Working with community partners to implement and evaluate the Chicago Park District's 100% Healthier Snack Vending Initiative

BACKGROUND

The objective of this case study was to evaluate the acceptability, sales impact, and implementation barriers for the Chicago Park District's 100% Healthier Snack Vending Initiative to strengthen and support future healthful vending efforts.

COMMUNITY CONTEXT

The Chicago Park District is the largest municipal park system in the United States, serving almost 200,000 children annually through after-school and summer programs. Chicago is one of the first US cities to improve park food environments through more healthful snack vending.

METHODS

A community-based participatory evaluation engaged community and academic partners, who shared in all aspects of the research. From spring 2011 to fall 2012, we collected data through observation, surveys, and interviews on staff and patron acceptance of snack vending items, purchasing behaviors, and machine operations at a sample of 10 Chicago parks. A new snack vending contract included nutrition standards for serving sizes, calories, sugar, fat, and sodium for all items. Fifteen months of snack vending sales data were collected from all 98 snack vending machines in park field houses.

OUTCOMES

Staff (100%) and patrons (88%) reacted positively to the initiative. Average monthly per-machine sales increased during 15 months ($84 to $371). Vendor compliance issues included stocking noncompliant items and delayed restocking.

INTERPRETATION

The initiative resulted in improved park food environments. Diverse partner engagement, participatory evaluation, and early attention to compliance can be important supports for healthful vending initiatives. Consumer acceptance and increasing revenues can help to counter fears of revenue loss that can pose barriers to adoption.

Hispanic Caregiver Perceptions of Water Intake Recommendations for Young Children and Their Current Beverage Feeding Practices

Hispanic children in the United States are at high risk of obesity. Sugar-sweetened beverage consumption (SSB) is a modifiable contributor to obesity. Hispanic children are more likely to drink SSB than non-Hispanic white children. The main goal of the study was to explore caregiver beverage feeding behaviors and evaluate reactions to water intake recommendations for children birth to five years old in a diverse U.S. Hispanic urban community. Findings will be used to develop community- and population-specific intervention messaging for obesity prevention for this population. The study used a qualitative focus group design using constant comparison coding methods. Participants included 35 Hispanic caregivers of children aged 0–5 years living in a low-income, predominantly Hispanic community in Chicago, Illinois. We found young children in this community drink a variety of SSBs and caregivers choose beverages based on cost, availability, health, and behavioral concerns. Participants report altering beverages for a variety of reasons, family member disagreement regarding beverage feeding practices, and older family members’ influence on children’s preferences. Puerto Rican and Mexican American participants differed in the range of beverages provided, concerns regarding water intake, and beverage alteration and feeding practices. Caregivers universally believe the recommended water intake amount of four six-ounce servings daily for children is too high. Findings will inform message development to reduce SSB intake and increase water consumption among young children in this community. Messaging should be ethnic group specific, target all family members, build on current beverage alteration practices, and include nutrition information specific to young children.

Second primary cancers occurring after I-125 brachytherapy as monotherapy for early prostate cancer

AIMS

Prostate brachytherapy may be associated with a lower risk of radiation-induced second primary cancer (SPC) as a significantly smaller volume of normal tissue is irradiated when compared with external beam techniques. Limited data are available as it has been a routine treatment option for less than 20 years. This study identified cases of SPC in patients who underwent I-125 prostate brachytherapy as monotherapy in a single institution.

MATERIALS AND METHODS

SPC incidence was retrieved by conducting a UK cancer registry search (Northern and Yorkshire Cancer Registry and Information Service) for 1805 consecutive patients with localised prostate cancer who received monotherapy with I-125 brachytherapy from 1995 to 2006 at a single public hospital. Of 1730 UK residents, the completeness of the registry match was 91% (1574 patients). The mean age at treatment (interquartile range) of the cohort was 63 (58-68) years with 1100 patients (70%) over the age of 60 years at treatment. The median (range) follow-up was 8 (6-10) years with 487 patients (31%) having 10 years or more.

RESULTS

In total, 170 patients (10.8%) were diagnosed with second primaries (1 year or more after implant); 20 of these were bladder and 10 rectal cancers. The 10 year cumulative incidences were 14.6, 1 and 0.84% for any second malignancy, bladder and rectal cancer, respectively. Only the standardised incidence rate (SIR) for bladder cancer was higher at 1.54 (95% confidence interval 0.96-2.46) compared with the general population. The SIR for bladder cancer was higher in the first few years after treatment, suggesting that the increased incidence of bladder cancer is due to increased urological surveillance.

CONCLUSIONS

Overall, the incidence of SPC after I-125 is comparable with other published data with no significant excess more than 5 years from treatment. Mortality secondary to SPC of the bladder or rectum is unusual.

"I know what CBPR is, now what do i do?": Community perspectives on CBPR capacity building

BACKGROUND

Community-based participatory research (CBPR) offers a promising approach for combating health disparities. CBPR capacity must be developed among academics and communities. Most published CBPR capacity development work focuses on general guidance or individual partnership development.

OBJECTIVES

Herein we have reported community perspectives on community capacity-building efforts involving multiple community partners, including capacity-building outcomes and identification of facilitators and challenges.

METHODS

We have presented a case study using qualitative and quantitative data from community-based organization (CBO) members of a committee guiding a university-based CBPR initiative. A survey measuring 11 CBPR capacity domains was fielded at two points. Three rounds of interviews were conducted.

RESULTS

Community CBPR capacity increased over time, although there remains room for improvement. Leader commitment, CBPR resources, and hands-on CBPR experiences were identified as key facilitators. Resource limitations, difficulty integrating CBPR into organizational operations, lack of specific information, and institutional inequities were identified as challenges. Recommendations offered include continued and expanded support for sharing/co-learning with academic partners and capacity-building activities and services.

CONCLUSIONS

Results will inform future efforts and contribute to the understanding of capacity-building outcomes for initiatives supporting multiple CBPR partnerships.

Partnering with community institutions to increase access to healthful foods across municipalities

Background

Low-income and minority communities have higher rates of nutrition-related chronic diseases than do high-income and nonminority communities and often have reduced availability to healthful foods. Corner store initiatives have been proposed as a strategy to improve access to healthful foods in these communities, yet few studies evaluating these initiatives have been published.

Community Context

Suburban Cook County, Illinois, encompasses 125 municipalities with a population of more than 2 million. From 2000 through 2009, the percentage of low-income suburban Cook County residents increased 41%; African-American populations increased 20%, and Hispanic populations increased 44%. A 2012 report found that access to stores selling healthful foods was low in several areas of the county.

Methods

Beginning in March 2011, the Cook County Department of Public Health recruited community institutions (ie, local governments, nonprofit organizations, faith-based institutions) who recruited corner stores to participate in the initiative. Corner stores were asked to add new, healthful foods (May–June 2011) to become eligible to receive new equipment, marketing materials, and enhanced community outreach (July 2011–February 2012).

Outcomes

Nine community institutions participated. Of the 53 corner stores approached, 25 (47%) participated in the trial phase, which included offering 6 healthful foods in their stores. Of those, 21 (84%) completed the conversion phase, which included expansion of healthful foods through additional equipment and marketing and promotional activities.

Interpretation

Community institutions can play a key role in identifying and engaging corner stores across jurisdictions that are willing and able to implement a retail environment initiative to improve access to healthful foods in their communities.

