Development of a Risk Score to Predict Sudden Infant Death Syndrome

Sudden Infant Death Syndrome (SIDS) is the third leading cause of death among infants younger than one year of age. Effective SIDS prediction models have yet to be developed. Hence, we developed a risk score for SIDS, testing contemporary factors including infant exposure to passive smoke, circumcision, and sleep position along with known risk factors based on 291 SIDS and 242 healthy control infants. The data were retrieved from death certificates, parent interviews, and medical records collected between 1989−1992, prior to the Back to Sleep Campaign. Multivariable logistic regression models were performed to develop a risk score model. Our finalized risk score model included: (i) breastfeeding duration (OR = 13.85, p < 0.001); (ii) family history of SIDS (OR = 4.31, p < 0.001); (iii) low birth weight (OR = 2.74, p = 0.003); (iv) exposure to passive smoking (OR = 2.64, p < 0.001); (v) maternal anemia during pregnancy (OR = 2.07, p = 0.03); and (vi) maternal age <25 years (OR = 1.77, p = 0.01). The area under the curve for the overall model was 0.79, and the sensitivity and specificity were 79% and 63%, respectively. Once this risk score is further validated it could ultimately help physicians identify the high risk infants and counsel parents about modifiable risk factors that are most predictive of SIDS.

College Students’ Opinions About Coping Strategies for Mental Health Problems, Suicide Ideation, and Self-Harm During COVID-19

Background

Mental health problems have emerged as a significant health complication in United States colleges during COVID-19, and as a result, they have been extensively investigated in the United States and internationally. In contrast, research on coping among the college population during the pandemic is scant. Hence, this study investigated coping strategies proposed by undergraduate students attending a Midwestern university.

Objectives

The purpose of this preliminary study was to obtain college students’ feedback/opinions about coping strategies for mental health problems, suicide ideation, and self-harm during COVID-19.

Methods

In December 2021, one-hundred and four undergraduate students (ages 18–22 years) completed an online survey on coping strategies using Qualtrics. Major topics included: (1) Types of coping strategies/styles expressed by students for general mental health problems, (2) Types of coping strategies for suicide ideation and self-harm behaviors, (3) Preferred platforms for receiving coping therapy, and (4) Reasons for accepting or refusing parent involvement with mental health problems.

Results

The most beneficial coping strategies for mental health were ranked by college students as follows: (1) a skills training development program (30%), (2) meditation (19%), and (3) mindfulness exercises (15%), and physical education (11%). The respondents’ best coping strategies for preventing self-harm and suicide ideation/behaviors during COVID-19 were ranked as: (1) improving support from friends (32%), (2) building self-esteem (29%), and (3) addressing anger, depression, stress, and loneliness (25%). Finally, a total of 50% of participants felt that parents should be involved in college student interventions. Students stated that the most important type of support that they received from their parents were: (1) emotional support (31%), (2) direction and/or assistance with solutions (27%), and problem-solving (16%).

Conclusion

This study identified potential avenues which could be implemented into action during future outbreaks. Specifically, employing interventions that: (i) train undergraduate students to employ more effective skills training coping strategies or practicing mindfulness or meditation; (ii) integrate mental health, suicide, and self-harm prevention into the curriculum; (iii) offer more in-person campus services targeted toward the psychological and emotional effects of a pandemic, and (iv) involve support persons (e.g., family) in students’ lives to enhance their well-being during and after COVID-19.

Serum ECP as a diagnostic marker for asthma in children less than 5 years: A systematic review and meta-analysis

BACKGROUND

Currently, there are no clear-cut clinical or laboratory parameters to diagnose asthma in young children. Spirometry or the lung function tests cannot be reliably measured in children less than 5 years. The purpose of this study is to evaluate the efficacy of serum eosinophilic cationic protein (sECP) in diagnosing asthma among children less than 5 years of age.

METHODS

A systematic review was performed in PubMed, EMBASE, and Web of Science databases to identify studies investigating the role of sECP in diagnosing childhood asthma. The quality of each study was assessed using quality assessment of diagnostic accuracy studies 2 scale. A meta-analysis was conducted using the RevMan 5.3 application.

RESULTS

A total of eight studies meeting the eligibility criteria were included in the systematic review and five studies in the meta-analysis. There was a degree of clinical heterogeneity between studies primarily related to the definition of asthma and the time of assessment of sECP levels. Pooled sensitivity was 0.79 (95% confidence interval [CI]: 0.66-0.88), pooled specificity was 0.79 (95% CI: 0.54-0.92), and the pooled diagnostic odds ratio was 14.73 (95% CI: 3.58-60.58).

CONCLUSION

Overall, this review found insufficient evidence to support the role of sECP levels in diagnosing early childhood asthma.

Existence of late-effects instruments for cancer survivors: A systematic review

Introduction

The number of cancer survivors is projected to increase to 22.1 million by 2030. Late effects incorporate the full domains of cancer survivorship (e.g., physiologic, psychosocial, economic). They are numerous, complex, and potentially alter the life trajectories of cancer survivors. Currently, research is missing on the impact of late effects (e.g., cardiomyopathy, fertility, lymphedema, anxiety) on cancer survivors.

Objective

The goal of this study is to present a systematic review of existing instruments for identifying, diagnosing, and managing late effects within cancer survivors.

Methods

Using PRISMA guidelines, a systematic search was conducted using the electronic databases of PubMed and Web of Science to identify relevant papers. Articles considered eligible for this review met the following criteria: 1) written in English, 2) published until September 30, 2019, and 3) containing instruments with questions on late effects. Hypothesis, study design, study sample, questionnaire domains, details of late effects, results, conclusions, and advantages/disadvantages of each article were assessed using a modified version of the NHLBI quality assessment tool.

