The role of allogeneic transplant for adult Ph+ ALL in CR1 with complete molecular remission: a retrospective analysis

Historically, Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL) has been associated with poor outcomes, and allogeneic hematopoietic cell transplantation (allo-HCT) is recommended in first complete remission (CR1). However, in the tyrosine kinase inhibitor (TKI) era, rapid attainment of a complete molecular remission (CMR) is associated with excellent outcomes without allo-HCT, suggesting transplant may not be required for these patients. To test this hypothesis, we retrospectively identified adult patients with Ph+ ALL treated with induction therapy, including TKIs, and attained CMR within 90 days of diagnosis at 5 transplant centers in the United States. We compared outcomes of those who did and did not receive allo-HCT in first remission. We identified 230 patients (allo-HCT: 98; non-HCT: 132). The allo-HCT cohort was younger with better performance status. On multivariable analysis (MVA), allo-HCT was not associated with improved overall survival (adjusted hazard ratio [aHR]: 1.05; 95% CI, 0.63-1.73) or relapse-free survival (aHR: 0.86; 95% CI, 0.54-1.37) compared with non-HCT treatment. Allo-HCT was associated with a lower cumulative incidence of relapse (aHR: 0.32; 95% CI, 0.17-0.62) but higher non-relapse mortality (aHR: 2.59; 95% CI, 1.37-4.89). Propensity score matching analysis confirmed results of MVA. Comparison of reduced-intensity HCT to non-HCT showed no statistically significant difference in any of the above endpoints. In conclusion, adult patients with Ph+ ALL who achieved CMR within 90 days of starting treatment did not derive a survival benefit from allo-HCT in CR1 in this retrospective study.

Prevalence and factors associated with diagnosed depression among hospitalized cancer patients with metastatic disease

PURPOSE

This study aimed to examine the factors associated with diagnosed depression among patients with a metastatic cancer.

METHODS

We conducted a cross-sectional analysis of 39,223 hospital records from 2008 to 2013 National Inpatient Sample for patients with metastatic cancer. Diagnosed depression was defined using ICD-9-CM for major depression. Weighted, multivariable hierarchical regression model was used to examine the association between sociodemographic and clinical factors and depression among patients with a metastatic cancer.

RESULTS

The prevalence of clinically diagnosed depression in patients with a metastatic cancer in our study sample was 7.3% (5.9% for males and 8.6% for females). The prevalence rate of diagnosed depression increased from 5.3 to 9.4% between 2008 and 2013. In multivariable analysis, patients were more likely to be diagnosed with depression if they were females (aOR = 1.44; 95% CI 1.25-1.66) compared to males; and had higher number of comorbidities (aOR = 1.11 per 1-unit increase in Elixhauser comorbidity score, 95% CI 1.07-1.15). In contrast, patients were less likely to be diagnosed with depression if they were blacks (aOR = 0.59; 95% CI 0.47-0.74) or other race (aOR = 0.58; 95% CI 0.47-0.72) compared with white patients.

CONCLUSIONS

Women and individuals with more comorbidities were diagnosed with depression more frequently, whereas black patients were diagnosed less. Our findings could help providers to identify hospitalized patients with the higher risk of depression and screened patients with signs and symptoms of clinical depression.

Protective Effects of Magnesium Chloride on Liver Enzymes and Biomarkers of Oxidative Stress in high fat diet fed Rats

The excessive consumption of high cholesterol diet has been associated with an increased incidence of obesity. This is because obesity induced pathologies with high mortality, such as complications of dyslipidaemia, diabetes mellitus, arthritis, hypertension, myocardial infarction, and hepatocellular carcinoma. Although the associated, disease are enhanced by formation of oxidative stress, lipid peroxidation and hypercholesterolaemia. Magnesium chloride is found to be beneficial in a wide range of diseases. Magnesium is one of the most neglected mineral in human body. It is crucial for a healthy and lasting life. Magnesium is responsible for the activation of more than 300 enzymes in the body. The present study intends to determine the protective effect of magnesium chloride on liver enzyme and biomarker of oxidative stress in high fat diet fed rats. Twenty (20) adult Male Wistar rats weighing (100 - 150) grams randomly divided into three treatments and one control groups of five rats each (n = 5). Group I Normal control receive normal feed only for 6weeks, Group II received high fat diet only for 6weeks, Group III received high fat diet with 250 mg/kg for 6weeks of mgcl2 and Group IV received 500 mg/kg for 6weeks of MgCl2 respectively all treatments were administered via oral route, at the end of the sixth week rats were euthanized and blood samples were drawn from the heart by cardiac puncture and used to estimate oxidative stress biomarkers (Superoxide dismutase, Catalase and Glutathione peroxidase), lipid peroxidation biomarkers (Malondialdehyde) and liver enzymes. Analysis of variance and Turkey's post hoc test were used to analyze the data obtained. In relation to the liver enzyme, the showed that there was a significant (p<0.05) decrease in value of AST, ALT and ALP in the group co-administered with the doses of the Magnesium chloride to compared to the control. For the oxidative stress biomarkers assessed, the results showed that there was significant decrease (P < 0.05) in the SOD, CAT and GPx level of the high fat diet fed groups, co-administered with   250 and 500 MgCl2, when compared with the high fat diet fed group only. Also, the lipid peroxidation shows significant (p<0.05) decrease in the groups administered the two doses of Magnesium chloride (250 and 500 mg/kg) respectively as compared to control. In relation to the liver enzyme, the showed that there were significant (p<0.05) changes in value of AST, ALT and ALP in the group co-administered with the two doses of the Magnesium chloride compared to the control. The result showed that high-fat diet induces ROS, dyslipidaemia and release of biological metabolite, as evidenced by the rise in oxidative stress and activities of liver enzymes. MgCl2 administration also protected the body against rise in the metabolites despite consumption of high-fat diet by the Wistar Rats.

Abstract 5047: Change in age of diagnosis of oropharyngeal cancer in the United States, 1975-2015

Introduction: Human papillomavirus (HPV) is the most common etiology of oropharyngeal squamous cell carcinoma (OPSCC), causing 70-90% of cases, and has continued to increase in incidence. While HPV-associated OPSCC has been associated with younger age at diagnosis compared to other head and neck cancers, research studies suggest that age of diagnosis might have increased in the last decade. There is currently no long-term, population-based estimate of age of diagnosis of oropharyngeal cancer, or differences in age of diagnosis based on race and gender. This study aimed to describe the change if any in the age of diagnosis of OPSCC in the last four decades.

Methods: The mean age at diagnosis of OPSCC patients from the Surveillance, Epidemiology, and End Results (SEER) 9 database diagnosed from 1975-2015 was computed for each year (n = 30,320). An independent samples t-test compared mean age at diagnosis by sex (female, male), and analysis of variance compared mean age at diagnosis by race/ethnicity (Hispanic, non-Hispanic (NH) white, NH black, NH other). Joinpoint regression estimated yearly increases/decreases in mean age of diagnosis by sex and race/ethnicity through annual percent changes (APC), which were summarized with average annual percent changes (AAPC).

Results: OPSCC patients were predominantly NH white (80.0%) and male (76.8%) with a mean age at diagnosis of 60.3 years (standard deviation = 10.9 years). Females had a significantly higher mean age at diagnosis than males (62.4 versus 59.7, p &lt; 0.01). Hispanic (mean = 59.2) and NH black patients (mean = 57.3) had a significantly lower mean age at diagnosis than NH white patients (mean = 60.8). Overall, mean age at diagnosis remained stable from 1975-1996 (APC = 0.00, p &gt; 0.05), significantly decreased from 1996-2002 (APC=-0.86, p &lt; 0.01), and significantly increased from 2002-2015 (APC = 0.35, p &lt; 0.01). However, the overall AAPC showed a stable trend in age of diagnosis from 1975-2015 (AAPC = -0.02, p &gt; 0.05). The AAPCs in age of diagnosis for gender (males and females) and race/ethnicity also both remained stable from 1975-2015 (p &gt; 0.05), except for NH blacks, with an estimated 0.13% yearly increase in age of diagnosis from 1975-2015 (AAPC = 0.13, p &lt; 0.01).