Evaluating the interaction between progesterone, tumor necrosis factor-alpha and cortisol on early loss of transferred embryo in beef cows

Mason, M., Cuadra, E. J., Elsasser, T. H., Lopez, J. and Yoonsung, J. 2013. Evaluating the interaction between progesterone, tumor necrosis factor-alpha and cortisol on early loss of transferred embryo in beef cows. Can. J. Anim. Sci. 93: 217–225. Fifty-eight non-lactating cows previously synchronized for estrus were assigned to two treatments to assess the effects of progesterone supplementation and its correlation with tumor necrosis factor-α (TNF-α) and cortisol on the survival of the transferred embryos. On day 7 after exhibiting estrus (day 0), cows in both groups received embryos. In contrast with the control group, animals in the CIDR-group had a controlled internal drug release (CIDR) additionally inserted. Blood samples for progesterone, TNF-α and cortisol analysis were taken immediately before insertion and removal of CIDRs and 7 d after insertion. Progesterone did not differ between the control and the CIDR animals at any day of the study; however, it significantly increased at 7 and 14 d after insertion of the embryos in the control animals, compared with the levels observed in that same experimental group at the time of the transfer. Regardless of the treatment, all pregnant cows experienced a significant increase in progesterone from day 0 to day 7. Progesterone on day 0 was correlated to itself (r=0.46) on day 14 and to TNF-α (r=−0.37) on day 0 in pregnant animals; TNF-α on day 7 was significantly higher in pregnant cows compared with non-pregnant and correlated between day 0 and day 14. These results suggest that high levels of progesterone during the first 14 d after the transfer are indicative of the survival of transferred embryos. Additionally, these data also indicate that the decrease in TNF-α concentration on day 7 after the transfer of embryos may be associated with the low concentrations of progesterone observed in the non-pregnant animals.

A novel program trains community-academic teams to build research and partnership capacity

The Community-Engaged Research Team Support (CERTS) program was developed and tested to build research and partnership capacity for community-engaged research (CEnR) teams. Led by the Northwestern University Clinical and Translational Sciences Institute (NUCATS), the goals of CERTS were: (1) to help community-academic teams build capacity for conducting rigorous CEnR and (2) to support teams as they prepare federal grant proposal drafts. The program was guided by an advisory committee of community and clinical partners, and representatives from Chicago's Clinical and Translational Science Institutes. Monthly workshops guided teams to write elements of NIH-style research proposals. Draft reviewing fostered a collaborative learning environment and helped teams develop equal partnerships. The program culminated in a mock-proposal review. All teams clarified their research and acquired new knowledge about the preparation of NIH-style proposals. Trust, partnership collaboration, and a structured writing strategy were assets of the CERTS approach. CERTS also uncovered gaps in resources and preparedness for teams to be competitive for federally funded grants. Areas of need include experience as principal investigators, publications on study results, mentoring, institutional infrastructure, and dedicated time for research.

Neoadjuvant androgen deprivation therapy for prostate volume reduction, lower urinary tract symptom relief and quality of life improvement in men with intermediate- to high-risk prostate cancer: a randomised non-inferiority trial of degarelix versus goserelin plus bicalutamide

AIMS

The treatment of intermediate- to high-risk prostate cancer with radical radiotherapy is usually in combination with neoadjuvant androgen deprivation therapy. The aim of the present trial was to investigate whether degarelix achieves comparable efficacy with that of goserelin plus bicalutamide as neoadjuvant therapy before radiotherapy.

MATERIALS AND METHODS

The study was a randomised, parallel-arm, active-controlled, open-label trial in 244 men with a UICC prostate cancer TNM category T2b-T4, N0, M0, Gleason score ≥7, or prostate-specific antigen ≥10 ng/ml and a total prostate volume >30 ml, who were scheduled to undergo radical radiotherapy and in whom neoadjuvant androgen deprivation therapy was indicated. Eligible patients received treatment with either monthly degarelix (240/80 mg) or goserelin (3.6 mg) for 12 weeks, the latter patients also receiving bicalutamide (50 mg) for 17 days initially. The primary efficacy measure was the mean percentage reduction in total prostate volume from baseline at week 12 measured by transrectal ultrasound. The severity and relief of lower urinary tract symptoms were assessed by the International Prostate Symptom Score questionnaire. Quality of life was assessed by the eighth question of the International Prostate Symptom Score. About 50% of the patients had moderate to severe lower urinary tract symptoms at baseline.