Results

An exhaustive literature review revealed 576 publications in PubMed, 628 in Web of Science, and 260 from additional sources. After removing duplicates, articles without late-effects questionnaires, and publications using identical questionnaires, 11 studies fulfilled the eligibility criteria. Study quality assessment was measured on a scale of 0–6 (0 = poor quality; 6 = highest quality). Only one study was rated with a score of 5 (Rocque).

Conclusions

Taken in totality, none of the studies adequately addressed the prevalence, etiology, characteristics, management, and prevention of late effects. There is currently no comprehensive questionnaire that captures all of the relevant details of late effects across the cancer survivorship continuum nor that tracks the interrelatedness of multiple late effects. Hence, it is difficult to identify, diagnose, manage, and ultimately prevent late effects.

Breast cancer staging by subtype in the Lower Mississippi Delta region States

INTRODUCTION

To evaluate disparities in breast cancer stage by subtype (categorizations of breast cancer based upon molecular characteristics) in the Delta Regional Authority (Delta), an impoverished region across eight Lower Mississippi Delta Region (LMDR) states with a high proportion of Black residents and high breast cancer mortality rates.

METHODS

We used population-based cancer registry data from seven of the eight LMDR states to explore breast cancer staging (early and late) differences by subtype between the Delta and non-Delta in the LMDR and between White and Black women within the Delta. Age-adjusted incidence rates and rate ratios were calculated to examine regional and racial differences. Multilevel negative binomial regression models were constructed to evaluate how individual-level and area-level factors affect rates of early- and late-stage breast cancers by subtype.

RESULTS

For all subtypes combined, there were no Delta/non-Delta differences in early and late stage breast cancers. Delta women had lower rates of hormone-receptor (HR+)/human epidermal growth factor 2 (HER2-) and higher rates of HR-/HER2- (the most aggressive subtype) early and late stage cancers, respectively, but these elevated rates were attenuated in multilevel models. Within the Delta, Black women had higher rates of late-stage breast cancer than White women for most subtypes; elevated late-stage rates of all subtypes combined remained in Black women in multilevel analysis (RR = 1.10; 95% CI = 1.04-1.15).

CONCLUSIONS

Black women in the Delta had higher rates of late-stage cancers across subtypes. Culturally competent interventions targeting risk-appropriate screening modalities should be scaled up in the Delta to improve early detection.

Spatial Accessibility to Mammography Services in the Lower Mississippi Delta Region States

PURPOSE

To characterize spatial access to mammography services across 8 Lower Mississippi Delta Region (LMDR) states. These states include the Delta Region, a federally designated, largely rural, and impoverished region with a high proportion of black residents and low mammography utilization rates.

METHODS

Using the enhanced 2-step floating catchment area method, we calculated spatial accessibility scores for mammography services across LMDR census tracts. We compared accessibility scores between the Delta and non-Delta Regions of the LMDR. We also performed hotspot analysis and constructed spatial lag models to detect clusters of low spatial access and to identify sociodemographic factors associated with access, respectively. We obtained mammography facility locations data from the Food and Drug Administration and sociodemographic variables from the American Community Survey and the US Department of Agriculture.

RESULTS

Overall, there were no differences in spatial accessibility scores between the Delta and non-Delta Regions, though there was some state-to-state variation. Clusters of low spatial access were found in parts of the Arkansas, Mississippi, and Tennessee Delta. Spatial lag models found that poverty was associated with greater spatial access to mammography.

CONCLUSIONS

The lack of identified differences in spatial access to mammography in the Delta and non-Delta Regions suggests that psychosocial or financial barriers play a larger role in lower mammography utilization rates. Identifying clusters of low spatial access to mammography services can help inform resource allocation. Further, our study underscores the value of using coverage-based methods rather than travel time or container measures to evaluate spatial access to care.

Abstract C87: Spatial accessibility to mammography services in the Lower Mississippi Delta states

Introduction: The Delta Regional Authority (DRA) is a federally designated region that includes 252 counties across 8 Lower Mississippi Delta Region states (Alabama, Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri, and Tennessee) and contains nearly 10 million residents. The DRA has a high proportion of African American residents, high levels of poverty, and is largely rural. As such, the region has limited access to health care services, which likely leads to underutilization of mammography services and the higher breast cancer mortality of the region compared to the non-DRA counties within these eight states. Limited spatial access to mammography has been shown, in some studies, to be associated with more advanced stage at diagnosis, which may contribute to greater mortality risk.

Objective: To assess spatial accessibility to mammography facilities in the DRA and non-DRA counties within the Lower Mississippi Delta Region states.

Methods: We obtained the locations of all mammography facilities within the Lower Mississippi Delta Region states from the Food and Drug Administration. We used data from the US Census Bureau's American Community Survey to estimate the number women of recommended screening age (i.e., 45-74, the available data most congruent with recommendations) in each census tract in these states. We implemented the enhanced two-step floating catchment area method to calculate census-tract level spatial accessibility scores (SAS). This method considers both supply of and demand for mammography services within a specified catchment area, such as 60-minute travel time, with weights applied to account for distance decay (i.e., people are less likely to access services that are further away). We calculated Global Moran's I and Local Moran's I to determine if these SAS were spatially clustered and where they were clustered, respectively, within the DRA. We also calculated univariate statistics to compare SAS in the DRA and non-DRA designations of the Lower Mississippi Delta Region states and by rural-urban status using the United States Department of Agriculture's Rural-Urban Commuting Area codes. Because SAS were skewed (i.e., not normally distributed), the nonparametric, Wilcoxon Sum Rank Test was used to compared scores.

