Global Neurosurgery at the 76th World Health Assembly (2023): First Neurosurgery-Driven Resolution Calls for Micronutrient Fortification to Prevent Spina Bifida.

Since 2018, a neurosurgery delegation has been actively engaged and consistently present at the World Health Assembly. Recognizing the growing impact of neurosurgical diseases, the neurosurgery delegation participated in the 76th World Health Assembly in May 2023, advocating for timely, safe, and affordable global neurosurgical care. The delegation focused on forging new collaborations, strengthening the World Health Organization-World Federation of Neurosurgical Societies official relations, and actively supporting resolutions that impact the neurosurgical patients. However, there is a long advocacy journey ahead to address unmet neurosurgical needs. Patient-centered advocacy is an inherent task of our profession and the essence of the Global Neurosurgery Bogota Declaration of 2016. The highlight of the 76th World Health Assembly was the adoption of the first neurosurgery-driven resolution calling for micronutrient fortification to prevent spina bifida and other micronutrient deficiencies. For the last 4 years, the Global Alliance for Prevention of Spina Bifida, a group spearheaded by neurosurgeons, advocated for spina bifida prevention. This Alliance collaborated with many stakeholders, notably, the Colombian government to promote the resolution: "Accelerating efforts for preventing micronutrient deficiencies and their consequences, including spina bifida and other neural tube defects, through safe and effective food fortification." This is a proud milestone for the neurosurgical profession. There are many strategies available for neurosurgeons, when working together with elected leaders, other stakeholders, and allied professionals, to implement initiatives that can prevent future cases of spina bifida and other neurological disorders and reduce the burden of neurosurgical disease.

Rationale, Procedures, and Response Rates for a Pilot Study to Sample Cancer Survivors for NCI's Health Information National Trends Survey: HINTS-SEER 2021.

The National Cancer Institute's (NCI) Health Information National Trends Survey (HINTS) is a nationally representative survey of U.S. adults in which 12-17% of respondents report a cancer history. To increase representation from adult cancer survivors, in 2021, NCI sampled survivors from three Surveillance, Epidemiology, and End Results (SEER) program cancer registries: Iowa, New Mexico, and the Greater Bay Area. Sampling frames were stratified by time since diagnosis and race/ethnicity, with nonmalignant tumors and non-melanoma skin cancers excluded. Participants completed a self-administered postal questionnaire. The overall response rate for HINTS-SEER (N = 1,234) was 12.6%; a non-response bias analysis indicated few demographic differences between respondents and the pool of sampled patients in each registry. