A systematic review of special events to promote breast, cervical and colorectal cancer screening in the United States

Background

Special events are common community-based strategies for health promotion. This paper presents findings from a systematic literature review on the impact of special events to promote breast, cervical or colorectal cancer education and screening.

Methods

Articles in English that focused on special events involving breast, cervical, and/or colorectal cancer conducted in the U.S. and published between January 1990 and December 2011 were identified from seven databases: Ovid, Web of Science, CINAHL, PsycINFO, Sociological Abstract, Cochrane Libraries, and EconLit. Study inclusion and data extraction were independently validated by two researchers.

Results

Of the 20 articles selected for screening out of 1,409, ten articles on special events reported outcome data. Five types of special events were found: health fairs, parties, cultural events, special days, and plays. Many focused on breast cancer only, or in combination with other cancers. Reach ranged from 50–1732 participants. All special events used at least one evidence-based strategy suggested by the Community Guide to Preventive Services, such as small media, one-on-one education, and reducing structural barriers. For cancer screening as an outcome of the events, mammography screening rates ranged from 4.8% to 88%, Pap testing was 3.9%, and clinical breast exams ranged from 9.1% to 100%. For colorectal screening, FOBT ranged from 29.4% to 76%, and sigmoidoscopy was 100% at one event. Outcome measures included intentions to get screened, scheduled appointments, uptake of clinical exams, and participation in cancer screening.

Conclusions

Special events found in the review varied and used evidence-based strategies. Screening data suggest that some special events can lead to increases in cancer screening, especially if they provide onsite screening services. However, there is insufficient evidence to demonstrate that special events are effective in increasing cancer screening. The heterogeneity of populations served, event activities, outcome variables assessed, and the reliance on self-report to measure screening limit conclusions. This study highlights the need for further research to determine the effectiveness of special events to increase cancer screening.

A pilot test of a church-based intervention to promote multiple cancer-screening behaviors among Latinas

We assessed the feasibility, acceptability, and initial impact of a church-based educational program to promote breast, cervical, and colorectal cancer screening among Latinas ages 18 years and over. We used a one-group pre-/post-evaluation within a low-income, Latino Baptist church in Boston, MA. Participants completed interviewer-administered assessments at baseline and at the end of the 6-month intervention. Under the guidance of a patient navigator (PN), women from the church (peer health advisors, or PHAs) were trained to deliver evidence-based screening interventions, including one-to-one outreach, small group education, client reminders, and reduction of structural barriers to screening. The PN and PHAs also implemented a health fair, and the pastor integrated health information into regular sermons. At pre-intervention, nearly half of the sample did not meet screening guidelines. The majority (97%, n = 35) of those who completed the post-intervention assessment participated in intervention activities. Two thirds (67%) reported talking with the PN or PHAs about health issues. Participation in small group education sessions was highest (72%), with health fairs (61%) and goal setting (50%) also being popular activities. Fourteen percent also reported receiving help from the PN in finding a primary care provider. This study supports the feasibility and acceptability of churches as a setting to promote cancer screening among Latinas.

Dimensions of religiousness and cancer screening behaviors among church-going Latinas

Churches are a promising setting through which to reach Latinas with cancer control efforts. A better understanding of the dimensions of religiousness that impact health behaviors could inform efforts to tailor cancer control programs for this setting. The purpose of this study was to explore relationships between dimensions of religiousness with adherence to cancer screening recommendations among church-going Latinas. Female Spanish-speaking members, aged 18 and older from a Baptist church in Boston, Massachusetts (N = 78), were interviewed about cancer screening behaviors and dimensions of religiousness. We examined adherence to individual cancer screening tests (mammography, Pap test, and colonoscopy), as well as adherence to all screening tests for which participants were age-eligible. Dimensions of religiousness assessed included church participation, religious support, active and passive spiritual health locus of control, and positive and negative religious coping. Results showed that roughly half (46 %) of the sample had not received all of the cancer screening tests for which they were age-eligible. In multivariate analyses, positive religious coping was significantly associated with adherence to all age-appropriate screening (OR = 5.30, p < .01). Additional research is warranted to replicate these results in larger, more representative samples and to examine the extent to which enhancement of religious coping could increase the impact of cancer control interventions for Latinas.

Women's responses to changes in U.S. Preventive Task Force's mammography screening guidelines: results of focus groups with ethnically diverse women

BACKGROUND

The 2009 U.S. Preventive Services Task Force (USPSTF) changed mammography guidelines to recommend routine biennial screening starting at age 50. This study describes women's awareness of, attitudes toward, and intention to comply with these new guidelines.

METHODS

Women ages 40-50 years old were recruited from the Boston area to participate in focus groups (k = 8; n = 77). Groups were segmented by race/ethnicity (Caucasian = 39%; African American = 35%; Latina = 26%), audio-taped, and transcribed. Thematic content analysis was used.

RESULTS

Participants were largely unaware of the revised guidelines and suspicious that it was a cost-savings measure by insurers and/or providers. Most did not intend to comply with the change, viewing screening as obligatory. Few felt prepared to participate in shared decision-making or advocate for their preferences with respect to screening.

CONCLUSIONS

Communication about the rationale for mammography guideline changes has left many women unconvinced about potential disadvantages or limitations of screening. Since further guideline changes are likely to occur with advances in technology and science, it is important to help women become informed consumers of health information and active participants in shared decision-making with providers. Additional research is needed to determine the impact of the USPSTF change on women's screening behaviors and on breast cancer outcomes.

Integration of health protection and health promotion: rationale, indicators, and metrics

OBJECTIVE

To offer a definition of an "integrated" approach to worker health and operationalize this definition using indicators of the extent to which integrated efforts are implemented in an organization.

METHODS

Guided by the question-How will we know it when we see it?-we reviewed relevant literature to identify available definitions and metrics, and used a modified Delphi process to review and refine indicators and measures of integrated approaches.

RESULTS

A definition of integrated approaches to worker health is proposed and accompanied by indicators and measures that may be used by researchers, employers, and workers.

CONCLUSIONS

A shared understanding of what is meant by integrated approaches to protect and promote worker health has the potential to improve dialogue among researchers and facilitate the research-to-practice process.

HPV vaccine decision-making and acceptance: does religion play a role?

We conducted a web-based survey among 476 white, Black, and Hispanic parents or caregivers with daughter(s) between the ages of 9-17 to better understand how religion influences HPV vaccine acceptance. Catholic parents were more likely than nonaffiliated parents to have already vaccinated their daughters (vs. being undecided) (OR = 3.26, 95% CI = 1.06, 10.06). Parents with frequent attendance at religious services were more likely than parents who do not attend services to have decided against vaccination (vs. being undecided) (OR = 2.92, 95% CI = 1.25, 6.84). Directions for research and implications for interventions are addressed.