Results: Global Moran's I indicated limited, but statistically significant, spatial autocorrelation within the DRA (Moran's I=0.17, Z-score=47.67, p&lt;0.001). Local Moran's I showed clusters of high SAS in the DRA designation of Illinois and the westernmost part of the Kentucky DRA designation. Low spatial access was clustered in much of the Arkansas DRA designation and parts of Tennessee and Mississippi (i.e., a cluster of low spatial access around Memphis). Smaller clusters of low spatial access were seen in southern Louisiana as well. There was no statistically significant difference in SAS by DRA designation, with median scores of 0.000175 and 0.000161 in the DRA and non-DRA designations, respectively (p=0.69). There were no differences in SAS scores stratified by state except for Illinois where median SAS were higher in the DRA compared to the non-DRA part of the state (0.000243 and 0.000156, respectively, p&lt;0.001). There were no differences in SAS between the rural and urban DRA and between the urban DRA and non-DRA. However, median spatial access was slightly higher in the rural DRA vs. the non-DRA (0.000171 vs. 0.000170, p=0.03).

Discussion: Despite disparities in mammography utilization and breast cancer mortality in the DRA, we found no differences in spatial access to mammography compared to the non-DRA designation of the 8 Lower Mississippi Delta states. However, we identified clusters of low spatial access to mammography in specific parts of the DRA. These areas may be appropriate areas to target with mobile mammography initiatives or construction of free-standing mammography facilities.

Citation Format: Whitney E. Zahnd, Sara McLafferty, Recinda Sherman, Susan Farner, Hillary Klonoff-Cohen, Karin Rosenblatt. Spatial accessibility to mammography services in the Lower Mississippi Delta states [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C87.

Late effects awareness website for pediatric survivors of acute lymphocytic leukemia

OBJECTIVES

Every day 43 children are newly diagnosed with cancer. Fortunately, almost 90% of these childhood cancer patients will survive. However, 60-90% of these survivors will experience late effects, health problems that occur months or years after treatment has ended. Late effects could occur as a result of the disease, its treatment, and patient-related factors. The two main objectives of this research are to: 1) Examine the existence of all web-based resources for childhood cancer survivors with acute lymphocytic leukemia which focus on medical and psychological aspects of late effects, and 2) Create an innovative website specifically designed to fill this void.

MATERIALS AND METHODS

A systematic literature review, followed by input from >20 different organizations, resulted in the creation of LEAP3 AHEAD (Late Effects Awareness for Patients, Physicians and the Public; Advancing Health and Eliminating All Disparities), a multi-dimensional website centering on late effects.

RESULTS

An extensive review revealed 14 pediatric cancer websites, none of which focused exclusively on late effects. LEAP3 AHEAD is the first interactive website for acute lympocytic leukemia childhood cancer survivors and families, as well as physicians, and the public to: a) increase awareness about risks, detection, diagnosis, treatment, and prevention of medical and psychological late effects, b) provide suggestions to successfully reintegrate into schools, careers, and socially, and c) present opportunities including camps, scholarships, and pet therapy programs.

CONCLUSION

LEAP3 AHEAD is the first national website to provide a comprehensive, accessible, affordable, and multi-dimensional resource for pediatricians, internists, nurse practitioners, psychologists, survivors and their families, as well as the public about late effects.

Equivalency of In vitro fertilization Success Rates in Elective Single Blastocyst Transfer and Elective Double Blastocyst Transfer: An Example of Equivalence Methodology in Clinical Reproductive Health

CONTEXT

When comparing success rates between treatments, it is more appropriate to structure analyses in terms of equivalence rather than traditional analyses that assess differences. Unfortunately, no studies of elective single blastocyst transfer (eSBT) have been conducted in this manner.

AIMS

The objective of this study was to assess clinical equivalence of in vitro fertilization success rates among patients undergoing eSBT.

SETTINGS AND DESIGN

A historical prospective study was conducted at a private fertility center.

METHODS

Medical records were reviewed to identify patients eligible for eSBT. Equivalency of success rates, defined as no more than a 10% difference based on 95% confidence intervals (CIs), was compared between eSBT (n = 125) and eDBT (n = 213) groups.

RESULTS

Using traditional analysis techniques, no differences in pregnancy or live-birth rates were seen (eSBT: 84.6% vs. eDBT: 84.5%, P = 0.99; eSBT: 65.3% vs. eDBT: 72.3%, P = 0.23). The 95% CI around the difference in pregnancy rates ranged from -7.9 to 8.1, suggesting clinically equivalent pregnancy rates. Clinical equivalence was not established for live-births (95% CI = -18.5-4.5).

CONCLUSIONS

Findings suggest comparable pregnancy rates can be achieved in a clinical setting when utilizing eSBT in good-prognosis patients. Although live-birth rate equivalence was not demonstrated, it is thought the additional complications associated with multiple gestations outweigh the potentially higher live-birth rate. The present study highlights the importance of utilizing equivalence analyses when making statements regarding the similarity of two treatments in reproductive health, rather than relying on superiority analyses alone.

Helping Hospitalized Smokers: A Factorial RCT of Nicotine Patches and Counseling

INTRODUCTION

Most smokers abstain from smoking during hospitalization but relapse upon discharge. This study tests the effectiveness of two proven treatments (i.e., nicotine patches and telephone counseling) in helping these patients stay quit after discharge from the hospital, and assesses a model of hospital-quitline partnership.

STUDY DESIGN

This study had a 2×2 factorial design in which participants were stratified by recruitment site and smoking rate and randomly assigned to usual care, nicotine patches only, counseling only, or patches plus counseling. They were evaluated at 2 and 6 months post-randomization.

SETTING/PARTICIPANTS

A total of 1,270 hospitalized adult smokers were recruited from August 2011 to November 2013 from five hospitals within three healthcare systems.

INTERVENTION

Participants in the patch condition were provided 8 weeks of nicotine patches at discharge (or were mailed them post-discharge). Quitline staff started proactively calling participants in the counseling condition 3 days post-discharge to provide standard quitline counseling.

