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Ballas LK, Reddy CA, Han HR, Makar J, Mian OY, Broughman JR, de Bustamante C, Eggener S, Liauw S, Abramowitz MC, Montoya C, Tendulkar RD. Patterns of Recurrence Following Radiation and ADT for Pathologic Lymph Node Positive Prostate Cancer: A Multi-Institutional Study. Int J Radiat Oncol Biol Phys 2023; 117:e365. [PMID: 37785252 DOI: 10.1016/j.ijrobp.2023.06.2459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Retrospective studies have suggested that post-operative radiation therapy (RT) can reduce the risk of cause-specific mortality in men with pathologic nodal involvement (pN1) after radical prostatectomy (RP). We evaluated prognostic factors and patterns of recurrence in patients who received post-operative RT +/- androgen deprivation therapy (ADT) for pN1 disease in a multicentric cohort of 4 academic centers. MATERIALS/METHODS Data from patients with pN1 prostate cancer after RP who subsequently received RT with short term (< = 6 mo) or long term (>6 mo) ADT were obtained from 4 academic institutions. Patterns of recurrence, biochemical progression free survival (bPFS) and distant metastasis free survival (DMFS) were evaluated. RESULTS A total of 270 patients with a median follow-up of 48 months were included. Gleason grade group (GG) 2 was present in 20 patients (7.5%), GG 3 in 81 (30%), GG4 in 36 (13.5%), GG5 in 130 (49%) patients. 256 (95%) patients had extracapsular extension, 70% had seminal vesicle invasion, 59% had positive surgical margins, and 66% had a detectable post-operative PSA. The number of positive nodes at surgery were 1 in 59%, 2 in 19% and >2 in 22% of patients. Of the 83 patients that had pre-RT imaging, 46 (55%) had a PET scan (PSMA, or fluciclovine); 25 (30%) of those had lymph nodes detected on imaging prior to RT. Median time from RP to RT was 6 mo (IQR 4.5-9.1 mo). 96% received radiation to both the prostate bed (median dose 68.4Gy) and pelvic lymph nodes (median dose 46Gy). ADT was prescribed short-term (20%) or long-term (68%), while 26 (10%) received no ADT, and 7 (3%) had an unknown duration. Biochemical failure (bF) was observed in 29% of men, with 5% having pelvic nodal failure and 11.5% having distant metastases (majority in bones, followed by paraaortic nodes) at last follow up. Of 59 patients who had normal baseline testosterone levels, 37% recovered their testosterone by last follow-up. The 4-year bRFS was 72% for all patients and was 83% for those with a pre-RT PSA of <0.1 ng/mL, 76% for PSA 0.1-<0.5 ng/mL, 60% for PSA 0.5-2 ng/mL, and 35% for PSA >2 ng/mL. On multivariable analysis, maximum pre-RT PSA ≥0.5 (0.5 to 2.0 vs <0.1 HR = 3.19; >2.0 vs <0.1 HR = 9.00), use of LTADT (HR = 0.47), and percent pN1 (HR = 1.03) were significantly associated with bF. Pre-RT PSA >2 (HR = 4.10), use of LT ADT (HR = 0.33) and percent pN1 (HR = 1.03) were also significantly associated with DM. CONCLUSION In pN1 patients, pelvic RT and ADT at low PSA levels is associated with improved oncologic outcomes compared to treatment at higher levels, suggesting that PSA may have prognostic value for pN1 prostate cancer.
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Affiliation(s)
- L K Ballas
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - C A Reddy
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - H R Han
- Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
| | - J Makar
- California University of Science and Medicine, Colton, CA
| | - O Y Mian
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | | | - C de Bustamante
- Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, IL
| | - S Eggener
- Department of Surgery, University of Chicago Medical Center, Chicago, IL
| | - S Liauw
- Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, IL
| | - M C Abramowitz
- Department of Radiation Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL
| | - C Montoya
- University of Miami School of Medicine, Miami, FL
| | - R D Tendulkar
- Dept of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
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Lock D, Vassantachart A, Ragab O, Jennelle R, Han HR, Mehta S, Cheng K, Yang C, Omeh S, Miller K, Stal J, Ballas LK. Radiation Therapy Knowledge and Health Literacy among Culturally Diverse Patients with Prostate Cancer Treated at a Safety-Net Hospital. Int J Radiat Oncol Biol Phys 2023; 117:e409-e410. [PMID: 37785358 DOI: 10.1016/j.ijrobp.2023.06.1553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Shared decision making is integral to the physician-patient relationship for radiotherapy (RT) patients. It is implicit that patients both comprehend and retain information explained during consultation. However, quality and quantity of patient knowledge following this visit is unknown. The purpose of this study was to evaluate post-consultation RT knowledge and health literacy among a diverse group of patients. MATERIALS/METHODS Participants were patients ≥18 years old who received consultation for definitive or salvage RT to the prostate gland/fossa between April 2021 and January 2023 at an urban safety-net hospital. Following consultation, patients completed the Radiation Oncology Knowledge Assessment Survey (ROKAS), designed to measure patient understanding of proposed RT treatment (e.g., treatment frequency, length, safety) and possible short- and long-term side effects (SE). Additional measures included patients' health literacy, health numeracy (numerical medical concepts), acculturation (assimilation to the dominant culture), and socioeconomic factors. ROKAS was administered in both English and Spanish with Spanish-speaking patients offered medical translation if desired. Bivariate Pearson correlations were conducted to examine the relationships between independent variables and post-consultation RT knowledge. Two-sided t-tests were conducted to examine differences in patients' knowledge by language. RESULTS Overall, 39 ROKAS were completed by 24 English-speaking and 15 Spanish-speaking patients (mean age 64.4 [SD 6.8], range 52-79). The majority (93%) of patients 'agreed' or 'strongly agreed' that they understood all the RT information presented. However, only 70% of the RT questions were answered correctly with 26% of patients answering all RT questions correctly. Similarly, 95% of patients 'agreed' or 'strongly agreed' with knowing the side effects of their proposed treatment, but only 71% and 74% of short- and long-term SE questions, respectively, were answered correctly. Higher health literacy (p = 0.04) and health numeracy (p = 0.001) were significantly correlated with better understanding of short-term SE, but not with RT knowledge or long-term SE. Spanish-speaking patients had significantly lower scores of health literacy (p = 0.001) and understanding of long-term (p = 0.01), but not short-term SE. CONCLUSION There is a significant gap between perceived and measured knowledge of RT treatment and SE in patients who receive consultation for RT to the prostate gland/fossa. Health literacy was significantly associated with improved knowledge of RT and short-term SE. Spanish-speaking patients had poorer understanding of long-term SE than English-speaking patients. Efforts to identify gaps in patient health literacy are needed to target those at risk and ensure that culturally diverse patient populations can engage in shared decision making with their providers.
