Association of Race and Ethnicity With High Longevity Deceased Donor Kidney Transplantation Under the US Kidney Allocation System

RATIONALE & OBJECTIVE

The US Kidney Allocation System (KAS) prioritizes candidates with ≤20% Estimated Post-Transplant Survival (EPTS) for high longevity kidneys defined by a ≤20% Kidney Donor Profile Index (KDPI). Use of EPTS in the KAS deprioritizes candidates with older age, diabetes, and longer dialysis durations. We assessed whether this use also disadvantages racial-ethnic minority candidates, who are younger but more likely to have diabetes and longer durations of kidney failure requiring dialysis.

STUDY DESIGN

Observational cohort study.

SETTING

& Participants: Adult candidates for and recipients of kidney transplantation represented in the Scientific Registry of Transplant Recipients from January 2015 through December 2020.

EXPOSURE

Race and ethnicity.

OUTCOMES

Age-adjusted assignment to ≤20% EPTS, transplantation of a ≤20% KDPI kidney, and post-transplant survival in longevity matched recipients by racial-ethnicity.

ANALYTIC APPROACH

Multivariable logistic regression, Fine-Gray competing risks survival analysis, and Kaplan-Meier and Cox Proportional Hazards methods.

RESULTS

The cohort included 199,444 candidates (7% Asian, 29% Black, 19% Hispanic/Latino, 43% White) listed for deceased donor kidney transplantation. Non-White candidates had significantly higher rates of diabetes, longer dialysis duration, and were younger than White candidates. Adjusted for age, Asian, Black, and Hispanic/Latino candidates had significantly lower odds of having a ETPS score ≤20% (OR 0.86, [0.81, 0.91], 0.52 [0.50, 0.54], and 0.49, [0.47, 0.51]), and were less likely to receive a ≤20% KDPI kidney (subHR 0.70 [0.66, 0.75], 0.89 [0.87, 0.92], and 0.73 [0.71, 0.76]), compared to White candidates. Among recipients with ≤20% EPTS scores transplanted with a ≤20% KDPI deceased donor kidney, Asian and Hispanic recipients had lower post-transplant mortality (HR 0.45 [0.27, 0.77], and 0.63 [0.47, 0.86]) and Black recipients had higher but not statistically significant post-transplant mortality (HR 1.22 [0.99, 1.52]) compared to White recipients.

LIMITATIONS

Provider reported race-ethnicity data and 5-year post transplant follow-up period.

CONCLUSIONS

The US kidney allocation system is less likely to identify racial-ethnic minority candidates as having a ≤20% EPTS score which triggers allocation of high longevity deceased donor kidneys. These findings should inform the OPTN about how to remedy racial/ethnic disparities introduced through KAS's current approach of allocating allografts with longer predicted longevity to recipients with longer estimated post-transplant survival.

Assessing knowledge of end-stage kidney disease and treatment options in hospitalized African American patients undergoing hemodialysis

OBJECTIVE

African Americans are more likely to develop end-stage kidney disease (ESKD) than whites and face multiple inequities regarding ESKD treatment, renal replacement therapy (RRT), and overall care. This study focused on determining gaps in participants' knowledge of their chronic kidney disease and barriers to RRT selection in an effort to identify how we can improve health care interventions and health outcomes among this population.

METHODS

African American participants undergoing hemodialysis were recruited from an ongoing research study of hospitalized patients at an urban Midwest academic medical center. Thirty-three patients were interviewed, and the transcribed interviews were entered into a software program. The qualitative data were coded using template analysis to analyze text and determine key themes. Medical records were used to obtain demographic and additional medical information.

RESULTS

Three major themes emerged from the analysis: patients have limited information on ESKD causes and treatments, patients did not feel they played an active role in selecting their initial dialysis unit, and interpersonal interactions with the dialysis staff play a large role in overall unit satisfaction.

DISCUSSION

Although more research is needed, this study provides information and suggestions to improve future interventions and care quality, specifically for this population.

Delivering COVID-19 Vaccine via Trusted Social Services: Program Evaluation Results from the Chicagoland CEAL Program

To describe the reach, implementation, and sustainability of COVID-19 vaccination programs delivered by social service community organizations. Five academic institutions in the Chicagoland CEAL (Community Engagement Alliance) program partnered with 17 community organizations from September 2021-April 2022. Interviews, community organizations program implementation tracking documents, and health department vaccination data were used to conduct the evaluation. A total of 269 events were held and 5,432 COVID-19 vaccines delivered from May 2021-April 2022. Strategies that worked best included offering vaccinations in community settings with flexible and reliable hours; pairing vaccinations with ongoing social services; giving community organizations flexibility to adjust programs; offering incentives; and vaccinating staff first. These strategies and partnership structures supported vaccine uptake, community organization alignment with their missions and communities' needs, and trust. Community organizations delivering social services are local community experts and trusted messengers. Pairing social service delivery with COVID-19 vaccination built individual and community agency. Giving COs creative control over program implementation enhanced trust and vaccine delivery. When given appropriate resources and control, community organizations can quickly deliver urgently needed health services in a public health crisis.