Alteration of digestive tract microbiome in neonatal Holstein bull calves by bacitracin methylene disalicylate treatment and scours

The effects of bacitracin methylene disalicylate (BMD) and scours on the fecal microbiome, animal performance, and health were studied in Holstein bull calves. Holstein bull calves (n = 150) were obtained from a single source at 12 to 24 h of age. Bull calves were randomly assigned to 1 of 2 treatments including CON (no BMD; n = 75 calves) and BMD (n = 75 calves). Starting 3 d after arrival, BMD was added into milk replacer (0.5 g/feeding; twice daily) and fed to the calves for 10 consecutive d. No differences (P > 0.10) were observed in ADG for d 0 to 28 and d 0 to 56, DMI for d 0 to 28, d 29 to 56, and d 0 to 56, or G:F for d 0 to 28, d 29 to 56, and d 0 to 56; ADG for d 29 to 56 tended to increase (P < 0.10) for BMD-treated calves compared with controls. Fecal samples were collected from 15 scouring calves and 10 cohorts (nonscouring calves received on the same day and administered the same treatment as the scouring calves). Animal morbidity and fecal score did not vary between the 2 treatments. Mortality was not influenced by the treatments in the BMD administration period or throughout the experiment. Fecal samples were subjected to pyrotagged 454 FLX pyrosequencing of 16S rRNA gene amplicon to examine compositional dynamics of fecal microbes. Escherichia, Enterococcus, and Shigella had greater (P < 0.05) populations in the BMD group whereas Dorea, Roseburia, Fecalibacterium, Papillibacter, Collinsella, Eubacterium, Peptostreptococcus, and Prevotella were decreased (P < 0.05) by BMD treatment. Genus populations were also compared between scouring and nonscouring calves. Streptococcus was the only genus that had notable increase (P < 0.05) in fecal samples from scouring calves whereas populations of Bacteroides, Roseburia, and Eubacterium were markedly (P < 0.05) greater in nonscouring calves. These results show that BMD has the ability to alter the composition of the fecal microbiome but failed to improve performance in Holstein bull calves. Discrepancy of microorganism profiles between scouring and nonscouring calves might be associated with the occurrence of scours and bacterial genera identified might be potential target of treating diarrhea.

Intention to quit smoking and concerns about household environmental risks: findings from the Health in Common Study in low-income housing

PURPOSE

To assess the association between intention to quit smoking and perceptions of household environmental risks among racially/ethnically diverse residents of low-income housing.

METHODS

Baseline data were collected from 2007 to 2009 for the Health in Common Study, which assessed social and physical determinants of cancer risk-related behaviors among residents of 20 low-income housing developments in the Greater Boston metropolitan area. Participants were surveyed about their tobacco use and concerns about household exposures. Household environmental inspections were also conducted to identify conditions associated with increased risk of exposure to indoor environmental agents, including pesticides, mold, and cleaning products.

RESULTS

Intention to quit smoking was associated with a greater degree of concern about exposures in the home, yet not with the actual presence of household hazards, as identified by home inspections and survey findings.

CONCLUSIONS

An ecological approach targeting multiple levels of influence may help to highlight the importance of both quitting tobacco and reducing potential household environmental exposures as part of comprehensive efforts to promote individual and household health.

Psychiatric pharmacogenomics predicts health resource utilization of outpatients with anxiety and depression

Antidepressants are among the most widely prescribed medications, yet only 35-45% of patients achieve remission following an initial antidepressant trial. The financial burden of treatment failures in direct treatment costs, disability claims, decreased productivity, and missed work may, in part, derive from a mismatch between optimal and actual prescribed medications. The present 1 year blinded and retrospective study evaluated eight direct or indirect health care utilization measures for 96 patients with a DSM-IV-TR diagnosis of depressive or anxiety disorder. The eight measures were evaluated in relation to an interpretive pharmacogenomic test and reporting system, designed to predict antidepressant responses based on DNA variations in cytochrome P450 genes (CYP2D6, CYP2C19, CYP2C9 and CYP1A2), the serotonin transporter gene (SLC6A4) and the serotonin 2A receptor gene (5HTR2A). All subjects had been prescribed at least one of 26 commonly prescribed antidepressant or antipsychotic medications. Subjects whose medication regimen included a medication identified by the gene-based interpretive report as most problematic for that patient and are in the 'red bin' (medication status of 'use with caution and frequent monitoring'), had 69% more total health care visits, 67% more general medical visits, greater than three-fold more medical absence days, and greater than four-fold more disability claims than subjects taking drugs categorized by the report as in the green bin ('use as directed') or yellow bin ('use with caution'). There were no correlations between the number of medications taken and any of the eight healthcare utilization measures. These results demonstrate that retrospective psychiatric pharmacogenomic testing can identify past inappropriate medication selection, which led to increased healthcare utilization and cost.

Abstract P5-14-02: Women's responses to changes in US Preventive Services Task Force mammography screening guidelines: results from focus groups among ethnically diverse women

Introduction: In 2009, the US Preventive Services Task Force (USPSTF) changed its recommendations on the age and frequency for routine mammography. To this point, responses to this change among ethnically diverse women have been not been well examined. The objective of this qualitative study is to describe women's awareness of the change in mammography screening guidelines by the U.S. Preventive Services Task Force and to describe their attitudes toward this change.

Methods: White, Black and Hispanic women ages 40–49 years were recruited from a variety of community settings in the Greater Boston, MA area to participate in focus groups (k = 10; N=73). Groups were segmented by race/ethnicity (Black = 29%; White=29%; Hispanic=15%). Women were asked if they were aware of the change in USPSTF guidelines, and if so, their understanding about reasons for this change and intention to comply. Focus groups were audio-taped and transcribed verbatim. Thematic content analysis was used to cull recurring discussion themes.

Results: Most women in this study were not aware of changes in the USPSTF mammography screening guidelines. Those who were aware of the guideline change were highly suspicious that it was motivated by a desire for cost savings on the part of insurance companies and/or providers. Concerns regarding the accuracy of mammography, pain associated with screening, and fear of receiving positive test results were prevalent. Nevertheless, most said that they did not intend to comply with changes in guidelines; many believed that regular (yearly) mammography should start at a young age (40 or before) and continue indefinitely.

Conclusion: Most women in this sample were unaware about changes in mammography screening guidelines and lacked understanding regarding underlying reasons for the change. Communication about the rationale for changes in mammography screening guidelines has left many women unconvinced about the potential downsides of screening and has generated a high degree of mistrust of insurance companies and medical providers.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-14-02.