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Affiliation(s)
- D Lock
- Department of Radiation Oncology, LAC+USC Medical Center, Los Angeles, CA; Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - A Vassantachart
- Department of Radiation Oncology, LAC+USC Medical Center, Los Angeles, CA; Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - O Ragab
- Department of Radiation Oncology, Washington DC VA Medical Center, Washington, DC
| | - R Jennelle
- Department of Radiation Oncology, LAC+USC Medical Center, Los Angeles, CA
| | - H R Han
- Department of Radiation Oncology, LAC+USC Medical Center, Los Angeles, CA; Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - S Mehta
- Department of Radiation Oncology, LAC+USC Medical Center, Los Angeles, CA; Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - K Cheng
- Department of Radiation Oncology, LAC+USC Medical Center, Los Angeles, CA; Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - C Yang
- Department of Radiation Oncology, LAC+USC Medical Center, Los Angeles, CA; Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - S Omeh
- Department of Radiation Oncology, LAC+USC Medical Center, Los Angeles, CA; Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - K Miller
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - J Stal
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - L K Ballas
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
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Han HR, Garsa AA. Timely Initiation of Radiation Treatment for Primary Head and Neck Squamous Cell Carcinoma in an Urban Safety Net Hospital during the COVID-19 Pandemic. Int J Radiat Oncol Biol Phys 2023; 117:e389-e390. [PMID: 37785309 DOI: 10.1016/j.ijrobp.2023.06.2512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Delayed initiation of radiation treatment for head and neck squamous cell cancer (HNSCC) may lead to worse survival, higher recurrence, and increased financial burden on patients. In times of limited resources, timely treating underserved population of HNSCC patients pose a special challenge to a safety net setting. This single-institutional study aims to characterize and compare treatment delays in HNSCC before and during the COVID-19 pandemic at an urban safety net hospital in Los Angeles to assess the success of efforts made to deliver timely care. MATERIALS/METHODS Patients who received definitive or post-operative radiotherapy for treatment of primary HNSCC at LAC+USC Medical Center between 2010-2021 were retrospectively reviewed. Time to treatment initiation (TTI) was defined as date of histopathological diagnosis to date of first radiation treatment for definitive and date of surgery to date of first radiation treatment for post-operative patients. RESULTS Among 70 patients with HNSCC (mean age at diagnosis 55 years, 79% male), 31 patients (18 pre-pandemic, 13 peri-pandemic) were treated definitively with chemoradiation, and 39 patients (24 pre-pandemic, 15 peri-pandemic) were treated post-operatively. Overall, the median TTI was 50 days (interquartile range, IQR 42-74 days); median TTI for pre-pandemic HNSCC patients was 49 days (IQR 43-70 days) and median TTI for peri-pandemic HNSCC patients was 51 days (IQR 43-75 days). The median TTI for definitive radiation was 52 days (IQR 42-93) for pre-pandemic and 52 days (IQR 44-61) for peri-pandemic patients. The median TTI for post-operative radiation was 47 days (IQR 41-75) for pre-pandemic and 50 days (IQR 48-73) for peri-pandemic patients. During the pandemic, there were fewer (38% vs 44%) definitive patients whose TTI exceeded 60 days, whereas more (40% vs 33%) post-operative patients had TTI >60 days. CONCLUSION By prioritizing treatment of definitive and high-risk post-operative HNSCC patients according to ASTRO-ESTRO consensus guidelines, expanding the use of telephone follow-up to ensure continuity of care, teleconferencing for multidisciplinary tumor board discussions, and initiating COVID-19 protocols in which mildly symptomatic patients were treated at the end of the day, we were able to maintain timely initiation of radiation treatment not compromised by the pandemic.
