Reproductive steroid hormones and recurrence-free survival in women with a history of breast cancer

Epidemiologic studies fairly consistently show in postmenopausal women that reproductive steroid hormones contribute to primary breast cancer risk, and this association is strongly supported by experimental studies using laboratory animals and model systems. Evidence linking sex hormone concentrations with risk for recurrence in women diagnosed with breast cancer is limited; however, beneficial effects of antiestrogenic therapy on recurrence-free survival suggest that these hormones affect progression and risk for recurrence. This study examined whether baseline serum concentrations of estradiol, testosterone, and sex hormone binding globulin were associated with recurrence-free survival in a nested case-control cohort of women from a randomized diet trial (Women's Healthy Eating and Living Study) who were followed for >7 years after diagnosis. In 153 case-control pairs of perimenopausal and postmenopausal women in this analysis, total estradiol [hazard ratio (HR), 1.41 per unit increase in log concentration; 95% confidence interval (95% CI), 1.01-1.97], bioavailable estradiol (HR, 1.26; 95% CI, 1.03-1.53), and free estradiol (HR, 1.31; 95% CI, 1.03-1.65) concentrations were significantly associated with risk for recurrence. Recurred women had an average total estradiol concentration that was double that of nonrecurred women (22.7 versus 10.8 pg/mL; P = 0.05). Testosterone and sex hormone binding globulin concentrations did not differ between cases and controls and were not associated with risk for recurrence. Although genetic and metabolic factors likely modulate the relationship between circulating sex hormones and risk, results from this study provide evidence that higher serum estrogen concentration contributes to risk for recurrence in women diagnosed with early stage breast cancer.

Warm or Cool, Large or Small? The Challenge of Thermal Displays

Thermal displays have been developed to present thermal cues to the hand to facilitate object recognition in virtual environments or in teleoperated robotic systems. This review focuses on this application domain of thermal displays and considers the models developed to simulate the thermal interaction between an object and the hand as they make contact. An overview of thermal perception and the mechanisms underlying the processing of thermal information is provided to give a framework for analyzing the design of thermal displays. The models developed to simulate thermal feedback are examined together with a description of the implementation of these models in thermal displays. The domains in which thermal displays have been used are described; this includes the simulation of material properties, the recreation of large-scale thermal effects in virtual environments, the encoding of abstract concepts and the use of thermal feedback in interactive art. The review concludes by considering the advantages and challenges associated with using thermal displays in these diverse areas.

Telephone counseling helps maintain long-term adherence to a high-vegetable dietary pattern

Achieving long-term adherence to a dietary pattern is a challenge in many studies investigating the relationship between diet and disease. The Women's Healthy Eating and Living Study was a multi-institutional randomized trial in 3088 women at risk for breast cancer recurrence. At baseline, the average participant followed a healthy dietary pattern of 7 vegetable and fruit servings, 21 g/d of fiber, and 28.7% energy from fat, although fat intake increased over the enrollment period. Using primarily telephone counseling, the intervention group was encouraged to substantially increase intakes of vegetables, fruits, and fiber while decreasing fat intake. Sets of 24-h dietary recalls were completed on 90% of eligible participants at 1 y and 86% at 4 y. Using a conservative imputation analysis, at 1 y, the intervention group consumed 38% more vegetable servings (100% when including juice) than the comparison group, 20% more fruit, 38% more fiber, 50% more legumes, and 30% more whole grain foods, with a 20% lower intake of energy from fat. At 4 y, the between-group differences were 65% for vegetables (including juice), 25% fruit, 30% fiber, 40% legumes, 30% whole grain foods, and 13% lower intake of energy from fat. The intervention effect on fat intake was similar for early vs. late enrollees. Plasma carotenoid concentrations on a random 28% sample validated self-reported vegetable and fruit intake, with a between-group difference of 66% at 1 y and over 40% at 4 y. This large change will allow testing of hypotheses on the role of dietary change in preventing additional breast cancer events.

Influence of a diet very high in vegetables, fruit, and fiber and low in fat on prognosis following treatment for breast cancer: the Women's Healthy Eating and Living (WHEL) randomized trial

CONTEXT

Evidence is lacking that a dietary pattern high in vegetables, fruit, and fiber and low in total fat can influence breast cancer recurrence or survival.

OBJECTIVE

To assess whether a major increase in vegetable, fruit, and fiber intake and a decrease in dietary fat intake reduces the risk of recurrent and new primary breast cancer and all-cause mortality among women with previously treated early stage breast cancer.

DESIGN, SETTING, AND PARTICIPANTS

Multi-institutional randomized controlled trial of dietary change in 3088 women previously treated for early stage breast cancer who were 18 to 70 years old at diagnosis. Women were enrolled between 1995 and 2000 and followed up through June 1, 2006.

INTERVENTION

The intervention group (n = 1537) was randomly assigned to receive a telephone counseling program supplemented with cooking classes and newsletters that promoted daily targets of 5 vegetable servings plus 16 oz of vegetable juice; 3 fruit servings; 30 g of fiber; and 15% to 20% of energy intake from fat. The comparison group (n = 1551) was provided with print materials describing the "5-A-Day" dietary guidelines.

MAIN OUTCOME MEASURES

Invasive breast cancer event (recurrence or new primary) or death from any cause.

RESULTS

From comparable dietary patterns at baseline, a conservative imputation analysis showed that the intervention group achieved and maintained the following statistically significant differences vs the comparison group through 4 years: servings of vegetables, +65%; fruit, +25%; fiber, +30%, and energy intake from fat, -13%. Plasma carotenoid concentrations validated changes in fruit and vegetable intake. Throughout the study, women in both groups received similar clinical care. Over the mean 7.3-year follow-up, 256 women in the intervention group (16.7%) vs 262 in the comparison group (16.9%) experienced an invasive breast cancer event (adjusted hazard ratio, 0.96; 95% confidence interval, 0.80-1.14; P = .63), and 155 intervention group women (10.1%) vs 160 comparison group women (10.3%) died (adjusted hazard ratio, 0.91; 95% confidence interval, 0.72-1.15; P = .43). No significant interactions were observed between diet group and baseline demographics, characteristics of the original tumor, baseline dietary pattern, or breast cancer treatment.

