A qualitative study of oral health knowledge among African Americans

OBJECTIVES

The purpose of this qualitative oral health needs assessment was to probe and better understand the oral health knowledge, beliefs, and barriers of District residents, particularly in DC wards where oral health disparities are most prevalent.

METHODS

Forty-eight (n = 48) participants were recruited for four focus groups. The focus group instrument consisted of a structured interview guide addressing the following topics: oral health history, perceived barriers to oral health, knowledge and perceptions about oral systemic health, and preferred message channels for receiving information on oral/dental health. Content analysis was performed using NVivo, a computerized, qualitative informatics tool.

RESULTS

The majority of participants in this study practiced both brushing and flossing in their daily dental routine and did not believe that tooth loss is a normal part of ageing. There was lack of knowledge on the connection between oral and systemic health, specifically impact of smoking, alcohol use, and sweets and sexual activity. Focus groups identified two main barriers to healthcare access-communication and affordability. Participants who had a dentist were satisfied and felt that their needs were met.

CONCLUSION

Our findings indicate a need for educational intervention and improved communication from oral health providers to increase awareness of the impact of systemic health and risky behaviors can have on oral health.

Abstract A23: Addressing men's health disparities in the District of Columbia

The Georgetown University Lombardi Comprehensive Cancer Center Office of Minority Health and Health Disparities Research is a community based center located in Ward 8 of the District of Columbia, which has some of the highest incidence and death from cancer in the city. Programs addressing men's health are very limited in these communities. Our location is easily accessible to the residents in Wards 6, 7, and 8 which are designated by the Department of Health and Human Services as medically underserved. Our mission is to facilitate, stimulate, and to promote synergy in addressing the biological and environmental basis of cancer health disparities via research, training, communication and education. Current programs include breast cancer prevention studies for African American and Hispanic Women, HPV Education, Environmental Justice, exercise studies to relieve the effects of cancer treatments for men and women. The Health Disparities Initiative also conducts community based boot camps, and regular focus groups to engage community support for our programs, and to give the residents the opportunity to let us know what their community needs are. The nearby Capitol Breast Care Center provides women with mammograms and cervical exams and needed follow-up regardless of a woman's ability to pay.

As a Community Health Educator I am a liaison between the residents of these communities and the Health Disparitiess Initiative. I actively participate in community activities that help promote healthy lifestyles and the reduction of chronic diseases. I am actively involved in the recruitment of residents from the community to form our Community Advisory Board and Environmental Justice Advisory Board. And I have accepted the invitation to sit on community boards and committees.

Citation Format: Everett Dodson. Addressing men's health disparities in the District of Columbia. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A23.

Abstract B12: The co-location of academia with the community in addressing cancer health disparities: A new model of partnerships for environmental public health

Environmental factors play an important and explanatory role in health disparities. Research suggests that a community should be an integral part of the process of solving community problems. Consequently, there has been a shift from traditional academic research to more community participatory approaches. To our knowledge none of these approaches have examined the role of academic co-locations (multiple site locations) as part of a community-level cancer prevention and disparities approach. Our co-location strategy involves exporting faculty and staff, clinical trials, interventions, outreach, education, and research from Georgetown University's main campus to a newly established office site located in Southeast, DC, a medically underserved area. Using the environmental focus group study as a case example of the impact of our co-location strategy, we seek to put forward an academic co-location definition and framework for implementation. Our findings show that co-location is a viable strategy that should be considered as part of a multifaceted approach in building and sustaining collaborative partnerships and research capacity, particularly within minority underserved communities. Focus group themes emerged around six topical areas: (1) the concept of environment, (2) perception of pollution, (3) perceptions of water quality, 4) perceptions of air quality, 5) health issues related environmental pollutants, (6) personal and community environment, and 7) environmental information received. Our co-location strategy was also associated with the following outcomes: beneficial in establishing trust, respect, accessibility, and success in study accrual and retention. Co-location benefits, challenges, and lessons learned are also discussed.

Citation Format: Sherrie Flynt Wallington, Chiranjeev Dash, Rhonda Hamilton, Everett Dodson, Lucile L. Adams-Campbell. The co-location of academia with the community in addressing cancer health disparities: A new model of partnerships for environmental public health. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr B12.