Conclusions: The overall age at diagnosis for OPSCC has remained stable in the United States between 1975 and 2015. The younger age at diagnosis among NH blacks and Hispanics is important in prevention, early detection, and surveillance of OPSCC in the United States

Citation Format: Brittany J. Cline, Matthew C. Simpson, Aleksandr R. Bukatko, Eric Adjei Boakye, Kahee A. Mohammed, Nosayaba Osazuwa-Peters. Change in age of diagnosis of oropharyngeal cancer in the United States, 1975-2015 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 5047.

Cumulative odds of increased comorbid score in head and neck cancer

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Background: Survival of head and neck cancer is impacted by known clinical factors, including anatomic subsite, stage of presentation, and treatment modality. An important clinical factor less explored is comorbidity burden. While it is known that a greater comorbidity burden is prognostic for poorer outcomes, it is unclear how the odds of presenting with increased comorbidity score is associated with head and neck cancer anatomic subsite. This study aimed at estimating the cumulative odds of increased comorbidity in head and neck cancer based on anatomic subsites. Methods: Data queried from National Cancer Database (2004-2015). Study sample (N = 328,504) consisted of Stage I-IV, Head and neck Squamous Cell Carcinoma (HNSCC) patients, with no missing demographic variables (age, sex, race, insurance status, local income, local population density). Multivariable cumulative logit model was used to estimate outcome of interest: odds of higher Charlson-Deyo comorbid condition score(CDCC) at HNSCC diagnosis. Results: Compared to patients diagnosed with oropharyngeal cancer (mostly HPV-related HNSCC), patients diagnosed with more tobacco-related HNSCC, such as laryngeal cancer (aOR: 1.69, 95% CI: 1.65-1.73), hypopharyngeal cancer (aOR: 1.33, 95% CI: 1.28-1.38), oral cavity (aOR: 1.26, 95% CI: 1.23-1.29), and sinonasal cancer (aOR: 1.12, 95% CI: 1.06-1.19) had greater odds of presenting with a higher CDCC. Patients with nasopharyngeal cancer did not statistically differ from oropharyngeal patients in odds of higher CDCC presentation. Conclusions: Patients diagnosed with cancers of larynx, hypopharynx and oral cavity (typically associated with tobacco and alcohol use) present with greater comorbid burden compared to patients diagnosed with oropharyngeal cancer (typically associated with HPV). It is important that the role of comorbidity burden be recognized in head and neck cancer prognostication.

Changes in the proportion of squamous cell carcinoma in head and neck cancer in the United States and Canada, 1995-2015

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Background: There has been a shift in the epidemiologic landscape of head and neck cancer (HNC) with decreasing incidence of tobacco-related and increasing incidence of human papillomavirus (HPV)-related HNC. While it is often reported that ≥ 90% of HNC is considered squamous cell carcinoma (SCC), there is an apparent lack of recent population-based data to support this claim. This study aimed to estimate the current proportion and evaluate change in the proportion of SCC in HNC diagnoses in North America (United States and Canada) from 1995 to 2015. Methods: We queried the North American Association of Central Cancer Registries (NAACCR) database for HNC cases that were of either squamous (SQ) (ICD-0-3: 8050-8089) or squamous plus unspecified epithelial (SQE) (ICD-0-3:8010-8089) origin in the United States and Canada ( n = 1,054,409). All HNC included in the analysis were microscopically confirmed, malignant head and neck primary tumor sites of the oral cavity, nasopharynx, hypopharynx, oropharynx, nasal cavity, and larynx. Sub-analyses were conducted across more extensive cohort restriction combinations (country specific, registry specific, and primary sequence of cancer). Results: The overall proportion of SCC in HNC in North America from 1995-2015 was 81.7% (95% CI: 81.7 – 81.8) for SQ and 84.9% (95% CI: 84.8 – 85.0) for SQE. The proportion of SCC in HNC peaked in 2015 with 83.3% (95% CI: 83.0 – 83.6) for SQ and 85.9% (95% CI: 85.6 – 86.2) for SQE; and was lowest in 2005 with 80.7% (95% CI: 80.4 – 81.1) for SQ and 84.3% (95% CI: 83.9 – 84.6) for SQE. In the time period of this study (1995 – 2015), there were no years for which SQ or SQE made up 90% or more of HNC for any of the HNC cohorts. Conclusions: The changing landscape of HNC risk factors in the United States and Canada warrants re-evaluation and update of HNC epidemiological literature with regards to the proportion of SCC in HNC.

Disparities in survival by insurance status in chronic lymphocytic leukemia

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Background: Chronic Lymphocytic Leukemia (CLL) is the most common leukemia in western world. It is the disease of older adults with a median age at diagnosis of approximately 70 years. However, significant proportion of younger adults are diagnosed with CLL and they usually have an adverse clinical and molecular risk profile necessitating early interventional strategies compared to older patients. Socioeconomic disparities may affect survival for some patient populations. This study examined survival by insurance status for younger patients with CLL. Methods: The Surveillance, Epidemiology, and End Results database was used to identify patients, aged 15 - 64 years, who were diagnosed with CLL between 2007 and 2014 and whose insurance status (no insurance, Medicaid, and other insurance) was documented at diagnosis. Unadjusted associations between insurance status and overall survival (OS) were plotted using Kaplan-Meier curves. The association between insurance status and CLL-specific mortality was assessed using multivariate Cox proportional hazards regression models, adjusting for sociodemographic covariates. Results: A total of 10,913 patients with CLL were included with a median follow up of 44 months. Five-year survival estimates were 87.3%, 87.2%, and 94.0% for patients with no insurance, Medicaid, and other insurance, respectively. In multivariate analysis, compared to patients with other insurance, patients with no insurance (hazard ratio [HR] = 2.33, 95% confidence interval [CI] = 1.73 – 3.140) and Medicaid (HR = 1.95, 95% CI = 1.49 – 2.54) had significantly worse OS survival after adjusting for sociodemographic factors. Conclusions: Younger patients with no insurance or Medicaid have lower survival outcomes after diagnosis with CLL compared to patients with other insurance. Addressing barriers to care, providing resources, and expanding access to care is paramount to reducing the gap in survival for the uninsured patients and those with lower socioeconomic status. Further studies are needed to address poor survival outcomes among Medicaid patients.

Housing characteristics, home environmental factors, and pulmonary function deficit in Chinese children: Results from the Seven Northeast Cities (SNEC) Study

To assess the effects of housing characteristics and home environmental factors on lung function of Chinese children, 6740 children (aged 6–16 years) were recruited from seven cities in Northeast China in 2012. Performance of lung function was determined by comparison of forced vital capacity (FVC), forced expiratory volume (FEV1), peak expiratory flow (PEF), and maximal mid-expiratory flow (MMEF). Multivariate regression models were used to evaluate the associations with lung function deficit. The results showed that housing conditions were associated with lung function deficit in children. The adjusted odds ratios were 0.47 (95% CI: 0.26–0.83) for FVC for “ping-fang” housing compared with “dan-yuan-lou-fang” housing and 2.90 (95% CI: 2.43–3.47) for FEV1 with home renovations completed within two years compared with counterparts. The linear regression models consistently showed a significant association of housing conditions and home environmental factors with lung function measurements across subjects. A residence taller than seven stories was negatively associated with FEV1 ( β = −55; 95% CI: −97 to −13). In conclusion, housing conditions and home environmental factors are particularly important to the development of lung function and respiratory health in children. These factors are concerning and action should be taken to improve them.

Radiation and Second Primary Thyroid Cancer Following Index Head and Neck Cancer

OBJECTIVES/HYPOTHESIS

Radiation is thought to increase risk of developing second primary thyroid cancer (SPTC). This study estimated the rate of SPTC following index head and neck cancer (HNC) and determined whether radiation treatment among HNC survivors increased SPTC risk.

STUDY DESIGN

Retrospective data analysis.