CONCLUSION

Among survivors of early stage breast cancer, adoption of a diet that was very high in vegetables, fruit, and fiber and low in fat did not reduce additional breast cancer events or mortality during a 7.3-year follow-up period.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00003787.

Material identification using real and simulated thermal cues

The objective of this study was to develop a thermal display for simulating the thermal cues associated with making contact with materials with different thermal properties. The thermal display was designed based on a semiinfinite body model. The performance of subjects using this display was compared to that with real materials in a material identification experiment. The results indicated that there was no significant difference in material identification when subjects were presented with real or simulated materials. The decreases in skin temperature were also comparable in the two experiments and were related to the contact coefficient of the material palpated, which is consistent with the semiinfinite body model. These findings suggest that thermal feedback in a haptic display can facilitate object recognition when visual cues are limited.

Community-Based Participatory Research and Gene-Environment Interaction Methodologies Addressing Environmental Justice among Migrant and Seasonal Farmworker Women and Children in Texas

The “From Mother to Child Project” is a molecular epidemiological study that employs a communitybased participatory research (CBPR) approach and gene-environment interaction research to address environmental justice in migrant and seasonal farmworker (MSF) women and children of Mexican origin home-based in Baytown and La Joya, Texas. This paper presents the background and rationale for the study and describes the study design and methodology. Preliminary data showed that MSF women and children in Texas have measurable levels of pesticides in their blood and urine, some of which were banned in the United States decades ago and are possible human carcinogens. Polymorphisms in genes involved in chemical detoxification and DNA repair have been associated with susceptibility to genetic damage and cancer development in populations exposed to environmental toxins. The “From Mother to Child Project” is testing three hypotheses: (1) MSF women and children who are occupationally exposed to pesticides are at higher risk for DNA damage than are non-exposed women and children. (2) Both, the extent of pesticide exposure and type of polymorphisms in chemical detoxification and DNA repair genes contribute to the extent of DNA damage observed in study participants. (3) The mutagenic potency levels measured in the organic compounds extracted from the urine and serum of study participants will correlate with the total concentrations of pesticides and with the measured DNA damage in study participants. The study will enroll 800 participants: 200 MSF mother-child pairs; 200 children (one per family) whose parents have never worked in agriculture, matched with the MSF children by ethnicity, age ± 2 years, gender, and city of residence; and these children’s mothers. Personal interviews with the mothers are used to gather data for both mothers and children on sociodemographic characteristics; pesticide exposure at work and home; medical and reproductive history; dietary assessment, and lifestyle factors. Blood and urine samples are collected from each participant and analyzed for (1) organochlorine and organophosphate pesticide levels, (2) genetic polymorphisms of chemical detoxification and DNA repair genes, (3) DNA damage (chromosomal aberrations), and (4) the mutagenic potential of pesticides in the serum and urine. Recruitment and data collection in Baytown is near completion, and over one third of the target population for the La Joya study site.

Cancer Screening Practices Among Chinese and Vietnamese in the Greater Houston Area

National data on Asian Americans indicate that compared to other groups in the US, cancer incidence and prevalence is relatively lower (Miller, Kolonel et al. 1996; American Cancer Society 2006). However, when the data is examined further based on specific Asian subgroups and for specific cancers, Asian Americans bear a disproportionate burden for cancers of infectious origin, such as cervical, liver, and stomach cancer (Chen 2005). Furthermore, Asian Americans are also experiencing increasing rates of cancers associated with “Westernization,” such as breast and prostate cancer (Kolonel, Yoshizawa et al. 1988; Whittemore, Kolonel et al. 1995; Ziegler, Hoover et al. 1996). Early detection and screening are among the frontline strategies in cancer control, yet Asian American and Pacific Islanders have the lowest cancer screening rates of all ethnic groups in the US (American Cancer Society 2006). The Asian American Health Needs Assessment (AsANA) project was designed to collect data on the rapidly growing Asian American community in the Greater Houston area. The AsANA project included a telephone survey to over 800 randomly selected households in the Chinese and Vietnamese communities, two of the largest Asian American subgroups in Texas. Included in the telephone interview were questions regarding cancer screening practices. This article describes the reported screening practices among the surveyed populations and discusses the implications for developing targeted programs that can address cancer screening disparities in this community.

Residential Perceptions of Environmental Exposures and Associated Health Effects in the Fresno, Texas Community

Background: Environmental contaminants are often located in areas heavily populated by African Americans, Hispanics/Latinos, and the poor. In many communities, the discovery of environmental hazards occurs following concern and investigation by its constituents. The residents of Fresno, Texas, which is a predominantly minority community located near Houston, Texas, have long-standing undocumented concerns related to potential environmental exposures and associated health effects. To begin to document the concerns of the members of the Fresno community, we used focus group methodology to examine the resident’s perceptions of the environment in the Fresno community, potential routes and sources of environmental exposures, and how Fresno residents perceived that these environmental hazards could affect their health. Methods: Focus group methodology was used to assess the Fresno communities’ perceptions of environmental exposure, perceived routes of exposure, and perceived adverse health affects. Nineteen Fresno residents took part in four focus group discussions that were recorded, transcribed, and analyzed using content analysis. Results: The residential participants overwhelmingly described poor water quality in the Fresno community. While some residents perceived that the air quality was good or clear, others described the air as poor or potentially dangerous. Some residents identified the local chemical companies, a landfill, chlorination, and a lack of public water supply as potential sources of contamination in the Fresno community. The residents perceived that environmental exposures could potentially affect their health status, in particular the drinking water. Conclusions: The findings of our study convey the concerns of the members of the Fresno community. Potential environmental exposures were identified along with sources of environmental hazards. Although there were differing perceptions of air quality, the perceptions of water quality and sources of contamination were consistent. These findings should be used in developing a larger-scale environmental health assessment in the Fresno community to examine self-reported health status and measure contaminant levels in the residential drinking water.