Abstract A37: Disparities in exposures to volatile organic compounds among the marginalized communities of inner city Washington DC

The District of Columbia has one of the highest cancer incidence and mortality rates in the nation in conjunction with significant cancer-related geographic and racial disparities. Besides exposures to behavioral and occupational risk factors, characterizing potential exposures to environmental carcinogens in such high risk areas as well as understanding exposure disparities is of public health importance. It has been reported that individuals residing in over-populated and /or underserved areas of major cities are at increased risk of being exposed to various air pollutants, but no studies to date have explored this issue among such communities of inner city Washington DC. Environmental carcinogens, such as chloroform, and benzene, are major components of air pollution from vehicular exhaust, factory and refinery emissions, some building materials and industrial/household solvents. In this study we examined the levels of chloroform, benzene, toluene, and 1,2-dichlorobenzene in high risk areas (<1 mile from highway/freeway) and compared it to those of low risk areas (>3 miles from the highway/freeway). Levels of selected volatile organic compounds (VOCs) including benzene, chloroform, toluene and 1,2-dichlorobenzene were measured inside and outside of 16 homes in high risk areas and 14 homes in low risk areas over a 72 hour time period using an 3M Organic Vapor Monitor and analyzed using gas chromatograph mass spectrometer (GC/MS). The levels of all the four VOCs in the high risk areas were higher both inside and outside the homes compared to the low risk areas. Mean chloroform levels outside the residences in high risk areas were significantly higher (1.24 μg/m3) in comparison to low risk areas (0.43μg/m3), (P < .05). Levels of all four compounds were higher inside the homes in both high and low risk areas than outside the homes, however, the inside-outside differences were significant for chloroform and toluene only. The mean exposure level of 1,2-dichlorobenzene was the highest (33.66μg/m3) inside the homes located in high risk areas as opposed to 1.48μg/m3 inside the homes in the low risk areas. This indicated a presence of additional indoor sources of this compounds including air fresheners, cleaning solvents, moth balls etc. in the high risk/low income communities. The results suggest that individuals living in high risk areas are more likely to be exposed to higher levels of indoor environmental carcinogens compared to low risk areas. Preventive efforts targeting indoor environmental carcinogens are warranted in efforts to reduce the cancer burden that disproportionately impacts African-Americans.

Citation Format: Ashley C. Huderson, Chiranjeev Dash, Everett Dodson, Amir Sapkota, Lucile Adams-Campbell. Disparities in exposures to volatile organic compounds among the marginalized communities of inner city Washington DC. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr A37.

National Institutes of Health State-of-the-Science Conference: role of active surveillance in the management of men with localized prostate cancer

National Institutes of Health (NIH) Consensus and State-of-the-Science Statements are prepared by independent panels of health professionals and public representatives on the basis of 1) the results of a systematic literature review prepared under contract with the Agency for Healthcare Research and Quality, 2) presentations by investigators working in areas relevant to the conference questions during a 2-day public session, 3) questions and statements from conference attendees during open discussion periods that are part of the public session, and 4) closed deliberations by the panel during the remainder of the second day and morning of the third. This statement is an independent report of the panel and is not a policy statement of NIH or the U.S. government. The statement reflects the panel’s assessment of medical knowledge available at the time the statement was written. Thus, it provides a “snapshot in time” of the state of knowledge on the conference topic. When reading the statement, keep in mind that new knowledge is inevitably accumulating through medical research. The following statement is an abridged version of the panel’s report, which is available in full at http://consensus.nih.gov/2011/prostatefinalstatement.htm

NIH State-of-the-Science Conference Statement: Role of active surveillance in the management of men with localized prostate cancer

OBJECTIVE

To provide healthcare providers, patients, and the general public with a responsible assessment of currently available data on the use of active surveillance and other observational management strategies for low-grade, localized prostate cancer.

PARTICIPANTS

A non-U.S. Department of Health and Human Services, nonadvocate 14-member panel representing the fields of cancer prevention and control, urology, pathology, epidemiology, genetics, transplantation, bioethics, economics, health services research, shared decisionmaking, health communication, and community engagement. In addition, 22 experts from pertinent fields presented data to the panel and conference audience.