RESULTS

The total prostate volume decreased significantly from baseline to week 12 in both treatment groups, reaching -36.0 ± 14.5% in degarelix-treated patients and -35.3 ± 16.7% in goserelin-treated patients (adjusted difference: -0.3%; 95% confidence interval: -4.74; 4.14%). At the end of the therapy, more degarelix- than goserelin-treated patients reported International Prostate Symptom Score decreases of ≥3 points (37% versus 27%, P = 0.21). In addition, in patients with a baseline International Prostate Symptom Score of ≥13, the magnitude of the decrease was larger in degarelix- (n = 53) versus goserelin-treated patients (n = 17) (6.04 versus 3.41, P = 0.06).

CONCLUSIONS

The efficacy of degarelix in terms of prostate shrinkage is non-inferior to that of goserelin plus bicalutamide. The added benefits of degarelix in terms of more pronounced lower urinary tract symptom relief in symptomatic patients could be the reflection of differences in the direct effects on extra-pituitary receptors in the lower urinary tract [Clinicaltrials.gov ID: NCT00833248].

Drivers for change in the management of prostate cancer - guidelines and new treatment techniques

Clinical practice guidelines and new treatment techniques are of particular importance for the effective management of prostate cancer. In Europe, the European Association of Urology guidelines offer a regularly updated evidence-based source of recommendations for the optimal treatment of prostate cancer. This review examines recent changes to guidelines highlighting developments in diagnosis, hormonal therapy in advanced and metastatic disease, bone protection, the definition of new terminology such as castrate-resistant prostate cancer, treatment of relapse after hormonal therapy, and cytotoxic therapy for castrate-resistant prostate cancer. The review also examines new surgical and radiotherapeutic developments in prostate cancer. This includes minimally invasive techniques such as robot-assisted radical prostatectomy, which is becoming the surgical gold standard for clinically localized disease in many countries. Other promising techniques reviewed include cryosurgical ablation of the prostate, laser-induced interstitial thermotherapy, vascular-targeted photodynamic therapy, and high-intensity focused ultrasound; with the exception of cryotherapy, these approaches are not currently recommended for routine clinical use. Finally, we will review the evidence supporting intensity modulated radiotherapy, an optimized high-precision form of three-dimensional conformal radiotherapy which aims to allow homogeneously increased radiation doses, without increased toxicity to healthy at-risk organs. Novel techniques such as proton beam or carbon ion radiotherapy, which may offer improved and more localized dose distribution with reduced damage to normal tissue, are also examined.

New developments in castrate-resistant prostate cancer

Castrate-resistant prostate cancer (CRPC) occurs when disease progresses in the presence of castrate levels of androgens and remains sensitive to further hormonal manipulation. For many years the treatment of CRPC was limited to the use of docetaxel for metastatic disease. However, this has recently changed with the approval of several new agents. Sipuleucel-T, an immunotherapeutic vaccine, is now available in the US for patients with non-metastatic CRPC and abiraterone, an oral enzyme inhibitor of androgen biosynthesis, as well as cabazitaxel, a cytotoxic chemotherapeutic, have been approved for the treatment of metastatic CRPC. Also, denosumab, a subcutaneous antibody, is now an option for the treatment of patients with CRPC with bone metastases, in addition to zoledronic acid, an intravenous bisphosphonate. Further treatment advances for metastatic CRPC therapeutics are in late stage phase III development. These include therapies affecting the androgen receptor (MDV3100) as well as additional immune-based therapeutics, PROSTVAC and ipilimumab. A broad range of agents is also emerging under the term targeted therapies. The endothelin-A receptor antagonist zibotentan, the tyrosine kinase inhibitors dasatinib, sorafenib and cabozantinib, the anti-angiogenic agent aflibercept, and the clusterin inhibitor custirsen, are all currently being tested for efficacy in metastatic CRPC. The mechanism of action of these and other promising agents are discussed alongside current therapeutic options and their potential place in the treatment landscape for CRPC is considered.