Community-Based Participatory Research and Gene-Environment Interaction Methodologies Addressing Environmental Justice among Migrant and Seasonal Farmworker Women and Children in Texas: "From Mother to Child Project"

The "From Mother to Child Project" is a molecular epidemiological study that employs a community- based participatory research (CBPR) approach and gene-environment interaction research to address environmental justice in migrant and seasonal farmworker (MSF) women and children of Mexican origin home-based in Baytown and La Joya, Texas. This paper presents the background and rationale for the study and describes the study design and methodology. Preliminary data showed that MSF women and children in Texas have measurable levels of pesticides in their blood and urine, some of which were banned in the United States decades ago and are possible human carcinogens. Polymorphisms in genes involved in chemical detoxification and DNA repair have been associated with susceptibility to genetic damage and cancer development in populations exposed to environmental toxins. The "From Mother to Child Project" is testing three hypotheses: (1) MSF women and children who are occupationally exposed to pesticides are at higher risk for DNA damage than are non-exposed women and children. (2) Both, the extent of pesticide exposure and type of polymorphisms in chemical detoxification and DNA repair genes contribute to the extent of DNA damage observed in study participants. (3) The mutagenic potency levels measured in the organic compounds extracted from the urine and serum of study participants will correlate with the total concentrations of pesticides and with the measured DNA damage in study participants. The study will enroll 800 participants: 200 MSF mother-child pairs; 200 children (one per family) whose parents have never worked in agriculture, matched with the MSF children by ethnicity, age ± 2 years, gender, and city of residence; and these children's mothers. Personal interviews with the mothers are used to gather data for both mothers and children on sociodemographic characteristics; pesticide exposure at work and home; medical and reproductive history; dietary assessment, and lifestyle factors. Blood and urine samples are collected from each participant and analyzed for (1) organochlorine and organophosphate pesticide levels, (2) genetic polymorphisms of chemical detoxification and DNA repair genes, (3) DNA damage (chromosomal aberrations), and (4) the mutagenic potential of pesticides in the serum and urine. Recruitment and data collection in Baytown is near completion, and over one third of the target population for the La Joya study site.

Working Toward Social Justice

Health disparities research encompasses a complex web of areas of cross-disciplinary expertise from fields such as health policy, public health, economics, sociology, psychology, anthropology, communications, genetics, biology, environmental science, ethics, and law. Dissemination of health disparities research is paramount to educating and training professionals, academics, community leaders, students and others about the subject area, and providing them with the necessary tools to affect change and eliminate health disparities. This paper chronicles the development of a unique health disparities and social justice research educational program held annually by The University of Texas M. D. Anderson Cancer Center, Center for Research on Minority Health. The program is composed of a college semester course and summer workshop, which in the past five years, has become a preeminent program in the United States. The program's impetus, premise, evaluation, and future directions are discussed.

Novel natural immunogenic peptides from Numb1 and Notch1 proteins for CD8+ cells in ovarian ascites

Notch is a plasma membrane receptor involved in the control of cell fate specification and in the maintenance of the balance between proliferation and differentiation in many cell lineages. Disruption of Notch has been implicated in a variety of hematological and solid cancers. Numb is also expressed in many adult mammalian cells. Adult cells divide symmetrically, and Numb is symmetrically partitioned at mitosis. The Numb-mediated regulation of Notch is believed to play a causative role in naturally occurring breast cancers. Reduction of Numb levels in breast tumors is regulated by proteasomal degradation. We reasoned that if the disregulated negative control of Notch by Numb protein is the consequence of Numb proteasomal degradation, then degradation of Numb can generate peptides which are transported, presented by MHC-I molecules. Surprisingly we found few candidate naturally processed peptides from Notch1, Notch2, and Numb1. CD8+ T cells expressing TCRs which specifically recognized peptides Notch1 (2112-2120) and Numb1 (87-95) were presented in the ascites of ovarian cancer patients. Many of these cells were differentiated and expressed high levels of Perforin. The natural immunogenicity of Notch1 and particularly of Numb1 suggests a mechanism of immunosurveillance which is overcome during tumor progression. Immunotherapy with tumor antigens from Notch and Numb should be important for treatment of cancer patients.

A stochastic method for generating signals with jointly specified probability mass, spectral, and correlation properties for the identification of physiological systems

An efficient stochastic interchange method was developed that allows two discrete time sequences to be created with a specified cross-correlation function and individually defined amplitude and spectral characteristics. The technique is particularly useful for creating sequences for the stimulation of multi-input physiological systems. It is very general in that sequences of any signal type can be manipulated and are not limited to being white and/or uncorrelated. By temporally separating occurrences of common frequencies, the method can even be used to create sequences that share common power, but can be treated as uncorrelated. The method is made practical by an algorithm that updates efficiently the auto- and cross-correlation functions of the sequences as they are being created.

Ocular toxoplasmosis: in the storm of the eye

Ocular toxoplasmosis (OT) can occur in the children of mothers infected with Toxoplasma gondii during pregnancy. It is not limited to the congenitally infected, but can also occur following adult-acquired infection or as a result of disease reactivation in immune-compromised and pregnant individuals. Many aspects of immune privilege in the eye, including constitutive TGF-beta expression and reduced MHC class 1 expression, would appear at first to favour parasite survival. Conversely, many of the mechanisms that control parasite multiplication in other anatomical sites, such as nitric oxide expression, IFN-gamma and TNF-alpha, are known to disrupt immune privilege and are associated with ocular damage. Taking into account the opposing needs of limiting parasite multiplication and minimizing tissue destruction we review the pathogenesis of OT in the murine model.

Pre-irradiation and post-irradiation fading of the Harshaw 8841 TLD in different environmental conditions

The pre-irradiation and post-irradiation fading of a commercially available LiF:Mg,Cu,P thermoluminescent detector (TLD)-the Harshaw 8841 TLD-have been assessed. The Harshaw 8841 TLD comprises three TLD-700H chips (99.7% 7LiF and 0.03% 6LiF by weight) and one TLD-600H chip (4.4% 7LiF and 95.6% 6LiF by weight). Pre-irradiation and post-irradiation fading were measured for storage times up to 164 d and three different storage temperatures (-8, 25 and 50 degrees C). Dosemeters were irradiated in a mixed photon-neutron field so that the fading behaviour of the photon and neutron signals could be studied. The TLD-700H and TLD-600H chips exhibited complex changes in sensitivity and signal that depended on storage time, storage temperature and the type of radiation to which the chips had been exposed. However, the magnitudes of these changes in sensitivity and signal were relatively small. TLD-600H and TLD-700H, therefore, exhibit good stability of sensitivity and signal.