Community-engaged research in vascular surgery: An approach to decrease amputation disparities and effect population-level change

Community-engaged research (CEnR) is a powerful tool to create sustainable and effective change in health outcomes. CEnR engages community members as equal partners, amplifying their voices and priorities by including them throughout the research process. Such engagement increases the relevance and meaning of research, improves the translation of research findings into sustainable health policy and practice, and ultimately enhances mutual trust among academic, clinical, and community partners for ongoing research partnership. There are a number of key principles that must be considered in the planning, design, and implementation of CEnR. These principles are focused on inclusive representation and participation, community empowerment, building community capacity, and protecting community self-determination. Although vascular surgeons may not be equipped to address these issues from the ground up by themselves, they should work with a team who can help them incorporate these elements into their CEnR project designs and proposals. This may be best accomplished by collaborating with researchers and community-based organizations who already have this expertise and have established social capital within the community. This article describes the theory and principles of CEnR, its relevance to vascular surgeons, researchers, and patients, and how using CEnR principles in vascular surgery practice, research, and outreach can benefit our patient population, with a specific focus on reducing disparities related to amputation.

The Impact of the COVID-19 Pandemic on Ethnic Minority Groups With Diabetes

Major ethnic disparities in diabetes care, especially for intermediate outcomes and diabetes complications, were evident prior to the coronavirus disease 2019 (COVID-19) pandemic. Diabetes is a risk factor for severe COVID-19, and the combination of these ethnic disparities in diabetes care and outcomes may have contributed to the inequity in COVID-19 outcomes for people with diabetes. Overall, ethnic minority populations have suffered disproportionate rates of COVID-19 hospitalization and mortality. Results from the limited number of studies of COVID-19 in ethnic minority populations with diabetes are mixed, but there is some suggestion that rates of hospitalization and mortality are higher than those of White populations. Reasons for the higher incidence and severity of COVID-19-related outcomes in minority ethnic groups are complex and have been shown to be due to differences in comorbid conditions (e.g., diabetes), exposure risk (e.g., overcrowded living conditions or essential worker jobs), and access to treatment (e.g., health insurance status and access to tertiary care medical centers), which all relate to long-standing structural inequities that vary by ethnicity. While guidelines and approaches for diabetes self-management and outpatient and inpatient care during the pandemic have been published, few have recommended addressing wider structural issues. As we now plan for the recovery and improved surveillance and risk factor management, it is imperative that primary and specialist care services urgently address the disproportionate impact the pandemic has had on ethnic minority groups. This should include a focus on the larger structural barriers in society that put ethnic minorities with diabetes at potentially greater risk for poor COVID-19 outcomes.

OR28-6 Combating Therapeutic Inertia: Project ECHO for Diabetes Improves Primary Care Providers’ Comfort and Use of Diabetes Medication and Technology

Background

Despite newer diabetes medications and technology being available, therapeutic inertia persists and there are more people living with "uncontrolled" diabetes than meeting A1c targets. Here we evaluate how the ECHO© model for diabetes management changed prescribing practices among participating primary care providers (PCPS).

Methodology

Three unique diabetes ECHO programs evaluated comfort or perception of prescribing practice changes for local community PCPs (n=74) in four regions (Illinois, District of Columbia, New Mexico, and Washington). One site representing two regions collected pre- and post-program participant surveys (n=45) while two sites collected post-program surveys only (n=29), in which respondents reported perceptions of changes resulting from participation in ECHO. Participants reported their use of technology (professional and personal continuous glucose monitoring (CGM) and insulin pumps) and medications (insulin and non-insulin).

Results

On a 4-point Likert scale, PCPs’ (n=45) average self-reported prescription use for newer diabetes medications with cardiovascular indications increased from 3.07 (sometimes) to 3.84 (sometimes-always).

Presentation: Tuesday, June 14, 2022 11:00 a.m. - 11:15 a.m.

Incorporating Health Equity Into COVID-19 Reopening Plans: Policy Experimentation in California

California has focused on health equity in the state's COVID-19 reopening plan. The Blueprint for a Safer Economy assigns each of California's 58 counties into 1 of 4 tiers based on 2 metrics: test positivity rate and adjusted case rate. To advance to the next less-restrictive tier, counties must meet that tier's test positivity and adjusted case rate thresholds. In addition, counties must have a plan for targeted investments within disadvantaged communities, and counties with more than 106 000 residents must meet an equity metric. California's explicit incorporation of health equity into its reopening plan underscores the interrelated fate of its residents during the COVID-19 pandemic and creates incentives for action. This article evaluates the benefits and challenges of this novel health equity focus, and outlines recommendations for other US states to address disparities in their reopening plans.

Renal Replacement Knowledge and Preferences for African Americans With Chronic Kidney Disease

BACKGROUND

Renal replacement therapies (RRT) other than in-centre haemodialyses are underutilised by African Americans with end-stage renal disease (ESRD) even though they are associated with reduced costs, morbidity and mortality as well as improved quality of life for patients.

OBJECTIVES

To understand African American patients' knowledge of RRT options and how patient, provider and system-factors contribute to knowledge and preferences. Participants' interviews were conducted at the University of Chicago Medical Center with African American patients with chronic kidney disease (CKD). The final analysis included 28 interviews; 22 patients had CKD not yet on dialysis or having received a transplant, while 6 had reached ESRD and were receiving treatment for kidney failure. Approach Transcripts were uploaded into NVivo8 for coding. Thematic analysis was used for data interpretation.