MAIN OUTCOME MEASURES

The primary outcome measure was self-reported 30-day abstinence at 6 months using an intention-to-treat analysis. Data were analyzed from September 2015 to May 2016.

RESULTS

The 30-day abstinence rate at 6 months was 22.8% for the nicotine patch condition and 18.3% for the no-patch condition (p=0.051). Nearly all participants (99%) in the patch condition were provided nicotine patches, although 36% were sent post-discharge. The abstinence rates were 20.0% and 21.1% for counseling and no counseling conditions, respectively (p=0.651). Fewer than half of the participants in the counseling condition (47%) received counseling (mean follow-up sessions, 3.6).

CONCLUSIONS

Provision of nicotine patches proved feasible, although their effectiveness in helping discharged patients stay quit was not significant. Telephone counseling was not effective, in large part because of low rates of engagement. Future interventions will need to be more immediate to be effective.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.gov NCT01289275.

Validation of a New Scale for Measuring Concerns of Women Undergoing Assisted Reproductive Technologies (CART)

A new instrument was developed and assessed for internal consistency, validity and test-retest reliability. A total of 151 women undergoing IVF/GIFT in California rated concern levels about anesthesia, surgery, recovery time, side-effects, finances, missing work, pain, insufficient information and delivering a healthy baby. Validity was assessed by comparing CART to the Infertility Reaction Scale and Bipolar Profile of Moods States, and reliability was investigated by calculating correlations between repeat CARTs. Factor analysis identified three domains: procedural concerns; missing work; and achieving a successful delivery. CART is a new, valid and reliable instrument, which measures concerns during IVF/GIFT not previously identified by existing instruments.

Eosinophil protein X and childhood asthma: A systematic review and meta-analysis

Background: There are no reference guidelines for health care providers regarding appropriate use and interpretation of urine eosinophil protein X (u‐EPX) in clinical practice. Currently, there are no clear‐cut clinical or laboratory parameters to diagnose asthma in young children. Objective: In this study, we (1) systematically reviewed and qualitatively appraised the epidemiological evidence to determine diagnostic u‐EPX cut points for pediatric asthma, and (2) performed a meta‐analysis to provide u‐EPX estimates for diagnosing pediatric asthma. Methods: Research articles in literature were identified from PubMed/Medline and Web of Science databases from 1966 to August 2015. Children <18 years of age were included. Both serum and urine EPX were included. Twenty‐seven studies met the inclusion criteria for the systematic review and nine studies for the meta‐analysis. Details regarding EPX analyses, treatment efficacy, and outcomes were assessed. For meta‐analyses, effect estimates were abstracted using standardized means. Results: Over 70% of studies found a significant relationship between u‐EPX and childhood asthma. There was 1.94 times higher standardized means of u‐EPX among acute asthmatics compared to healthy controls (confidence interval [CI]: 1.67–2.22). Similarly, the difference in standardized means between asymptomatic asthmatics and healthy controls was 1.58 times higher (CI: 1.27–1.88). Conclusions and Clinical Relevance: Despite differences in sample sizes, EPX processing and measurement, and ages of children, a consistent trend of higher EPX levels with childhood asthma was revealed.

Timing of breast cancer surgery, menstrual phase, and prognosis: Systematic review and meta-analysis

BACKGROUND

For over 25 years, there has been a debate revolving around the timing of breast cancer surgery, menstrual cycle, and prognosis.

METHODS

This systematic review synthesizes and evaluates the body of evidence in an effort to inform evidence-based practice. A keyword and reference search was performed in PubMed and Web of Science to identify human studies that met the inclusion criteria. A total of 58 studies (48 international and 10 U.S.-based) were identified. We provided a narrative summary on study findings and conducted a meta-analysis on a subset of studies where quantitative information was available.

RESULTS

Findings from both qualitative and quantitative analyses were inconclusive regarding performing breast cancer surgery around a specific phase of the menstrual cycle.

CONCLUSION

Based on the Institute of Medicine criteria, evidence is insufficient to recommend a change in current primary breast cancer surgery practice based on menstrual phase.

Nicotine patches and quitline counseling to help hospitalized smokers stay quit: study protocol for a randomized controlled trial

Background

Hospitalized smokers often quit smoking, voluntarily or involuntarily; most relapse soon after discharge. Extended follow-up counseling can help prevent relapse. However, it is difficult for hospitals to provide follow-up and smokers rarely leave the hospital with quitting aids (for example, nicotine patches). This study aims to test a practical model in which hospitals work with a state cessation quitline. Hospital staff briefly intervene with smokers at bedside and refer them to the quitline. Depending on assigned condition, smokers may receive nicotine patches at discharge or extended quitline telephone counseling post-discharge. This project establishes a practical model that lends itself to broader dissemination, while testing the effectiveness of the interventions in a rigorous randomized trial.

Methods/design

This randomized clinical trial (N = 1,640) tests the effect of two interventions on long-term quit rates of hospitalized smokers in a 2 x 2 factorial design. The interventions are (1) nicotine patches (eight-week, step down program) dispensed at discharge and (2) proactive telephone counseling provided by the state quitline after discharge. Subjects are randomly assigned into: usual care, nicotine patches, telephone counseling, or both patches and counseling. It is hypothesized that patches and counseling have independent effects and their combined effect is greater than either alone. The primary outcome measure is thirty-day abstinence at six months; a secondary outcome is biochemically validated smoking status. Cost-effectiveness analysis is conducted to compare each intervention condition (patch alone, counseling alone, and combined interventions) against the usual care condition. Further, this study examines whether smokers’ medical diagnosis is a moderator of treatment effect. Generalized linear (binomial) mixed models will be used to study the effect of treatment on abstinence rates. Clustering is accounted for with hospital-specific random effects.