When do auditory/visual differences in duration judgements occur?

Four experiments examined judgements of the duration of auditory and visual stimuli. Two used a bisection method, and two used verbal estimation. Auditory/visual differences were found when durations of auditory and visual stimuli were explicitly compared and when durations from both modalities were mixed in partition bisection. Differences in verbal estimation were also found both when people received a single modality and when they received both. In all cases, the auditory stimuli appeared longer than the visual stimuli, and the effect was greater at longer stimulus durations, consistent with a "pacemaker speed" interpretation of the effect. Results suggested that Penney, Gibbon, and Meck's (2000) "memory mixing" account of auditory/visual differences in duration judgements, while correct in some circumstances, was incomplete, and that in some cases people were basing their judgements on some preexisting temporal standard.

Between and within: international perspectives on cancer and health disparities

The purpose of this article is to compare reasons for cancer health disparities in developing and developed countries. By 2010, approximately 60% of new cancer cases will occur in the developing world, higher than rates developed countries. However, disparities exist not only between countries but also within countries. Cancer epidemiology in developing countries is paradoxical: Increased incidence is partially due to increased development resulting in longer life expectancy and unhealthy lifestyle behaviors. Reduced mortality from infectious diseases results in relatively greater mortality from chronic diseases. However, infectious diseases are also risk factors for the leading causes of cancer mortality in these countries. While health disparities in developing versus developed countries are quantitatively worlds apart, they are qualitatively rather similar. They share common causes, such as environmental pollution, the need for social justice, large gaps between the rich and the poor, lack of access to cancer resources, and health services that are available to some but not to all. While industrialization and urbanization elevate a country's economic base while contributing to cancer incidence and mortality. Strategies to reduce international cancer disparities include country- and regional-level interventions, utilizing nongovernmental organizations, and developing long-term inter-institutional partnerships. Although economic aid is undoubtedly necessary, it is not sufficient to control cancer in the developing world. To address these problems, it will be necessary to focus attention on what can be done locally-within countries, not only between countries.

Initial Assessment of a Forgotten Minority Community

Background. Environmental hazards are increasingly being detected in minority and low-income communities. The Fresno, Texas community is located near Houston, Texas, and many of its residents are ethnic minorities and of low socioeconomic status. While Fresno residents have voiced concerns about long-standing undocumented environmental hazards, the extent to which the concerns were accurate was unclear. As an initial assessment of environmental exposure hazards, key informant interviews of residents and officials were conducted to examine the perceptions of environmental exposures and associated health effects in the Fresno community. Results. The responses about perceived environmental exposures and the extent of access to primary healthcare were similar between residents and officials. The key informants identified inadequate public water supply and possible groundwater contamination as sources of potential environmental exposures and agreed that access to primary healthcare was a major problem in the Fresno area. However, Fresno residents and officials had contrasting perceptions about the overall health of the community, the existence of community-based organizations, strengths and barriers of the community, and how well environmental concerns were addressed. Methods. Qualitative methodology was used to conduct key informant interviews of seven residents and five elected or assigned officials who serve residents of Fresno. An interview guide designed to obtain information on potential environmental hazards and associated health effects was utilized to collect qualitative data that were then utilized to identify recurrent themes and dissimilarities of responses. Conclusions. The responses obtained in this study suggest that potential environmental exposures may be present in this community. However, although residents and officials identified access to primary healthcare as a barrier to residing in Fresno, residents and officials had differing perceptions of the overall heath status of the Fresno community. These findings must be further investigated to develop additional qualitative and quantitative studies that will validate the preliminary findings of this study and begin to accurately measure contaminant levels and health status in Fresno residents.

Houston AANCART best practices: from vision to synergy to reality

The theme for the 2004 AANCART Academy, "Community Partnerships for Cancer Control: From Vision to Synergy to Reality", characterizes Best Practices for the Houston AANCART site. Researchers and community members share a common vision for addressing the cancer and health disparities that exist in our Asian community. They banded together synergistically to bring to reality the programs and projects that are enabling more Asian Americans to understand their risks for cancer, receive screening and education, and access treatment and survivorship support. Along the way, Houston AANCART was also able to conduct meaningful and relevant community-based participatory research and to train young Asian and other investigators in how to reach out to this community in a culturally sensitive and appropriate manner.

Assessing breast cancer knowledge, beliefs, and misconceptions among Latinas in Houston, Texas

BACKGROUND

Limited breast cancer knowledge and beliefs, risk factors, screening procedures, and cultural barriers may keep Latinas from seeking health care.

METHOD

We examined the breast cancer knowledge, beliefs, and misconceptions of 63 Latinas residing in Houston, Texas.

RESULTS

More than a third of participants held a negative or fatalistic view of breast cancer, 29% believed pain was a warning sign for the disease, and 11.1% had never heard of breast cancer.

CONCLUSIONS

Our findings indicate this population holds many misconceptions about breast cancer, which may have a negative impact on preventive behaviors on this minority population.

Detection of chromosomal aberrations by fluorescence in situ hybridization in cervicovaginal biopsies from women exposed to diethylstilbestrol in utero

Epidemiologic studies have associated estrogens with human neoplasms such as those in the endometrium, cervix, vagina, breast, and liver. Perinatal exposure to natural (17beta-estradiol [17beta-E(2)]) and synthetic (diethylstilbestrol [DES]) estrogens induces neoplastic changes in humans and rodents. Previous studies demonstrated that neonatal 17beta-E(2) treatment of mice results in increased nuclear DNA content of cervicovaginal epithelium that precedes histologically evident neoplasia. In order to determine whether this effect was associated with chromosomal changes in humans, the frequencies of trisomy of chromosomes 1, 7, 11, and 17 were evaluated by the fluorescence in situ hybridization (FISH) technique in cervicovaginal tissue from 19 DES-exposed and 19 control women. The trisomic frequencies were significantly elevated in 4 of the 19 (21%) DES-exposed patients. One patient presented with trisomy of chromosomes 1, 7, and 11, while trisomy of chromosome 7 was observed in one patient. There were two patients with trisomy of chromosome 1. Trisomy of chromosomes 1, 7, 11, and 17 was not observed in the cervicovaginal tissue taken from control patients. These data suggest that DES-induced chromosomal trisomy may be an early event in the development of cervicovaginal neoplasia in humans.