EVIDENCE

Presentations by experts and a systematic review of the literature prepared by the Tufts Evidence-based Practice Center, through the Agency for Healthcare Research and Quality (AHRQ). Scientific evidence was given precedence over anecdotal experience.

CONFERENCE PROCESS

The panel drafted its statement based on scientific evidence presented in open forum and on published scientific literature. The draft statement was presented on the final day of the conference and circulated to the audience for comment. The panel released a revised statement later that day at http://consensus.nih.gov. This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government.

CONCLUSIONS

Prostate cancer screening with prostate-specific antigen (PSA) testing has identified many men with low-risk disease. Because of the very favorable prognosis of low-risk prostate cancer, strong consideration should be given to modifying the anxiety-provoking term "cancer" for this condition. Treatment of low-risk prostate cancer patients with radical prostatectomy or radiation therapy leads to side effects such as impotence and incontinence in a substantial number. Active surveillance has emerged as a viable option that should be offered to patients with low-risk prostate cancer. More than 100,000 men a year diagnosed with prostate cancer in the United States are candidates for this approach. However, there are many unanswered questions about active surveillance strategies and prostate cancer that require further research and clarification. These include: • Improvements in the accuracy and consistency of pathologic diagnosis of prostate cancer • Consensus on which men are the most appropriate candidates for active surveillance • The optimal protocol for active surveillance and the potential for individualizing the approach based on clinical and patient factors • Optimal ways to communicate the option of active surveillance to patients • Methods to assist patient decisionmaking • Reasons for acceptance or rejection of active surveillance as a treatment strategy • Short- and long-term outcomes of active surveillance. Well-designed studies to address these questions and others raised in this statement represent an important health research priority. Qualitative, observational, and interventional research designs are needed. Due to the paucity of evidence about this important public health problem, all patients being considered for active surveillance should be offered participation in multicenter research studies that incorporate community settings and partners.

Channels in the gramicidin S-with-urea structure and their possible relation to transmembrane ion transport

The structure of membrane-active antibiotic cyclodecapeptide gramicidin S in the crystals of its complex with urea, C(60)H(92)N(12)0(10).0.(5)[(NH(2))(2)CO].7.94H(2)0, has been investigated with three-dimensional X-ray data by the automatic sequential approximation method. The crystals are trigonal, space group P3(1)21, a = 25.80(3), c= 21.49 (2) A, M(r) = 7968, calculated density = 1.088 mg m(-3), Z = 1. Conventional R factor: R1 = 0.0943, wR2 = 0.2478 [I> 2sigma(I)]. The molecule possesses an antiparallel twisted beta-structure, with turns involving the Phe-Pro peptides. The Orn side chains extend on one side of the sheet, while the non-polar Val and Leu side chains are located on the other face. One of the Orn residues (namely Orn2) is linked by an intermolecular hydrogen bond to the O atom of Phe4 residue, the other is free. The side chains of the Phe residues have trans orientation (chi(1) approximately 180 degrees ) and those of the Val, Orn, Leu residues, except those of Orn2, have the preferential gauche orientation with the chi(1) angle close to 60. Two side chains show statistical disorder and conformation of the Pro residues is C(s)-C(beta)-exo. There is half a urea molecule and also 7.94 water molecules distributed on 13 positions for each antibiotic molecule. A partially occupied and poorly ordered alcohol molecule had been identified. The gramicidin S molecules are arranged around the 3(1) axis in the form of a left-handed double spiral forming suggestive channels. The outer hydrophobic surface of the spiral is made of uncharged side radicals while the inside surface consists of the main-chain atoms, mainly O and N, and of ornithine side chains with N atoms at the ends. By changing the Orn side-chain conformation, the inner diameter of the channels may change from 3.4 to 6.3 A. Thus, ions and particles of rather large size may pass through the channel. The possibility of the creation of the gramicidin S channels in mitochondrial membranes has been noted by some biochemists. The channel complexes are close-packed in a hexagonal arrangement in the crystal. The CI(-) ions, present in abundance in the mother solution, are not found ordered in the crystals, which may indicate the absence of the charges in the terminal N atoms of the Orn residues.