RESULTS

Four themes were identified: (1) limited knowledge of home modalities and deceased donor options, (2) CKD patients gave little thought to choosing RRT options, (3) CKD patients relied on doctors for treatment decisions, and (4) while patients reported knowledge of living kidney donation transplants (LKDT), it did not translate to receiving an LKDT.

CONCLUSION

African Americans face significant knowledge and access barriers when deciding on their RRT treatment. Even patients with advanced CKD were still in the early stages of RRT selection. Understanding the knowledge gaps and barriers patients face will inform our subsequent intervention to educate and motivate patients to increase CKD self-care and improve communication between patients, their families and their providers about different RRT treatments.

Financing Diabetes Care in the U.S. Health System: Payment Innovations for Addressing the Medical and Social Determinants of Health

PURPOSE OF REVIEW

Review innovations in health care financing promoting health system investments in addressing medical and social determinants of health (SDH) for patients with diabetes.

RECENT FINDINGS

Particular payment models implemented in the public and private sectors increasingly offer flexibility in health care organizations (HCOs) to allocate resources towards helping patients with diabetes overcome the medical and socio-economic problems driving poor population and individual health. The barriers imposed by the traditional fee-for-service (FFS) payment model to incorporating SDH into health care delivery across the health system are being overcome with new payment approaches rewarding the quality of care provided rather than strictly the volume of health services rendered. Evidence suggests health care financing changes will facilitate the realization of health reform goals to provide the right care to the right people at the right time through the expansion of the role of integrated care teams that can address patients' medical and health-related social needs.

Abstract 5273: Outcomes from a religiously tailored intervention to enhance mammography uptake among American Muslims

Objective: Describe outcomes of a religiously-tailored peer-led group educational intervention addressing mammography-related barrier beliefs of American Muslims.

Methods: We used focus groups and interviews with a diverse group of Muslim women aged 40 and older to identify salient behavioral, normative and control beliefs regarding mammography. We used these data to design the curriculum and messaging for a mosque-based intervention involving peer-led group education. A novel model for religious tailoring was developed to address barrier beliefs by reframing, reprioritizing, and/or reforming belief structures. Peer educators were recruited/trained from mosques to match the ethnic composition of target population. The classes involved facilitated discussions and guest-led didactics covering religion and health, and mammography guidelines. Survey data was collected pre-, post, 6 months, and one-year post-intervention which captured changes in three primary outcome variables (1) perceived mammography intention, likelihood, confidence, (2) breast cancer knowledge and (3) receipt of mammograms. Resonance with barrier and facilitator beliefs was also measured.

Results: Fifty-eight Muslim women who had not had a mammogram in the past two years participated. Mean age was 50 years, with 29 being South Asian and 18 being of Arab descent. With respect to changed intention/likelihood/confidence pre-post there was a significant increase in mean perception of likelihood to obtain a mammogram (0.29, P = 0.01). Mammography knowledge also significantly increased following the intervention (p = 0.0002). Importantly, 22 participants received a mammogram at one-year follow-up. With respect to belief structures, a marginally significant increase was observed in level of agreement with mammography facilitator beliefs (p = 0.08) post-intervention. Although overall level of agreement with the outcome variable of mammography barrier beliefs did not change following the intervention (p = 0.94), there was a significant decrease in agreement with the specific belief in fatalism (p = 0.03). Multivariable models demonstrated that higher levels of agreement with fatalistic beliefs at baseline was significantly associated with a lower odds of increased mammography knowledge following the intervention (OR = 0.73), while higher religiosity at baseline was significantly associated with higher odds of increased mammography knowledge following the intervention (OR = 1.90).

Conclusion: Our mosque-based intervention involving religiously-tailored messages and peer-led classes demonstrated efficacy in behavioral change by improving Muslim women's self-reported likelihood of obtaining mammograms and having 38% of participants obtained a mammogram within a year.

Citation Format: Aasim I. Padela, Sana Malik, Shaheen Nageeb, Stephen Hall, Fatema Mirza, Monica Peek, Michael Quinn. Outcomes from a religiously tailored intervention to enhance mammography uptake among American Muslims [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5273.

Abstract C03: Reducing Muslim mammography disparities: Outcomes from a religiously tailored mosque-based intervention

Objective: To describe the design of, and participant-level outcomes related to, a religiously tailored peer-led group education program that addressed mammography-related barrier beliefs of American Muslims.

Methods: Using community-engaged research methods including a multidisciplinary community advisory board, we identified and then intervened upon barrier beliefs impeding mammography screening among American Muslim women. Phase 1 of the project involved focus groups and interviews with an ethnically diverse group of women aged 40 and older sampled from Muslim organizations to identify salient behavioral, normative, and control beliefs regarding mammography. Phase 2 entailed interviews with the same target population to elicit ideas about intervention design. CAB members and staff used these data to design the curriculum and messaging for a religiously tailored mosque-based intervention involving peer-led group education classes. Peer educators were recruited and trained from mosques and were religious and ethnically concordant with the target intervention population. The classes involved facilitated discussions and guest-led didactics covering religion and health and mammography. Survey data from group education participants were collected pre-intervention, post-intervention, 6 months post-intervention, and one year post-intervention. Survey instruments recorded changes in mammography intention, likelihood, confidence, and resonance with barrier and facilitator beliefs.