METHOD

The Surveillance, Epidemiology, and End Results database (1975-2014) was queried for cases of index HNC (N = 127,563) that developed SPTC. Adjusted multivariable competing risk proportional hazards model tested risk of developing a SPTC following index HNC. Sensitivity analyses using proportional hazards models were also performed restricting data to patients who 1) received both radiation and chemotherapy and 2) radiation alone.

RESULTS

Only 0.2% of index HNC survivors (n = 229) developed SPTC, yielding a rate of 26.1 per 100,000 person-years. For every increasing year of age at diagnosis, patients were 3% less likely to develop an SPTC (adjusted hazard ratio [aHR] = 0.97, 95% CI: 0.96-0.98). Males were also less likely to develop an SPTC (aHR = 0.73, 95% CI: 0.55-0.96). Radiation (aHR = 0.92, 95% CI: 0.68-1.25), surgery (aHR = 0.79, 95% CI: 0.56-1.11), and chemotherapy (aHR = 1.13, 95% CI: 0.76-1.69) were not significantly associated with developing SPTC. The sensitivity models also did not find an association between treatment and risk of SPTC.

CONCLUSIONS

Rate of developing SPTC following index HNC was very low, and previous exposure to radiation did not significantly increase risk in our study population. More studies are needed to understand the increasing incidence of thyroid cancer across the United States.

LEVEL OF EVIDENCE

NA Laryngoscope, 129:1014-1020, 2019.

Abstract 4255: Differences in the sociodemographic correlates of HPV-associated cancer survival in the United States

Purpose: Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. One in every four individuals-nearly 80 million-is infected. More than 38,000 new cases of HPV-associated cancers are diagnosed annually. However, factors related to HPV-associated cancer survivorship, based on primary anatomic site, remain understudied. The aim of this study was to assess sociodemographic factors related to survival following diagnosis of HPV-associated cancers in the United States.

Methods: Patients ≥18 years diagnosed with first-primary HPV-associated cancer between 2007 and 2014 were identified from the Surveillance, Epidemiology, and End Results 18. HPV-associated cancers sites were defined as anal, cervical, oropharyngeal, penile, vaginal, and vulvar per the International Classification of Diseases for Oncology, third edition codes. Kaplan-Meier curves showing cancer-specific survival (CSS) from each HPV-associated cancer site stratified by sex with differences assessed by log-rank tests. Fine and Gray proportional hazards regression models for each HPV-associated site controlled for clinical covariates and estimated sociodemographic predictors of hazard of death from cancer.

Results: A total of 63,329 patients with HPV-associated cancers were included in the analyses. The most common sites were cervix for females (58%) and oropharynx for males (78%). Overall 8-year survival at the end of follow-up was 56%. For males, anal cancer had the lowest CSS (62%) compared to oropharyngeal (69%) and penile (72%) cancer (p&lt;0.01). For females, vaginal cancer had the lowest CSS (46%) compared to anal (71%), cervical (67%), oropharyngeal (57%), and vulvar (72%) cancer. Final adjusted model showed significant CSS differences based on sociodemographic factors, including sex, age, marital status, race/ethnicity, and insurance status. Males were more likely to die from anal cancer compared to females (aHR=1.53, 95% CI 1.39, 1.68), while less likely than females to die from oropharyngeal cancer (aHR=0.91, 95% CI 0.84, 0.98). Blacks were more likely to die from anal (aHR=1.33, 95% CI 1.16, 1.52), cervical (aHR=1.13, 95% CI 1.05, 1.22), and oropharyngeal cancer (aHR=1.54, 95% CI 1.41, 1.68) compared with Whites. Each increasing year of diagnosis was associated with a 1-3% increase in hazard of cancer-specific death for all cancers.

Conclusions: There is marked variability in sociodemographic correlates among HPV-associated cancer survivors in the United States, based on sex, age, insurance and marital status, race/ethnicity, and cancer type. This has important implications for clinical decision making and identification of populations at greater risk of death from HPV-associated cancers.

Citation Format: Nosayaba Osazuwa-Peters, Matthew C. Simpson, Eric Adjei Boakye, Kahee A. Mohammed, Longwen Zhao, Sai D. Challapalli, Rebecca L. Rohde, Vy T. Pham, Sean T. Massa, Mark A. Varvares. Differences in the sociodemographic correlates of HPV-associated cancer survival in the United States [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4255.

Abstract 5279: Prevalence and correlates of perceived harmfulness and addictiveness to traditional and alternative tobacco products among US adults

Purpose: Beliefs about addictiveness and harmfulness of tobacco products are associated with intentions to use them. This study aimed to (1) evaluate perceived harmfulness and addictiveness patterns towards multiple tobacco products and (2) examine sociodemographic variables that influence those perceptions.

Methods: Weighted multivariate ordinal logistic regression analyses were performed on 5,474 US adults aged ≥18 years who participated in the 2015 and 2017 cycles of the Health Information National Trends Survey-FDA. The two primary outcomes were perceived harmfulness and addictiveness of traditional (cigarette, cigar, and pipe filled with tobacco) vs alternative tobacco (e-cigarette, hookah, and “roll your own” cigarettes). All models were adjusted for age, gender, race/ethnicity, education, household income, census region, and smoking status.

Results: Overall, 7.9% of adults in the U.S. perceived alternative tobacco as “not harmful at all” compared to 2.4% for the traditional products. Similarly, 16.2% of adults perceived alternative tobacco as “not addictive at all” compared to 13.6% for the traditional products. Beliefs about the harmfulness and addictiveness of traditional and alternative tobacco products differed by sociodemographic characteristics and smoking status: Those who believed traditional and alternative tobacco products are more harmful were more likely to be female, older (compared with those aged 18-34), Black (compared with White), former or never smokers (compared with current smokers), and adults living in West (compared with Northeast). Similarly, those who believed traditional and alternative tobacco products are more addictive were more likely to be female, older, Black, and adults living in West. However, no association between smoking status and perceived addictiveness was noted.

Conclusion: Adults in U.S. perceive tobacco harmfulness and addictiveness differently based on their sociodemographic characteristics and smoking status. These findings are potential areas for targeted behavioral interventions to increase individuals' perceived risk of harm and addiction to all forms of tobacco products in the United States.

Citation Format: Kahee A. Mohammed, Martin W. Schoen, Nosayaba Osazuwa-Peters, Ahmad M. Al-Taee, Gebran W. Khneizer, Lauren D. Arnold, Leslie Hinyard, Thomas E. Burroughs. Prevalence and correlates of perceived harmfulness and addictiveness to traditional and alternative tobacco products among US adults [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5279.

Abstract 4244: Hookah pipe awareness and perceived harmfulness: Prevalence, correlates, and association with smoking cessation outcomes

Introduction: Hookah smoking is becoming an increasingly popular choice of tobacco use and is remarkably common among young adults in the United States. This study aimed to evaluate the prevalence and correlates of hookah awareness and perceived harmfulness among US adults and to examine its association with cigarette smoking quit intention and attempt. Methods: Data from the Health Information National Trends Survey 2013 to 2017 were analyzed. The sample included 6,711 adults aged ≥ 18 years. Weighted multivariable logistic regression analyses were performed and adjusted for age, gender, race/ethnicity, education, household income, region, and cigarette smoking status. Results: Overall, 78% of US adults were aware of hookah. Of these, 72% believed hookah pipes were equally harmful as cigarettes, whereas 17.6% believed otherwise. Those who were aware of hookah were less likely to be older (aOR=0.12, 95% CI=0.09 - 0.16), Black (aOR=0.56, 95% CI=0.43 - 0.72) and Hispanic (aOR=0.61, 95% CI=0.48 - 0.79), and lesser-educated (aOR=0.40, 95% CI=0.29 - 0.54) adults. Compared to never smokers, former smokers were 64% (95% CI=1.37 - 1.96) more likely to be aware of hookah. Among those aware of hookah, older (aOR=0.49, 95% CI=0.37 - 0.65), Black (aOR=0.73; 95% CI=0.58 - 0.97), and lesser-educated (aOR=0.69; 95% CI=0.48 - 0.95) were less likely to perceive hookah as less harmful than cigarettes. Those who perceived hookah to be just as harmful as cigarettes were less likely to try to quit cigarette smoking in the past year (aOR=0.49, 95% CI=0.25 - 0.93). Those who perceived hookah to be less harmful than cigarettes were more likely to consider quitting cigarette smoking in the next 6 months (aOR=2.86, 95% CI=1.29 - 6.33). Conclusions: Young, White, and college graduate adults are more likely to believe that hookah smoking is less harmful that cigarettes. These disparities can be used to target behavioral interventions aimed at increasing individuals' perceived risk, knowledge, and perceived harmfulness of hookah smoking.