An Initial Assessment of a Forgotten Minority Community: Key Informant's Perceptions of Environmental Health in Fresno, Texas

BACKGROUND

Environmental hazards are increasingly being detected in minority and low-income communities. The Fresno, Texas community is located near Houston, Texas, and many of its residents are ethnic minorities and of low socioeconomic status. While Fresno residents have voiced concerns about long-standing undocumented environmental hazards, the extent to which the concerns were accurate was unclear. As an initial assessment of environmental exposure hazards, key informant interviews of residents and officials were conducted to examine the perceptions of environmental exposures and associated health effects in the Fresno community.

RESULTS

The responses about perceived environmental exposures and the extent of access to primary healthcare were similar between residents and officials. The key informants identified inadequate public water supply and possible groundwater contamination as sources of potential environmental exposures and agreed that access to primary healthcare was a major problem in the Fresno area. However, Fresno residents and officials had contrasting perceptions about the overall health of the community, the existence of community-based organizations, strengths and barriers of the community, and how well environmental concerns were addressed.

METHODS

Qualitative methodology was used to conduct key informant interviews of seven residents and five elected or assigned officials who serve residents of Fresno. An interview guide designed to obtain information on potential environmental hazards and associated health effects was utilized to collect qualitative data that were then utilized to identify recurrent themes and dissimilarities of responses.

CONCLUSIONS

The responses obtained in this study suggest that potential environmental exposures may be present in this community. However, although residents and officials identified access to primary healthcare as a barrier to residing in Fresno, residents and officials had differing perceptions of the overall heath status of the Fresno community. These findings must be further investigated to develop additional qualitative and quantitative studies that will validate the preliminary findings of this study and begin to accurately measure contaminant levels and health status in Fresno residents.

Cervical cancer among Vietnamese women: Efforts to define the problem among Houston's population

INTRODUCTION

Asian American/Pacific Islanders (AAPIs) in the United States (US) continue to bear a disproportionate burden of cancer. This report focuses on the interviews with local health-care delivery providers, directors, administrators, and community outreach liaisons in the Vietnamese community in Houston, Texas.

METHODS

The Center for Minority Health (CMRH) at the University of Texas M.D. Cancer Center interviewed 17 leaders, as defined above, to identify factors that have a negative impact on screening practices among Vietnamese women.

RESULTS

The results show that some of the barriers to cervical cancer screening include: lack of knowledge, lack of female physicians, language barriers, lack of insurance, and embarrassment. Interviews established that "prevention" is a Western concept that the Vietnamese community has not yet adopted. Vietnamese women used their churches, community physicians (licensed or not), circle of friends, and families for their health information. Many patients used herbs as alternative or complementary therapies.

CONCLUSION

Cultural factors play a vital role in limiting Vietnamese women in the use of cervical screening. Further research needs to focus on identifying specific barriers and how they can be overcome.

Genome wide significant linkage in schizophrenia conditioning on occurrence of depressive episodes

BACKGROUND

Schizophrenia shows substantial clinical heterogeneity. One common important clinical variable in presentation is the occurrence of episodes of major depression.

METHODS

We undertook analyses in an attempt to detect loci that influence susceptibility to, or modify the clinical expression of, schizophrenia according to the occurrence of episodes of major depression. We used a logistic regression framework in which lifetime presence/absence of major depression was entered as a covariate in the linkage analysis of our UK schizophrenia affected sibling pair series (168 affected sibling pairs typed for a 10 cM map of microsatellite markers).

RESULTS

Inclusion of presence/absence of depression as a covariate detected a genome wide significant linkage signal on chromosome 4q28.3 at 130.7 cM (LOD = 4.59; p = 0.038; increase in maximum LOD over univariate analysis (ILOD) = 3.62). Inclusion of the depression covariate also showed suggestive evidence of linkage on 20q11.21 (LOD = 4.10; expected to occur by chance 0.093 times per genome scan, ILOD = 2.83).

CONCLUSIONS

Our findings identify loci that may harbour genes that play a role in susceptibility to, or modify the risk of, episodes of major depression in people with schizophrenia.

Association of p53 mutations and a codon 72 single nucleotide polymorphism with lower overall survival and responsiveness to adjuvant radiotherapy in endometrioid endometrial carcinomas

p53 Genetic alterations are associated with advanced stage and aggressive tumors in a variety of human malignancies. The aim of this study was to examine p53 for genetic alterations and to evaluate the association of these alterations with clinical outcome and response to adjuvant radiotherapy in endometrioid endometrial carcinomas. p53 mutations in exons 2-11 were assessed in 59 endometrioid carcinomas by polymerase chain reaction-single-strand conformational polymorphism and sequence analysis. Twelve mutations (20.3%) and nine polymorphisms were identified. Seven of the nine polymorphisms were codon 72 single nucleotide polymorphisms (SNP) with an Arg/Pro allelotype. Women harboring either a mutation or an Arg/Pro allelotype at codon 72 had a lower overall survival rate than women whose tumors lacked alterations in the p53 gene (P= 0.0029). Women were stratified based on p53 genetic alterations (p53 mutation or p53 codon 72 SNP) and whether or not they received adjuvant radiation therapy. Women with p53 genetic alterations who did not receive adjuvant radiotherapy had the lowest survival rate (P= 0.0005). Treated women with p53 genetic alterations and untreated women with no p53 alteration had similar rates of survival. Among women with p53 alterations, adjuvant radiotherapy substantially increased survival (P= 0.035). In multivariate analyses, the group of women with p53 genetic alterations who did not receive adjuvant radiation therapy had a 5.9-fold increased risk of death (95% confidence interval: 1.5-22.7) compared to women whose tumors lacked p53 alterations and did not receive adjuvant radiation therapy.