South Asian American perspectives on overweight, obesity, and the relationship between weight and health

Introduction

Compared with other racial groups, South Asian adults develop type 2 diabetes and cardiovascular disease at a lower body mass index (BMI). Perceptions of weight and the effect of weight on health can influence weight-loss attempts but are not well described in this population. The objective of this study was to examine perceptions of weight appropriateness and the effect of weight on health among South Asian Americans.

Methods

We recruited 75 South Asian American adults from a single metropolitan area in the Midwestern United States. During individual, face-to-face interviews, we asked participants what they think about their weight and how weight affects their health. We measured their weight and height and calculated BMI. Each interview was audiotaped, transcribed verbatim, and translated into English. We conducted analyses using NVivo software. A second investigator coded 20% of interviews to verify coding consensus.

Results

Sixty-seven percent of participants were overweight or obese; 40% of overweight participants and 12% of obese participants perceived themselves to be normal weight or underweight. Forty-eight percent of overweight and 82% of obese participants believed their weight affected their health. Participants commonly cited physical problems as being associated with their weight, but few connected their weight with risk for chronic diseases.

Conclusion

South Asian Americans may underestimate their weight status and the effect of their weight on their risk for chronic diseases. Interventions to promote weight loss among South Asian Americans should focus on modifying perceptions of normal weight and personalizing the relationship between overweight and chronic diseases.

Defunctioning stomas prior to chemoradiation for anal cancer are usually permanent

AIM

A few patients with anal cancer will require a defunctioning stoma prior to chemoradiotherapy (CRT). The purpose of this retrospective review was to determine the frequency with which a pretreatment stoma was subsequently reversed.

METHOD

Between 1997 and 2007, 46/344 patients who were treated for anal cancer underwent a defunctioning stoma prior to CRT. Thirty-five of these were treated with curative intent.

RESULTS

Of the 35 patients, 16 patients had T4, 17 T3 and 2 T2 disease. Sixteen were node positive. The average tumour size was 7 cm. The median interval between stoma formation and CRT was 6 (4-20) weeks. The median follow up was 26 (2-80) months. A defunctioning stoma was performed for rectovaginal fistula or risk of fistula in 18 and severe local symptoms in 17. Seven (20%) patients had the stoma reversed subsequently. The reasons for nonreversal were progressive disease (n = 9), persistent fistula (n = 3), predicted poor function (n = 4), cavity formation (n = 1), fibrosis (n = 3), death from another cause (n = 2), patient choice (n = 3) and salvage surgery (n = 2). The overall 3-year survival was only 48%, explained by the advanced stage of disease at presentation.

CONCLUSION

Most patients who undergo a defunctioning stoma before CRT will not undergo subsequent reversal. The patient should therefore be informed that the stoma is likely to be permanent and this should be taken into account when considering the type and site of stoma to be formed.

Androgen deprivation therapy as adjuvant/neoadjuvant to radiotherapy for high-risk localised and locally advanced prostate cancer: recent developments

Androgen deprivation therapy (ADT) has traditionally formed the mainstay of treatment for advanced/metastatic prostate cancer (PCa); however, it is now also having an increasingly important role in earlier stages of disease. Indeed, in patients with locally advanced or high-risk localised disease, the addition of neoadjuvant and adjuvant hormone therapy is now considered the standard of care for those men treated with radical radiotherapy. Although luteinising hormone-releasing hormone (LHRH) agonists have been used for many years as ADT, they may be associated with clinical flare and testosterone breakthrough. Newer hormonal agents continue to be developed, such as gonadotropin-releasing hormone antagonists, which reduce testosterone and prostate-specific antigen levels more rapidly than LHRH agonists, without testosterone flare. This review examines ADT use in combination with radiotherapy to improve outcomes in localised or locally advanced disease, and examines some of the latest developments in hormonal therapy for PCa.