Utilizing spatial statistics to identify cancer hot spots: a surveillance strategy to inform community-engaged outreach efforts

The HealthStreet Cancer Survivor Cohort: a Community Registry for Cancer Research

PURPOSE

This report describes a cancer survivor cohort from a community engagement program and compares characteristics and willingness to participate in health research between the cancer survivors and non-cancer community members.

METHODS

Among 11,857 members enrolled in HealthStreet at the University of Florida (10/2011-03/2020), 991 cancer survivors were identified and 1:1 matched to control members without cancer on sex, age, and zip code. Demographics, body weight, height, social determinants of health, history of cancer, and willingness to participate in research were recorded by Community Health Workers as a part of the baseline Health Needs Assessment.

RESULTS

Among the cancer survivors, 71.6% were female and 19.2% lived in rural areas with a mean age of 56.7 years in females and 60.8 years in males. At baseline, 44.7% received a cancer diagnosis within 5 years, while 15.8%, more than 20 years. Cancer survivors (vs. matched non-cancer controls) were less likely to be Black (31.1% vs. 63.6%) but more likely to be divorced, separated, or widowed (49.5% vs. 41.2%), be normal/underweight (34.0% vs. 25.6%) and have health insurance (80.0% vs. 68.6%; all p < 0.05). Cancer survivors versus matched controls reported higher rates of ever being in a health research study (32.4% vs. 24.9%) and interest in participating in studies ranging from minimal risk to greater-than-minimal risk.

CONCLUSIONS

Cancer survivors from this community engagement program agnostic to cancer types and treatment are diverse in geography, race, and social determinants of health and can be a valuable resource for observational, interventional, and biospecimen research in cancer survivorship.

Spatial clustering of colorectal cancer in Malaysia

INTRODUCTION

The rise in colorectal cancer (CRC) incidence becomes a global concern. As geographical variations in the CRC incidence suggests the role of area-level determinants, the current study was designed to identify the spatial distribution pattern of CRC at the neighbourhood level in Malaysia.

METHOD

Newly diagnosed CRC cases between 2010 and 2016 in Malaysia were identified from the National Cancer Registry. Residential addresses were geocoded. Clustering analysis was subsequently performed to examine the spatial dependence between CRC cases. Differences in socio-demographic characteristics of individuals between the clusters were also compared. Identified clusters were categorized into urban and semi-rural areas based on the population background.

RESULT

Most of the 18 405 individuals included in the study were male (56%), aged between 60 and 69 years (30.3%) and only presented for care at stages 3 or 4 of the disease (71.3%). The states shown to have CRC clusters were Kedah, Penang, Perak, Selangor, Kuala Lumpur, Melaka, Johor, Kelantan, and Sarawak. The spatial autocorrelation detected a significant clustering pattern (Moran's Index 0.244, p< 0.01, Z score >2.58). CRC clusters in Penang, Selangor, Kuala Lumpur, Melaka, Johor, and Sarawak were in urbanized areas, while those in Kedah, Perak and Kelantan were in semi-rural areas.

CONCLUSION

The presence of several clusters in urbanized and semi-rural areas implied the role of ecological determinants at the neighbourhood level in Malaysia.  Such findings could be used to guide the policymakers in resource allocation and cancer control.

Cancer Data Visualization: Developing Tools to Serve the Needs of Diverse Stakeholders

Purpose of review

To describe how cancer data visualization tools can catalyze novel research and inform local cancer control planning.

Recent findings

In recent years, cancer centers across the nation have increasingly embraced geospatial tools to respond to the unique distributions of disease and multilevel risk factors within their catchment areas. Sylvester Comprehensive Cancer Center in Miami, Florida, recently developed a publicly available, interactive, web-based cancer data visualization tool called SCAN360. Using SCAN360 as an example, we discuss key considerations and challenges for the development of cancer data visualization tools that serve the needs of stakeholders in community, academic and government settings.

Summary

Cancer data visualization tools are useful for stakeholders from diverse sectors and may facilitate a range of cancer control efforts, from identifying regions for targeted outreach and engagement, to informing the allocation of resources for government and community initiatives, and motivating collaborative, interdisciplinary cancer research.

Geospatial analysis of the global growth of community psychology: Geographic proximity and socioeconomic and political indicators

Data on 105 countries from the Global Development of Applied Community Studies project and a geographic information system (ArcGIS) were used to map and identify spatial patterns in the international growth of community psychology, as measured by professional associations and conferences, graduate and undergraduate programs and courses, and publications. Our primary aim was to analyze the field's global development, emphasizing professional training and research products, in the context of geographic proximity and theories of knowledge transfer and knowledge spillover. The results of Hot Spot Analysis and Cluster and Outlier Analysis spatially confirmed our hypothesis, revealing statistically significant hot spots of the strength of community psychology in the countries sharing borders. Hierarchical regression analysis found that the strength of community psychology in neighboring countries significantly predicted the development of community psychology beyond the influence of population size, Human Development Index, freedom score, and a history of grassroots activism. Implications for theory, research, and international professional and student exchanges are discussed.