Discussion

If this model is effective, quitlines across the U.S. could work with interested hospitals to set up similar systems. Hospital accreditation standards related to tobacco cessation performance measures require follow-up after discharge and provide additional incentive for hospitals to work with quitlines. The ubiquity of quitlines, combined with the consistency of quitline counseling delivery as centralized state operations, make this partnership attractive.

Trial registration

Smoking cessation in hospitalized smokers NCT01289275. Date of registration February 1, 2011; date of first patient August 3, 2011.

Abstract 4439: Childhood cancer late effects: Knowledge base and meaningful resources from a community perspective

Each year, cancer kills more children between 1 and 20 years of age than asthma, diabetes, cystic fibrosis, and AIDS combined, and remains the leading cause of death in children. Over 80% of children with cancer will survive, due to ongoing research and treatment in pediatric cancer. While long-term survival rates for pediatric cancer are fairly high, more than 3/4 of survivors experience late effects–complications, disabilities or other adverse outcomes as a result of the disease, its treatment, or both. The development of a website focusing on pediatric cancer late effects for diverse patients and the public is currently underway. The process is guided by community based participatory components. As part of the needs assessment we conducted a series of four focus group discussions. A total of 39 adults participated, including 7 to 12 participants per group. All group discussions were conducted in community sites and lasted up to two hours. Participants of diverse background from the local underserved communities were recruited. Gender and language of preference (English-Spanish) was used to breakdown the group discussions into 4 homogeneous groups. All groups conducted in Spanish included individuals from Latino descent. In addition, primarily African Americans, Asian Americans, Native Hawaiians and Pacific Islanders, and Latinos participated in the groups conducted in English. The results indicated that knowledge about childhood cancer based on other than personal experience was extremely limited. Participants across the groups consistently referred to TV ads as the only source of information. In addition, participants across the groups expressed that they lacked information about cancer in general. Personal experience varied greatly among the groups and included experience through close family members. Notably, the groups including women expressed greater direct experience with families, friends, or acquaintances and were more proactive sharing details of the experiences and hardships related to childhood cancer. Unfortunately often the information shared during the discussions pointed out to the premature deaths of strong exemplary children and the devastation in their families. Another common theme was the complete lack of information about the topic that the families confronted when the disease was diagnosed. Written resources and information distributed at community group meetings were identified across all groups as necessary to increase awareness about childhood cancer (and cancer in general), including late effects. Websites were also discussed as potential sources of information. Given the unequal burden of pediatric cancer on underserved communities, the results are important to guide the development of community programs addressing pediatric cancer knowledge and late effects awareness.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4439. doi:1538-7445.AM2012-4439

Patterns of prenatal alcohol exposure and associated non-characteristic minor structural malformations: a prospective study

The characteristic facial features of the more severe end of Fetal Alcohol Spectrum Disorders (FASD) include smooth philtrum, thin vermillion of the upper lip, and short palpebral fissures. A systematic evaluation of a comprehensive list of minor structural defects in association with varying patterns of prenatal exposure to alcohol has not been performed. We examined the patterns and timing of prenatal alcohol exposure to minor structural malformations occurring in at least 5% of the sample. Patterns of drinking were evaluated by drinks per day, number of binge episodes, and maximum number of drinks. Timing of exposure was evaluated 0-6 weeks post-conception, 6-12 weeks post-conception, first trimester, second trimester, and third trimester. Naevus flammeus neonatorum is significantly associated with various patterns of drinking during the second half of the first trimester (RR 1.14, 95% CI 1.04, 1.24 for average number of drinks per day; RR 1.04, 95% CI 1.02, 1.07 for number of binge episodes; RR 1.08, 95% CI 1.01, 1.15 for maximum number of drinks in one episode) and similar for number of binge episodes in all categories of timing of exposure and in the second trimester for average number of drinks per day. Other minor malformations occurring in at least 5% of the sample were not found to be significantly associated with prenatal alcohol exposure. Expected minor malformations were not found to be significantly associated with prenatal alcohol exposure. Naevus flammeus neonatorum appears to be part of the spectrum of features associated with prenatal alcohol exposure.

The effect of an expressive writing intervention (EWI) on stress in infertile couples undergoing assisted reproductive technology (ART) treatment: a randomized controlled pilot study

OBJECTIVES

Infertile couples undergoing fertility treatments may experience stress and could benefit from psychological intervention. Expressive Writing Intervention (EWI) has shown promising results on various psychological outcomes, yet only one study has applied the method to infertility-related stress. Our aim was to assess feasibility and effectiveness of EWI for patients in treatment with Assisted Reproductive Technology (ART).

DESIGN AND PARTICIPANTS

Patients enrolling in their first ART treatment at the fertility clinic, Aarhus University Hospital, Denmark were offered to participate. A total of 82 participants (45 women, 37 men), mean age: 33.17, were randomized to home-based EWI or neutral writing control group and completed an infertility-related stress questionnaire at treatment enrollment, 3 weeks later (at the time of down regulation), and 6 weeks after the intervention. The intervention took place 2 weeks after treatment start.

RESULTS

Mixed between-within ANOVA showed a main effect of time (Wilks Lambda = 0.68, F(2,28) = 6.48) as well as a significant interaction effect between group (control/ EWI) and time (Wilks Lambda = 0.83, F(2,28) = 2.92). Infertility-related stress decreases were observed after the intervention in the EWI group compared to controls. Six weeks after the intervention, stress tended to increase in both groups, with the control group, follow-up stress levels exceeding baseline stress scores, whereas the follow-up scores of EWI-participants' did not exceed baseline levels.

