture was found to have examination and diagnostic test findings consistent with brachial artery transection. His injury was explored and repaired acutely, resulting in acute return of perfusion. Final follow-up revealed 0° to 130° of flexion-extension arc of motion and full pronation and supination with normal sensory and motor function of the hand. Conclusions: Pediatric medial epicondyle fractures should alert the clinician to the possibility of an occult dislocation of the elbow, and a full neurovascular assessment should be performed. Early recognition and repair of a vascular injury associated with this fracture can lead to a good outcome.
Cardiorespiratory fitness, cognition and brain structure after TIA or minor ischemic stroke
Authors: Boss H Myrthe , Van Schaik Sander M , Witkamp Theo D , Geerlings Mirjam I , Weinstein Henry C , Van den Berg-Vos Renske M
Published: April 2017

Background

It is not known whether cardiorespiratory fitness is associated with better cognitive performance and brain structure in patients with a TIA or minor ischemic stroke.

Aims

To examine the association between cardiorespiratory fitness, cognition and brain structure in patients with a TIA and minor stroke.

Methods

The study population consisted of patients with a TIA or minor stroke with a baseline measurement of the peak oxygen consumption, a MRI scan of brain and neuropsychological assessment. Composite z-scores were calculated for the cognitive domains attention, memory and executive functioning. White matter hyperintensities, microbleeds and lacunes were rated visually. The mean apparent diffusion coefficient was measured in regions of interest in frontal and occipital white matter and in the centrum semiovale as a marker of white matter structure. Normalized brain volumes were estimated by use of Statistical Parametric Mapping.

Results

In 84 included patients, linear regression analysis adjusted for age, sex and education showed that a higher peak oxygen consumption was associated with higher cognitive z-scores, a larger grey matter volume (B = 0.15 (95% CI 0.05; 0.26)) and a lower mean apparent diffusion coefficient (B = −.004 (95% CI −.007; −.001)). We found no association between the peak oxygen consumption and severe white matter hyperintensities, microbleeds, lacunes and total brain volume.

Conclusions

These data suggest that cardiorespiratory fitness is associated with better cognitive performance, greater grey matter volume and greater integrity of the white matter in patients with a TIA or minor ischemic stroke. Further prospective trials are necessary to define the effect of cardiorespiratory fitness on cognition and brain structure in patients with TIA or minor stroke.
Ways of Viewing Pictorial Plasticity
Authors: Wijntjes Maarten W. A.
Published: April 2017

The plastic effect is historically used to denote various forms of stereopsis. The vivid impression of depth often associated with binocular stereopsis can also be achieved in other ways, for example, using a synopter. Accounts of this go back over a hundred years. These ways of viewing all aim to diminish sensorial evidence that the picture is physically flat. Although various viewing modes have been proposed in the literature, their effects have never been compared. In the current study, we compared three viewing modes: monocular blur, synoptic viewing, and free viewing (using a placebo synopter). By designing a physical embodiment that was indistinguishable for the three experimental conditions, we kept observers naïve with respect to the differences between them; 197 observers participated in an experiment where the three viewing modes were compared by performing a rating task. Results indicate that synoptic viewing causes the largest plastic effect. Monocular blur scores lower than synoptic viewing but is still rated significantly higher than the baseline conditions. The results strengthen the idea that synoptic viewing is not due to a placebo effect. Furthermore, monocular blur has been verified for the first time as a way of experiencing the plastic effect, although the effect is smaller than synoptic viewing. We discuss the results with respect to the theoretical basis for the plastic effect. We show that current theories are not described with sufficient details to explain the differences we found.
Major depressive disorder with religious struggle and completed suicide after hair transplantation
Authors: Ceylan Mehmet Emin , Önen Ünsalver Barış , Evrensel Alper
Published: April 2017

Objectives:

Psychological outcomes of aesthetic surgical procedures like hair transplantation are mostly positive including decreased anxiety, depression and social phobia and increased general well-being, self-efficacy and self-esteem. However, some patients may suffer from post-surgical depression and post-surgical increased suicide rates have been reported for breast augmentation patients. Difficulty adapting to the new image, unfulfilled psychological needs expected to be met by the surgery, side effects of the surgery like tissue swelling or bruising, uncontrolled pain, presence of body dysmorphic disorder and previous history of mood disorder may be some of the risk factors for post-surgical depression.