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Affiliation(s)
- H R Han
- Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, CA; Department of Radiation Oncology, LAC+USC Medical Center, Los Angeles, CA
| | - A A Garsa
- University of Southern California Keck School of Medicine, Department of Radiation Oncology, Los Angeles, CA
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Han HR, Choi CE, Nagad M, Patwardhan KR, Boer J, Jemec G, Chandran NS. Prevalence and Perceptions Towards Hidradenitis suppurativa; A Cross-Sectional Study in a Non-Dermatological Outpatient Population. J Eur Acad Dermatol Venereol 2022; 36:e392-e394. [PMID: 35034401 DOI: 10.1111/jdv.17933] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/05/2021] [Accepted: 01/07/2022] [Indexed: 11/26/2022]
Affiliation(s)
- H R Han
- Division of Dermatology, Department of Medicine, National University Hospital, Singapore
| | - C E Choi
- Division of Dermatology, Department of Medicine, National University Hospital, Singapore
| | - M Nagad
- Division of Dermatology, Department of Medicine, National University Hospital, Singapore
| | - K R Patwardhan
- Division of Dermatology, Department of Medicine, National University Hospital, Singapore
| | - J Boer
- Department of Dermatology, Deventer Hospital, N. Bolkesteinlaan 75, 7416 SE, The Netherlands
| | - Gbe Jemec
- Department of Dermatology, Zealand University Hospital, Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - N S Chandran
- Division of Dermatology, Department of Medicine, National University Hospital, Singapore
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Jenkins E, D'Aoust R, Elias S, Han HR, Sharps P, Alvarez C. Faculty peer review of teaching taskforce: A quantitative descriptive research study for the peer review process. Nurse Educ Today 2021; 106:105055. [PMID: 34304102 DOI: 10.1016/j.nedt.2021.105055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 06/16/2021] [Accepted: 07/05/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Peer review of teaching is important for both the faculty and student experience. Enhanced awareness of student learning experiences and a deeper reflection on teaching makes this process attractive to faculty leaders, staff and students. Evidence suggests that teachers who are reviewed gain confidence, anticipate improvement in teaching and are inclined to discuss their teaching with colleagues in the future. OBJECTIVE To describe the development of a peer review of teaching process by the Faculty Peer Review of Teaching Taskforce at a school of nursing. METHODS A five-step Design for Six Sigma methodology was used and includes: Define, Measure, Analyze, Design, Verify (DMADV). In keeping with this methodology we: (1) established a Faculty Peer Review of Teaching Taskforce; (2) conducted a literature review on best practices; (3) reviewed peer institution practices; and (4) surveyed faculty to obtain their perspectives on the qualities of good teaching and the peer review of teaching process. Twenty-seven of the 68 full-time faculty members returned Qualtrics surveys (return rate = 39.7%). RESULTS Review of the literature yielded four major themes, including post-observation discussion and systematic assignment of peer review pairs. Variation in practices across institutions was identified, from formal structured processes, to peer review conducted only in special circumstances. Survey findings revealed that faculty members overwhelmingly endorse the qualities of good teaching, agree that the peer review process should be required, and that peer reviewers should have several years of teaching experience. CONCLUSIONS Our faculty were supportive of a peer review teaching process. As teaching demands continue to increase given the evolving complexities of nursing care, teaching platforms (i.e. online, hybrid), and diverse student body, we hope the process we develop may serve as a model for other higher education schools to enhance and maintain excellence in teaching for both the faculty and student experience.
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Affiliation(s)
- Emerald Jenkins
- Johns Hopkins School of Nursing, 525 N. Wolfe St, Baltimore, MD 21205, United States of America.
| | - Rita D'Aoust
- Johns Hopkins School of Nursing, Joint Appointment, General Internal Medicine, Johns Hopkins School of Medicine, 525 N. Wolfe St, Baltimore, MD 21205, United States of America.
| | - Sabrina Elias
- Johns Hopkins School of Nursing, 525 N. Wolfe St, Baltimore, MD 21205, United States of America.
| | - Hae Ra Han
- Johns Hopkins School of Nursing, Joint Appointment with the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 525 N. Wolfe St, Baltimore, MD 21205, United States of America.
| | - Phyllis Sharps
- Johns Hopkins School of Nursing, 855 N Wolfe St - Rangos Building - Room 608, Baltimore, MD 21205, United States of America.
| | - Carmen Alvarez
- Johns Hopkins School of Nursing, 525 N. Wolfe St, Baltimore, MD 21205, United States of America.
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Mendez KJW, Budhathoki C, Labrique AB, Sadak T, Tanner EK, Han HR. Factors Associated With Intention to Adopt mHealth Apps Among Dementia Caregivers With a Chronic Condition: Cross-sectional, Correlational Study. JMIR Mhealth Uhealth 2021; 9:e27926. [PMID: 34463637 PMCID: PMC8441609 DOI: 10.2196/27926] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/26/2021] [Accepted: 06/04/2021] [Indexed: 12/19/2022] Open
Abstract
Background In the United States, nearly 80% of family caregivers of people with dementia have at least one chronic condition. Dementia caregivers experience high stress and burden that adversely affect their health and self-management. mHealth apps can improve health and self-management among dementia caregivers with a chronic condition. However, mHealth app adoption by dementia caregivers is low, and reasons for this are not well understood. Objective The purpose of this study is to explore factors associated with dementia caregivers’ intention to adopt mHealth apps for chronic disease self-management. Methods We conducted a cross-sectional, correlational study and recruited a convenience sample of dementia caregivers. We created a survey using validated instruments and collected data through computer-assisted telephone interviews and web-based surveys. Before the COVID-19 pandemic, we recruited dementia caregivers through community-based strategies, such as attending community events. After nationwide closures due to the pandemic, the team focused on web-based recruitment. Multiple logistic regression analyses were used to test the relationships between the independent and dependent variables. Results Our sample of 117 caregivers had an average age of 53 (SD 17.4) years, 16 (SD 3.3) years of education, and 4 (SD 2.5) chronic conditions. The caregivers were predominantly women (92/117, 78.6%) and minorities (63/117, 53.8%), experienced some to extreme income difficulties (64/117, 54.7%), and were the child or child-in-law (53/117, 45.3%) of the person with dementia. In logistic regression models adjusting for the control variables, caregiver burden (odds ratio [OR] 1.3, 95% CI 0.57-2.8; P=.57), time spent caregiving per week (OR 1.7, 95% CI 0.77-3.9; P=.18), and burden of chronic disease and treatment (OR 2.3, 95% CI 0.91-5.7; P=.08) were not significantly associated with the intention to adopt mHealth apps. In the final multiple logistic regression model, only perceived usefulness (OR 23, 95% CI 5.6-97; P<.001) and the interaction term for caregivers’ education and burden of chronic disease and treatment (OR 31, 95% CI 2.2-430; P=.01) were significantly associated with their intention to adopt mHealth apps. Perceived ease of use (OR 2.4, 95% CI 0.67-8.7; P=.18) and social influence (OR 1.8, 95% CI 0.58-5.7; P=.31) were not significantly associated with the intention to adopt mHealth apps. Conclusions When designing mHealth app interventions for dementia caregivers with a chronic condition, it is important to consider caregivers’ perceptions about how well mHealth apps can help their self-management and which app features would be most useful for self-management. Caregiving factors may not be relevant to caregivers’ intention to adopt mHealth apps. This is promising because mHealth strategies may overcome barriers to caregivers’ self-management. Future research should investigate reasons why caregivers with a low education level and low burden of chronic disease and treatment have significantly lower intention to adopt mHealth apps for self-management.