The structural elements and messages of the classes tackled barrier beliefs in at least one of 3 ways: (i) Reprioritizing--introducing another religious belief that has greater resonance with participants such that the barrier belief is marginalized; (ii) Reframing the belief within a religious worldview such that it is consistent with the health behavior desired; and (iii) Reforming--using a religious scholar to provide “correct” interpretations of religious doctrine.

Results: 52 Muslim women (mean age = 50 yrs) who had not had a mammogram in the past two years, of whom 18 were of Arab descent and 27 South Asian, participated in the two-session course. The pre- and post-self-reported likelihood of obtaining a mammogram increased significantly following the intervention (p=0.03), as did breast cancer screening knowledge (p=0.0002). Greater resonance with facilitator beliefs significantly predicted positive likelihood changes (OR 1.31, p=.003). Participants with higher negative religious coping (OR = 1.33, p=0.04) and greater resonance with facilitator beliefs (OR = 1.44, p = 0.00) had higher odds for having an intention to get a mammogram post the class, while those with higher religiosity (DUREL, OR = 0.72, p= 0.01), and more resonance with barrier beliefs (OR= 0.72, p= 0.01) had significantly lower intentions. At six months' follow-up, 42% (n= 20/47) of participants had obtained a mammogram and 7.7% (n=4) were lost to follow-up.

Conclusion: Our pilot mosque-based intervention involving religiously tailored messages delivered through peer-led classes demonstrated efficacy in improving Muslim women's self-reported likelihood of obtaining mammograms post-class, and over 40% of participants eventually obtained a mammogram within 6 months of the classes.

Citation Format: Aasim Padela, Sana Malik, Shaheen Nageeb, Monica Peek, Michael Quinn. Reducing Muslim mammography disparities: Outcomes from a religiously tailored mosque-based intervention [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C03.

Racial disparities in the choice of definitive treatment for squamous cell carcinoma of the oral cavity

BACKGROUND

Definitive surgery is recommended for oral cavity squamous cell carcinoma (SCC). The purpose of this study was to present our assessment of the disparities in treatment selection for oral cavity SCC.

METHODS

Non-Hispanic white and non-Hispanic black patients with oral cavity SCC were identified in the National Cancer Database (NCDB). Regression models were used to estimate relative risk (RR) of receiving surgery and absolute difference between non-Hispanic white and non-Hispanic black patients.

RESULTS

There were 82.3% of non-Hispanic white patients who received surgery, compared to 64.2% of non-Hispanic black patients (P < .001). The non-Hispanic black patients were less likely to receive surgery than non-Hispanic white patients (RR 0.87) with an absolute difference of 10.9%. The non-Hispanic black patients were significantly more likely to not be offered surgery (RR 1.42) and to refuse recommended surgery (RR 1.38) but not have a contraindication to surgery (RR 1.17).

CONCLUSION

The non-Hispanic black patients are less likely to receive or be recommended surgery for oral cavity SCC and are more likely to refuse surgery. Further study is needed to identify strategies to close this disparity.

Reducing Muslim Mammography Disparities: Outcomes From a Religiously Tailored Mosque-Based Intervention

OBJECTIVE

To describe the design of, and participant-level outcomes related to, a religiously tailored, peer-led group education program aimed at enhancing Muslim women's mammography intention.

METHOD

Using a community-engaged approach and mixed methods, we identified and addressed barrier beliefs impeding mammography screening among Muslim American women. Our religiously tailored, mosque-based, peer-led intervention involved facilitated discussions and expert-led didactics conveying health-related religious teachings, and information about the benefits and process of mammography. Barrier beliefs were addressed through reframing, reprioritizing, or reforming such beliefs. Participant surveys were collected preintervention, postintervention, 6 months postintervention, and 1 year postintervention. These measured changes in mammography intention, likelihood, confidence, and resonance with barrier and facilitator beliefs.

RESULTS

A total of 58 Muslim women (mean age = 50 years) that had not had a mammogram in the past 2 years participated in the two-session program. Self-reported likelihood of obtaining a mammogram increased significantly ( p = .01) and coincided with a positive trend in confidence ( p = .08). Individuals with higher agreement with barrier beliefs preintervention had lower odds for positive change in likelihood (odds ratio = 0.80, p = .03), while those who were married had higher odds for positive change in likelihood (odds ratio = 37.69, p = .02). At 1-year follow-up, 22 participants had obtained a mammogram.

CONCLUSION

Our pilot mosque-based intervention demonstrated efficacy in improving Muslim women's self-reported likelihood of obtaining mammograms, and increased their mammography utilization, with nearly 40% obtaining a mammogram within 12 months of the intervention.

IMPACT

Our conceptual model for religiously tailoring messages, along with its implementation curriculum, proved effective in enhancing the likelihood and receipt of mammograms among Muslim American women. Accordingly, our work advances both the theory and practice of faith-based interventions and provides a model for addressing Muslim women's cancer screening disparities.