Virtual temporal bone dissection simulation

We have developed a working prototype system for the virtual simulation of temporal bone dissection. The system offers a paradigm from traditional practices by integrating technological advances to provide a safer and more cost effective way to learn fundamental techniques used in temporal bone surgeries. We present our methods to provide a real-time interactive volumetric system that obviates the need for physical materials in initial training, and provides a more accessible way for residents to practice and to increase exposure to pathological variance. Finally, we discuss ways to extend this work to more advanced resident training, presurgical planning, and surgical documentation.

The role of validation in macromolecular crystallography

The importance of validation techniques in X-ray structure determination and their relation to refinement procedures are discussed, with particular reference to atomic resolution structures. The requirements of deposition and publication, and the role of validation tools in this are analysed. The need for a rigorously defined file format is emphasized.

High resolution crystal structures and comparisons of T-state deoxyhaemoglobin and two liganded T-state haemoglobins: T(alpha-oxy)haemoglobin and T(met)haemoglobin

The origin of co-operativity in haemoglobin (Hb) resides in the reduced affinity of the T-state. T-state Hb crystals grown from polyethyleneglycol can be liganded without the molecule switching to the R high affinity state. X-ray analysis of T-state alpha-oxy Hb and T-state met Hb has identified the structural basis for reduced affinity. The nature of the chemical tension at the haem environment is different in the alpha and beta haems. There are small but definite structural changes associated with ligation in the T-state: these prove to be mostly in the same direction as the larger changes that occur in the T-->R transition.

Crystallographic refinement of trichosanthin at 2.6A resolution

The molecule model of trichosanthin has been rebuilt by using the electron density map improved by the solvent flatten and in accordance with the primary structure put forward by Collins. The crystallographic refinement of two trichosanthin molecules (3828 nonhydrogen atoms) in an asymmetric unit has been carried out by means of the restrain least-square procedure and diffraction data to a resolution of 2.6 A. The results are: an R factor 0.223 and the r.m.s. deviation of the bond length = 0.023 A. The new molecular model is in good agreement with the electron density map calculated with the coefficient 2Fo-Fc.

[Gramicidin channels: a new mechanism for transmembrane transfer of ions (from high resolution x-ray structural studies of the antibiotic)]

The crystal structure of the membrane-active antibiotic-cyclopeptide gramicidin S complex with urea was determined by the X-ray structure analysis. The gramicidin S molecule possesses an antiparallel beta-structure, its slightly twisted 30-membered cycle has a roughly rectangular form about 4.8 x 13.6 A in size, with the lesser side being formed by the main chain atoms of Phe and Pro residues. The maximum size of the molecule is 22.9 A. A characteristic feature of the molecule is the position of the extended side chains of the Orn residues on one side of the molecular cycle in the form of peculiar "legs--tentacles". One of these legs is "fastened" by the intramolecular H-bond to O atom of the nearer Phe4 residue, the other being free. The distance between the terminal NE atoms of the Orn residues is 5.7 A. The side chains of the Phe and Orn2 residues have trans-orientation, those of the Val, Orn7, Leu residues gauche-orientation. For Val1 and Leu3 side chains statistical disorder of the terminal C atoms is realized. The pyrrolidine rings of the Pro residues adopt Cs-C beta-exo conformation. There are one urea and 20 water molecules per one antibiotic molecule in the structure. The positions of three water molecules are fully occupied, the others with the probability of 0.56-0.20. One of the "water" positions is occupied on 2/3 by water, and on 1/3 by the O atom of the alcohol. There is a complicated system of intra- and intermolecular H-bonds in the structure, with and without the participation of water, alcohol and urea molecules. The gramicidin S molecules, collecting around 3(1) axis according to the left-handed double helix, form the channels whose outside hydrophobic surface is built of the side uncharged radicals, the inside surface being built of the main chain atoms, mainly of the O and N atoms and of the ornithine "tails" with uncharged NE atoms at the termini. The outer diameter of the channel is 29-43 A, inner (without ornithine "tails") is about 12.7 A. At the expense of the change of these "tails" conformation, the inner diameter of the channel filled with water molecules may change from 3.4 up to 6.3 A. Thus, the ions and particles of a rather large size may pass through the channel. The gramicidin channels are discovered and described for the first time. The channels in the crystal structure are close-packed under the hexagonal law.(ABSTRACT TRUNCATED AT 400 WORDS)