Abstract B89: Understanding changes in the USPSTF mammography screening guidelines: The role of the Avon Breast Health Outreach Program in reaching underserved women

Objective: Given recent changes to mammography screening guidelines from the US Preventive Services Task Force (USPSTF) advising against routine screening of women ages 40-49, we sought to better understand knowledge, attitudes and educational practices of those charged with educating women about breast cancer screening. A major goal of the Avon Breast Health Outreach Program (BHOP) is to educate women about breast cancer early detection and to connect them to screening services. Special emphasis is focused on reaching women in underserved communities where there are disproportionately high rates of advanced-stage disease and breast cancer mortality. BHOP supports breast health Outreach Educators (OE), Case Managers (CM) and Patient Navigators (PN) who assist women from the point of learning about screening, getting screened and following up on results, as needed. The revised USPSTF guidelines have caused controversy and confusion among the lay public, as well as breast health educators and providers.

Methods: An online survey of Avon BHOP fiscal year 2011 grantees was conducted to document understanding of USPSTF guideline changes, strategies used to educate BHOP clients and provide decision support, and to identify potential training needs. An electronic mail invitation was sent to a total of 175 Avon BHOP grantee organizations across the US (n=112 community-based organizations and 63 Safety Net Hospitals). Avon BHOP OEs, CM, and PN participated in the self-administered, anonymous survey between December 2011 and January 2012.

Results: A total of 164 respondents completed survey. Most were over age 40, had at least a college education, and reported that their role was to reach underserved, underinsured, and uninsured women. Half were White (49%) and about a quarter were Hispanic or African American (25% and 23%, respectively). Despite the USPSTF guideline change, 86% of respondents reported that they continue to tell women ages 40-49 that they should have an annual mammogram. The majority (75%) learned about the guideline change through mass media. Of those who were aware of the guideline change, 73% reported that they did not agree with the change; most did not believe that there were disadvantages to having a mammogram. Few respondents perceived the need to discuss the pros and cons of screening with their clients.

Conclusions: In our sample of relatively well-educated BHOP staff, knowledge and awareness regarding USPSTF guidelines for mammography was low. Our findings support the notion that stakeholders, including women, breast cancer educators and outreach workers, remain committed to annual mammography for women over 40. Results indicate a need for additional training for BHOP staff regarding the range of mammography screening guidelines across major medical organizations, and strategies for explaining inconsistencies to their clients. While the need for decision support for women age 40-49 was not recognized as a high priority, helping women to understand that there are pros and cons of screening in this age range are also needed for informed decision-making, especially in underserved communities.

Citation Format: Shirley M. Bluethmann, Jennifer D. Allen, Hannah L. Mills, Kelly Morrison Opdyke, Kathryn Gates-Ferris, Marc Hurlbert, Elizabeth Harden. Understanding changes in the USPSTF mammography screening guidelines: The role of the Avon Breast Health Outreach Program in reaching underserved women. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B89.

Multi-media support for informed/shared decision-making before and after a cancer diagnosis

OBJECTIVES

To define and distinguish informed decision-making (IDM) from shared decision-making (SDM) and review the evidence for technology-based interventions designed to facilitate informed decisions about cancer screening and treatment.

DATA SOURCES

Peer-reviewed research articles from Medline and other data sources accessible through pubmed.gov.

CONCLUSION

There is evidence that multi-media decision aids (DAs) or support systems can improve quality of decision-making in terms of enhancing knowledge relevant to decision-making, reducing decisional conflict, and customizing education and coaching of patients with cancer.

IMPLICATIONS FOR NURSING PRACTICE

Nurses have a key role to play in designing, deploying, monitoring, and evaluating multi-media DAs in oncology practice settings. DAs are an adjunct to interpersonal education, providing information to patients in both the clinical setting and in more familiar settings without the time constraints of clinical encounters. Nurses can adopt such DAs and support systems and work with patients to ensure that information has been comprehended, that values have been considered, and that patients play an active role in the decision-making process as they desire.

An investigation into the social context of low-income, urban Black and Latina women: implications for adherence to recommended health behaviors

Understanding factors that promote or prevent adherence to recommended health behaviors is essential for developing effective health programs, particularly among lower income populations who carry a disproportionate burden of disease. We conducted in-depth qualitative interviews (n = 64) with low-income Black and Latina women who shared the experience of requiring diagnostic follow-up after having a screening mammography with abnormal findings. We found that in addition to holding negative and fatalistic cancer-related beliefs, the social context of these women was largely defined by multiple challenges and major life stressors, factors that may interfere with their ability to attain health. Factors commonly mentioned included competing health issues, economic hardship, demanding caretaking responsibilities and relationships, insurance-related challenges, distrust of health care providers, and inflexible work policies. Black women also reported discrimination and medical mistrust, whereas Latinas experienced difficulties associated with immigration and social isolation. These results suggest that effective health interventions not only address change among individuals but must also change health care systems and social policies in order to reduce health disparities.

Improving Breast Cancer Control via the Use of Community Health Workers in South Africa: A Critical Review

Breast cancer is a growing concern in low- and middle-income countries (LMCs). We explore community health worker (CHW) programs and describe their potential use in LMCs. We use South Africa as an example of how CHWs could improve access to breast health care because of its middle-income status, existing cancer centers, and history of CHW programs. CHWs could assume three main roles along the cancer control continuum: health education, screening, and patient navigation. By raising awareness about breast cancer through education, women are more likely to undergo screening. Many more women can be screened resulting in earlier-stage disease if CHWs are trained to perform clinical breast exams. As patient navigators, CHWs can guide women through the screening and treatment process. It is suggested that these roles be combined within existing CHW programs to maximize resources and improve breast cancer outcomes in LMCs.

A randomized trial of a computer-tailored decision aid to improve prostate cancer screening decisions: results from the Take the Wheel trial

OBJECTIVE

To evaluate a decision aid (DA) designed to promote informed decision making for prostate cancer screening.

METHODS

Twelve work sites were randomly assigned to an intervention or nonintervention comparison condition. Intervention sites received access to a computer-tailored DA at the workplace. Male employees age 45 years and above (n = 625) completed surveys at baseline and at 3-month follow-up, documenting aspects of informed decision making.

RESULTS

Using an intention-to-treat analysis, men in the intervention group were significantly more likely to have made a screening decision and to have improved knowledge without increased decisional conflict, relative to men in the comparison group. These changes were observed despite the fact that only 30% of men in intervention sites used the DA. Among DA users, similar improvements were observed, although the magnitudes of changes were substantially greater, and significant improvements in decision self-efficacy were observed.