Using Geographic Information Systems (GIS) for Targeted National Recruitment of Community-Dwelling Caregivers Managing Dementia-Related Behavioral and Psychological Symptoms: A Recruitment Approach for a Randomized Clinical Trial

Over 16 million caregivers of people living with dementia require support in a range of issues, including self-care, disease education, and guidance for how to manage behavioral and psychological symptoms of dementia (BPSD). Non-pharmacological interventions are needed to address these areas, and online applications have been shown to be safe and effective. To ensure the efficacy of such interventions, racially, ethnically, geographically, and socioeconomically diverse participants must be recruited to increase the generalizability of study outcomes. This protocol paper describes a recruitment plan using Geographic Information Systems (GIS) to reach a representative sample of caregivers across the United States for a national Phase III clinical study. Using publicly available census data from the American Community Survey (ACS), combined with location data for local aging resources such as Area Agencies on Aging (AAA), recruitment will be derived from data analysis conducted in ESRI ArcGIS v10.7.1. Datasets including age, gender, income, and education will be assessed nationally at the county and census tract spatial scale in a nine-step process to develop recruitment priority areas containing high concentrations of eligible participants living in the community. Overall, the current protocol will demonstrate the value of GIS in tailoring targeted outreach strategies to recruit community-dwelling populations through local resource institutions. This novel approach may have far-reaching implications in future recruitment initiatives and help to secure racially/ethnically diverse samples.

Leprosy in urban space, areas of risk for disability and worsening of this health condition in Foz Do Iguaçu, the border region between Brazil, Paraguay and Argentina

BACKGROUND

Leprosy is a public health problem and a challenge for endemic countries, especially in their border regions where there are intense migration flows. The study aimed to analyse the dynamics of leprosy, in order to identify areas of risk for the occurrence of the disease and disability and places where this health condition is worsening.

METHOD

This ecological study considered the new cases of leprosy reported in the municipality of Foz do Iguaçu from 2003 to 2015. Spatial and spatial-temporal scan statistics were used to identify the risk areas for the occurrence of leprosy, as well as the Getis-Ord Gi and Getis-Ord Gi* methods. Areas of risk for disabilities were identified by the scan statistic and kernel density estimation.

RESULTS

A total of 840 cases were reported, of which 179 (21.3%) presented Grade 1 or 2 disabilities at the time of diagnosis. Leprosy risk areas were concentrated in the Southern, Eastern and Northeastern Health Districts of the municipality. The cases of Grade 2 disability were observed with higher intensity in regions characterized by high population density and poverty.

CONCLUSION

The results of the study have revealed changes in the pattern of areas at risk of leprosy according to the investigated periods. In addition, it was possible to verify disabilities as a condition present in the investigated cases, or that may be related to the late diagnosis of the disease. In the areas of risk identified, patients have reported worse physical disability after diagnostic confirmation, or indicate inadequate clinical examination, reinforcing the need for structuring leprosy control services in a qualified manner.

The development of a participatory assessment technique for infrastructure: Neighborhood-level monitoring towards sustainable infrastructure systems

Climate change and increasing natural disasters coupled with years of deferred maintenance have added pressure to infrastructure in urban areas. Thus, monitoring for failure of these systems is crucial to prevent future impacts to life and property. Participatory assessment technique for infrastructure provides a community-based approach to assess the capacity and physical condition of infrastructure. Furthermore, a participatory assessment technique for infrastructure can encourage grassroots activism that engages residents, researchers, and planners in the identification of sustainable development concerns and solutions. As climate change impacts disproportionately affect historically disenfranchised communities, assessment data can further inform planning, aiming to balance the distribution of public resources towards sustainability and justice. This paper explains the development of the participatory assessment technique for infrastructure that can provide empirical data about the condition of infrastructure at the neighborhood-level, using stormwater systems in a vulnerable neighborhood in Houston, Texas as a case study. This paper argues for the opportunity of participatory methods to address needs in infrastructure assessment and describes the ongoing project testing the best use of these methods.

Microgeographic Heterogeneity of Border Malaria During Elimination Phase, Yunnan Province, China, 2011-2013

Malaria was concentrated in a few townships along the China–Myanmar border.

To identify township-level high-risk foci of malaria transmission in Yunnan Province, China, along the international border, we retrospectively reviewed data collected in hospitals and clinics of 58 townships in 4 counties during 2011–2013. We analyzed spatiotemporal distribution, especially hot spots of confirmed malaria, using geographic information systems and Getis-Ord G_i*(d) cluster analysis. Malaria incidence, transmission seasonality, and Plasmodium vivax:P. falciparum ratio remained almost unchanged from 2011 to 2013, but heterogeneity in distribution increased. The number of townships with confirmed malaria decreased significantly during the 3 years; incidence became increasingly concentrated within a few townships. High-/low-incidence clusters of P. falciparum shifted in location and size every year, whereas the locations of high-incidence P. vivax townships remained unchanged. All high-incidence clusters were located along the China–Myanmar border. Because of increasing heterogeneity in malaria distribution, microgeographic analysis of malaria transmission hot spots provided useful information for designing targeted malaria intervention during the elimination phase.