Methods:

Here, we present a case without prior psychiatric history who developed major depressive disorder after hair transplantation and died of suicide.

Results:

He started experiencing religious struggle related to his decision about the hair transplant which he interpreted as acting against God’s will. While religious involvement has been reported to be a protective factor against depression, spiritual struggle, which includes religious guilt, has been described as an important risk factor for depression, hopelessness and suicidality which might explain the severity of depression in our patient.

Conclusions:

This case highlights the importance of a detailed psychiatric evaluation and exploration of religious concerns of any patient before any type of aesthetic surgery. Major depressive disorder is a treatable condition; however, mild depression can go unnoticed. Religious belief and related religious practices affect an individual’s personal health attitudes; therefore, we think that every physician is needed to explore the religious concerns of any patient during any medical examination or surgical procedure. Relevant religious authorities should be consulted when necessary.
Risk and Cost of Reoperation After Single-Level Posterior Cervical Foraminotomy: A Large Database Study
Authors: Sayari Arash J. , Tuchman Alexander , Cohen Jeremiah R. , Hsieh Patrick C. , Buser Zorica , Wang Jeffrey C.
Published: April 2017

Study Design:

Retrospective cohort study.

Objective:

To examine the risk of undergoing another cervical spine surgery after single-level posterior cervical foraminotomy (PCF) and analyze the costs of such reoperations.

Methods:

Using the PearlDiver database, we created database algorithms to identify cohorts of patients who underwent single-level PCF and also had various reoperations of interest, within 1, 2, and 4 years of follow-up. We also identified the per-patient average charge (PPAC) for each reoperation cohort.

Results:

In the Medicare cohort, the incidence of any reoperation was 8.3%, 9.8%, and 10.5% within 1, 2, and 4 years of follow-up, respectively. The PPAC was $8520 for the initial PCF procedure. When a second cervical surgery was performed, the PPAC was $70 349 for anterior fusion, $15 760 for posterior decompression alone, and $77 976 for posterior decompression and fusion. In the UnitedHealth cohort, the incidence of any reoperation was 13.6%, 16.7%, and 17.0% within 1, 2, and 4 years of follow-up, respectively.

Conclusions:

The overall incidence of another cervical spine operation was slightly higher in the Medicare population to that in previous literature, but much higher in the UnitedHealth population. The most common reoperation after PCF varied between the Medicare and UnitedHealth datasets, and costs varied widely based on the procedure performed. This study provides pertinent information that surgeons can use to discuss the risk of reoperation with their patients.
The Burden of Spine Fractures in India
Authors: Aleem Ilyas S. , DeMarco Dylan , Drew Brian , Sancheti Parag , Shetty Vijay , Dhillon Mandeep , Foote Clary J. , Bhandari Mohit
Published: April 2017

Study Design:

Prospective cohort study.

Objectives:

The objectives of this study were (1) to determine the characteristics of patients sustaining spinal trauma in India and (2) to explore the association between patient or injury characteristics and outcomes after spinal trauma.

Methods:

In affiliation with the ongoing INternational ORthopaedic MUlticentre Study (INORMUS), 192 patients with spinal injuries were recruited during an 8-week period (November 2011 to June 2012) from 14 hospitals in India and followed for 30-days. The primary outcome was a composite of mortality, complications, and reoperation. This was regressed on a set of 13 predictors in a multiple logistic regression model.

Results:

Most patients were middle-aged (mean age = 51.0 years; median age = 55.5 years; range = 18.0 to 72.0 years), male (60.4%), injured from falls (72.4%), and treated in a private setting (59.9%). Fractures in the lumbar region (51.0%) were most common, followed by thoracic (30.7%) and cervical (18.2%). More than 1 in 5 (21.6%) patients experienced a treatment delay greater than 24 hours, and 36.5% arrived by ambulance. Thirty-day mortality and complication rates were 2.6% and 10.0%, respectively. Care in the public hospital system (odds ratio [OR] = 6.7, 95% CI = 1.1-41.6), chest injury (OR = 11.1, 95% CI = 1.8-66.9), and surgical intervention (OR = 4.8, 95% CI = 1.2-19.6) were independent predictors of major complications.