CONCLUSIONS

A DA offered in the workplace promoted decision making, improved knowledge, and increased decision self-efficacy among users, without increasing decisional conflict. However, participation was suboptimal, suggesting that better methods for engaging men in workplace interventions are needed. IMPACT STATEMENT: This trial shows the efficacy of a computer-tailored DA in promoting informed decisions about prostate cancer screening. The DA was delivered through work sites, thereby providing access to resources required to participate in informed decision making without requiring a medical appointment. However, participation rates were suboptimal, and additional strategies for engaging men are needed.

Schedule-induced drinking as a function of percentage reinforcement

Drinking was recorded in rats while lever pressing was maintained on a series of percentage reinforcement schedules in which the per cent of 1-min fixed intervals terminating with food was 100, 90, 30, 70, 10, 50, and 100%. Intervals in which a pellet was omitted were terminated by brief light flash and click stimuli that were also correlated with food presentations. Drinking failed to develop in five of six subjects following intervals in which the brief stimuli were presented regardless of percentage reinforcement. Postpellet drinking, which followed intervals terminated with pellet delivery, however, increased in both duration and amount ingested per interval as percentage reinforcement was systematically decreased. The increase in postpellet drinking above that produced by 100% reinforcement was interpreted as an analogue of the positive-contrast effect observed with food-reinforced operants.

Schedule-induced drinking as functions of interpellet interval and draught size in the Java macaque

Three Java monkeys received food pellets that were assigned by both ascending and descending series of fixed-time schedules whose values varied between 8 and 256 seconds. The draught size dispensed by a concurrently available water-delivery tube was systematically varied between 1.0 and 0.3 milliliter per lick at various fixed-time values during the second and third series determinations. Session water intake was bitonically related to the interpellet interval and was determined by the interaction of (1) the probability of initiating a drinking bout, which fell off at the highest interpellet intervals and, (2) the size of the bout, which increased directly with increases in interpellet interval. Variations in draught size had little effect on total session intakes, but reduced bout size at draught sizes of 0.5 milliliter and below. Thus, a volume-regulation process of schedule-induced drinking operated generally at the session-intake level, but was limited to higher draught sizes at the bout level.

Schedule-induced drinking as a function of interreinforcement interval in the rhesus monkey

Lever presses by two rhesus monkeys produced food pellets that were assigned by both an ascending and descending series of fixed-interval schedules whose values varied between 1 and 512 sec. The amount of schedule-induced drinking was bitonically related to interreinforcement interval, reaching a maximum at approximately 120 sec and declining at longer fixed intervals. The relation between water intake and interreinforcement interval was complexly related to two drinking measures: (1) the probability of drinking following a pellet and (2) the amount drunk per bout. Drinking rate was also bitonically related to interreinforcement interval.

Do men make informed decisions about prostate cancer screening? Baseline results from the "take the wheel" trial

BACKGROUND

Baseline data from a randomized trial in 12 worksites were analyzed. Men aged 45+ (n = 812) completed surveys documenting screening history, screening preferences and decisions, CaP knowledge, decision self-efficacy, and decisional consistency. Psychosocial and demographic correlates of IDM were also assessed.

RESULTS

Approximately half of the sample had a prior PSA test, although only 35% reported having made an explicit screening decision. Across the sample, CaP knowledge was low (mean = 56%), although decision self-efficacy was high (mean = 78%), and the majority of men (81%) made decisions consistent with their stated values. Compared with those who were undecided, men who made an explicit screening decision had significantly higher levels of knowledge, greater decisional self-efficacy, and were more consistent in terms of making a decision in alignment with their values. They tended to be white, have high levels of income and education, and had discussed screening with their health care provider.

CONCLUSIONS

Many men undergo CaP screening without being fully informed about the decision. These findings support the need for interventions aimed at improving IDM about screening, particularly among men of color, those with lower levels of income and education, and those who have not discussed screening with their provider.

A systematic review of measures used in studies of human papillomavirus (HPV) vaccine acceptability

BACKGROUND

The recent proliferation of studies describing factors associated with HPV vaccine acceptability could inform health care providers in improving vaccine coverage and support future research. This review examined measures of HPV and HPV-vaccine knowledge, attitudes, beliefs and acceptability, described psychometric characteristics, and provided recommendations about their use.

METHODS

A systematic search of Medline, CINAHL, PsychoInfo, and ERIC through May 2008 for English language reports of quantitative data from parents, young adults or adolescents yielded 79 studies.

RESULTS

The majority of studies were cross-sectional surveys (87%), self-administered (67%), conducted before prophylactic vaccines were publicly available (67%) and utilized convenience samples (65%). Most measured knowledge (80%), general attitudes about HPV vaccination (40%), and willingness to vaccinate one's daughter (26%). Two-thirds did not report reliability or validity of measures. The majority did not specify a theoretical framework.

CONCLUSIONS

Use of a theoretical framework, consistent labeling of constructs, more rigorous validation of measures, and testing of measures in more diverse samples are needed to yield measurement instruments that will produce findings to guide practitioners in developing successful community and clinical interventions.

Timely care after an abnormal mammogram among low-income women in a public breast cancer screening program

BACKGROUND

Since 1990, the National Breast and Cervical Cancer Early Detection Program (BCCEDP) has funded breast cancer screening and diagnostic services for low-income, underinsured women. Case management was implemented in 2001 to address barriers to follow-up after an abnormal mammogram, and free treatment was introduced in 2004. However, the effect of these policies on timeliness of care has not been empirically evaluated.

METHODS

Among 2252 BCCEDP participants in Massachusetts during 1998 through 2007, we conducted a time-to-event analysis with prepolicy-postpolicy comparisons to examine associations of case management and free treatment with diagnostic and treatment delays (>60 days and >90 days, respectively) after an abnormal mammogram.

RESULTS

The proportion of women experiencing a diagnostic delay decreased from 33% to 23% after the introduction of case management (P < .001), with a significant reduction in the adjusted risk of diagnostic delay (relative risk [RR], 0.65; 95% confidence interval [CI], 0.53-0.79) that did not differ by race and ethnicity. However, case management was not associated with changes in treatment delay (RR, 0.93; 95% CI, 0.80-1.10). Free treatment was not associated with changes in the adjusted risk of diagnostic delay (RR, 0.61; 95% CI, 0.33-1.14) or treatment delay (RR, 0.77; 95% CI, 0.43-1.38) beyond improvements associated with case management.

CONCLUSIONS

Case management to assist women in overcoming logistic and psychosocial barriers to care may improve time to diagnosis among low-income women who receive free breast cancer screening and diagnostic services. Programs that provide services to coordinate care, in addition to free screening and diagnostic tests, may improve population health.