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Affiliation(s)
| | - Chakra Budhathoki
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Alain Bernard Labrique
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Tatiana Sadak
- School of Nursing, University of Washington, Seattle, WA, United States
| | - Elizabeth K Tanner
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Hae Ra Han
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States.,Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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Nkimbeng M, Bandeen-Roche K, Han HR, Szanton SL, Thorpe R. EXPERIENCES OF DISCRIMINATION ARE ASSOCIATED WITH DECREASED FUNCTIONAL ABILITY IN AFRICAN IMMIGRANT OLDER ADULTS. Innov Aging 2019. [PMCID: PMC6841022 DOI: 10.1093/geroni/igz038.2622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Discrimination impacts functional health outcomes of African Americans and other racial/ethnic minorities in the United States; yet this is understudied in African immigrants whose population has risen by 137% since 2000. We examined the relationship between discrimination and physical function with a convenience sample of first-generation African immigrants age 50+ recruited through community-based organizations (N=124). Discrimination was measured with the Everyday Discrimination scale with higher scores indicating more experiences of discrimination (range=0-23). High versus low levels of discrimination were categorized at the mean. Physical function was measured using the PROMIS Physical Function measure with high scores indicating greater functional ability (range=11-50). Raw function scores were converted to standardized T-scores with a population mean of 50 and standard deviation (SD) of 10. Linear regression was used for analyses. Mean age of the sample was 61.4(SD=7.9) years. About two-thirds (63%) were female, more than half (52.4%) immigrated in search of better opportunities and half of the sample had high levels of discrimination. The mean function score was 44.2(SD=8.3) indicating that this sample had functional ability 6 points less than the population average. After adjusting for demographic and migration factors, the mean physical function score was 2.5 points lower (b=-2.53, 95% CI= -5.04, -0.01) for participants with more experiences compared to those with fewer experiences of discrimination. In conclusion, discrimination was associated with poor physical function in African immigrant older adults after adjusting for covariates. Longitudinal studies of discrimination and physical functioning should be pursued in more diverse, larger samples of African immigrants.
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Affiliation(s)
- Manka Nkimbeng
- Johns Hopkins School of Nursing, Baltimore, Maryland, United States
| | - Karen Bandeen-Roche
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - Hae Ra Han
- Johns Hopkins School of Nursing, Baltimore, Maryland, United States
| | - Sarah L Szanton
- Johns Hopkins School of Nursing, Baltimore, Maryland, United States
| | - Roland Thorpe
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
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Gleason KT, Dennison Himmelfarb CR, Ford DE, Lehmann H, Samuel L, Han HR, Jain SK, Naccarelli GV, Aggarwal V, Nazarian S. Association of sex, age and education level with patient reported outcomes in atrial fibrillation. BMC Cardiovasc Disord 2019; 19:85. [PMID: 30953478 PMCID: PMC6451250 DOI: 10.1186/s12872-019-1059-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 03/21/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In atrial fibrillation (AF), there are known sex and sociodemographic disparities in clinical outcomes such as stroke. We investigate whether disparities also exist with respect to patient-reported outcomes. We explored the association of sex, age, and education level with patient-reported outcomes (AF-related quality of life, symptom severity, and emotional and functional status). METHODS The PaTH AF cohort study recruited participants (N = 953) with an AF diagnosis and age ≥ 18 years across 4 academic medical centers. We performed longitudinal multiple regression with random effects to determine if individual characteristics were associated with patient-reported outcomes. RESULTS Women reported poorer functional status (β - 2.23, 95% CI: -3.52, - 0.94) and AF-related quality of life (β - 4.12, 95% CI: -8.10, - 0.14), and higher symptoms of anxiety (β 2.08, 95% CI: 0.76, 3.40), depression (β 1.44, 95% CI: 0.25, 2.63), and AF (β 0.29, 95% CI: 0.08, 0.50). Individuals < 60 years were significantly (p < 0.05) more likely to report higher symptoms of depression, anxiety, and AF, and poorer AF-related quality of life. Lack of college education was associated with reporting higher symptoms of AF (β 0.42, 95% CI: 0.17, 0.68), anxiety (β 1.86, 95% CI: 0.26, 3.45), and depression (β 1.11, 95% CI: 0.15, 2.38), and lower AF-related quality of life (β - 4.41, 95% CI: -8.25, - 0.57) and functional status. CONCLUSION Women, younger adults, and individuals with lower levels of education reported comparatively poor patient-reported outcomes. These findings highlight the importance of understanding why individuals experience AF differently based on certain characteristics.