Developing religiously-tailored health messages for behavioral change: Introducing the reframe, reprioritize, and reform ("3R") model

RATIONALE

As community health interventions advance from being faith-placed to authentically faith-based, greater discussion is needed about the theory, practice, and ethics of delivering health messages embedded within a religious worldview. While there is much potential to leverage religion to promote health behaviors and improve health outcomes, there is also a risk of co-opting religious teachings for strictly biomedical ends.

OBJECTIVE

To describe the development, implementation, and ethical dimensions of a conceptual model for religiously-tailoring health messages.

METHOD

We used data from 6 focus groups and 19 interviews with women aged 40 and older sampled from diverse Muslim community organizations to map out how religious beliefs and values impact mammography-related behavioral, normative and control beliefs. These beliefs were further grouped into those that enhance mammography intention (facilitators) and those that impede intention (barriers). In concert with a multi-disciplinary advisory board, and by drawing upon leading theories of health behavior change, we developed the "3R" model for crafting religiously-tailored health messages.

RESULTS

The 3R model addresses barrier beliefs, which are beliefs that negatively impact adopting a health behavior, by (i) reframing the belief within a relevant religious worldview, (ii) reprioritizing the belief by introducing another religious belief that has greater resonance with participants, and (iii) reforming the belief by uncovering logical flaws and/or theological misinterpretations. These approaches were used to create messages for a peer-led, mosque-based, educational intervention designed to improve mammography intention among Muslim women.

CONCLUSIONS

There are benefits and potential ethical challenges to using religiously tailored messages to promote health behaviors. Our theoretically driven 3R model aids interventionists in crafting messages that address beliefs that hinder healthy behaviors. It is particularly useful in the context of faith-based interventions for it highlights the ethical choices that must be made when incorporating religious values and beliefs in tailored messages.

How Should Physicians Respond When Patients Distrust Them Because of Their Gender?

There are many reasons why gender-concordant care benefits patients and is requested by them. For training hospitals, however, such requests present challenges as well as opportunities in providing patient-centered care. Responding to a case in which a female patient who is having a routine exam refuses care from a male medical student, we discuss ethical principles involved in gender-concordant care requests, when it is appropriate to question such requests, and a team-based approach to responding to them.

Religious beliefs and mammography intention: findings from a qualitative study of a diverse group of American Muslim women

OBJECTIVE

Studies suggest that American Muslim women underutilize mammography. While religion has a strong influence upon Muslim health behaviors, scant research has examined how religion-related beliefs inform Muslim women's intention for mammography. Our study identifies and examines such beliefs.

METHODS

Muslim women aged 40 years and older sampled from mosques participated in focus groups and individual interviews. Drawing upon the theory of planned behavior, interviews elicited salient behavioral, normative, and control beliefs regarding mammography and the influence of Islam upon screening intention.

RESULTS

Fifty women participated in 6 focus groups and 19 in semistructured interviews, with near-equal numbers of African American, South Asian, and Arab Muslims. Forty-two percent of participants had not had a mammogram within the past 2 years. Across differences in race/ethnicity and mammography status, women voiced four religion-related salient beliefs that inform mammography intention: (1) the perceived duty to care for one's health, (2) religious practices as methods of disease prevention, (3) fatalistic notions about health, and (4) comfort with gender concordant health care.

CONCLUSIONS

Religious beliefs influence decisions to pursue mammography across the ethnic/racial diversity of Muslim women. Notions about duty to God and the stewardship of one's body appear to enhance mammography intention. Theocentric notions of cure and illness and varied views regarding personal agency also inform decisional frames that impact mammography intention. Given the salience of religion among our participants, religiously tailored messages in interventions have the potential to enhance cancer screening.

Associations between religion-related factors and breast cancer screening among American Muslims

American Muslims have low rates of mammography utilization, and research suggests that religious values influence their health-seeking behaviors. We assessed associations between religion-related factors and breast cancer screening in this population. A diverse group of Muslim women were recruited from mosques and Muslim organization sites in Greater Chicago to self-administer a survey incorporating measures of fatalism, religiosity, discrimination, and Islamic modesty. 254 surveys were collected of which 240 met age inclusion criteria (40 years of age or older). Of the 240, 72 respondents were Arab, 71 South Asian, 59 African American, and 38 identified with another ethnicity. 77% of respondents had at least one mammogram in their lifetime, yet 37% had not obtained mammography within the past 2 years. In multivariate models, positive religious coping, and perceived religious discrimination in healthcare were negatively associated with having a mammogram in the past 2 years, while having a PCP was positively associated. Ever having a mammogram was positively associated with increasing age and years of US residency, and knowing someone with breast cancer. Promoting biennial mammography among American Muslims may require addressing ideas about religious coping and combating perceived religious discrimination through tailored interventions.

Abstract P1-11-12: Religion-related factors and breast cancer screening among American Muslims

Background: Cancer disparities research often overlooks the influence a shared religion may have across race and ethnicity, and thereby misses opportunities to leverage shared religious networks to promote screening. While American Muslims have low rates of mammography and their health behaviors are strongly influenced by religion, a description of such relationships is lacking in the literature. Our study fills this gap.