Integrating clinical, community, and policy perspectives on human papillomavirus vaccination

Infection with genital human papillomavirus (HPV) may cause anogenital cancers, oropharyngeal cancers, anogenital warts, and respiratory papillomas. Two prophylactic vaccines (a bivalent and a quadrivalent vaccine) are now licensed and currently in use in a number of countries. Both vaccines prevent infection with HPV-16 and HPV-18, which together cause approximately 70% of cervical cancers, and clinical trials have demonstrated 90%-100% efficacy in preventing precancerous cervical lesions attributable to HPV-16 and HPV-18. One vaccine also prevents HPV-6 and HPV-11, which cause 90% of genital warts. A growing literature describes psychosocial, interpersonal, organizational, and societal factors that influence HPV vaccination acceptability. This review summarizes the current literature and presents an integrated perspective, taking into account these diverse influences. The resulting integrated framework can be used as a heuristic tool for organizing factors at multiple levels to guide intervention development and future research.

A computer-tailored intervention to promote informed decision making for prostate cancer screening among African American men

African American men experience a disproportionate burden of prostate cancer (CaP) morbidity and mortality. National screening guidelines advise men to make individualized screening decisions through a process termed informed decision making (IDM). In this pilot study, a computer-tailored decision-aid designed to promote IDM was evaluated using a pre-/posttest design. African American men aged 40 years and older were recruited from a variety of community settings (n = 108). At pretest, 43% of men reported having made a screening decision; at posttest 47% reported this to be the case (p = .39). Significant improvements were observed between pre- and posttest on scores of knowledge, decision self-efficacy, and decisional conflict. Men were also more likely to want an active role in decision making after using the tool. These results suggest that use of a computer-tailored decision aid is a promising strategy to promote IDM for CaP screening among African American men.

College men's knowledge, attitudes, and beliefs about the human papillomavirus infection and vaccine

Men enrolled in an urban university participated in focus groups (k=6; n=45) to explore knowledge about human papillomavirus and attitudes toward prophylactic vaccine. Results suggest that regardless of whether vaccines become available to men, educational efforts should include them, as men tend to have many misconceptions and do not perceive themselves to be vulnerable.

Effect of preslaughter feeding and ractopamine hydrochloride supplementation on growth performance, carcass characteristics, and end product quality in market dairy cows

An experiment was conducted in market dairy cows to determine the effect of feeding time and ractopamine hydrochloride (RAC) on growth performance, carcass characteristics, and end product quality. In 3 replicates, 9 Holstein cows per replicate (n = 27; 659 +/- 25.3 kg initial BW) culled from 3 dairies were randomly assigned to 3 treatments: 1) slaughter immediately (control), 2) feed for 90 d (NoR), or 3) feed for 90 d with RAC (312 mg.cow(-1).d(-1)) for the final 32 d (RAC). On d 0, NoR and RAC cows were placed in individual pens and fed a high concentrate diet (86% concentrate, DM basis) for 90 d before slaughter. All cows were subjectively scored for BCS and locomotion score on d 0, and NoR and RAC cows were evaluated again after 90 d. Individual DMI was recorded daily throughout the trial, and BW was collected every 14 d. Age and age x treatment did not affect (P > 0.05) any of the traits evaluated in this study. When cows fed for 90 d (NoR and RAC combined) were compared with nonfed controls, fed cows had greater (P < 0.001) final BCS, BW and HCW, lower (P < 0.001) final locomotion score, and greater (P < 0.03) dressing percentage, external fat thickness, and marbling score. Fed cows also tended to have more desirable yield grade (P = 0.08), ribeye area (P = 0.11), fat color (P = 0.09), lean maturity (P = 0.06), and quality grade (P = 0.09) compared with control cows. Warner-Bratzler shear force was not affected (P = 0.23) by feeding. However, a 12-member trained sensory panel revealed that fed cow carcasses had more desirable (P < 0.04) tenderness, juiciness, and overall acceptability than control cow carcasses. Flavor intensity also tended (P = 0.10) to be more desirable for fed vs. control cows. No difference (P > 0.10) in off-flavor was detected among treatments. Finally, there was no effect (P > 0.10) of RAC on growth performance, carcass characteristics, or end product quality. In conclusion, feeding a high concentrate diet for 90 d improved important live animal, carcass, and end product characteristics related to the quality and palatability of beef from market dairy cows; however, no effect of RAC supplementation was observed.

Do social network characteristics predict mammography screening practices?

BACKGROUND

Many breast cancer outreach programs assume that dissemination of information through social networks and provision of social support will promote screening. The authors prospectively examined the relationship between social network characteristics and adherence to screening guidelines.

METHOD

Employed women age 40 years and older completed baseline and 2-year follow-up assessments (N=1,475) as part of an intervention trial. The authors modeled screening adherence at follow-up as a function of social network characteristics at baseline.

RESULTS

Baseline adherence explained most of the variation in adherence at follow-up. For women age 40 to 51 years, having a mammogram at follow-up was predicted by encouragement by family and/or friends and subjective norms at baseline (odds ratio=2.20 and 1.18, respectively). For women age 52 years and older, the perception that screening was normative was related to adherence at follow-up (odds ratio=1.46).

CONCLUSIONS

Previous mammography use is strongly predictive of future screening. Social network characteristics have a modest impact on screening. Outreach efforts should focus on those who have previously underutilized mammography.

Follow-up of abnormal screening mammograms among low-income ethnically diverse women: findings from a qualitative study

OBJECTIVE

To understand factors that women feel facilitate or hinder their receipt of diagnostic services following an abnormal screening mammogram.

METHODS

This qualitative study used a purposive sampling strategy to identify low-income, ethnically diverse women aged 40 or over who had a recent abnormal mammogram. Working with a community health center, breast evaluation center, and mobile mammography van, 64 women were interviewed to identify salient themes that differentiated women who received timely follow-up from those who did not.

RESULTS

Prominent themes among women who delayed follow-up included dissatisfaction with communication of results; perceived disrespect on the part of providers and clinic staff; logistical barriers to access of diagnostic services; anxiety and fear about a possible cancer diagnosis; and a lack of information about breast cancer screening and symptoms. Women who received timely care more often reported an appreciation of efforts by providers and clinic staff to support their prompt follow-up; availability of social support that facilitated appointment-keeping; confidence in their ability to advocate for their health; and a high priority placed on self-care.

CONCLUSION

A comprehensive approach to improving timely diagnostic follow-up among underserved groups must address patient beliefs and attitudes, provider practices and communication, and practices at the health care systems level.

PRACTICE IMPLICATIONS

Implications and strategies for improving patient education, patient-provider communication, and organizational practices are discussed.