CONCLUSIONS

Our preliminary results suggest EWI to be a feasible, cost-effective, and efficient method for alleviating infertility-related stress, although results should be considered preliminary and further testing with a larger sample is warranted.

Outdoor carbon monoxide, nitrogen dioxide, and sudden infant death syndrome

AIMS

To investigate whether infants who died of SIDS were more likely to have higher acute and lifetime average exposures to outdoor carbon monoxide (CO) and nitrogen dioxide (NO2) than comparison healthy infants.

METHODS

A total of 169 case and 169 matched control infants born between 1988 and 1992, were studied. CO and NO2 concentrations, averaged for all days within the infant's lifespan, and the last 30 days, 7 days, 3 days, and 1 day of life were obtained from air pollutant data provided by the California Air Resources Board.

RESULTS

Based on monthly aggregated data, average CO and particularly NO2 were associated with SIDS count, even after adjustment for seasonal trends. SIDS outcome was not significantly associated with high average outdoor CO levels for any time period. However, high average outdoor NO2 levels on the last day of the infant's exposure period were significantly associated with SIDS; the adjusted odds ratio was 2.34 (95% CI 1.13 to 4.87).

CONCLUSIONS

SIDS may be related to high levels of acute outdoor NO2 exposure during the last day of life. Further studies are needed to replicate this finding.

What factors affect intracytoplasmic sperm injection outcomes?

Within the last decade, intracytoplasmic sperm injection (ICSI), a new assisted reproductive technique that allows for the direct injection of spermatozoa into the oocyte, has become available to infertile couples. While most studies indicate that ICSI has success rates similar to those of traditional in vitro fertilization, there are many concerns about the safety of the procedure, including increased risks of chromosomal and developmental abnormalities in children conceived by ICSI. Factors that contribute to these increased risks have not been well elucidated. The purpose of this paper is to review the latest literature concerning 1) the adverse outcomes associated with ICSI; and 2) factors that affect the success rates of ICSI (with emphasis on paternal factors).

TARGET AUDIENCE

Obstetricians & Gynecologists, Family Physicians.

LEARNING OBJECTIVES

After completion of this article, the reader should be able to explain the procedure, intracytoplasmic sperm injection (ICSI), to outline the data surrounding chromosomal and developmental outcomes after ICSI, and to list and explain the potential factors that influence ICSI.

Female and male lifestyle habits and IVF: what is known and unknown

There is no greater tribute to the importance and efficacy of IVF than the fact that >1 x 10(6) babies have been born to infertile couples since its clinical introduction in 1978. Despite enormous advances regarding the technical aspects of the IVF procedure, the parents' contribution has virtually been ignored when considering aspects that influence success rates. This systematic review focuses on the effects of female and male lifestyle habits (specifically: smoking, alcohol and caffeine use, and psychological stress) on the reproductive endpoints of IVF (i.e. oocyte aspiration, fertilization, embryo transfer, achievement of a pregnancy, live birth delivery, and perinatal outcomes, e.g. low birthweight, multiple gestations). What is currently known in the field of lifestyle habits and IVF? There is compelling evidence that smoking has a negative influence on IVF outcomes, whereas for stress, the evidence is suggestive but insufficient due to the heterogeneity of studies. The evidence for the effects of alcohol and caffeine on IVF is inadequate, and therefore unknown, due to the scarcity of studies.

The concerns during assisted reproductive technologies (CART) scale and pregnancy outcomes

OBJECTIVE

To determine whether concerns specific to IVF/GIFT (i.e., side effects, surgery, anesthesia, not enough information, pain, recovery, finances, missing work, and live birth delivery) that were measured by the previously validated Concerns During Assisted Reproductive Technologies (CART) instrument are negatively associated with reproductive endpoints.

DESIGN

Prospective study.

SETTING

Seven centers in Southern California between July 1993 and June 1998.

PATIENT(S)

One hundred fifty-one women completed two questionnaires at baseline and at the time of the procedure.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Number of oocytes aspirated and fertilized, number of embryos transferred, pregnancy rates, and live birth delivery rates.

RESULT(S)

At baseline, women who were concerned about the medical aspects (i.e., side effects, surgery, anesthesia, not enough information, pain, and recovery) of the procedure had 20% fewer oocytes retrieved and 19% fewer oocytes fertilized, while simultaneously adjusting for female age, race, education, smoking status, parity, type of assisted reproductive technologies (ART) procedure (IVF or GIFT), type of infertility, and number of previous attempts. Women who were very concerned about missing work had 30% fewer ooyctes fertilized. For women who were moderately concerned about missing work, the odds ratio was 2.83 for not achieving a pregnancy. Women who were extremely concerned about the finances associated with the procedure had a very high risk (odds ratio [OR] = 11.62) of not achieving a successful live birth delivery.

CONCLUSION(S)

The CART scale identified two areas of concerns for women undergoing IVF or GIFT: "missing work/finances" and "medical aspects of the procedure."

Effects of maternal and paternal alcohol consumption on the success rates of in vitro fertilization and gamete intrafallopian transfer

OBJECTIVE

To determine whether the amount and timing of female and male alcohol use during IVF and GIFT affect reproductive endpoints.

DESIGN

Multicenter prospective study.

SETTING

Clinics in southern California.

PATIENT(S)

Two hundred twenty-one couples with female infertility.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Egg retrieval, transfer, fertilization, pregnancy, miscarriage, live birth, and multiple gestations.

RESULT(S)

Female alcohol consumption was associated with: (1) a 13% decrease in the number of eggs aspirated (adjusted 95% confidence interval [CI]: -2% to -23%, for one additional drink per day, 1 year before the IVF or GIFT attempt); (2) an increase in risk of not achieving pregnancy by 2.86 times (0.99-8.24, 1 month prior); and (3) an increase in risk of miscarriage by 2.21 times (1.09-4.49, 1 week before the procedure). For men, one additional drink per day increased the risk of not achieving a live birth by 2.28 (1.08-4.80) to 8.32 (1.82-37.97) times, depending on the time period; beer also affected live births (ORs = 5.49-45.64). This outcome may be due partially to increased risk of miscarriage by 2.70 to 38.04 times for men who drank <or=1 month before and during IVF and GIFT.