Methods: We conducted a mixed-methods exploration of how religion-related factors impact breast cancer screening practices. We sampled an ethnically and racially diverse group of Muslim women frequenting mosques and community sites. A survey incorporated measures of fatalism, religiosity, religious discrimination, and Islamic modesty, while subsequent focus groups elicited perspectives on how religious beliefs, values and identity impact breast cancer screening intentions. Survey analyses involved logistic regression models, while focus groups were analyzed using a team-based framework content analysis approach.

Results: Of 240 survey respondents, 72 were Arabs, 71 S. Asians and 59 African Americans. Seventy-five percent had insurance, while 85% had a PCP. 77% reported ever having a mammogram while only 37% a mammogram within the past 2 years. In multivariate models, positive religious coping (OR= 0.21;P &lt;.05) and perceived religious discrimination in healthcare (OR=0.74;P &lt;.05) were negatively associated with having a mammogram in the past two years, while having a primary care physician (OR=20;P&lt;.01) was positively associated. Ever having a mammogram was positively associated with increasing age (OR=1.1;P&lt;.05), years of US residency (10-20 yrs OR=11; 20 yrs OR=4.3;P&lt;.05) and knowing someone with breast cancer (OR=3.5;P&lt;.01). Importantly, ethnic/racial affiliation did not influence mammography rates.

Of 50 focus group participants there were nearly equal numbers of S. Asians, Arabs, and African Americans, 74% reported ever having a mammogram, with 56% having a mammogram within the past two years. Focus group data revealed that family support and encouragement strongly impacted screening intentions, and that obtaining screening in a way that accommodated notions of religious modesty was paramount and prior experiences with such accommodations influenced subsequent intentions. Focus group participants believed that the mosque is a critical community venue for setting religious mores but is underutilized for health education and for motivating theological responses to illness. Participants expressed the need for mosque administration and religious leaders to openly discuss breast health and mammography screening among the Muslim community.

Conclusions: Aspects of religion appear to influence cancer screening behaviors similarly across the socioeconomic, ethnic, and racial diversity of American Muslims. Promoting biennial mammography screening among American Muslims requires addressing ideas about religious coping as related to preventive cancer screening and empowering women to combat perceived religious discrimination. Mosques are underutilized in breast cancer screening interventions but are a ripe setting for religiously-tailored programming that can address barriers to screening and promote a culture of health in this community.

Citation Format: Aasim Padela, S Murrar, S Mallick, Z Hosseinain, C Liao, C Ajax, F Marfani, M Peek. Religion-related factors and breast cancer screening among American Muslims [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-11-12.

Abstract C52: Associations between religion-related factors and breast cancer screening among American Muslims

Background: The limited research of breast cancer screening among different American Muslim groups consistently demonstrates low rates of mammography. There has been no survey of how religion-related factors influence screening patterns in a diverse sample of American Muslims.

Methods: We partnered with the Council of Islamic Organizations of Greater Chicago to survey English-speaking women aged 40 years and older frequenting mosques and community sites. The self-administered survey included several adapted measures of religiosity, fatalism, and discrimination from the literature, and incorporated a pilot measure of Islamic modesty.

Results: 240 women completed the survey with nearly equal numbers of indigenous African Americans (27%), Arab Americans (33%), and South Asians (32%). 77% of the sample reported ever having a mammogram while only 37% had a mammogram within the past 1-2 years. There were no significant differences in rates by race/ethnicity. On multivariate analysis positive religious coping (OR= 0.21, p &lt;0.05) and perceived religious identity-directed discrimination (OR=0.74, p&lt;0.05) were negatively associated with having biennial mammograms, while having a primary care physician (OR=20, p&lt;0.01,) greatly increased the odds of having a mammogram. Ever having a mammogram was positively associated with years of US residence (&gt;20 yrs OR=4.3, p&lt;0.05) and increasing level of educational attainment. Islamic modesty, fatalistic beliefs, breast cancer knowledge, educational attainment, insurance status and were not associated with mammography rates.

Conclusions: Cancer disparity research typically focuses on inequities across ethnic and racial lines, and therefore overlooks the influence of a shared religion upon health behaviors across race and ethnicity. Our survey suggests that religion-related factors such as positive religious coping and perceived religious discrimination influence breast cancer screening patterns among American Muslims. Consequently, programs leveraging shared religious networks, such as mosques and Imams, may be a means to address religious barriers that impede screening across ethnic and racial lines.