Technology enters the hospital's executive suite

Two major forces are driving the emergence of more powerful and comprehensive executive information systems: compression of the time horizon--CEO's cannot wait weeks or months for historical trends data--and EIS technological development that allows executives to tap into daily operations on all levels.

A serine protease triad forms the catalytic centre of a triacylglycerol lipase

True lipases attach triacylglycerols and act at an oil-water interface; they constitute a ubiquitous group of enzymes catalysing a wide variety of reactions, many with industrial potential. But so far the three-dimensional structure has not been reported for any lipase. Here we report the X-ray structure of the Mucor miehei triglyceride lipase and describe the atomic model obtained at 3.1 A resolution and refined to 1.9 A resolution. It reveals a Ser..His..Asp trypsin-like catalytic triad with an active serine buried under a short helical fragment of a long surface loop.

High-resolution (1.5 A) crystal structure of phospholipase C from Bacillus cereus

Both the phosphatidylinositol-hydrolysing and the phosphatidylcholine-hydrolysing phospholipases C have been implicated in the generation of second messengers in mammalian cells. The phosphatidylcholine-hydrolysing phospholipase C (PLC) from Bacillus cereus, a monomeric protein containing 245 amino-acid residues, is similar to some of the corresponding mammalian proteins. This, together with the fact that the bacterial enzyme can mimic the action of mammalian PLC in causing, for example, enhanced prostaglandin biosynthesis, suggests that B. cereus PLC can be used as a model for the hitherto poorly characterized mammalian PLCs. We report here the three-dimensional structure of B. cereus PLC at 1.5 A resolution. The enzyme is an all-helix protein belonging to a novel structural class and contains, at least in the crystalline state, three Zn2+ in the active site. We also present preliminary results from a study at 1.9 A resolution of the complex between PLC and inorganic phosphate (Pi) which indicate that the substrate binds directly to the metal ions.

Bonding of molecular oxygen to T state human haemoglobin

Haemoglobin (Hb) is the tetrameric protein molecule that in vertebrate blood transports oxygen from the lungs to the tissues. This function depends on four subunits in the molecule binding cooperatively so that their affinity for oxygen increases as the level of oxygenation increases. X-ray analysis has shown that deoxyhaemoglobin, which has a low oxygen affinity, and oxyhaemoglobin, which has a high oxygen affinity, differ principally in their subunit or quaternary structures, referred to as the T and R states, respectively. As it switches from the T state to the R state during oxygenation, Hb increases its oxygen affinity. However, the structural pathway between deoxy- and oxy-haemoglobin is not known, principally because there has been no accurate structural knowledge of the intermediate states. We report here the crystal structure of T state human Hb in which the alpha chains are oxygenated and the beta subunits are oxygen-free. In this crystal the Hb appears to be in an intermediate state between the unliganded T state and the liganded R state. There is also evidence that the Hb molecule operates by loading and unloading the beta haems and thus the alpha-oxy, beta-deoxy Hb crystal may represent a physiologically important state.

Evidence concerning insulin activity from the structure of a cross-linked derivative

The important of crystallographic refinement for confident structural description, even at modest resolution, is demonstrated for N alpha A1,N epsilon B29-L,L-2,7-diaminosuberoyl (A2sb) insulin, a cross-linked insulin of low potency. The spatial arrangement of the cross-link itself can be described, and reliable estimates of the accuracy in atomic positions obtained. Comparison of invariant A2sb and native insulins shows a strong structural similarity, especially for the A chain surface residues and the dimer-forming residues of the B chain which have generally been strongly implicated in the receptor-binding region. Evidence from this analysis directs attention to the A chain, particularly the backbone, as being important in interactions with the membrane-bound receptor.