Geographic information system for improving maternal and newborn health: recommendations for policy and programs

This correspondence argues and offers recommendations for how Geographic Information System (GIS) applied to maternal and newborn health data could potentially be used as part of the broader efforts for ending preventable maternal and newborn mortality. These recommendations were generated from a technical consultation on reporting and mapping maternal deaths that was held in Washington, DC from January 12 to 13, 2015 and hosted by the United States Agency for International Development's (USAID) global Maternal and Child Survival Program (MCSP). Approximately 72 participants from over 25 global health organizations, government agencies, donors, universities, and other groups participated in the meeting.The meeting placed emphases on how improved use of mapping could contribute to the post-2015 United Nation's Sustainable Development Goals (SDGs), agenda in general and to contribute to better maternal and neonatal health outcomes in particular. Researchers and policy makers have been calling for more equitable improvement in Maternal and Newborn Health (MNH), specifically addressing hard-to-reach populations at sub-national levels. Data visualization using mapping and geospatial analyses play a significant role in addressing the emerging need for improved spatial investigation at subnational scale. This correspondence identifies key challenges and recommendations so GIS may be better applied to maternal health programs in resource poor settings. The challenges and recommendations are broadly grouped into three categories: ancillary geospatial and MNH data sources, technical and human resources needs and community participation.

Seasonal dynamics and microgeographical spatial heterogeneity of malaria along the China-Myanmar border

Malaria transmission is heterogeneous in the Greater Mekong Subregion with most of the cases occurring along international borders. Knowledge of transmission hotspots is essential for targeted malaria control and elimination in this region. This study aimed to determine the dynamics of malaria transmission and possible existence of transmission hotspots on a microgeographical scale along the China-Myanmar border. Microscopically confirmed clinical malaria cases were recorded in five border villages through a recently established surveillance system between January 2011 and December 2014. A total of 424 clinical cases with confirmed spatial and temporal information were analyzed, of which 330 (77.8%) were Plasmodium vivax and 88 (20.8%) were Plasmodium falciparum, respectively. The P. vivax and P. falciparum case ratio increased dramatically from 2.2 in 2011 to 4.7 in 2014, demonstrating that P. vivax malaria has become the predominant parasite species. Clinical infections showed a strong bimodal seasonality. There were significant differences in monthly average incidence rates among the study villages with rates in a village in China being 3-8 folds lower than those in nearby villages in Myanmar. Spatial analysis revealed the presence of clinical malaria hotspots in four villages. This information on malaria seasonal dynamics and transmission hotspots should be harnessed for planning targeted control.

A serum-circulating long noncoding RNA signature can discriminate between patients with clear cell renal cell carcinoma and healthy controls

Serum biomarkers have not been fully incorporated into clinical use for the diagnosis of renal cell carcinoma (RCC). The recent discovery of long noncoding RNAs (lncRNAs), which have been reported in a variety of cancer types, suggested a promising new class of biomarkers for tumour diagnosis. The aim of our study was to evaluate whether the levels of circulating lncRNAs could be used as a tumour marker to discriminate between clear cell RCC (ccRCC) patients and healthy controls. Serum samples were collected from 71 ccRCC patients including 62 age- and sex-matched healthy controls and 8 patients with benign renal tumours. Eighty-two cancer-associated lncRNAs were assessed by reverse transcription and quantitative polymerase chain reaction in paired tissues and serum. A 5-lncRNA signature, including lncRNA-LET, PVT1, PANDAR, PTENP1 and linc00963, were identified and validated in the training set and testing set, respectively. The receiver operating characteristic curves for this serum 5-lncRNA signature were 0.900 and 0.823 for the two sets of serum samples. Moreover, five-minus-one lncRNA signatures demonstrated that none of the lncRNAs had a higher area under the curve than the others in either set. A risk model for the serum 5-lncRNA signature also determined that benign renal tumours can be distinguished from ccRCC samples. This work may facilitate the detection of ccRCC and serve as the basis for further studies of the clinical value of serum lncRNAs in maintaining surveillance and forecasting prognosis.

Building global capacity for brain and nervous system disorders research

The global burden of neurological, neuropsychiatric, substance-use and neurodevelopmental disorders in low- and middle-income countries is worsened, not only by the lack of targeted research funding, but also by the lack of relevant in-country research capacity. Such capacity, from the individual to the national level, is necessary to address the problems within a local context. As for many health issues in these countries, the ability to address this burden requires development of research infrastructure and a trained cadre of clinicians and scientists who can ask the right questions, and conduct, manage, apply and disseminate research for practice and policy. This Review describes some of the evolving issues, knowledge and programmes focused on building research capacity in low- and middle-income countries in general and for brain and nervous system disorders in particular.