CONCLUSION(S)

This is the first study to report an association between alcohol use and reproductive endpoints of IVF and GIFT. Because alcohol use is ubiquitous, modifying drinking habits may increase assisted reproductive technology success rates.

A prospective study of the effects of female and male caffeine consumption on the reproductive endpoints of IVF and gamete intra-Fallopian transfer

BACKGROUND

This study evaluated the timing and amount of caffeine intake by women and men undergoing IVF and gamete intra-Fallopian transfer (GIFT) on oocyte retrieval, sperm parameters, fertilization, multiple gestations, miscarriage, and live births.

METHODS

A prospective study of 221 couples was conducted in Southern California between 1993 and 1998. "Usual" caffeine intake during lifetime and 1 year prior to attempt, caffeine intake during the week of the initial clinic visit, as well as intake during the week of the procedure, was evaluated from beverages (coffee, soda, tea) and chocolates.

RESULTS

Not achieving a live birth was significantly associated with "usual" female caffeine consumption [adjusted odds ratios (95% confidence intervals): 3.1 (1.1, 9.7) and 3.9 (1.3, 11.6) for intake of >2-50 and 50 mg/day, compared with 0-2 mg/day] and consumption during the week of the initial visit [2.9 (1.1, 7.5) and 3.8 (1.4, 10.7)] female compared with 0-2 mg/day, although caffeine use was low. Infant gestational age decreased by 3.8 (-6.9, -0.7) or 3.5 (-6.7, -0.3) weeks for women who consumed >50 mg/day of caffeine "usually" or during the week of the initial visit. The odds of having multiple gestations increased by 2.2 (1.1, 4.4) and 3.0 (1.2, 7.4) for men who increased their "usual" intake or intake during the week of the initial visit by an extra 100 mg/day. Caffeine intake was not significantly associated with other outcomes.

CONCLUSIONS

This is the first IVF/GIFT study to report any effect of caffeine on live births, gestational age, and multiple gestations. If these findings are replicated, caffeine use should be minimized prior to and while undergoing IVF/GIFT.

A prospective study of stress among women undergoing in vitro fertilization or gamete intrafallopian transfer

OBJECTIVE

To evaluate whether baseline or procedural stress during in vitro fertilization (IVF) or gamete intrafallopian transfer (GIFT) affects pregnancy or live birth delivery rates.

DESIGN

Prospective study.

SETTING

Seven clinics in Southern California between 1993 and 1998.

PATIENT(S)

One hundred and fifty-one women completed two questionnaires.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

The number of oocytes aspirated and fertilized, the number of embryos transferred, the achievement of a pregnancy, live birth delivery, and infant outcomes.

RESULT(S)

Positive-affect negative-affect score at baseline negatively influenced the number of oocytes retrieved and embryos transferred. A higher expectation of pregnancy was associated with greater numbers of oocytes fertilized and embryos transferred. At baseline, the risk of no live birth was 93% lower for women who had the highest positive-affect score compared to those with the lowest score. Furthermore, the score on the Infertility Reaction Scale was related to negative outcomes in live birth delivery, infant birth weight, and multiple births. During the time of the procedure, the PANAS and Bipolar Profile of Moods States results were related to the number of oocytes fertilized and embryos transferred; stress did not affect pregnancy or delivery.

CONCLUSION(S)

Baseline (acute and chronic) stress affected biologic end points (i.e., number of oocytes retrieved and fertilized), as well as pregnancy, live birth delivery, birth weight, and multiple gestations, whereas (procedural) stress only influenced biologic end points.

Effects of female and male smoking on success rates of IVF and gamete intra-Fallopian transfer

BACKGROUND

Smoking by both male and female partners may play a significant role in the success rates of assisted reproductive technologies. The objective of this 5-year prospective study was to investigate the influence of cigarette smoking by the wife, husband, and couple at various time points (e.g. lifetime, week prior, or during the procedures) on different biological parameters of IVF and gamete intra-Fallopian transfer (GIFT).

METHODS AND RESULTS

A total of 221 couples, aged >20 years, of Caucasian, Black, Asian or Hispanic descent were recruited from seven infertility clinics located in Southern California. Couples (i.e. either female or male or both) who ever smoked compared with non-smokers, had adjusted relative risks (RR) of 2.41 (95% CI 1.07-5.45, P = 0.03) of not achieving a pregnancy, and 3.76 (95% CI 1.40-10.03, P < 0.01) of not having a live birth delivery, while adjusting for potential confounders. For couples who smoked for >5 years, there was an adjusted RR = 4.27 of not achieving a pregnancy (95% CI l.53-11.97, P = 0.01). The number of oocytes retrieved decreased by 40% for couples (smokers, n = 6) and by 46% for men who smoked during the week of the visit for IVF or GIFT. Women who smoked in their lifetime had adjusted risks of 2.71 of not achieving a pregnancy (95% CI 1.37-5.35, P < 0.01), and 2.51 (95% CI 1.11-5.67, P < 0.03) of not having a live birth delivery.

CONCLUSIONS

There is compelling evidence that couples should be made aware that smoking years before undergoing IVF and GIFT can impact treatment outcome. This study may also provide insight into the timing and effects of male and female smoking on natural reproduction.

Maternal and paternal recreational drug use and sudden infant death syndrome

OBJECTIVE

To determine whether maternal or paternal use of cocaine, opiates, or marijuana during conception and pregnancy and postnatally increases the risk of sudden infant death syndrome (SIDS) during the first year of the infant's life. This is an important issue and may prove useful in further decreasing the rate of SIDS.