The multidrug transporter ABCG2 (BCRP) is inhibited by plant-derived cannabinoids

BACKGROUND AND PURPOSE

Cannabinoids are used therapeutically for the palliation of the adverse side effects associated with cancer chemotherapy. However, cannabinoids also inhibit both the activity and expression of the multidrug transporter, P-glycoprotein in vitro. Here we address the interaction of cannabinol (CBN), cannabidiol (CBD) and delta 9-tetrahydrocannabinol (THC) with the related multidrug transporter, ABCG2.

EXPERIMENTAL APPROACH

Cannabinoid inhibition of Abcg2/ABCG2 was assessed using flow cytometric analysis of substrate accumulation and ATPase activity assays. The cytotoxicity and chemosensitization by cannabinoids was determined with cell viability assays. Expression of cannabinoid and vanilloid receptors was assessed using reverse transcriptase polymerase chain reaction, and cannabinoid modulation of ABCG2 expression was examined using immunoblotting.

KEY RESULTS

CBN, CBD and THC increased the intracellular accumulation of the Abcg2/ABCG2 substrate, mitoxantrone, in an over-expressing cell line. The THC metabolite, (-)-11-nor-9-carboxy-delta 9-THC was much less potent. The plant cannabinoids inhibited both basal and substrate stimulated ATPase activity of human ABCG2. Cannabinoid cytotoxicity occurred in the absence of known cannabinoid cell surface receptors, and only at concentrations higher than those required for Abcg2/ABCG2 inhibition. Sub-toxic concentrations of the cannabinoids resensitized the overexpressing cell line to the cytotoxic effect of Abcg2/ABCG2 substrates, mitoxantrone and topotecan. This occurred in the absence of any effect on ABCG2 expression.

CONCLUSIONS AND IMPLICATIONS

Cannabinoids are novel Abcg2/ABCG2 inhibitors, reversing the Abcg2-mediated multidrug-resistant phenotype in vitro. This finding may have implications for the co-administration of cannabinoids with pharmaceuticals that are ABCG2 substrates.

African-American men's perceptions about prostate cancer: implications for designing educational interventions

This qualitative study explores African-American men's perceptions about prostate cancer (CaP) screening and assesses the acceptability of various strategies and settings for interventions to promote informed decision-making. We conducted four focus groups among healthy men (n=37) and two groups among CaP survivors (n=14) aged 35-70 in the greater Boston area, USA. Also, we conducted 14 in-depth interviews with key community informants. The audio-taped focus groups and interviews were transcribed, coded, and analyzed for emergent themes. Except for survivors, men had insufficient information about the prostate, the elevated cancer risk among African-Americans, and the controversy concerning screening. Key informants and focus group participants cited inadequate access to services, mistrust of the health system, poor relationships with medical providers, and perceived threats to male sexuality as major barriers to receiving prostate care. They recommended that interventions be embedded in community settings, address men's overall health, and be administered by culturally competent providers, and repeatedly emphasized trust building and a sustained presence in the community. Efforts to present balanced information about CaP screening may be hindered by lingering mistrust of the medical system, poor relationships between patients and providers, and enthusiastic support for screening on the part of CaP survivors. Implications for interventions are discussed.

Theoretical foundations for interventions designed to promote informed decision making for cancer screening

BACKGROUND

Decision aids are currently being developed and evaluated for use in cancer-screening decisional settings.

PURPOSE

The purpose of this article is to review and discuss the theoretical basis of interventions to promote informed decision making in cancer screening.

METHODS

We reviewed interventions cited in Briss et al. and Rimer et al. to identify their theoretical basis, intervention content, measurement strategies, and outcomes.

RESULTS

Few interventions had a strong, decision-oriented conceptual basis. This was apparent in their intervention content, the measurement strategy, and the choice of outcomes for the study.

CONCLUSIONS

We recommend that more research occur into the basis of decision making in cancer screening and that future interventions use this research to rigorously design and evaluate decision aids to help people make choices about cancer screening.

The effects of cannabinoids on P-glycoprotein transport and expression in multidrug resistant cells

Cannabis is the most widely used illicit drug in the world. Cannabinoids are used therapeutically by some patients as they have analgesic, anti-emetic and appetite stimulant properties which palliate adverse symptoms. Use of these agents in an oncology setting raises the question of whether they act to modulate the effectiveness of concurrently administered anti-cancer drugs. The transporter, P-glycoprotein (P-gp) confers multiple drug resistance (MDR) by effluxing a diverse array of anti-cancer agents. This study was undertaken to examine the effect of cannabinoids on P-gp. Unlike the known P-gp inhibitor, PSC833, short 1h exposure to three plant-derived cannabinoids, cannabinol (CBN), cannabidiol (CBD) and Delta(9)-tetrahydrocannabinol (THC) and the synthetic cannabinoid receptor agonist, WIN55, 212-2 (WIN) did not inhibit the efflux of the P-gp substrate Rhodamine 123 (Rh123) in either a drug-selected human T lymphoblastoid leukaemia cell line (CEM/VLB(100)) or in a mouse fibroblast MDR1 transfected cell line (77.1). However, in CEM/VLB(100) cells, prolonged 72 h exposure to the cannabinoids, THC and CBD, decreased P-gp expression to a similar extent as the flavonoid, curcumin (turmeric). This correlated with an increase in intracellular accumulation of Rh123 and enhanced sensitivity of the cells to the cytotoxic actions of the P-gp substrate, vinblastine. Taken together, these results provide preliminary evidence that cannabinoids do not exacerbate P-gp mediated MDR. Further, plant-derived cannabinoids are moderately effective in reversing MDR in CEM/VLB(100) cells by decreasing P-gp expression.

Decreasing Women's Anxieties After Abnormal Mammograms: A Controlled Trial

BACKGROUND

Few studies have evaluated interventions to decrease a woman's anxiety after she receives an abnormal mammogram (i.e., one with a recommendation for follow-up). We performed a controlled trial to compare the effects of both an immediate reading of mammograms (i.e., a radiology intervention) and of an educational intervention that taught skills to cope with anxiety on the psychological status of women whose mammograms were normal or abnormal.

METHODS

Eligible women (n = 8543) aged 39 years or older were recruited from seven mammography sites at the time of their scheduled mammography screening and assigned to receive no intervention, either the radiology or the educational intervention, or both interventions. We used the Impact of Events Scale (IES) and the Hopkins Symptom Checklist subscales for Anxiety (HSC-A) and Depression (HSC-D) in structured telephone interviews of 2844 women to assess the psychological status of all women with abnormal mammograms (excluding women diagnosed with breast cancer) and of a random sample of women with normal mammograms at 3 weeks and 3 months after their mammograms. All statistical tests were two-sided.