Citation Format: Kahee A. Mohammed, Martin W. Schoen, Nosayaba Osazuwa-Peters, Divya S. Subramaniam, Lauren D. Arnold, Leslie Hinyard, Thomas E. Burroughs. Hookah pipe awareness and perceived harmfulness: Prevalence, correlates, and association with smoking cessation outcomes [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4244.

Effects of Clove and Fermented Ginger on Blood Glucose, Leptin, Insulin and Insulin Receptor Levels in High Fat DietInduced Type 2 Diabetic Rabbits

The aimed of this research is to evaluate the effects of clove and fermented ginger supplements on blood glucose,serum insulin, insulin receptor and Leptin levels of high fat diet-induced type 2 diabetes mellitus in rabbits. Clove and gingerare spices with records of medicinal value over decades. Thirty males rabbits weighing, 1-1.5kg were used for the research.Type 2 diabetes was induced by feeding the animals with a high fat diet for a period of eight weeks. Blood glucose levelswere determined after the induction period and rabbits having 140 mg/dL and above were selected for the study. The animalswere grouped into six groups with five (n=5) rabbits in each group: Group 1 (Normoglycemic control group.) received normalfeed and distilled water ad libitum for six weeks; Group 2 (Diabetic negative control group.) received normal feed anddistilled water ad libitum for six weeks; Groups 3 (Diabetic positive control.) received cholestran 0.26g/kg and normal feedfor a period of six weeks; Group 4 and 5 (diabetic rabbits) were fed on 12.5%, clove and 12.5% fermented gingerrespectively for a period of six weeks; while Group 6 were co-fed on 12.5% clove and 12.5% fermented ginger for a periodof six weeks. Fasting blood glucose levels were determined at weekly interval during the treatment period. At the end of theexperiment, the rabbits were euthanized by cervical dislocation and blood samples were collected for the determination ofinsulin, insulin receptor and leptin levels. A significantly (P<0.05) decrease in blood glucose levels was recorded in thesupplements treated groups compared to diabetic control group. Clove supplement been most effective and sustaining inantihyperglycemic activity, also appears with a significant decreasing effect on leptin levels compared to diabetic controlgroup. A significant increase in insulin levels was also noted in the fermented ginger treated group along with higher levelsof Leptin compared as compared to control group. In conclusion the result of the study show that clove and fermented gingersupplementation possesses anti-diabetic properties and may help in the control of hyperleptinaemia in type 2 diabetes.

An Observational Epidemiological Study of Exercise-induced Rhabdomyolysis Causing Acute Kidney Injury: A Single-center Experience

Exercise-induced rhabdomyolysis (EIR) is an uncommon cause of severe rhabdomyolysis and a very rare cause of acute kidney injury (AKI). A prospective observational study of 25 patients diagnosed with EIR was conducted in a multispecialty hospital in Dubai, from 2009 to 2015. Five out of 25 patients experienced AKI necessitating temporary renal replacement therapy. The initial presentation, biochemical parameters, and clinical course of patients were monitored, to understand epidemiology and risk factors for the development of AKI. There was male preponderance (4 out of 5 patients), higher rate of systemic symptoms (all 5 patients) versus 60% in NRAKI), oligo-anuria (all 5 patients), compartment syndrome (3 out \of 5) and severe dehydration seen in patients with RAKI group. On laboratory evaluation, there was higher rise in creatinine kinase (CK) enzyme, serum and urine myoglobin levels impaired renal function on presentation, hyperuricemia, high D-dimer level, PCV of more than 55%, found to be associated with RAKI as compared to NRAKI group. Hematuria by positive urine dipstick with absent red blood cells on urinalysis, is an insensitive tool as was present in only 62% and 43% of RAKI and NRAKI groups, respectively. It was also observed that delayed pesentation for medical care, metabolic acidosis, were commonly associated with AKI. All patients with RAKI required RRT for a comparable period of time (3-4 weeks). In all of them, no deterioration or relapse reported on follow-up of 3 months.

Correlates of health information seeking between adults diagnosed with and without cancer

PURPOSE

To examine predictors of information seeking behavior among individuals diagnosed with cancer versus those without.

METHODS

Cross-sectional data from the Health Information National Trends Survey 4 Cycles 1-3 (October 2011 to November 2013) were analyzed for 10,774 survey respondents aged ≥18 years. Binary logistic regression was used to examine the effect of socio-demographic and behavioral factors on health information seeking.

RESULTS

Cancer diagnosis did not predict health information seeking. However, respondents diagnosed with cancer were more likely to seek health information from a healthcare practitioner. Compared to males, females were more likely to seek health information irrespective of cancer diagnosis. Regardless of cancer diagnosis, those without a regular healthcare provider were less likely to seek health information. Likelihood of seeking health information declined across education strata, and significantly worsened among respondents without high school diplomas irrespective of cancer diagnosis.

CONCLUSIONS

Respondents sought health information irrespective of cancer diagnosis. However, the source of health information sought differed by cancer diagnosis. Gender, education, and having a regular healthcare provider were predictors of health information seeking. Future health communication interventions targeting cancer patients and the general public should consider these findings for tailored interventions to achieve optimal results.

Rural-urban differences in human papillomavirus knowledge and awareness among US adults

Rural residents of the United States have higher HPV-associated cancer incidence and mortality, and suboptimal HPV vaccine uptake compared to urban residents. This study aimed to assess differences in knowledge and awareness of HPV, the HPV vaccine, and HPV-associated cancers among rural and urban residents. We analyzed data from the Health Information National Trends Survey 2013-2017 on 10,147 respondents ages ≥18 years. Multivariable logistic regression analyses compared urban/rural differences in knowledge and awareness of HPV, associated cancers, and HPV vaccine. Models were adjusted for sex, age, race/ethnicity, education, household income, census region, health insurance, regular provider, internet use, and personal history of cancer. Overall, 67.2% and 65.8% of urban residents were aware of HPV and HPV vaccine, respectively, compared to only 55.8% and 58.6% of rural residents. Adjusted models illustrated that compared to urban residents, rural residents were less likely to be aware of HPV (OR = 0.68, 95% CI = 0.53-0.86) and HPV vaccine (OR = 0.78, 95% CI = 0.63-0.97). Among those who were aware of HPV, rural residents were less likely to know that HPV causes cervical cancer (OR = 0.62, 95% CI = 0.46-0.84) and that HPV can be transmitted through sexual contact (OR = 0.72, 95% CI = 0.56-0.94). No significant differences between rural and urban residents were noted for knowledge that HPV is transmitted sexually and that it causes oral, anal, and penile cancers. This study highlights significant rural health disparities in knowledge and awareness of HPV and the HPV vaccine compared to urban counterparts.