Conclusions:

Treatment in the public health care system, increased severity of injury, and surgical intervention were associated with increased risk of major complications following spinal trauma. The need for a large-scale, prospective, multicenter study taking into account spinal stability and neurologic status is feasible and warranted.
Long-term effects of severe acute malnutrition on lung function in Malawian children: a cohort study
Authors: Lelijveld Natasha , Kerac Marko , Seal Andrew , Chimwezi Emmanuel , Wells Jonathan C. , Heyderman Robert S. , Nyirenda Moffat J. , Stocks Janet , Kirkby Jane
Published: April 2017

Early nutritional insults may increase risk of adult lung disease. We aimed to quantify the impact of severe acute malnutrition (SAM) on spirometric outcomes 7 years post-treatment and explore predictors of impaired lung function.

Spirometry and pulse oximetry were assessed in 237 Malawian children (median age: 9.3 years) who had been treated for SAM and compared with sibling and age/sex-matched community controls. Spirometry results were expressed as z-scores based on Global Lung Function Initiative reference data for the African–American population.

Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were low in all groups (mean FEV1z-score: −0.47 for cases, −0.48 for siblings, −0.34 for community controls; mean FVC z-score: −0.32, −0.38, and −0.15 respectively). There were no differences in spirometric or oximetry outcomes between SAM survivors and controls. Leg length was shorter in SAM survivors but inter-group sitting heights were similar. HIV positive status or female sex was associated with poorer FEV1, by 0.55 and 0.31 z-scores, respectively.

SAM in early childhood was not associated with subsequent reduced lung function compared to local controls. Preservation of sitting height and compromised leg length suggest “thrifty” or “lung-sparing” growth. Female sex and HIV positive status were identified as potentially high-risk groups.
Unique Barriers to Care and Outcomes of Pediatric Acute Lymphoblastic Leukemia Treatment in Gaza City, Occupied Palestinian Territory
Authors: Mills David , Abushanab Salah , Elhaloul Awad , El Nuweiry Heiam , Shaaban Mohamad Abu , Salman Zeena
Published: April 2017

Abstract 56

Background:

Although cure rates for childhood acute lymphoblastic leukemia (ALL) in developed countries surpass 90%, 1 rates in resource-limited countries, to which barriers to care contribute, are as low as 35%. 2 In the Gaza Strip—a lower middle-income economy 3 —children face unique barriers to ALL treatment. We undertook this work to describe barriers to care for patients with pediatric ALL as well as treatment outcomes at the only pediatric oncology ward in the Gaza Strip.

Methods:

A comprehensive review of 131 charts was performed. Eighty-four patients met an inclusion criterion of diagnosis of ALL by bone marrow evaluation between 2010 and 2015 in children age < 12 years.

Results:

Eighty-four patients with ALL (T cell, 12 [14%]; pre-B cell, 72 [86%]) were stratified as being at standard (n = 64; 76%), intermediate (n = 3; 4%), or high risk (HR; n = 17; 20%). Of patients, 100% were referred to an international hospital for definitive diagnosis and induction therapy; 52% required at least one additional international hospital referral as a result of chemotherapy shortages (n = 8), methotrexate monitoring (n = 28), induction failure (n = 5), or relapse (n = 5). Three-year overall survival was 93% (CI, 82% to 97%), event free survival (EFS) was 80% (CI, 66% to 89%; events: death, induction failure, and relapse), and EFS of HR patients was 23% (CI, 4% to 51%).

Conclusion:

HR patients had extremely poor outcomes, even compared with those in other resource-limited settings. 4 Overall, patients experienced relatively high overall survival and EFS, which was likely confounded by exclusion of HR patients age > 12 years because of low pediatric age cutoff and missing charts. Barriers to care, including limited freedom of movement, contribute to delays in treatment, perhaps affecting outcomes of the HR cohort. An NGL–Ministry of Health partnership is addressing these barriers 5 by providing resources to decrease referrals.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

No COIs from the authors.
Incidence of Skeletal-Related Events in Patients With Advanced and Metastatic Prostate Cancer Treated With Hormone Therapy in a Low- and Middle-Income Country
Authors: Aisuodionoe-Shadrach Oseremen , Abu Sadiq N.
Published: April 2017

Abstract 16

Background:

Skeletal-related events (SREs) are fractures, radiotherapy to bone, or spinal cord compression that occurs concurrently with or after the first bone metastasis in men with prostate cancer (PC) and may result from hormone therapy (HT). In this work, we report the incidence of SREs in patients with PC who are treated with HT and highlight the burden of advanced and metastatic PC in a practice in a low- and middle-income country.

Methods:

Retrospective data was of newly diagnosed patients with PC with SREs who were treated with androgen deprivation therapy at the University of Abuja Teaching Hospital, Abuja, Nigeria, between January 2012 and December 2015.

Results:

Of 219 cases reviewed, 142 patients (64.8%) had American Joint Committee on Cancer stage IV PC and so commenced treatment with HT, with > 50% of these patients being older than 65 years (mean [standard deviation], 68.3 [± 9.5] years). Serum prostate-specific antigen range was 1.4 to 2,461.58 ng/mL (mean [standard deviation], 113.7 [± 288.9] ng/mL). Twenty-nine patients (20.5%) had one or more SREs: spinal cord compression (19.1%), pathological fractures (1.4%), and radiotherapy to the affected bone (1.4%) being the most common. Fifty additional patients (35.2%) had bone pain with localization to the lumbosacral spine in > 50% of them, whereas two patients with pathologic fractures had internal fixation and bone radiotherapy, respectively. HT was orchiectomy, luteinizing hormone-releasing hormone agonists (LHRH), antiandrogens, and complete androgen blockade (orchiectomy plus antiandrogens) in 14 (9.8%), 3 (2.1%), 44 (30.9%), and 81 (57%) patients, respectively.

Conclusion:

That 65% of our patients had advanced or metastatic PC at first diagnosis lends credence to late presentation with increased morbidity and mortality of PC in our environment where penetration of radiotherapy services and access to LHRH is significantly low, as evidenced by patients who had complete androgen blockade that was treated with orchiectomy plus antiandrogens.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

No COIs from either author.
Effective Global Cancer Care Requires Radiation Therapy: Defining a Path From No Radiotherapy to Radiotherapy of High Quality Globally
Authors: Coleman C. Norman , Pistenmaa David , Jaffray David , Gospodarowicz Mary , Vikram Bhadrasain , Myers Steve , Vretenar Maurizio , Amaldi Ugo , Dosanjh Manjit
Published: April 2017

Abstract 46

Background:

The increasing global burden of cancer in health disparity regions is now well recognized. To appropriately address the need, the full spectrum of cancer care is required, including cancer control plans, cancer registries, prevention, diagnosis, treatment, multidisciplinary care, and follow-up. Radiation therapy is required for curative treatment, particularly for solid tumors, and for palliation. The Global Task Force for Radiation for Cancer Control, created by the Union for International Cancer Control, demonstrated that radiotherapy is economically beneficial and affordable (Lancet Oncol. 2015 16:1153-86). Recognizing that many low- and middle-income countries have inadequate or no radiation therapy and that there is a need globally for at least 5,000 radiation therapy machines, a well-designed implementation plan is necessary. This includes attention to the potential danger from misuse or mishandling of cobalt-60 and the potential for remote networking to ensure high-quality treatment.

Methods:

Experts with a broad range of interests and representatives from public and private sectors met at an International Cancer Expert Corps–sponsored workshop on the CERN campus on November 7 and 8, 2016, to consider future options, including innovative technology, a software and systems approach to dealing with the complexity of radiation therapy, and the need for ongoing education and training. Discussions included replacement of cobalt-60 units over time for security and safety reasons.

Results:

The International Cancer Expert Corps–CERN workshop produced criteria for what could be a newly designed linear accelerator. Three task groups were established to address technology/software solutions, education and training, and economic issues.

Conclusion:

The workshop report is forthcoming and the task groups will work to define short- and long-term solutions to this major global shortfall. This workshop represents a potential watershed moment for augmenting global cancer care by bringing together expertise and potential investment at the scope needed to address the gap in radiation treatment capacity.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

C. Norman Coleman No relationship to disclose David Pistenmaa No relationship to disclose David Jaffray Consulting or Advisory Role: IBA Mary Gospodarowicz No relationship to disclose Bhadrasain Vikram No relationship to disclose Steve Myers No relationship to disclose Maurizio Vrentenar No relationship to disclose Ugo Amaldi No relationship to disclose Manjit Dosanjh No relationship to disclose
Preferred Information Sources and Needs of Patients With Cancer on Disease Symptoms and Management: A Cross-Sectional Study
Authors: Belachew Sewunet Admasu , Mekuria Abebe Basazn , Erku Daniel Asfaw
Published: April 2017

Abstract 3

Background:

The provision of appropriate information to patients with cancer has a weighty impact on heightening the quality of cancer care across the whole community of patients with cancer. Diagnosis and management of cancer require patients to be aware of their disease. This study aimed at identifying the information needs of patients with cancer, their preferences for the means of receiving health information, and the perceived level of satisfaction of existing possibilities for acquiring cancer-related information in Ethiopia.

Methods:

An institutional-based cross-sectional survey was administered to 556 patients with cancer who were undergoing chemotherapy in the oncology wards of Gondar University Referral Hospital and Tikur Anbesa Specialized Hospital. Data were collected through an interviewer-administered questionnaire.

Results:

Information regarded as most important by the majority of patients (67.26%) concerned that of the specific type of cancer (name and stage of cancer), followed by information on the adverse effects of chemotherapy and their management (63.29%) and prognosis (survival; 51.8%). Doctors, overwhelmingly, were the source of information about cancer (88.8%), followed by nurses (34%). The majority of respondents (70.3%) were not satisfied at all or only a little satisfied, whereas 15.6% of respondents reported that they were “quite” or “very” satisfied with the existing possibilities for acquiring information regarding cancer.

Conclusion:

Medical practitioners other than doctors and nurses, such as clinical pharmacists, should support and identify measures that can enhance patient satisfaction regarding existing possibilities for acquiring information about cancer. Periodic assessment of the information requirements of a patient with cancer is also crucial, considering the ever-changing dynamics of priorities of such information desires.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

No COIs from the authors.
Leveraging HIV Research and Implementation for Cancer and Noncommunicable Diseases in Malawi
Authors: Mipando Mwapatsa , Mkandawire Nyengo , Masiye Jones , Wroe Emily , Dullie Luckson , Mataya Ron , Muula Adamson , Mwapatsa Victor , Dzamalala Charles , Masamba Leo , Tomoka Tamiwe , Moses Agnes , Chinula Lameck , Kaimila Bongani , Mulima Gift , Nyasosela Richard , Ngoma Jonathan , Chunda Lilian , Namarika Dan , Kamiza Steve , Nyirenda Moffat , Crampin Amelia , Gordon Stephen , Eckerle Michelle , Ware Russell , Berman Josh , van Oesterhout Joep , Sclafani Joe , El-Mallawany Nader Kim , Wasswa Peter , Kazembe Peter , Dadabhai Sufia , Taha Taha , Kumwenda Johnstone , McCollum Eric , Damania Blossom , Charles Anthony , Fedoriw Yuri , Dittmer Dirk , Hosseinipour Mina , Hoffman Irving , Phiri Sam , Gopal Satish
Published: April 2017

Abstract 33

Background:

Enabled by collaboration and political stability, Malawi is a global leader for HIV research and implementation. We undertook this work to identify ways to leverage successes in HIV treatment and research for cancer and noncommunicable diseases (NCDs).