Citation Format: Aasim I. Padela, Sohad Murrar, Brigid Adviento, Zahra Hosseinain, Monica Peek, Olufunmilayo Olopade, Farr Curline. Associations between religion-related factors and breast cancer screening among American Muslims. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr C52. doi:10.1158/1538-7755.DISP13-C52

Acceptance of neonatal genetic screening for hereditary hemochromatosis by informed parents

The aim of this study was to assess attitudes to neonatal genetic screening for hereditary hemochromatosis. A total of 135 consecutive, pregnant women and their partners attending a hospital antenatal clinic in the Australian Capital Territory were given detailed written and verbal information about potential risks and benefits of neonatal genetic screening. Issues such as uncertainty of disease expression, confidentiality, genetic discrimination, and storage of genetic data were addressed. Attitudes were assessed by interview and questionnaire. There was a high level of acceptance for neonatal genetic screening in general (99%) and for hemochromatosis in particular (91.5%). There was no association of prior knowledge of hemochromatosis, family history of hemochromatosis, ethnicity, age, education, or occupation class with nonacceptance. Of the subjects, 39.5% reported feeling "a little anxious" about the prospect of screening their infants, although only 5.4% reported feeling "very anxious." Reasons given for nonacceptance of screening included inability of the child to give informed consent, insufficient evidence that diagnosis of hemochromatosis in childhood is beneficial, risk of discrimination on genetic grounds, lack of agreement between partners, and privacy issues. These data suggest that an Australian neonatal genetic screening program for hemochromatosis is likely to be accepted by this and similar groups of subjects, but there should be an opportunity for parents who object to screening to opt out of any such program.

The tissue factor region that interacts with factor Xa in the activation of factor VII

Tissue factor is the cell membrane-anchored cofactor for factor VIIa and triggers the coagulation reactions. The initial step is the conversion of factor VII to factor VIIa which, in vitro, is efficiently catalyzed by low concentrations of factor Xa. To identify the tissue factor region that interacts with the activator factor Xa during this process, we evaluated a panel of soluble tissue factor (1-219) mutants for their ability to support factor Xa-mediated activation of factor VII. The tissue factor residues identified as most important for this interaction (Tyr157, Lys159, Ser163, Gly164, Lys165, Lys166, and Tyr185) were identical to those found to be important for the interaction of substrate factor X with the tissue factor.factor VIIa complex. The residues form a continuous surface-exposed patch with an area of about 500 A(2), which appears to be located outside the tissue factor-factor VII contact zone. In agreement, the two monoclonal antibodies 5G6 and D3H44-F(ab')(2), whose epitopes overlap with this identified region, inhibited the rates of factor VII activation by 86% and 95%, respectively. These antibodies also strongly inhibited the conversion of (125)I-labeled factor VII when cell membrane-expressed, full-length tissue factor (1-263) was employed. Together the results suggest the usage of a common surface region of tissue factor in its dual role-as a cofactor for factor Xa-mediated factor VII activation and as a cofactor for factor VIIa-mediated factor X activation. The finding that factor Xa and factor X may engage in similar, if not identical, molecular interactions with tissue factor further indicates that factor Xa and factor X are similarly oriented toward their respective interaction partners in the ternary catalytic complexes.

Sexual origins of placental dysfunction

Severe placental dysfunction is much more common in pregnancies with a male than with a female fetus. Furthermore, the birthweight/placental weight ratio is increased in these pregnancies, consistent with fetal growth restriction, and is higher with a male fetus than with a female fetus. These observations of placental insufficiency may underlie the increased in-utero loss rate of male fetuses.

A human antibody that binds to the gamma-carboxyglutamic acid domain of factor IX is a potent antithrombotic in vivo

10C12, a human antibody F(ab')2, which specifically binds to the Gla domain of factor IX, interfered with all known coagulation processes that involve factor IX/IXa. These include the function of the intrinsic Xase complex and the activation of zymogen factor IX by factor XIa and by the tissue factor:factor VIla complex. Furthermore, 10C12 potently inhibited activated partial thromboplastin clotting times (APTT) in plasma of guinea pig and rat, thus enabling in-vivo evaluation. In guinea pigs, a bolus administration of 10C12 (10 microg/kg) prevented cyclic flow variations in damaged carotid arteries without affecting coagulation or bleeding parameters. At a 100-fold higher dose, 10C12 had no effect on normal hemostasis as assessed by the cuticle bleeding time. At this dose, 10C12 was also efficacious in a rat arterial thrombosis model, substantially reducing clot weight and duration of vessel occlusion while prolonging ex-vivo APTT only 1.2-fold. The dose of heparin required to produce comparable antithrombotic effects prolonged the APTT by 12-fold and increased the tail bleeding time (TBT) by 8-fold. In contrast, 10C12 had no effect on TBT. However, rat tails showed a tendency for rebleeding which 10C12 exacerbated. In conclusion, the antithrombotic potency of the 10C12 antibody in two species provides evidence for an important role of F.IX, and its Gla domain in particular, during thrombogenesis under arterial flow conditions. The relative safety at effective doses of this fully human antibody suggests that it may have therapeutic value for treatment of thrombotic disorders.

Sexually transmitted diseases in patients attending a Baltimore tuberculosis clinic. Assessment of use of multiple categoric services

BACKGROUND

Recent increases in the incidence of tuberculosis and syphilis have occurred disproportionately in young heterosexuals of low socioeconomic status. The authors hypothesized that an overlap of tuberculosis and sexually transmitted disease clinic populations potentially could result in inefficient use of limited public health resources.

METHODS

The authors conducted a retrospective study to determine the coinfection rate of syphilis and other sexually transmitted diseases in patients seen for evaluation at the Baltimore City Tuberculosis Clinic, Baltimore, Maryland. The authors determined the sexually transmitted disease clinic utilization patterns of this patient population.