New scoring classification for primary biliary cholangitis-autoimmune hepatitis overlap syndrome

Autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC) are two major immune‐mediated chronic liver diseases. Overlap syndrome (OS) is diagnosed if patients have features of both AIH and PBC; however, there is no consensus on the definition or diagnostic criteria for OS. Here, we report a new scoring classification for OS and evaluate its usefulness. This new scoring classification was developed by modifying the International Autoimmune Hepatitis Group classification by selecting histologic features of AIH and PBC along with modifications of biochemical and immunologic characteristics. We evaluated 272 patients with chronic liver disease, including 105 with AIH, 102 with PBC, and 65 with OS. The best performance for the diagnosis of OS was noted among patients with an overlap score of ≥21 who had a sensitivity of 98.5%, a specificity of 92.8%, a positive predictive value of 81.0%, and a negative predictive value of 99.5%. By using a cut‐off score of 21, 64 (98.5%) patients were diagnosed with OS as opposed to 9 (8.8%) and 6 (5.7%) with PBC and AIH, respectively. All patients with OS had an aggregate score of >19, whereas most patients with PBC or AIH scored <19, making this a safe discriminatory cut‐off point against OS. Conclusion: The new scoring system for the diagnosis of OS has a high sensitivity and specificity for scores ≥21, while a score <19 suggests a diagnosis other than OS. This classification can identify patients and diagnose OS with a reasonable amount of accuracy and may be superior to current OS scoring systems in detecting mild forms of OS. (Hepatology Communications 2018;2:245‐253)

Incidence of Sinusitis Associated With Endotracheal and Nasogastric Tubes: NIS Database

BACKGROUND

Endotracheal and nasogastric tubes are recognized risk factors for nosocomial sinusitis. The extent to which these tubes affect the overall incidence of nosocomial sinusitis in acute care hospitals is unknown.

OBJECTIVE

To use data for 2008 through 2013 from the Nationwide Inpatient Sample database to compare the incidence of sinusitis in patients with nasogastric tubes with that in patients with an endotracheal tube alone or with both an endotracheal tube and a nasogastric tube.

METHODS

Patients' data with any of the following International Classification of Disease, Ninth Revision, Clinical Modification codes were abstracted from the database: (1) 96.6, enteral infusion of concentrated nutritional substances; (2) 96.07, insertion of other (naso-)gastric tube; or (3) 96.04, insertion of an endotracheal tube. Sinusitis was defined by the appropriate codes. Weighted and unweighted frequencies and weighted percentages were calculated, categorical comparisons were made by χ² test, and logistic regression was used to examine odds of sinusitis development by tube type.

RESULTS

Of 1 141 632 included cases, most (68.57%) had an endotracheal tube only, 23.02% had a nasogastric tube only, and 8.41% had both types of tubes. Sinusitis was present in 0.15% of the sample. Compared with patients with only a nasogastric tube, the risk for sinusitis was 41% greater in patients with an endotracheal tube and 200% greater in patients with both tubes.

CONCLUSION

Despite the low incidence of sinusitis, a significant association exists between sinusitis and the presence of an endotracheal tube, especially when a nasogastric tube is also present.

Effects of Fermented Ginger Rhizome (Zingiber officinale) and Fenu Greek (Trigonella foenum-graceum) Supplements on Oxidative stress and Lipid Peroxidation Biomarkers in Poloxamer-407 Induced -Hyperlipidemic Wistar Rats

This research was aimed at investigating the Effects of Fermented Ginger Rhizome (Zingiber officinale) and Fenu Greek (Trigonella foenum-graceum) on Oxidative stress and Lipid Peroxidation Biomarkers in Poloxamer 407Induced-Hyperlipidemic Wistar Rats. Hyperlipidaemia was induced with poloxamer P407 (1.5 g/kg   b.w. i.p.) The Animals were grouped into six of five animals each group. Group 1 normal control, Group 2 served as the hyperlipidemic control, Group 3 administered 0.26 g/kg cholestyramine, Group 4 fed on Fenugreek 25% supplement. Group 5 fed on 25% fermented ginger supplement, while group 6 were fed on 25% ginger and fenu greek combined   respectively. All treatments were given for a period of four week. Serum antioxidant activities such as catalase (CAT), glutathione peroxidase (GPx), Superoxide dismutase (SOD) and Malondialdehyde were evaluated.  As regards to the catalase activity there was a significant decrease in the groups' fed on 25% fenugreek and 25% fermented ginger supplements respectively. However, co-fed with both supplements significantly increase the catalase activity as compared with the hyperlipidaemic control untreated. Comparism with the positive control cholestyramine, there was also a significant increase. Also in relation to the SOD activity there was a significant increase in the activity as compared with the hyperlipidemic control. Furthermore, the Gpx activity there was a significant increase in the as compared with the hyperlipidemic control. oxidative stress biomarker activities SOD) there was significant increase (p<0.05) when compared with hyperlipidemic control. There was a significant (p<0.05) decrease in the Malondialdehyde levels in the groups fed with the supplement when compared with hyperlipidemic control. In conclusion supplements of Fenugreek and Ginger improved antioxidant status and reduced Malondialdehyde in Poloxamer-407 Induced-Hyperlipidemic Wistar Rats.

Approaching a decade since HPV vaccine licensure: Racial and gender disparities in knowledge and awareness of HPV and HPV vaccine

Purpose: Gaps remain in the public's knowledge of the human papillomavirus (HPV). We assessed racial/ethnic and gender disparities in knowledge and awareness of HPV and the HPV vaccine among US adults.

METHODS

Data from the Health Information National Trends Survey 4 Cycle 3 (September - December 2013) and Cycle 4 (August - November 2014) were analyzed for 6,862 respondents aged 18 years and older. Weighted multivariable logistic regression models were used to estimate racial/ethnic and gender disparities in HPV knowledge and HPV vaccination awareness.

RESULTS

Sixty-six percent of respondents had heard of HPV and the HPV vaccine (57% of men vs. 75% of women). In multivariable analyses, compared with men, women were 225% (95% CI: 2.60 - 4.07) more likely to have heard of HPV, and 281% (95% CI: 3.06 - 4.74) more likely to have heard of the HPV vaccine. Non-Hispanic Blacks were 33% (95% CI: 0.47 - 0.96) and 44% (95% CI: 0.39 - 0.81) less likely than non-Hispanic Whites to have heard of HPV and the HPV vaccine, respectively. Hispanics were 27% (95% CI: 0.52 - 1.02) and 53% (95% CI: 0.34 - 0.64) less likely than non-Hispanic Whites to have heard of HPV and the HPV vaccine, respectively.

CONCLUSIONS

There was evidence of disparities in HPV and HPV vaccine awareness among men compared with women and non-Hispanic Blacks and Hispanics compared with non-Hispanic Whites. To foster improvements in HPV vaccine uptake and reduce disparities in HPV associated cancers, future interventions must target men and minority populations, for whom knowledge gaps exist.

Anti-hyperglycaemic Effects of Rutin on Blood Glucose, Oxidative Stress Biomarkers and Lipid Peroxidation in Alloxan-induced Hyperglycaemic Wistar Rats

The present study investigated the anti-hyperglycaemic effect of rutin on blood glucose, oxidative stressbiomarkers and lipid peroxidation in alloxan induced hyperglycaemic wistar rats. Diabetes was induced in rats by anintraperitoneal (i.p) injection of alloxan monohydrate 150 mg/kg body weight. Twenty five wistar rats were divided asfollows; Group1 served as diabetic control received distilled water 2 mg/kg, Group served as positive control received 2mg/kg glibenclamide, 3, 4 and 5 received rutin at 50, 100 and 200 mg/kg body weight for 28 days respectively. At the end of the treatment, rats were sacrificed and the blood and serum were used for the analysis of blood glucose and oxidativestress biomarkers respectively. The determinations of blood glucose levels were carried out at intervals of 7, 14, 21 and 28days respectively Serum oxidative stress biomarkers lipid peroxidation, were done on the 28 days. Administrations of rutinat the three different doses 50,100 and 200 mg/kg to diabetic rats significantly (p<0.05) decreased the blood glucose levelsas compared to diabetic control. The dose of 200 mg/kg exhibited a maximum glucose lowering effect with blood glucoseof 102.8± 0.06 as compared to diabetic control 346.2±0.16. Furthermore, in relation to the oxidative stress biomarkers therewas a significant (p<0.05) increased in the levels of gluthathione peroxidase, superoxide dismutase and catalase as comparedto control. However, there was also a significant decreased in the malondialdehyde levels as compared to control. It may beconcluded that oral administration of Rutin for 28 days decreases blood glucose levels and prevented oxidative stress andantioxidant status in hyperglycaemic rats.