Long-term effects of neonatal exposure to hydroxylated polychlorinated biphenyls in the BALB/cCrgl mouse

The neonatal mouse model has been a valuable tool in determining the long-term effects of early exposure to estrogenic agents in mammals. Using this model, we compared the effects of 2',4',6'-trichloro-4-biphenylol (OH-PCB-30) and 2',3',4',5'-tetrachloro-4-biphenylol (OH-PCB-61) as prototype estrogenic hydroxylated PCBs (OH-PCBs) because they are reported to exhibit relatively high estrogenic activity both in vivo and in vitro. The purpose of this study was to examine the relationship between estrogenicity and carcinogenicity of OH-PCB congeners. The OH-PCBs were tested individually and in combination to determine whether effects of combined OH-PCBs differed from those of these OH-PCBs alone. We evaluated the long-term effects of neonatal exposure to OH-PCBs with treatment doses that were based on the reported binding affinity of specific OH-PCB congeners to estrogen receptor alpha. BALB/cCrgl female mice were treated within 16 hr after birth by subcutaneous injections every 24 hr, for 5 days. The mice treated with OH-PCB-30 (200 microg/day) or 17beta-estradiol (5 microg/day) showed similar increased incidences of cervicovaginal (CV) tract carcinomas (43% and 47%, respectively). In addition, when mice were treated with OH-PCBs as a mixture, a change in the type of CV tract tumor was observed, shifting from predominantly squamous cell carcinomas to adenosquamous cell carcinoma. From our results, we conclude that the individual OH-PCBs tested were estrogenic and tumorigenic in mice when exposed during development of the reproductive tract. These data support the hypothesis that mixtures may act differently and unexpectedly than do individual compounds.

Therapeutic potential of dendritic-based vaccines

Involving a delicate balance of cell types, the interaction between the immune system and disease or abnormality in the human body is complex. Moreover, the mere presence of antigen and immune cells is necessary, yet insufficient to elicit immune reactivity. In order to elicit an immune response, an antigen in some form must be processed and presented to the immune system. Arguably, the most efficient antigen-presenting cell, the dendritic cell (DC), is the centre of intense investigation. The elicitation or cessation of an immune response is not a simple matter. The body must be able either to up-regulate (e.g., in the case of infectious disease) or down-regulate (e.g., in the case of transplantation) immunity to antigens located anywhere in the body. This sentinel role is capably filled via the distribution of Langerhans cells in the epidermis of the skin, and the migration of DCs throughout the lymphatic and circulatory systems. DCs are potent, as well as efficient: small numbers of cells and low levels of antigen still induce clinically relevant immunity. Lastly, they are capable of tolerance induction to self components by helping to delete self-reactive thymocytes and generating anergy in committed T-cells. Since DCs both initiate and modulate immunity, they are a component of a vast array of vaccines. This review highlights some of the intriguing basic research involving the development of DC-based therapeutics. Furthermore, whenever an area of study has progressed to human treatment, recent and on-going clinical trials are discussed.

On the Importance of Using Multiple Methods of Dietary Assessment

BACKGROUND

Plasma carotenoid concentrations reflect intake of vegetables and fruits, the major food sources of these compounds. This study compared the ability of 2 measures of dietary intake (24-hour diet recalls and food frequency questionnaires [FFQs]) to corroborate plasma carotenoid concentrations in a subset of women participating in a diet intervention trial.

METHODS

Plasma carotenoid concentrations and dietary intakes, estimated from 24-hour diet recalls and FFQs, were examined at baseline and 1 year later in a subset of 395 study participants (197 intervention and 198 comparison group). We used longitudinal models to examine associations between estimated intakes and plasma carotenoid concentrations. These analyses were stratified by study group and adjusted for body mass index (BMI), plasma cholesterol concentration, and total energy intake. We conducted simulations to compare mean-squared errors of prediction of each assessment method.

RESULTS

In mixed-effects models, the estimated carotenoid intakes from both dietary assessment methods were strongly associated with plasma concentrations of alpha-carotene, beta-carotene, and lutein. Furthermore, modeling the 2 sources of intake information as joint predictors reduced the prediction error.

CONCLUSION

These findings underscore the importance of using multiple measures of dietary assessment in studies examining diet-disease associations.

Effects of a high-fiber, low-fat diet intervention on serum concentrations of reproductive steroid hormones in women with a history of breast cancer

PURPOSE

Diet intervention trials are testing whether postdiagnosis dietary modification can influence breast cancer recurrence and survival. One possible mechanism is an effect on reproductive steroid hormones.

PARTICIPANTS AND METHODS

Serum reproductive steroid hormones were measured at enrollment and 1 year in 291 women with a history of breast cancer who were enrolled onto a randomized, controlled diet intervention trial. Dietary goals for the intervention group were increased fiber, vegetable, and fruit intakes and reduced fat intake. Estradiol, bioavailable estradiol, estrone, estrone sulfate, androstenedione, testosterone, dehydroepiandrosterone sulfate, follicle-stimulating hormone, and sex hormone-binding globulin were measured.

RESULTS

The intervention (but not the comparison) group reported a significantly lower intake of energy from fat (21% v 28%), and higher intake of fiber (29 g/d v 22 g/d), at 1-year follow-up (P <.001). Significant weight loss did not occur in either group. A significant difference in the change in bioavailable estradiol concentration from baseline to 1 year in the intervention (-13 pmol/L) versus the comparison (+3 pmol/L) group was observed (P <.05). Change in fiber (but not fat) intake was significantly and independently related to change in serum bioavailable estradiol (P <.01) and total estradiol (P <.05) concentrations.

CONCLUSION

Results from this study indicate that a high-fiber, low-fat diet intervention is associated with reduced serum bioavailable estradiol concentration in women diagnosed with breast cancer, the majority of whom did not exhibit weight loss. Increased fiber intake was independently related to the reduction in serum estradiol concentration.