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Affiliation(s)
- Kelly T Gleason
- School of Nursing, Johns Hopkins University, 525 N Wolfe Street, Baltimore, MD, 21205, USA.
| | | | - Daniel E Ford
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Harold Lehmann
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Laura Samuel
- School of Nursing, Johns Hopkins University, 525 N Wolfe Street, Baltimore, MD, 21205, USA
| | - Hae Ra Han
- School of Nursing, Johns Hopkins University, 525 N Wolfe Street, Baltimore, MD, 21205, USA
| | - Sandeep K Jain
- School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Gerald V Naccarelli
- Penn State Milton S. Hershey Medical Center, State College, Hershey, PA, USA
| | - Vikas Aggarwal
- University of Michigan Health System/Frankel Cardiovascular Center, Ann Harbor, MI, USA
| | - Saman Nazarian
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA.,School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Jo EA, Wu SS, Han HR, Cho KI. 221Impact of exergame vs. treadmill exercise on cardiorespiratory fitness, endothelial function and epicardial fat thickness in patients with high cardiovascular risk. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- E A Jo
- Kosin University School of Medicine, Convergence medicine & Exercise science research institute, Busan, Korea Republic of
| | - S S Wu
- Pusan National University Hospital, Department of Sports Science, Pusan, Korea Republic of
| | - H R Han
- Pusan National University Hospital, Department of Sports Science, Pusan, Korea Republic of
| | - K I Cho
- Kosin University School of Medicine, Cardiology, Internal medicine, Busan, Korea Republic of
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Gray TF, Cudjoe J, Han HR, Wenzel J, Thorpe R, Murphy J. Abstract 5293: Have you checked? Disparities in cancer screening practices among minority populations. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-5293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Objective: There is a disproportionately higher burden of cancer among racial and ethnic minorities, with the incidence only expected to increase significantly by 2050. These racial differences may be due to the quality of early detection screening among this population. The purpose of this research is to provide case study reports about cancer screening practices among at-risk populations as well as those from underrepresented racial and ethnic minority backgrounds as well as sexual and gender minorities in order to describe disparities in cancer screening practices. These five case studies reveal how racial disparities vary by cancer site. These case studies will share information about current cancer prevalence, current recommendations for cancer prevention, national guidelines about early detection for lung, colorectal, prostate, cervical and breast cancers, as well as discuss ways to reduce cancer health disparities and improve screening practices.
Methods: Data sources for these case studies include research reports, literature review, clinically-based articles, research articles, websites, as well as clinical practice observations and experiences.
Research Summary: These case studies contribute to the growing body of knowledge related to cancer health disparities, with a special emphasis on cancer screening behaviors among underrepresented, at-risk, and racial and ethnic minority backgrounds. Since cancer care is multidisciplinary, these case reports also highlight the role of oncology nurses in helping to lead in educating, promoting, and bringing awareness to cancer screening recommendations and current cancer prevention guidelines for individuals and their families. Nurses recognize that one of the biggest barriers to screening is when individual have unrelated health care priorities that overshadow priorities related to screening, such as food, shelter, and safety. Nurses are also positioned to provide cancer-specific screening guidelines and resources to help individuals implement these recommendations into their daily lives. Improving screening rates among minority populations requires collaborations with the health care systems and the community.
Conclusion: Evidence indicates that there are significant disparities that exist in cancer screening practices among minority populations as well as disproportionately higher cancer mortality rates in these populations. Barriers to screening include lack of access to high-quality health care, lack of health insurance, transportation issues, fear and lack of trust in the health care team, embarrassment, stigma related to sexual orientation or gender identity, discrimination in quality care and treatment, as well as lack of awareness about screening recommendations. Recognition of barriers to screening among minority populations is critical to developing targeted interventions that promote adherence and decrease risks of cancer-related mortality.
Citation Format: Tamryn F. Gray, Joycelyn Cudjoe, Hae Ra Han, Jennifer Wenzel, Roland Thorpe, Jeanne Murphy. Have you checked? Disparities in cancer screening practices among minority populations [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5293. doi:10.1158/1538-7445.AM2017-5293
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Affiliation(s)
| | | | - Hae Ra Han
- 1Johns Hopkins University, Baltimore, MD
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11
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Han HR, Lee JE, Kim K, Chung Y, Kim MT, Robinson C, Lee M. Healthcare utilization among North Korean refugees in South Korea: a mixed methods study. Public Health 2016; 142:116-120. [PMID: 27592505 DOI: 10.1016/j.puhe.2016.07.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 07/23/2016] [Accepted: 07/29/2016] [Indexed: 11/16/2022]
Affiliation(s)
- H R Han
- The Johns Hopkins University School of Nursing, Baltimore, MD, USA.
| | - J E Lee
- Catholic University of Korea College of Nursing, Seoul, Republic of Korea
| | - K Kim
- The Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Y Chung
- The Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - M T Kim
- University of Texas at Austin School of Nursing, Austin, TX, USA
| | - C Robinson
- The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - M Lee
- Yonsei University School of Public Health, Seoul, Republic of Korea
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Han HR, Ryu HJ, Cha HS, Go MJ, Ahn Y, Koo BK, Cho YM, Lee HK, Cho NH, Shin C, Shin HD, Kimm K, Kim HL, Oh B, Park KS. Genetic variations in the leptin and leptin receptor genes are associated with type 2 diabetes mellitus and metabolic traits in the Korean female population. Clin Genet 2008; 74:105-15. [DOI: 10.1111/j.1399-0004.2008.01033.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Shin IS, Nam MJ, Park SJ, Youn HY, Han HR. Cloning of canine GM-CSF and SCF genes. J Vet Sci 2001; 2:159-66. [PMID: 12441694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
Abstract
Cytokines have pleiotropic regulatory effects on hematopoietic cells and many other cell types that participate in host defence and repair processes. Granulocyte-macrophage colony-stimulating factor (GM-CSF) mediates the growth and differentiation of granulocytes and macrophages and regulates the biological functions expressed by mature cells of these lineages. Stem cell factor (SCF) is a multifunctional cytokine involved in hematopoiesis, melanogenesis and gametogenesis. In order to determine the complementary DNA (cDNA) of canine GM-CSF and canine SCF, cDNA clones were generated from lipopolysaccharide (LPS) stimulated peripheral blood mononuclear cells (PBMCs) and bone marrow cells by reverse transcription PCR amplification. The canine GM-CSF cDNA obtained in this study contains an open reading frame encoding 144 amino acid residues and has 53-75% homology with those of human, cat, sheep, pig, cow and mouse, Canine SCF cDNA consist of an open reading frame encoding 274 amino acid residues and shares 81-92% homology with those of human, cat, pig, cow and mouse.