Factors Associated With Parents' Intent to Vaccinate Adolescents for Human Papillomavirus: Findings From the 2014 National Immunization Survey-Teen

Introduction

While factors associated with receipt of human papillomavirus (HPV) vaccination have been well characterized, less is known about the characteristics associated with parents’ intent to have their adolescent children vaccinated. This study aimed to examine factors associated with parental intention toward HPV vaccination.

Methods

We analyzed data on 10,354 adolescents aged 13 to 17 years from the 2014 National Immunization Survey–Teen. Weighted multivariable logistic regression was used to examine associations between sociodemographic characteristics of mothers and adolescents, as well as a health care provider recommendation with parents’ intention to have their children receive HPV vaccine.

Results

Among unvaccinated adolescents, Hispanic ethnicity (boys adjusted odds ratio [AOR], 1.87, 95% confidence interval [CI], 1.34–2.61; and girls AOR, 1.57; 95% CI, 1.05–2.35), mothers with less than a high school diploma (boys AOR, 2.41; 95% CI, 1.58–3.67; and girls AOR, 1.86; 95% CI, 1.02–3.38), and having a health care provider recommend the vaccine (boys AOR, 1.87; 95% CI, 1.52–2.31; and girls AOR, 1.38; 95% CI, 1.05–1.82) were significantly associated with parents’ intention to have their adolescent child vaccinated within the next 12 months. In addition, non-Hispanic black race was a significant predictor of parents’ intent to vaccinate for boys (AOR, 1.89; 95% CI, 1.35–2.65).

Conclusion

Maternal education and Hispanic ethnicity were the strongest predictors of parental intent to vaccinate against HPV, followed by provider recommendation. As HPV vaccination rates in the United States remain below the Healthy People 2020 goal, messages may need to be targeted based on maternal education, race/ethnicity, and provider recommendation.

Not just a woman's business! Understanding men and women's knowledge of HPV, the HPV vaccine, and HPV-associated cancers

Few studies have included men when assessing differences in knowledge about HPV, and HPV-associated cancers. We examined gender differences in knowledge about HPV, HPV vaccine, and HPV-associated cancers. Multivariable logistic regression models were used to analyze data of 3,677 survey respondents aged 18 years and older from the 2014 Health Information National Trends Survey. Covariates included age, race/ethnicity, marital status, education, income level, regular provider, general health, internet use, and family structure aged 9 to 27 years. Analyses were conducted in 2015. Sixty-four percent of respondents had heard of HPV and the HPV vaccine. Seventy-eight percent of respondents knew HPV causes cervical cancer, but only 29% knew it causes penile cancer, 26% knew it causes anal cancer, and 30% knew it causes oral cancer. In multivariable analyses, males were less likely to have heard of HPV (aOR: 0.33; 95% CI: 0.25-0.45), and less likely to have heard of the HPV vaccine (aOR: 0.24; 95% CI: 0.18-0.32) compared to females. No differences existed between males and females regarding knowledge about HPV-associated cancers. In conclusion, knowledge of HPV, the vaccine, and HPV-associated cancers in both males and females in the United States remains very low, especially among men.

A Comparison of Parent- and Provider-Reported Human Papillomavirus Vaccination of Adolescents

INTRODUCTION

There is considerable effort at the state and national levels to monitor human papillomavirus (HPV) vaccine uptake and understand the factors that influence who gets vaccinated. Accurate measurement of vaccination coverage is critical for monitoring HPV vaccination. This study aimed to determine comparability between parent- and provider-reported HPV vaccination status for a sample of adolescents in the U.S.

METHODS

Data from the 2014 National Immunization Survey-Teen were analyzed in 2016 for 20,827 adolescents. Information on HPV vaccine uptake (initiation [one or more dose] and completion [three or more doses]) was obtained using parental (recall) and provider reports (electronic medical records). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and κ-coefficient were computed to determine how comparable parental and provider (ref group) reports were for HPV vaccination.

RESULTS

Prevalence of HPV vaccine initiation was comparable between parental and provider report (51.3% vs 50.0%) and for completion (30.7% vs 27.3%). Compared with provider report, parent-reported HPV vaccine initiation had high sensitivity (86.0%), specificity (87.4%), PPV (87.5%), NPV (85.9%), and acceptable κ-coefficient (0.73). Compared with provider report, parent-reported HPV vaccine completion had a sensitivity of 71.5%, specificity of 91.1%, PPV of 78.5%, NPV of 87.6%, and κ-coefficient of 0.64. Similar characteristics-adolescent age, sex, number of doctor visits, and region-were associated with HPV vaccine uptake using parental and provider reports.

CONCLUSIONS

Parental recall is comparable to provider report in monitoring HPV vaccine uptake for adolescents, although parental recall is less comparable for HPV vaccine completion.

Hematopoietic cell transplant comorbidity index (HCT-CI) to assess AML induction risk

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Background: Induction therapy for acute myeloid leukemia (AML) is intense and methods for risk appraisal of therapy are controversial. Formal comorbidity assessment may allow for improved prognostication in addition to age. The HCT-CI(+/-Age) was developed to inform risk of patients undergoing stem cell transplant, and has found use in predicting early outcomes in AML induction. We applied HCT-CI retrospectively to our experience to analyze the predictive power regarding patient survival during induction. Methods: 140 cases induced with idarubicin and cytarabine (IA) or IA plus cladribine (IAC) between Jan 2008 and Sept 2015. HCT-CI (+/- Age) was derived from information available prior to chemotherapy and NCCN Leukemia Risk were calculated. Death prior to discharge from the initial induction hospitalization was the primary outcome for logistic regression. Results: 107 patients received IAC and 33 IA with mean age of 57 and 66 years respectively (p<0.01). Regimen did not predict death (p=0.27). Median age was 61 (range 20-86) with mean scores of 2.0±0.2 (HCT-CI) and 2.9±0.2 (HCT-CI+Age). In univariate analysis HCT-CI (+/-Age) predicted death during induction. In multivariate analyses, when HCT-CI (+/-Age) was adjusted for (NCCN risk and regimen) or (age and regimen) predictive power was maintained (Table). Conclusions: These data suggest that HCT-CI predicts death during induction of AML and age did not augment prediction, up to age 70. We conclude that HCT-CI(+/-Age) may be a more useful tool than age alone or clinical instinct to help patients and providers make difficult decisions about therapy. [Table: see text]

Correlates of Hookah Pipe Awareness and Perceived Harmfulness Among U.S. Adults

INTRODUCTION

Hookah smoking has recently become a common form of smoking, and its prevalence has increased worldwide. This study determined the prevalence and correlates of hookah awareness and perceived harmfulness among U.S. adults.

METHODS

Weighted multivariable logistic regression analyses were performed on 6,711 adults aged ≥18 years collected from the 2013-2014 Health Information National Trends Survey (Cycles 3 and 4). Analysis was conducted in 2016.

RESULTS

Overall, 74.3% were aware of hookah. Of these, 73.4% believed hookah pipes were equally harmful as cigarettes whereas 15.7% believed otherwise. Older (OR=0.13, 95% CI=0.09, 0.18), black (OR=0.51, 95% CI=0.38, 0.71), Hispanic (OR=0.52, 95% CI=0.37, 0.71), and less-educated (OR=0.42, 95% CI=0.27, 0.65) respondents had lower odds of being aware of hookah. Compared with non-smokers, former smokers had 83% (95% CI=1.44, 2.33) higher odds of hookah awareness. Among those aware of hookah, older (OR=0.44, 95% CI=0.31, 0.62), black (OR=0.64, 95% CI=0.43, 0.96), and less-educated (OR=0.55, 95% CI=0.33, 0.92) respondents had lower odds of perceiving hookah as less harmful than cigarettes.

CONCLUSIONS

Most adults in U.S. are aware of hookah, but only 15.7% believe it is less harmful than cigarettes. This small proportion are mostly young, white, and college graduates. Targeted behavioral interventions will be necessary to increase individuals' perceived risk, knowledge, and perceived harmfulness of hookah smoking.

Disparities in Provider Recommendation of Human Papillomavirus Vaccination for U.S. Adolescents

PURPOSE

To determine the prevalence of and examine factors associated with provider recommendation of human papillomavirus vaccination for U.S. adolescents.