Changes in pinch force with bidirectional load forces

The forces used to grasp an object were measured while positive (push) and negative (pull) load forces were applied to the hand under varying frictional conditions. Subjects held between the tips of their thumb and index finger a manipulandum composed of two symmetrically mounted disks. The manipulandum was connected to the stage of an electromagnetic linear motor that generated load forces under computer control. In the first experiment, subjects held the position of the manipulandum constant while the motor generated forces in first the positive and then the negative direction. The motor force at which the manipulandum slipped from the fingers was measured in the second experiment. In both experiments, friction was varied by changing the surface (sandpaper, suede, or plastic) of the manipulandum disks. The pinch forces produced by subjects were linearly related to changes in motor force in both the positive and negative directions, with the slope of this relation varying as a function of the surface properties of the manipulandum. The modulation of pinch force with motor force was influenced, however, by the direction of the load force; higher forces were produced in response to negative load forces. Slip forces varied as a function of pinch force and surface texture; higher forces were associated with materials with lower coefficients of friction. These findings suggest that the friction between the skin and an object being grasped changes as a function of the direction of force that the object applies to the skin, possibly due to the anisotropic nature of glabrous skin, and that this mechanical property contributes to variations in pinch force.

Self-reported schizotypy and bipolar disorder: demonstration of a lack of specificity of the Kings Schizotypy Questionnaire

Previous studies have demonstrated that schizophrenia patients score highly on self-reported measures of schizotypy such as the Kings Schizotypy Questionnaire (KSQ), but relatively little is known about the specificity of these self-reported features to schizophrenia. We aimed to explore the specificity of schizotypal features to schizophrenia by measuring their prevalence in subjects with bipolar disorder. The Kings Schizotypy Questionnaire (KSQ) was administered to participants (n=92) in a sibling-pair genetic linkage study of bipolar disorder. Scores were compared with those of participants in a similarly designed, concurrent family study of schizophrenia (n=135) and psychiatrically well controls (n=263). The bipolar group had significantly more schizotypal features than controls but significantly less than schizophrenia patients. Whether a bipolar subject had experienced positive psychosis had no effect on his/her schizotypy score. We conclude that elevated self-reported schizotypy as measured by the KSQ is not specific to schizophrenia, and may be associated with functional psychosis in general.

A systematic genomewide linkage study in 353 sib pairs with schizophrenia

We undertook a genomewide linkage study in a total of 353 affected sib pairs (ASPs) with schizophrenia. Our sample consisted of 179 ASPs from the United Kingdom, 134 from Sweden, and 40 from the United States. We typed 372 microsatellite markers at approximately 10-cM intervals. Our strongest finding was a LOD score of 3.87 on chromosome 10q25.3-q26.3, with positive results being contributed by all three samples and a LOD-1 interval of 15 cM. This finding achieved genomewide significance (P<.05), on the basis of simulation studies. We also found two regions, 17p11.2-q25.1 (maximum LOD score [MLS] = 3.35) and 22q11 (MLS = 2.29), in which the evidence for linkage was highly suggestive. Linkage to all of these regions has been supported by other studies. Moreover, we found strong evidence for linkage (genomewide P<.02) to 17p11.2-q25.1 in a single pedigree with schizophrenia. In our view, the evidence is now sufficiently compelling to undertake detailed mapping studies of these three regions.

Overview of the summit meeting evaluating research in African-American women

There is a disparity in the breast cancer survival rate among African-American women compared with the rate among white women. The summit meeting addressed the breast cancer crisis among African-American women by bringing together scientists, breast cancer advocates, and policy makers. The goal of the meeting was to develop a research agenda. For breast cancer research to advance, priority areas must be identified. The current article suggests questions and issues which are addressed in this cancer monograph.

Impact of breast cancer on African American women: priority areas for research in the next decade

Despite all the gains that have been made in the area of breast cancer research, African American women suffer disproportionately from the effects of the disease. Breast cancer is the second leading cause of cancer death among African American women, exceeded only by lung cancer. Improvements in cancer incidence, mortality, and survival rates among populations are undoubtedly the outcome of quality research. Therefore, there is a need to identify and discuss issues regarding breast cancer among African American women and to determine whether these issues should be a part of the nation's breast cancer research agenda. This commentary summarizes the results of the Summit Meeting Evaluating Research on Breast Cancer in African American Women, which was held September 8-11, 2000, in Washington, DC. Listed are priority areas and some of the questions that fueled this 2-day discussion among 130 participants, including health advocates, cancer survivors, and experts representing various areas of cancer research.

Correlation of p53 mutations with resistance to platinum-based chemotherapy and shortened survival in ovarian cancer

PURPOSE

The p53 tumor suppressor gene plays a central role in cell cycle regulation and induction of apoptosis. We analyzed p53 alterations and their impact on response to chemotherapy and clinical outcome in ovarian cancer patients.

EXPERIMENTAL DESIGN

One hundred seventy-eight ovarian carcinomas, snap frozen and stored at -80 degrees C, were analyzed for mutations of the p53 gene (exons 2-11) by single-strand conformation polymorphism and DNA sequencing and for p53 overexpression by immunohistochemistry (monoclonal antibody DO7).

RESULTS

p53 mutations were found in 56% (99 of 178) of the tumors, and 62% of these were located in evolutionary highly conserved domains of the gene. Time to progression and overall survival were significantly shortened in patients with p53 mutations compared with wild-type p53 (P = 0.029 and P = 0.014) and patients with mutations in highly conserved domains as opposed to nonconserved domains or wild-type p53 (P = 0.010 and P = 0.007). p53 protein overexpression (>10% positively stained nuclei) was found in 62% (110 of 178). Time to progression and overall survival were shorter in cases with p53 overexpression (cutpoint, 10%: P = 0.071 and P = 0.056) but only marginally significant. Resistance to adjuvant cisplatin or carboplatin chemotherapy was significantly more frequent in patients with p53 overexpression (P = 0.001) or p53 missense mutations (P = 0.008) than patients with normal p53.

CONCLUSIONS

p53 alterations correlate significantly with resistance to platinum-based chemotherapy, early relapse, and shortened overall survival in ovarian cancer patients in univariate analysis. In multivariable analysis though, p53 was not an independent prognostic factor.

Aggressive behaviour in patients with schizophrenia is associated with catechol-O-methyltransferase genotype

BACKGROUND

Evidence exists for an association between aggression and schizophrenia. Although the aetiology of aggression is multifactorial, three studies have reported associations between polymorphisms of the catechol-O-methyltransferase (COMT) gene and aggression in schizophrenia.