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Affiliation(s)
- I S Shin
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Seoul National University, Seoul 151-742, Korea
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Kim YH, Cho KW, Youn HY, Yoo HS, Han HR. Detection of canine distemper virus (CDV) through one step RT-PCR combined with nested PCR. J Vet Sci 2001; 2:59-63. [PMID: 14614296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
A one step reverse transcription PCR (RT-PCR) combined nested PCR was set up to increase efficiency in the diagnosis of canine distemper virus (CDV) infection after developement of nested PCR. Two PCR primer sets were designed based on the sequence of nucleocapsid gene of CDV Onderstepoort strain. One-step RT-PCR with the outer primer pair was revealed to detect 10(2) PFU/ml. The sensitivity was increased hundredfold using the one-step RT-PCR combined with the nested PCR. Specificity of the PCR was also confirmed using other related canine virus and peripheral blood mononuclear cells (PBMC) and body secretes of healthy dogs. Of the 51 blood samples from dogs clinically suspected of CD, 45 samples were revealed as positive by one-step RT-PCR combined with nested PCR. However, only 15 samples were identified as positive with a single one step RT-PCR. Therefore approximately 60% increase in the efficiency of the diagnosis was observed by the combined method. These results suggested that one step RT-PCR combined with nested PCR could be a sensitive, specific, and practical method for diagnosis of CDV infection.
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Affiliation(s)
- Y H Kim
- Department of Internal Medicine and Infectious Diseases, College of Veterinary Medicine and School of Agricultural Biotechnology, Seoul National University, Seoul 151-742, Korea
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Han HR, Belcher AE. Computer-mediated support group use among parents of children with cancer--an exploratory study. Comput Nurs 2001; 19:27-33. [PMID: 11210451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
This study describes aspects of computer group use as a vehicle for self-help by parents of children with cancer. Using an electronic mail system, data were gathered from 73 parents who had participated in online support groups. Most participants were Caucasian, well educated, and reported annual incomes of more than $50,000. The perceived benefits of the computer group involvement were getting information, sharing experiences, receiving general support, venting feelings, gaining accessibility, and using writing. The disadvantages included "noise," negative emotions, large volume of mail, and lack of physical contact and proximity. The findings indicate that computer group use is more common in parents with relatively high socioeconomic status. There are certain advantages and disadvantages of computer group use that need to be recognized and addressed by health professionals and users.
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Affiliation(s)
- H R Han
- University of Maryland School of Nursing, Baltimore, MD, USA
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Han HR, Pak S, Guidry A. Prevalence of capsular polysaccharide (CP) types of Staphylococcus aureus isolated from bovine mastitic milk and protection of S. aureus infection in mice with CP vaccine. J Vet Med Sci 2000; 62:1331-3. [PMID: 11193354 DOI: 10.1292/jvms.62.1331] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
To determine the prevalence of capsular polysaccharide (CP) types of Staphylococcus aureus isolated from bovine mastitic milk in Korea, the protective effect of the conjugates, composed of microencapsulated S. aureus clinical isolate type 8 CP bound to Pseudomonas aeruginosa exotoxin A (ETA) was evaluated in mice. Of 107 S. aureus isolates, serotype 5 and 8 accounted for only 26 or 24.2%. When serotype 336 antiserum was employed, fifty of the remaining 81 isolates were typed as 336, 26 reacted with two serotypes, and 5 were nontypeable. Mice challenged with the same strain used for immunization had fewer S. aureus cells in their kidneys than mice challenged with the heterologous strain. But the magnitudes of difference on bacterial clearance were similar in both groups, indicating that the significance of this result remains to be determined. Mice immunized with the conjugate elicited an antibody response 3 days post injection, which persisted for 13 days of the observation period after second injection in some mice. The mice immunized with the CP8-ETA conjugates developed antibodies significantly higher than those immunized with CP-Freund's adjuvant or PBS. In in vivo bacterial challenge experiment, the survival rate of mice immunized with CPS-ETA conjugate was significantly higher than that of mice immunized with PBS. It was suggested that CP8-ETA vaccine had a potential to protect mice against experimental S. aureus bacteremia.