METHODS

Multivariable logistic regression analyses were performed using data from the National Immunization Survey-Teen 2014 on 34,478 adolescents aged 13-17 years.

RESULTS

Overall prevalence of vaccine recommendation was 72.6% for girls and 51.8% for boys. Lower rates were observed among girls aged 13 years, living below poverty line, adolescents of lesser educated mothers, and those residing in the South. Overall, girls had higher odds of vaccine recommendation (odds ratio [OR] = 2.57; 95% confidence interval [CI] = 2.35-2.82). Correlates of higher vaccine recommendation for girls were: older age-17 versus 13 (OR = 1.51; 95% CI = 1.20-1.89), living above versus below poverty line, and residing in Northeast (OR = 1.45; 95% CI = 1.21-1.73) and Midwest (OR = 1.29; 95% CI = 1.11-1.50) versus South. For boys, correlates of higher vaccine recommendation were: non-Hispanic black (OR = 1.30; 95% CI = 1.07-1.58) and Hispanic (OR = 1.24; 95% CI = 1.03-1.48) versus non-Hispanic white race and residing in Northeast (OR = 1.79; 95% CI = 1.54-2.08) and West (OR = 1.41; 95% CI = 1.17-1.70) versus South. Other factors associated with vaccine recommendation were having a college-educated mother and frequent doctor visits in the past 12 months.

CONCLUSIONS

This study highlights significant disparities in provider recommendation of human papillomavirus vaccination for U.S. adolescents. Findings suggest possible areas for tailored interventions to bridge the gap in vaccine recommendation and uptake in high-risk populations.

Abstract 2577: A comparison of parent and provider verified HPV vaccination initiation and completion in US adolescents: findings from the National Immunization Survey - Teen, 2014

Introduction:

Several studies have examined predictors of HPV vaccine initiation and completion. Two common methods to measure HPV vaccine initiation and completion are parental recall and provider verified vaccine history. Some studies use parental recall because it is cost-effective and time-consuming. Others argue that the provider report should be used because it is the gold standard, although it is more costly and time-consuming. Yet, few studies compare the accuracy of parental report versus provider report for HPV vaccine initiation and completion.

Objective:

To compare the accuracy of parental reported and provider reported data on HPV vaccine initiation and completion among a national sample of adolescents in the United States.

Methods:

Data from the 2014 National Immunization Survey-Teen (NIS-Teen) were analyzed for 38,703 adolescents. HPV vaccine initiation and completion were assessed using parental recall (shot cards) and provider verified (medical records) vaccine history. Adjusted, weighted multivariable logistic regression compared the accuracy of parental and provider reported data on HPV vaccine initiation and completion.

Results:

HPV vaccine initiation (a) and completion (b), by subgroup analysis, is similar for parental recall and provider report. However, subgroup analyses for parental report were slightly lower than provider report, although not statistically significant (Table 1).

Conclusion:

This study showed that parental report is comparable to provider report when measuring HPV vaccine initiation and completion among adolescents in the US. For more cost-effective and timely assessment of vaccine uptake, an accurate and practical method of measuring HPV vaccine initiation and completion is paramount. Utilizing parental report may be a more cost-effective and timely alternative to provider report for clinical evaluation of vaccine uptake. Table 1:Subgroup analysis of HPV vaccine initiation and completion, Odds Ratios (95% CI)HPV Vaccine Initiation (a)Parental RecallProvider verifiedGender (Ref: Boys)1.98 (1.81, 2.15)2.02 (1.81, 2.26)Race (Ref: Caucasian)African American1.19 (1.03, 1.37)1.31 (1.10, 1.56)Hispanic1.38 (1.20, 1.58)1.51 (1.27, 1.79)Region (Ref: South)Northeast1.31 (1.18, 1.46)1.46 (1.27, 1.67)Midwest1.11 (1.01, 1.22)1.15 (1.02, 1.30)West1.25 (1.09, 1.43)1.42 (1.20, 1.69)HPV Vaccine Completion (b)Parental RecallProvider verifiedGender (Ref: Boys)2.24 (2.02, 2.48)2.37 (2.09, 2.69)Race (Ref: Caucasian)African American0.91 (0.77, 1.07)1.05 (0.87, 1.28)Hispanic1.06 (0.91, 1.23)1.40 (1.17, 1.68)Region (Ref: South)Northeast1.39 (1.23, 1.57)1.55 (1.34, 1.80)Midwest1.14 (1.02, 1.27)1.24 (1.08, 1.41)West1.20 (1.03, 1.40)1.36 (1.12, 1.66)

Citation Format: Eric Adjei Boakye, Nosayaba Osazuwa-Peters, Kahee A. Mohammed, Christian J. Geneus, Betelihem B. Tobo. A comparison of parent and provider verified HPV vaccination initiation and completion in US adolescents: findings from the National Immunization Survey - Teen, 2014. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 2577.

Abstract 1787: Adolescent boys and the human papillomavirus (HPV) - Geographical patterns of vaccination uptake

INTRODUCTION

Human Papillomavirus (HPV) remains the most common sexually transmitted infection (STI) and is associated with multiple cancers. Previous research has examined HPV vaccine initiation and completion among girls. Among adolescent boys who are also at risk for contracting HPV, however, vaccine initiation and completion have not been widely explored.

OBJECTIVE

To examine predictors of HPV vaccine initiation and completion among boys in the United States.

METHODS

Analysis was conducted on 10,866 adolescent boys aged 13-17 using the 2014 National Immunization Survey-Teen. Our outcomes of interest, HPV vaccine initiation and completion, were measured using provider-verified vaccine history. Weighted multivariable logistic regression models assessed predictors of HPV vaccine initiation and completion.

RESULTS

Data stratified by geographic region showed that the prevalence of HPV vaccine initiation and completion ratio was lowest in the South: South (initiation: 38.82%, completion: 18.20%), Midwest (initiation: 38.15%, completion: 19.69%), West (initiation, 48.88%, completion: 26.12%), Northeast (initiation: 48.30%, completion: 26.96%).

Multivariable analysis of geographic patterns indicated that adolescent boys residing in the West had higher odds of vaccine initiation compared to those in the South (OR = 1.41; 95% CI: 1.08 - 1.83).On the other hand, the odds of vaccine completion were higher in adolescents residing both in the Northeast (OR = 1.46; 95% CI: 1.14 - 1.87) and West (OR = 1.42; 95% CI: 1.03 - 1.95) compared to adolescent boys residing in the South.

Adolescent boys who were recommended the HPV vaccine by a physician had 8.49 (95% CI; 7.03 - 10.26) and 5.97 (95% CI: 4.49 - 7.94) higher odds of initiation and completion, respectively. Compared to White adolescent boys, the odds of vaccine initiation (OR = 1.90; 95% CI: 1.47 - 2.48) and completion (OR = 1.49; 95% CI: 1.09 - 2.04) were higher amongHispanics boys. Moreover, boys aged 17 had higher odds of vaccine initiation compared to those who were 13 (OR = 1.41; 95% CI: 1.05 - 1.90). Finally, while mothers’ education partially influenced the odds of vaccine initiation in adolescent boys (&lt;12 years; OR = 2.053; 95% CI: 1.43 - 2.95), such was not significant in vaccine completion. Instead, higher odds of vaccine initiation among adolescent boys were associated with mothers who had two children aged&lt;18 years compared to one child (OR = 1.29; 95% CI: 1.07 - 1.56).

CONCLUSION

Our findings highlight the suboptimal HPV vaccine across the United States, as well as the sociodemographic disparities and geographic variation of HPV vaccine initiation and completion. Particularly among adolescent boys residing in the South, tailored interventions are needed to improve HPV vaccine uptake.

Citation Format: Christian J. Geneus, Kahee A. Mohammed, Betelihem B. Tobo, Eric Adjei Boakye, Nosayaba Osazuwa-Peters. Adolescent boys and the human papillomavirus (HPV) - Geographical patterns of vaccination uptake. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1787.