Methods:

Over more than two decades, investment from the National Institutes of Health (NIH) and other funders has allowed Malawi participation in international HIV networks. As these sought to address HIV-positive cancer, investment occurred to increase pathology, improve cancer registration, scale up cervical cancer screening, and improve nursing and pharmacy skills for chemotherapy administration. This allowed Malawi to participate in multinational clinical trials for HIV-positive Kaposi sarcoma treatment and cervical cancer prevention. Building on this, Malawi was one of six countries in 2014 to receive an NIH U54 consortium award for HIV-positive malignancies and was one of six countries added to the National Cancer Institute (NCI) AIDS Malignancy Consortium. In 2016, expanding beyond HIV-positive cancer, Malawi was one of three countries invited to join a new NCI–International Agency for Research on Cancer esophageal cancer consortium, one of five recipients of a new NCI Burkitt lymphoma award, and one of six recipients of a new NCI P20 grant for a regional center of research excellence for NCDs. Malawi is also one of 11 countries to convene a Lancet noncommunicable diseases and injury poverty commission for NCDs and injury. Finally, partners have improved surveillance and treatment for hypertension, diabetes, injury, and sickle cell anemia, in part, through a national Knowledge Translation Platform for HIV-NCD integration. With this support and funding, career development opportunities are embedded for Malawian NCD researchers.

Results:

Building on successes in HIV treatment and research, Malawi has become a global leader for cancer and NCD research and implementation.

Conclusion:

Continue developing a multilateral national platform for NCD research and implementation that is globally impactful and can lead to measurable outputs for individual cancer and NCD focus areas. Funding: National Institutes of Health.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

No COIs from the authors.
Phased Implementation Model of Resource-Stratified Guidelines for Breast Cancer Control
Authors: Dvaladze Allison , Duggan Catherine , Gralow Julie R. , Anderson Benjamin O.
Published: April 2017

Abstract 59

Background:

Review of breast cancer control efforts in low- and middle-income countries (LMICs) has identified the need for a model to bridge the gap between evidence-based planning and implementation or scale-up of breast cancer diagnosis and treatment programs. We undertook this work to develop an evidence-based framework to guide systematic implementation of resource-stratified, effective, and sustainable systems to improve breast health care delivery in LMICs.

Methods:

On the basis of survey data and site visits, Breast Cancer Initiative 2.5 (BCI2.5) partners developed a phased implementation model for breast cancer management in LMICs. The model outlines an adaptable framework for step-wise implementation of health system requirements across the continuum of care, with successful and systematic management of clinically detectable (palpable) breast disease being a prerequisite to population-based screening. Prerequisites: Standardized protocols, guidelines, and trained health care workforce. Phase 1: Systematic triage and diagnosis of palpable breast disease; phase 2: adapted stage-appropriate treatment planning; phase 3: scaling-up of clinical breast exam to promote downstaging of clinically detectable disease; and phase 4: upgrading of image-based diagnostic systems and management of nonpalpable disease. Once these systems are in place, mammographic screening can be initiated.

Results:

Successful implementation of the Breast Health Global Initiative resource-stratified guidelines in northern Peru from 2011 to 2016 followed this phased implementation strategy and demonstrated that this approach can help advance specific aspects of a comprehensive cancer control plan in a systematic fashion, surmounting what may seem to be overwhelming barriers to improving early diagnosis.

Conclusion:

By using this model, BCI2.5 partners, in collaboration with the Government of Tanzania, are developing recommendations to inform the design, implementation, and scale-up of a breast cancer early diagnosis and treatment platform that can be achieved if adequately resourced and implemented in a phased fashion.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

Allison Dvaladze Consulting or Advisory Role: Pfizer Travel, Accommodations, Expenses: Roche Catherine Duggan No relationship to disclose Julie R. Gralow Consulting or Advisory Role: Novartis, Genentech, Eli Lilly, Bayer, Pfizer Research Funding: Genentech (Inst), Novartis (Inst), Amgen (Inst) Benjamin O. Anderson Consulting or Advisory Role: Pfizer Research Funding: Pfizer, Roche
Tumor Burden in Bangladesh: A Pathology-Based Tumor Registry Overview
Authors: Shahriar Mohammad Hasan , Kamal Mohammad , Islam Tariqul , Rakibuz-Zaman Muhammad , Ahsan Habibul
Published: April 2017