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Affiliation(s)
- H R Han
- Department of Internal Medicine, Veterinary Medical Teaching Hospital, College of Veterinary Medicine, Seoul National University, Korea
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Abstract
To evaluate clinical effects of autogenous toxoid-bacterin treatment for Staphylococcus aureus subclinical mastitis in lactating cows, 22 cows which had at least one S. aureus infected quarter were selected from among cows at a S. aureus prevalent dairy farm. Eleven cows were injected with their own autogenous toxoid-bacterin and the others were maintained as non-injected control. In the toxoid-bacterin injected group, 27% of infected quarters were cured during the 12-week trial, compared to 5% in the control group. New intramammary infections with S. aureus were only detected in 3 quarters of the control group. Mean IgG antibody titer against S. aureus somatic antigens and alpha-toxin in serum and milk were significantly increased in the toxoid-bacterin injected group (p<0.05) and remained higher than those of the control group which showed no significant changes (p<0.05). In contrast to the control group, from 3 weeks after the second injection of the toxoid-bacterin injected group, mean S. aureus cfu/ml in milk samples from injected quarters with S. aureus was significantly decreased until the end of the study (p<0.05). In the toxoid-bacterin injected group, significant decreases of mean SCC were detected from milk samples from infected quarters with S. aureus from week 7 to week 10 (p<0.05). These data show that autogenous toxoid-bacterin treatment against S. aureus subclinical mastitis in lactating cows may increase the cure rate of the infections, reduce the severity of the infections and also prevent occurrence of the new infections.
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Affiliation(s)
- C Y Hwang
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Seoul National University, Korea
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Han HR, Pak SI, Kang SW, Jong WS, Youn CJ. Capsular polysaccharide typing of domestic mastitis-causing Staphylococcus aureus strains and its potential exploration of bovine mastitis vaccine development. I. Capsular polysaccharide typing, isolation and purification of the strains. J Vet Sci 2000; 1:53-60. [PMID: 14612621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
One hundred seven isolates of Staphylococcus aureus from bovine mastitis were investigated for colony morphology in serum-soft agar (SSA), autoagglutination in salt, and capsular serotype. Capsular polysaccharide (CP) was purified and quantified from the extracts of clinical isolates. Overall, 89 isolates (83.2%) were diffuse in the SSA, without any difference in the proportion of diffuse colony between type 5 and type 8 strains. Some strains exhibited compact colonies in the SSA and expressed CP as determined by an enzyme-linked immunosorbent assay, indicating that compact morphology does not exclude encapsulation. The majority of the strains (11/12) showed autoagglutination in the salt aggregation test. The serotype 336 accounted for 46.7% of the isolates followed by serotype 5 (12.1%) and serotype 8 (12.1%). Particularly, twenty-six (24.3%) isolates reacted with two serotypes; 7 for type 8/336 and 19 for type 5/336. Five isolates (4.7%) were nontypeable with monoclonal antibodies specific for CP serotype 5, 8, or 336. The CP concentration in culture supernatants varied with the serotypes, and the total amount of CP produced by cells grown in a liquid medium was much less than that produced by cells grown on a solid medium. The Western blotting indicated that the CP bands of S. aureus serotype 5 and 8 were ranged in the molecular mass of 58-84 kilodalton (kDa), with additional bands in the region of approximately >/= 48 or </= 84 kDa.
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Affiliation(s)
- H R Han
- Department of Internal Medicine, College of Veterinary Medicine, Seoul National University, Seoul 151-742, Korea
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Abstract
This study was performed to isolate a vaccine strain of S. aureus from clinical or subclinical mastitis and to choose the most optimal adjuvant for immune response of alpha toxin and capsular polysaccharide (CPS) of field strain. Of thirty strains of S. aureus isolated from milk of clinical or subclinical mastitis, V112 strain isolated from milk of gangrenous mastitis was used in this vaccine. Twenty one of rabbits were allocated into 5 groups based on adjuvants and immunized twice every 2 weeks for 8 weeks. This vaccine was composed of alpha toxin (10 hemolytic units) and formalinized whole cells (1 x 10(11) cells/ml. Five rabbits received PBS solution as a control group. The highest antibody titers against alpha toxin and CPS were observed in dextran sulfate- and aluminium hydroxide-adjuvant group at 8 weeks after immunization, respectively. These results of the study showed that one adjuvant could not induce strong and long-term immune response of alpha toxin and CPS antigens. Therefore, the use of combined adjuvants in subunit vaccine may be useful and feasible.
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Affiliation(s)
- H R Han
- Department of Veterinary Internal Medicine College of Veterinary Medicine, Seoul National University, Republic of Korea
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20
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Abstract
Despite the increasing number of studies that have substantiated that women who have been abused are psychologically distressed, existing research has little focus on women from diverse ethnic backgrounds, and variables that may influence the development of psychological distress have yet to be examined. This study was conducted to examine the correlation of psychological distress with abuse and psychosocial factors in a sample of 62 White and 62 Hispanic abused women. A set of measures of posttraumatic stress disorder, depression, and anxiety showed that White women experienced a higher prevalence of psychological distress than Hispanics. Life changes significantly related to the severity of psychological distress, whereas exposure to abuse was not consistently associated with it. Implications for practice and research are discussed.
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Affiliation(s)
- S Torres
- Department of Behavioral and Community Health, University of Maryland School of Nursing, Baltimore 21201-1545, USA
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21
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Abstract
Twelve strains of the methicillin-resistant Staphylococcus aureus (MRSA) recovered from hospitalized dogs were analyzed for in vitro antimicrobial susceptibility and virulence, and were genetically characterized by pulsed-field gel electrophoresis (PFGE). Antibiotic susceptibility test showed that nearly all isolates were resistant to beta-lactam antibiotics tested and all the strains were fully susceptible to glycopeptides. There were no inhibitory activities among the aminoglycosides. The 50% lethal dose (LD50) was determined by intraperitoneal injection of cell suspensions and estimated by the Spearman-Kärber method. The mouse lethality of MRSA and methicillin-susceptible S. aureus (MSSA) was not significantly different in both normal and cyclophosphamide-treated mice (p>0.05), indicating that they were equally virulent. There was a great difference in the incidence of toxin production between the MRSA and MSSA group; 83.3% (10 of 12) of the MRSA and 14.3% (1 of 7) of the MSSA were toxin producers. The predominant types produced by MRSA was B. All the MRSA strains were capsular type 5 producers, while of 7 MSSA strains, four were type 5, one for type 8, and two were nontypeable. Based on the PFGE analysis, the 12 MRSA isolates generated 9 to 11 fragments in the size range of <48.5 to 630.5 kb, and yielded 6 different patterns. The results indicated that production of toxin and capsule type do not play a role in the pathogenicity to mouse and PFGE is a valuable tool for the characterization of MRSA. This report is the first such cases in the veterinary literature in Korea and may indicate the frequent emergence of MRSA in veterinary clinic hereafter.