METHODS

A case-control study was conducted consisting of 239 infants who died of SIDS in southern California between 1989 and 1992, and 239 healthy infants who were matched on the basis of birth hospital, date of birth, age, and sex. Specific drug use at the period of conception, during pregnancy and breastfeeding, and in the presence or vicinity of the infant was ascertained by telephone for the white, African American, Hispanic, Asian American, and Pacific Islander case and control fathers and mothers.

RESULTS

Maternal recreational drug use during pregnancy was not associated with the risk of SIDS after adjusting for maternal smoking during pregnancy (adjusted odds ratio [OR] = 2.0; 95% confidence interval [CI], 0.6-6.5). There were statistically significant differences between case and control fathers' use of marijuana during conception (OR = 2.2; 95% CI, 1.2-4.2; P =.01), during pregnancy (OR = 2.0; 95% CI, 1.0-4.1; P =.05), and postnatally (OR = 2.8; 95% CI, 1.1-7.3; P =.04) and the risk of SIDS, while adjusting for paternal smoking and alcohol use.

CONCLUSIONS

There was no association between maternal recreational drug use and SIDS. Paternal marijuana use during the periods of conception and pregnancy and postnatally were significantly associated with SIDS. The role of paternal psychoactive drug use, especially the relationship between marijuana and SIDS, is an understudied area; however, before any definitive role for the father can be confirmed, these findings should be investigated and replicated in future studies.

Tracking strategies involving fourteen sources for locating a transient study sample: parents of sudden infant death syndrome infants and control infants

Strategies involving 14 sources were used to locate 230 parents of sudden infant death syndrome infants who died in Southern California between 1989 and 1992 and 255 parents of healthy, living infants matched by birth hospital, birth date, race and sex. The sample consisted of adults of reproductive age residing in Southern California. After an event of sudden infant death, many parents moved without a forwarding address; only their names, last known address, and the infant's race, birth date, and sex were available. There was no access to birth certificates, obstetric or pediatric medical records, parents' Social Security numbers, or parents' birth dates. The most successful tracking sources for case parents were the Department of Motor Vehicles, postal service, reverse directory and neighbors, private investigator, and California Medicaid services. For control parents, the post office, Department of Motor Vehicles, and Folks Finders proved the most helpful. Using a combination of the 14 sources achieved an adequate sample size.

Bed sharing and the sudden infant death syndrome

OBJECTIVE

To determine whether infants who died of the sudden infant death syndrome routinely shared their parents' bed more commonly than control infants.

DESIGN

Case-control study.

SETTING

Southern California.

SUBJECTS

200 white, African-American, Latin American, and Asian infants who died and 200 living controls, matched by birth hospital, date of birth, sex, and race.

MAIN OUTCOME MEASURES

Routine bedding (for example, crib, cradle), day and night time sleeping arrangement (for example, alone or sharing a bed); for cases only, sleeping arrangement at death. Differences in bed sharing practices among races.

RESULTS

Of the infants who died of the syndrome, 45 (22.4%) were sharing a bed. Daytime bed sharing was more common in African-American (P < 0.001) and Latin American families (P < 0.001) than in white families. The overall adjusted odds ratio for the syndrome and routine bed sharing in the daytime was 1.38 (95% confidence interval 0.59 to 3.22) and for night was 1.21 (0.59 to 2.48). These odds ratios were adjusted for routine sleep position, passive smoking, breast feeding, intercom use, infant birth weight, medical conditions at birth, and maternal age and education. There was no interaction between bed sharing and passive smoking or alcohol use by either parent.

CONCLUSIONS

Although there was a significant difference between bed sharing among African-American and Latin American parents compared with white parents, there was no significant relation between routine bed sharing and the sudden infant death syndrome.

Cigarette smoking and preeclampsia

OBJECTIVE

To examine the relationship between cigarette smoking during pregnancy and the development of preeclampsia.

METHODS

A case-control study compared the smoking histories of 110 nulliparous preeclamptic women and 115 healthy nulliparas aged 15-35 years who delivered at North Carolina Memorial Hospital.

RESULTS

Unconditioned logistic regression relating smoking during pregnancy to preeclampsia yielded an odds ratio of 0.71 (95% confidence interval 0.33-1.50) when adjusting for working during pregnancy, alcohol use, medication use, contraceptive choices with the father of the index pregnancy, and family history of preeclampsia. There was no evidence of a dose-response effect of reduced risk for heavier smokers.

CONCLUSIONS

Despite major methodologic improvements from previous studies, including rigorous diagnostic criteria for preeclampsia, a negative, non-statistically significant association persisted between cigarette smoking during pregnancy and preeclampsia, similar in magnitude to that of previous reports.

Albumin levels as a predictor of mortality in the healthy elderly

Serum albumin levels probably predict subsequent mortality in the elderly, but it is not clear whether this is independent of disease. A 3 year prospective study of 2342 healthy non-institutionalized men and women aged 50-89 years old, residing in Rancho Bernardo, California, confirmed the following findings. Serum albumin levels decreased with increasing age in both men and women, and this association was independent of health status. In addition, for every standard deviation decrease in albumin, the relative odds of dying was 1.24 (p = 0.04), after adjusting for age, sex and lifestyle factors such as smoking, exercise and alcohol consumption. Separating the study sample into those who did and did not report disease at baseline did not appreciably alter these findings. Most of the albumin levels of the older adults (70-89) fall within the normal and narrow range of the younger adults (50-69), nevertheless, albumin levels predict outcome independent of known disease. The albumin-early mortality association suggests that serum albumin levels are a predictor for subclinical disease in the healthy elderly.