Abstract 15

Background:

Cancer is a public health concern in both developed and developing countries. Appropriate prevention and surveillance of cancer deserves urgent attention as incidence of the disease is expected to double in the next 20 to 25 years in most developing nations. Given the dearth of basic cancer-related data in Bangladesh and feasibility considerations, Bangabandhu Sheikh Mujib Medical University, in collaboration with University of Chicago, has continued a pathology-based tumor registry in Bangladesh for the last 4 years (from 2012 to present) at Bangabandhu Sheikh Mujib Medical University. We undertook this work to assess the incidence and prevalence of major cancers in Bangladesh according to a histopathology-based cancer registry by establishing a functional network among pathologists working at different government and private sectors as well as to collect tissue and paraffin blocks from patients.

Methods:

Basic epidemiologic and socioeconomic data were obtained via questionnaire from all patients (N = 13,040 patients; collected from 2012 to 2014) who came to the department laboratory for diagnostic purposes. Histopathologic and/or cytopathologic data were obtained from the department database.

Results:

Middle-aged (30 to 50 years) adults are more vulnerable (62%) than other extreme age groups to the development of different tumors, including cancer. Women (61.11%) are more prone to develop tumors than men (39.89%). Low socioecomic status (86.73%) and poor education level (less than grade 5; 69.48%) have a key impact on the development of tumors in Bangladesh. In terms of occupation, housewife (49%) is the most vulnerable group compared with all others. Skin tumor (55.6%) is the most common benign tumor among men, and breast tumor (33.28%) among women. In the case of malignancy, uterine malignancy (23.38%) is the most common in women, and mouth and oral cavity cancer (11.7%) in men. The uterus (13.18%) is the most common tumor site, followed by breast (10.69%), among all cases.

Conclusion:

Although such an effort underestimates the true occurrence of cancers in this population, these data are valuable for formulating any plan or program for epidemiology, prevention, and treatment of cancers at the local and/or national level.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

No COIs from the authors.
Cancer 101 in Minimum and Medium State Prisons: A Model for Preventing Cancer Among Incarcerated Men
Authors: Valera Pamela
Published: April 2017

Abstract 40

Background:

Incarcerated men generally have not been the focus of cancer health studies, despite the strong need for cancer health prevention interventions. Mounting evidence suggests that approximately 60% to 80% of incarcerated adults in the United States have histories of tobacco use compared with 15% of the general adult population. Tobacco use is still a major risk factor for a variety of chronic health problems, including certain cancers and heart disease. Smoking tobacco products daily elicits carcinogens that affect bodily tissues, thereby increasing smokers’ chances of developing cancer-related disparities. I undertook this work to adapt the Cancer 101—a cancer education resource to improve cancer knowledge, survival rates, and cancer control in vulnerable populations—for incarcerated men in correctional settings.

Methods:

Three state prisons were enrolled in a cancer education program that provided current smokers and ex-smokers information about cancer and tobacco dependence. Men were recruited by using several approaches: through announcements that were displayed in all cell blocks, word of mouth, and invitation directly from prison guards and administrative staff. Ten modules of Cancer 101 were provided for 8 weeks. At each session, pretest and post-test assessments were administered with each module.

Results:

Participants increased their cancer knowledge and were provided information about the health risks of tobacco products. Current smokers indicated cigarette smoking was helpful in curbing appetite, managing stress, anxiety, disappointment, and boredom.

Conclusion:

Cancer education classes in state prisons may be useful in increasing cancer knowledge and improving awareness about making better health choices. Cancer health programs are urgently needed in state prisons to empower inmates to take control of their bodies and prevent the risk of developing cancer during incarceration. Funding: National Institute of Health/National Cancer Institute Grant No. K22CA197066.

AUTHOR'S DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

Pamela Valera No COIs from the author.