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Affiliation(s)
- S I Pak
- Department of Internal Medicine, Veterinary Medical Teaching Hospital, College of Veterinary Medicine, Seoul National University, Shillim-dong Kwanak-gu Korea
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Park HM, Yoo HS, Oh TH, Kim D, Han HR. Immunogenicity of alpha-toxin, capsular polysaccharide (CPS) and recombinant fibronectin-binding protein (r-FnBP) of Staphylococcus aureus in rabbit. J Vet Med Sci 1999; 61:995-1000. [PMID: 10535504 DOI: 10.1292/jvms.61.995] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study was conducted to evaluate the antibody levels of alpha-toxin, capsular polysaccharides (CPS) and fibronectin-binding protein (FnBP) in rabbits immunized with an experimental vaccine against Staphylococcus aureus and to develop the bovine mastitis subunit vaccine in the future. Enzyme immunoassay was used for detection of IgG antibodies against staphylococcal CPS, alpha-toxin and FnBP. The levels of specific antibodies against CPS, alpha-toxin and FnBP in immunized rabbits were significantly increased after first immunization compared with control animals (p<0.05). Of three antigen used in vaccine, immunogenicity of CPS was relatively lower, compared with those of alpha toxin and fibronectin binding protein. Numbers of S. aureus in blood of immunized groups were lower than those of control group after bacterial challenge. But the bacterial numbers among immunized groups were not significantly different. S. aureus counts in excised organs were significantly lower in all immunized rabbits than in PBS-control group (p<0.05). The present study showed that alpha-toxin, capsular polysaccharide and fibronectin binding protein included in a subunit vaccine were protective.
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Affiliation(s)
- H M Park
- Department of Internal Medicine and Infectious Disease, College of Veterinary Medicine, Seoul National University, Sinlim-dong, Korea
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Abstract
OBJECTIVE To understand the consequences when mothers experience fatigue throughout the first 18 months after birth. DESIGN Secondary analysis of data from a longitudinal study. Fatigue was measured five times between birth and 18 months after delivery. SETTING Data for the longitudinal study were collected in different settings (hospital, telephone, and homes). PARTICIPANTS White mothers who delivered full-term neonates of normal birth weight in a community hospital (N=229). MAIN OUTCOME MEASURES Persistent fatigue was operationally defined as the report of at least one symptom of fatigue at all five time periods. The association between persistent fatigue and performance outcomes (maternal health, infant health, and infant development) was tested. RESULTS Results were significant using alpha of .05. Persistent fatigue is associated with perceived maternal health and infant development at 18 months but not infant health. CONCLUSIONS Findings suggest that persistent fatigue may have a negative effect on performance outcomes for mothers and infants. Assessment for fatigue symptoms should be part of each nursing contact and interpreted as a pattern. Helping mothers choose methods of symptom relief and energy conservation can benefit both the mother and the infant.
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Affiliation(s)
- P L Parks
- Columbia University School of Nursing in New York, NY, USA
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Wilson DJ, Rossiter C, Han HR, Sears PM. Association of Mycobacterium paratuberculosis infection with reduced mastitis, but with decreased milk production and increased cull rate in clinically normal dairy cows. Am J Vet Res 1993; 54:1851-7. [PMID: 8291762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Approximately 45 Holstein cows that were Mycobacterium paratuberculosis-positive on the basis of fecal culture results were maintained at any one time in a 210-cow dairy herd. Farm management participated in the New York State Paratuberculosis Eradication Program. Paratuberculosis-positive cows were grouped separately from paratuberculosis-negative cows, but they were otherwise managed identically. During a 1-year study, 180 paratuberculosis-negative cows and 113 clinically normal paratuberculosis-positive cows were identified. Quarter milk samples (n = 6,100) were aseptically collected for microbiologic culture of mastitis pathogens from paratuberculosis-negative cows, and 3,129 quarter samples were obtained from paratuberculosis-positive cows. Dairy Herd Improvement Association (DHIA) records were used to monitor milk somatic cell count linear scores, mature equivalent milk production, new mastitis infections, and chronic mastitis infections. For second-lactation cows greater than 100 days in milk production, and increasing with age beyond that point, paratuberculosis-positive cows had lower mature equivalent milk production than did negative herdmates. Rates of new and chronic mastitis infections, as measured by DHIA linear scores were significantly (P < 0.05, P = 0.05, respectively) lower in cows with nonclinical paratuberculosis. Infected cows were culled from the herd at a faster rate than were paratuberculosis-negative herdmates. Therefore, paratuberculosis was associated with financial loss attributable to reduced milk production and increased culling of infected cows.
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Affiliation(s)
- D J Wilson
- Quality Milk Promotion Services, Cornell University, Ithaca, NY 14850
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Abstract
Procedures for mastitis diagnosis and control include culturing individual cow and bulk tank milk samples, antibiotic susceptibility testing, and evaluation of somatic cell count reports and clinical mastitis treatment records. Integrated use of such procedures is necessary for effective mastitis diagnosis and control.
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Affiliation(s)
- P M Sears
- Quality Milk Promotion Services, Cornell University College of Veterinary Medicine, Ithaca, New York
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