AIMS

To replicate these findings in a larger sample using the Overt Aggression Scale (OAS).

METHOD

A sample of 180 people with DSM-IV schizophrenia were rated for aggression using the OAS. Kruskal-Wallis and contingency table analyses were applied to the OAS results.

RESULTS

The high-activity homozygotes showed significantly higher scores of aggression, whereas the heterozygotes showed significantly lower scores. The odds ratio for aggression for the high-activity homozygotes was 2.07 (95% Cl=1.03-4.15), whereas that for the heterozygotes was 0.54 (95% Cl=0.30-1.00). CONCLUSIONS; The high-activity COMT homozygote confers a higher risk of recorded aggression in schizophrenia. Heterozygotes had a significantly lower risk, which may represent an example of heterosis/heterozygote advantage.

The contact lens and myopia progression (CLAMP) study: design and baseline data

BACKGROUND

Although previous contact lens myopia control studies indicate that rigid contact lenses slow the progression of myopia in children, they have all suffered from limitations that challenge the significance of their results. The Contact Lens and Myopia Progression (CLAMP) Study addresses the limitations of previous studies and attempts to correct them by implementing alternative Study designs. The CLAMP study also measures all the ocular components to examine the potential mechanism of treatment effect.

METHODS

Eligible children were fitted with rigid gas-permeable contact lenses and enrolled in a run-in period to determine whether they were able to adapt to rigid contact lens wear. Subjects who successfully completed the run-in period were randomly assigned to wear rigid contact lenses or soft contact lenses for the remainder of the 3-year study. The primary outcome measure will be the 3-year change in cycloplegic autorefraction; the secondary outcome measures will include the 3-year change in axial length, peripheral autorefraction, crystalline lens curvatures, corneal curvature and thickness, accommodation, and intraocular pressure, which are being measured annually.

RESULTS

We examined 148 eligible subjects who participated in the run-in period. Of the 148 eligible subjects, 116 (78.4%) were able to adapt to rigid contact lens wear and were enrolled in the CLAMP Study. The mean age of the participants at the baseline visit was 10.5 years, and 59.5% were girls. At the randomization visit, the mean (+/-SD) spherical equivalent refractive error in the right eye was -2.09 +/- 0.89 D, the mean central curvature of the right cornea by videokeratography was 44.5 +/- 1.3 D, and the mean axial length of the right eye was 24.13 +/- 0.71 mm.

CONCLUSIONS

Four of five children aged 8- to 11-years-old were able to adapt to rigid gas-permeable contact lens wear. The CLAMP Study aims to further clarify the effect of rigid gas-permeable contact lenses on myopia progression in children.

Comparison of animal models for the evaluation of radiolabeled androgens

Biodistribution of two 18F-labeled androgens and an 124I/125I-labeled androgen were studied in five androgen receptor (prostate) animal models with or lacking sex hormone binding globulin (SHBG). As models for androgen-receptor positive ovarian cancer, xenografts of three human ovarian cancer cell lines were tested in SCID mice. SHBG in the prostate model systems significantly affects the metabolism, clearance, and distribution of the radiolabeled androgens in several tissues, but ovarian cancer animal models were disappointing.

A genomewide linkage study of age at onset in schizophrenia

There is strong evidence for a genetic contribution to age at onset of schizophrenia, which probably involves both susceptibility loci for schizophrenia and modifying loci acting independent of disease risk. We sought evidence of linkage to loci that influence age at onset of schizophrenia in a sample of 94 affected sibling pairs with DSM-IV schizophrenia or schizoaffective disorder, and age at first psychiatric contact of 45 years or less. Individuals were genotyped for 229 microsatellite markers spaced at approximately 20 cM intervals throughout the genome. Loci contributing to age at onset were sought by a quantitative maximum-likelihood multipoint linkage analysis using MAPMAKER/SIBS. A nonparametric multipoint analysis was also performed. The genomewide significance of linkage results was assessed by simulation studies. There were six maximum-likelihood LOD score peaks of 1.5 or greater, the highest being on chromosome 17q (LOD = 2.54; genomewide P = 0.27). This fulfils Lander and Kruglyak's [1995: Nat Genet 11:241-247] criteria for suggestive linkage in that it would be expected to occur once or less (0.3 times) per genome scan. However, this finding should be treated with caution because the LOD score appeared to be almost solely accounted for by the pattern of ibd sharing at one marker (D17S787), with virtually no evidence of linkage over flanking markers. None of the linkage results achieved genomewide statistical significance, but the LOD score peak on chromosome 13q (LOD = 1.68) coincided with the region showing maximum evidence for linkage in the study by Blouin et al. [1998: Nat Genet 20:70-73] of categorical schizophrenia.

Effect of administration route on FES uptake into MCF-7 tumors

We have observed that intraperitoneal administration of [(18)F]fluoroestradiol (FES), a radiolabeled estrogen receptor ligand, results in higher abdominal organ uptake and slower blood clearance than intravenous administration in female mice. In SCID mice bearing MCF-7 human tumors SC, IP administration resulted in tumor uptake that was only about one third that obtained with IV administration. Thus, the route of administration of a radiopharmaceutical for imaging or radiotherapy of a tumor in the abdomen, an ovarian tumor, for example, could have a profound effect on the efficiency and selectivity of delivery of the agent to the tumor.

Sustained and selective attention as measures of genetic liability to schizophrenia

We tested for a relationship between attention and genetic liability to schizophrenia. Samples of probands with DSM-IV schizophrenia (n=20), their well first-degree relatives (n=40) and healthy controls (n=82) were tested using measures of sustained attention (degraded-stimulus continuous performance test: DS-CPT) and selective attention (spatial negative priming task). Assuming a liability-threshold model, we predicted that probands would display greater attentional decrements than controls and that the relatives would show intermediate levels of decrement. We did not observe the predicted pattern of effect using either measure, although the probands showed a trend towards less negative priming. However, our results may have been affected by self-selection bias in probands and relatives and clinical heterogeneity among probands, which could have reduced our power to detect effects.