RESULTS

For patients referred to the tuberculosis clinic, 9.0% had a history of syphilis and 13.6% had at least one documented visit at a Baltimore City sexually transmitted disease clinic. Blacks presenting to the tuberculosis clinic were more likely to have previously diagnosed syphilis (13.6%) and to have had visited the sexually transmitted disease clinics (16.5%).

CONCLUSIONS

In Baltimore, the patient population of tuberculosis clinics overlaps with those at the public sexually transmitted disease clinics. Thus, cross screening for syphilis and tuberculosis at urban clinics would be an important mechanism for identifying new cases of disease and increasing the efficiency of the public health system.

Hypertension in pregnancy: which method of blood pressure measurement is most predictive of outcome?

OBJECTIVE

To determine the clinical effectiveness of blood pressure (BP) measurement using conventional sphygmomanometry in the antenatal clinic and obstetric day unit compared with automated BP monitoring at home.

METHODS

The study population consisted of 109 nulliparous white women with BPs of at least 140 or 90 mmHg at the antenatal clinic after 20 weeks' gestation, who underwent obstetric day unit and 24-hour automated BP monitoring on the same day. Automated measurement was obtained every half hour for 24 hours using a commercially available device that had been previously validated in pregnancy.

RESULTS

At the traditional BP cutoff point (140/90 mmHg), the relative risk for subsequent development of adverse obstetric outcome was greatest for automated BP measurement: The relationships between outcome and automated diastolic BP were all statistically significant: proteinuria (P = .034), preterm delivery (P < .001), birth weight below the tenth percentile (P = .001), admission to the special care neonatal unit (P = .001), and cesarean delivery (P = .007).

CONCLUSION

Automated BP measurement appears to improve the identification of patients who are at high risk of poor obstetric outcome. Automated BP measurement is worthy of further evaluation as an antenatal screening and diagnostic test.

The endometrial capillaries during the normal menstrual cycle: a morphometric study

The areas of the capillary lumen, the entire capillary, the endothelial cells and the adventitia, as well as the thickness of the endothelial cell layer and the adventitia were studied using morphometric methods in endometrial samples from 34 fertile women who had a hormonal profile compatible with normal ovarian function. The biopsies were grouped around the luteinizing hormone surge. The results were calculated as mean values of 72-h periods and related to the mean levels of oestradiol and progesterone circulating in plasma 72 h prior to the biopsy. The results indicated that the sub-epithelial capillary plexus of the human endometrium undergoes dynamic changes during the normal menstrual cycle with a significant dilatation of the vessels during the post-ovulatory phase. A significant correlation was found between the area of the capillary lumen and the mean level of progesterone circulating in the plasma 72 h prior to the biopsy (P = 0.037). We conclude that the ovarian steroids produced during the normal menstrual cycle are likely to influence sub-epithelial vascularization causing dilatation in the post-ovulatory phase. This dilatation of the sub-epithelial capillaries may be related to the development of oedema appearing in the stroma at the time of the expected implantation. The possible functional significance of the capillary dilatation in terms of implantation, however, needs to be further investigated.

Improvement in survival of patients with renal cell carcinoma--the role of the serendipitously detected tumor

A review of 212 cases of renal cell carcinoma diagnosed during a 40-year period revealed an increasing number of cases detected during imaging studies performed for nonurological reasons. These so-called incidentally detected renal cell carcinomas are increasing in incidence, generally of low stage and associated with significantly improved survival, and they constitute the majority of the patients with improved prognosis during the recent 2 decades. The clinical course and disease stage in patients who continue to present with symptoms of the disease have not changed in the last 40 years. These data suggest that with currently available treatments for renal cell carcinoma a principal method to improve the prognosis of this disease would be through earlier detection. Low disease incidence would mitigate against morphological screening but case finding techniques may prove useful.

Impact of routine screening for adenocarcinoma of the prostate on stage distribution

The impact of routine screening with digital rectal examination for carcinoma of the prostate on stage distribution of the disease was assessed in the primary treatment population of our medical center. Two, 5-year periods were compared: 1974 to 1978--before the onset of routine screening and 1979 to 1983--during the period of routine screening of this population. The clinical stage distribution of prostatic cancer before the onset of routine screening was not significantly different from national averages. Routine screening during the latter period significantly increased the percentage of patients with clinically curable carcinoma of the prostate. Pathologically, the disease was upstaged in many patients in both series. Digital rectal examination can have a significant impact on early detection of carcinoma of the prostate within a given population but it cannot be interpreted as a panacea for this disease.

The impact of cigarette smoking on stage, grade and number of recurrences of transitional cell carcinoma of the bladder

The records of 386 patients with diagnosed transitional cell carcinoma of the bladder were reviewed to determine a correlation between smoking history, and stage, grade and number of recurrences of transitional cell carcinoma. A significant association was detected between smoking history and all 3 variables. Within this military population 79 per cent of the patients were noted to have a smoking history, which is higher than most previously studied groups. These data further confirm the association between cigarette smoking and transitional cell carcinoma of the bladder, and suggest that cigarette smoking within the military population may portend a much higher cancer risk in this group.