RESULTS

We obtained usable 3-week interviews for 2390 (84%) women. By the 3-week interview, 1037 (72.1%) of the 1439 interviewed women with abnormal mammograms had completed the recommended work-up and knew that their abnormal mammograms were false positives. Women with abnormal mammograms had higher IES and HSC-A scores (i.e., more anxiety) than women with normal mammograms (mean IES scores: 4.97 [95% confidence interval [CI] = 4.47 to 5.50] and 1.82 [95% CI = 1.51 to 2.14], respectively; P<.001; mean HSC-A scores: 1.14 [95% CI = 1.12 to 1.15] and 1.11 [95% CI = 1.09 to 1.13], respectively, P=.002). Among women with false-positive mammograms, those who had received the radiology intervention reported less anxiety than those who had not (mean IES scores: 4.42 [95% CI = 3.73 to 5.07] and 5.53 [95% CI = 4.82 to 6.28], respectively, P=.026). The educational intervention was not associated with any difference in psychological outcomes. Three months after the mammogram, by which time more than 80% of the women with abnormal results knew their mammograms to be false positives, anxiety levels of women with false-positive mammograms remained higher than those of women with normal mammograms (mean IES scores: 2.34 [95% CI = 1.99 to 2.69] and 1.15 [95% CI = 0.87 to 1.47], respectively, P<.001).

CONCLUSION

Immediate reading of screening mammograms, but not an educational intervention targeting coping skills, was associated with less anxiety among women with false-positive mammograms 3 weeks after mammography.

Multidrug resistance genes in infant acute lymphoblastic leukemia: Ara-C is not a substrate for the breast cancer resistance protein

Infants with acute lymphoblastic leukemia (ALL) are more resistant to chemotherapeutic drugs than older children with ALL, except for Ara-C. Drug resistance mechanisms in infant ALL, however, remain unknown. Possibly, multidrug resistance (MDR) proteins like P-glycoprotein, MDR-associated protein (MRP1), lung resistance-related protein (LRP/MVP) and the breast cancer resistance protein (BCRP) play a role. Accordingly, we measured the mRNA levels of these proteins in infants (n=13) and non-infants (n=13) with ALL, using quantitative RT-PCR. Infants expressed 2.4-fold less BCRP mRNA (P=0.009) than non-infants with ALL. MDR1, MRP1 and LRP/MVP expression did not differ between both groups. MDR gene expression levels did not correlate to prednisolone, vincristine, daunorubicin or Ara-C cytotoxicity, except for BCRP expression, which correlated with resistance to Ara-C (Rs=0.53, P=0.012), suggesting that Ara-C might be a BCRP substrate. However, culturing patients ALL cells in the presence of the BCRP inhibitor Ko143 had no effect on Ara-C sensitivity. Inhibiting Bcrp1 in the Mdr1a-, Mdr1b- and Mrp1-deficient and Bcrp1-overexpressing mouse cell line Mef3.8/T6400, also did not modulate Ara-C cytotoxicity. Therefore, we conclude that Ara-C is not a substrate for BCRP and that MDR proteins do not play a significant role in drug resistance in infant ALL.

Laparoscopic dismembered pyeloplasty: 50 consecutive cases

OBJECTIVE

To test the hypothesis that laparoscopic dismembered pyeloplasty offers the same good results as open pyeloplasty, but without the disadvantages of the loin incision (which is painful, prolongs hospitalization and prevents a return to normal activities for several weeks) in the treatment of pelvi-ureteric junction (PUJ) obstruction.

PATIENTS AND METHODS

Fifty consecutive consenting patients presenting with PUJ obstruction underwent laparoscopic dismembered pyeloplasty carried out by one surgeon using an extraperitoneal approach.

RESULTS

Two (4%) procedures were converted to open surgery. The mean (range) operative duration was 164 (120-240) min. Fifteen (30%) of the patients had their ureter transposed anterior to a crossing lower-pole vessel; 22 (44%) patients had a separate renal pelvic suture line. The mean (range) postoperative parenteral analgesic requirement was 19.1 (0-111) mg of morphine sulphate. The mean (range) hospitalization was 2.6 (2-7) days. Two (4%) patients had complications. After a mean (range) follow-up of 18.8 (3-72) months all but one patient, who had failed endopyelotomy, had a normal renogram and were symptom-free.

CONCLUSION

These results suggest that a loin wound is not necessary for a successful outcome after dismembered pyeloplasty, and that in expert hands laparoscopic dismembered pyeloplasty should now be considered the standard of care.

Discrimination of gamma-hydroxybutyrate and ethanol administered separately and as a mixture in rats

The physiological effects of gamma-hydroxybutyrate (GHB) are complex and not yet clearly defined. GHB has been labeled as a recreational drug and is reported to be frequently coabused with ethanol (ETH). Other studies have yielded discrepant results as to the interaction between GHB and ETH. Thus, the present study investigated extensively the discriminative stimulus of GHB and ETH and a mixture of the two compounds. Thirty male Long-Evans rats were divided into three groups and trained to discriminate doses of either 300 mg/kg GHB, 1000 mg/kg ETH, or a mixture (MIX: 150 mg/kg GHB+500 mg/kg ETH) from vehicle on a two-lever fixed-ratio (FR) 10 schedule of food reinforcement. Dose-response curves were attained in each group with its respective training drugs. GHB and ETH did not cross-generalize in the ETH- and GHB-trained rats, respectively. However, when the effects of the MIX were tested in the GHB- and ETH-trained rats, a greater than additive response was observed. Testing also revealed that the MIX-trained rats did not perceive a novel stimulus but a near-equal contribution from GHB and ETH. This study provides evidence of a complex relationship between GHB and ETH and opposes previous work reporting cross-generalization between GHB and ETH.