Pineal Gland Calcification in Kurdistan: A Cross-Sectional Study of 480 Roentgenograms

Objective

The goal of this study was to compare the incidence of Pineal Gland Calcification (PGC) by age group and gender among the populations living in the Kurdistan Region-Iraq.

Methods

This prospective study examined skull X-rays of 480 patients between the ages of 3 and 89 years who sought care at a large teaching public hospital in Duhok, Iraq from June 2014 to November 2014. Descriptive statistics and a binary logistic regression were used for analysis.

Results

The overall incidence rate of PGC among the study population was 26.9% with the 51–60 age group and males having the highest incidence. PGC incidence increased after the first decade and remained steady until the age of 60. Thereafter the incidence began to decrease. Logistic regression analysis revealed that both age and gender significantly affected the risk of PGC. After adjusting for age, males were 1.94 (95% CI, 1.26–2.99) times more likely to have PGC compared to females. In addition, a one year increase in age increases the odds of developing PGC by 1.02 (95% CI, 1.01–1.03) units after controlling for the effects of gender.

Conclusion

Our analysis demonstrated a close relationship between PGC and age and gender, supporting a link between the development of PGC and these factors. This study provides a basis for future researchers to further investigate the nature and mechanisms underlying pineal gland calcification.

Abstract A60: A paradox: Engaging in at-risk behavior may not correlate with perceived susceptibility to cancer or heart disease

Background: The Health Belief Model states that behavioral change is highly influenced by perceived susceptibility to disease. The literature shows that physical activity, nutrition, and smoking are top factors associated with heart disease and cancer. Some studies have examined factors that affect perceived susceptibility to heart disease and cancer; however, there are no studies directly comparing predictors of perceived susceptibility to cancer and heart disease.

Objective: The objective of this study was to examine shared and differing predictors of respondents' perceived susceptibility to cancer and heart disease.

Methods: Data from the Health Information National Trends Survey 4 Cycle 3 (November 2013) were analyzed for 2,508 survey participants aged 18 years and older. Binary logistic regression was used to examine behavioral and socio-demographic risk factors for heart disease and cancer to determine predictors' of perceived susceptibility to these diseases.

Results:

Behavioral predictors:

Smoking status (p = 0.4385), nutrition (p = 0.6387), and physical activity (p = 0.5889) were not significant predictors of perceived susceptibility to cancer. Similarly, smoking status (p = 0.3702), nutrition (p = 0.1583), and physical activity (p = 0.0979) were not significant predictors of perceived susceptibility to heart disease. Former and current smokers perceived low susceptibility to heart disease but high susceptibility to cancer compared to non-smokers. In addition, those who consumed less than 5 servings of fruits and vegetables weekly perceived high susceptibility to heart disease but low susceptibility to cancer, compared to respondents who consumed 5 or more servings of fruits and vegetables weekly. Moreover, those who exercised 1-4 times per week perceived high susceptibility to heart disease and cancer, compared to respondents who exercised 5-7 times per week. On the other hand, those who did not engage in any physical activity perceived low susceptibility to heart disease and cancer, compared to respondents who exercised 5-7 times per week. Yet, none of these findings were significant.

Sociodemographic predictors:

Health status (p = 0.0116) was a significant predictor of perceived risk for cancer, illustrating a dose response relationship. Compared to those who reported excellent/very good health, those who reported fair/poor health (OR: 2.0; 95% CI: 1.22, 3.45) and good health (OR: 1.5; 95% CI: 1.04, 2.13) perceived high susceptibility to cancer. Similarly, health status (p = 0.0007) was a significant predictor of perceived susceptibility to heart disease. Compared to those who reported excellent/very good health, those who reported fair/poor health (OR: 1.8; 95% CI: 1.13, 2.99) and good health (OR: 2.0; 95% CI: 1.37, 2.79) perceived high susceptibility to heart disease. Race (p = 0.0002) was a significant predictor of perceived susceptibility to cancer. Compared to White respondents, Non-Hispanic Blacks (95% CI: 0.28, 0.84), Hispanics (95% CI: 0.38, 0.90), and other races (95% CI: 0.19, 0.62) were 49%, 58%, and 34% less likely to perceive susceptibility to cancer, respectively. However, race was not statistically significant predictor of perceived risk for heart disease.

Conclusions: Despite evidence that indicates the significance of engaging in top protective factors against cancer and heart disease—not smoking, proper nutrition, and exercise—our findings show that respondents at higher risk were not significantly more likely to perceive high susceptibility to illness. Perceived susceptibility is a key component of reducing risk behaviors and increasing health promoting behaviors. These paradoxical results pose important implications for disease-specific interventions targeting health behaviors. Healthcare providers and program planners should consider these findings for optimal intervention planning and implementation.

Citation Format: Betelihem B. Tobo, Tonya Short, Nosayaba Osazuwa-Peters, Kahee A. Mohammed, Lorinette Wirth, Christian Geneus, Eric Adjei Boakye. A paradox: Engaging in at-risk behavior may not correlate with perceived susceptibility to cancer or heart disease. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A60.

Talc mediates angiostasis in malignant pleural effusions via endostatin induction

Talc remains the most effective sclerosing agent for pleurodesis. However, its mechanism of action in resolving pleural malignant disease remains unclear. The present study evaluated the angiogenic balance in the pleural space in patients with malignant pleural effusions (MPE) following talc insufflation. Patient pleural fluid samples were collected both before and after talc insufflation. The ability of pleural mesothelial cells (PMC) and malignant mesothelioma cells (MMC) to produce endostatin in vitro was compared. The biological effects of pleural fluids and conditioned media from talc-activated PMC on endothelial cells were evaluated by performing proliferation, invasion, tube formation and apoptosis assays. Pleural fluids from patients with MPE who received thoracoscopic talc insufflation contained significantly higher levels of endostatin (median 16.75 ng.mL(-1)) compared with pre-talc instillation (1.06 ng.mL(-1)). Talc-activated PMC released significantly greater amounts of endostatin (mean+/-SEM 1052.39+/-38.66 pg.mL(-1)) when compared with a MMC line (134.73+/-8.72 pg.mL(-1)). In conclusion, talc alters the angiogenic balance in the pleural space from a biologically active and angiogenic environment to an angiostatic milieu. Functional improvement following talc poudrage in patients with malignant pleural effusions may, in part, reflect these alterations in the pleural space.

Mycobacteria induces pleural mesothelial permeability by down-regulating beta-catenin expression

Patients with pulmonary tuberculosis develop pleural effusions with a high protein content. Pleural mesothelial adherens junctions promote mesothelial cell-cell adhesion and contribute to pleural integrity. In the present study we have investigated the effect of mycobacterium (BCG) on mesothelial cell adherens junction proteins and pleural permeability. BCG enhanced pleural mesothelial cell (PMC) release of vascular endothelial growth factor (VEGF), and decreased electrical resistance across the PMC monolayer. Neutralizing antibodies to VEGF significantly restored the drop in PMC electrical resistance caused by BCG. BCG infection down regulated beta-catenin (adherens junction protein) expression and caused increased permeability across confluent mesothelial monolayer. Our results suggest that in TB pleurisy, mycobacteria cause VEGF release from mesothelial cells and leads to protein exudation by altering mesothelial adherens junction proteins.

Does long-term follow-up have a role for node negative squamous carcinoma of the vulva? The Gateshead experience

A retrospective review was performed of 138 cases of squamous vulval cancer referred to Gateshead between 1986 and 1997, with a median follow-up of 48 months. Eighteen recurrences were detected, 11 within one year of surgery. All nine patients with groin/distant recurrence (including 4 presenting initially with local recurrence only) died of vulval cancer. Vulval pain, bleeding or other symptoms heralded all recurrences. Routine review was ineffective in detecting recurrence. Eight cases were detected by general practitioners, three by specialists, and one was self-diagnosed. Six of these had had clinical review less than two months previously. Follow-up does not appear to offer early detection or survival advantages. Patient education, with symptom-triggered rapid clinic access, may be more effective. Prospective research is indicated to assess both the effectiveness and psychological implications of routine follow-up and alternative strategies.