Waveform optimization for internal atrial defibrillation: effects of waveform rounding, phase duration, and voltage swing

The aim of this study was to compare the efficacy of internal atrial defibrillation by conventional truncated exponential biphasic waveforms with and without waveform rounding (1-2 phases) and to determine optimal duration for this novel double rounded waveform. Atrial fibrillation, induced by rapid electrical stimulation, was converted by internal shocks through defibrillation catheters (lateral right atrium and coronary sinus) in anesthetised sheep. Rounding the leading edges of the conventional biphasic waveform (Ventritex HVS-02; settings 100/-50 V, 150/-70 V, and 200/-100 V; n = 8) reduced delivered peak and trough voltages, currents, and energy (by > or = 21 %, P < 0.001; for double (both phases) rounded) without decreasing cardioversion success. At 100/-50 V the efficacy of single (first phase) rounded (53 +/- 13%; mean +/- SEM) and double rounded (59 +/- 11%) shocks was similar to the conventional waveform (56 +/- 14%). Double rounded waveform (phase durations 1-20 ms) efficacy was optimum at 6-10 ms phase duration (100% success at 10-ms phase duration; 1.52 +/- 0.04 J delivered energy; n = 6). Successful cardioversion by conventional, single rounded, and double rounded biphasic waveforms (duration 6 ms each phase), conventional monophasic, rounded monophasic (duration 12 ms), and a damped sine waveform correlated strongly with peak-to-trough voltage swing within the waveform (r = 0.882; P < 0.01; n = 8). For internal atrial defibrillation, rounding both phases of the conventional biphasic waveforms, the double rounded waveform, permits similar efficacy to the conventional truncated exponential biphasic waveform at reduced peak voltage, current, and delivered energy. Optimum phase duration is 6-10 ms (tested range 1-20 ms).

Myocardial expression of the endothelin system in endotoxin-treated rats

Although circulating plasma levels of endothelin (ET)-1 are elevated in endotoxemia, little is known about the myocardial expression of the ET system in endotoxic shock. We assessed the temporal mRNA expression pattern of key components of the ET system (pre-pro ET (ppET) -1, -2, ET-converting enzyme-1, ET(A) and ET(B) receptors) by reverse transcription polymerase chain reaction in a rat model of early endotoxic shock. Lipopolysaccharide (5 mg/kg, i.p.) caused a transient increase (p < 0.05) in inducible nitric oxide synthase mRNA expression. ppET-1 mRNA expression was increased at 2 h (approximately 12-fold increase; p < 0.05) in the lipopolysaccharide compared with the saline group and ppET-2 mRNA expression was unaltered. ET-converting enzyme-1, ET(A), and ET(B) receptor mRNA expression was unaltered in the lipopolysaccharide compared with the saline group. While ppET-1 mRNA expression is selectively upregulated in ventricular myocardium of lipopolysaccharide-treated rats, an absence of alteration in ET-converting enzyme-1 mRNA expression suggests an excess capacity of ET-converting enzyme-1 to cope with the increased expression of ET-1. At the level of the receptor, endotoxic shock did not affect the expression of either ET(A) or ET(B) receptor mRNA. These data are consistent with the increased expression of myocardial ET-1 as an acute-phase response due to hemodynamic instability associated with the early stages of endotoxic shock.

Inhaled nitric oxide in combination with volume resuscitation refines a porcine model of endotoxic shock

BACKGROUND

Existing porcine models of endotoxic shock poorly represent the human situation.

AIMS

To assess whether the cardiovascular profile of a porcine model could be improved by refining the protocol.

METHODS

In 30 pigs, right and left heart pressures and cardiac output were measured. Lipopolysaccharide (LPS) was administered as a bolus (n=12), as a 30 minute infusion (n=6) or as a 30 minute infusion along with inhaled NO and volume resuscitation (n=6) and six sham-treated pigs received normal saline. Haemodynamic values were measured over three hours.

RESULTS

LPS increased pulmonary vascular resistance (PVR) (13.3 +/- 1.4 to 37.0 +/- 3.9kPa/l per sec, p<0.05) and reduced cardiac output (6.0 +/- 0.6 to 4.8 +/- 0.41/min). Mortality was 50% within 30 minutes. Inhaled NO and volume resuscitation controlled pulmonary vascular resistance (PVR) and preserved CO. Systemic vascular resistance (SVR) declined in the first hour (118.4 +/- 11.8 to 65.8 +/- 8.2kPa/l per sec, p<0.05) and remained low.

CONCLUSIONS

Porcine models of endotoxaemia based on LPS administration are a poor model of human septic shock, but can be improved by regulating PVR and supporting CO which may contribute to future studies of septic shock

Promoting breast and cervical cancer screening at the workplace: results from the Woman to Woman Study

OBJECTIVES

This article reports findings from a peer-delivered intervention designed to increase use of breast and cervical cancer screening.

METHODS

Twenty-six worksites were randomly assigned to the intervention or comparison group. The 16-month intervention consisted of group discussions, outreach, and educational campaigns. Data were collected from a random sample of women employees stratified by age (baseline n = 2943; final n = 2747). Cross-sectional analyses were conducted to evaluate the impact of the intervention on screening behaviors.

RESULTS

Relative to comparison worksites, the intervention group experienced greater increases in the percentage of women who reported a recent mammogram (7.2% vs 5.6%), clinical breast examination (5.8% vs 2.1%), and Papanicolaou (Pap) test (4.7% vs 1.9%). After worksite cluster and age strata were controlled for, the observed increase in Pap tests was significantly greater in the intervention group (odds ratio [OR] = 1.28; 95% confidence interval [CI] = 1.01, 1.62); however, differences in mammography screening rates (OR = 1.14; 95% CI = 0.90, 1.44) and clinical breast examination (OR = 1.19; 95% CI = 0.96, 1.49) were not statistically significant.

CONCLUSIONS

Intervention activities produced a modest increase in cervical cancer screening, but they did not accelerate breast cancer screening rates above the observed secular trend.

Forearm vasoreactivity in type 1diabetic subjects

This study compared forearm vasoreactivity in 15 Type I diabetic subjects with 15 healthy controls. The groups were matched for age, exercise capacity, and the absence of other cardiovascular risk factors. Vasoreactivity was measured using strain gauge plethysmography, at rest, after arterial occlusion (OCC), and following OCC coupled with handgrip exercise (ROCC). Forearm blood flows were significantly elevated between conditions 2.58 +/- 0.37ml/100mltissue at rest to 26.80 +/- 6.56 after OCC and 32.80 +/- 8.26ml/100mltissue following ROCC in Type I diabetic subjects. There were no differences in forearm blood flow between groups for any of the conditions. These data indicate the degree of forearm blood flow is directly related to the intensity of the vasodilatory stimulus. However, our study did not reveal evidence of impaired vasodilatory capacity in Type I diabetic subjects compared to controls in the absence of other risk factors.

Inhibition of BCRP-mediated drug efflux by fumitremorgin-type indolyl diketopiperazines

A library of 42 diastereoisomeric mixtures of fumitremorgin-type indolyl diketopiperazines, prepared by parallel solid-phase synthesis, was screened for Breast Cancer Resistance Protein inhibitory activity and compared with GF120918. Demethoxy-fumitremorgin C was synthesized by solid-phase techniques and tested as well. Structure-activity relationship studies have identified several potent analogues, both in assays using the T6400 mouse and the T8 human cell line, whereas low cytotoxicity was seen at effective concentrations.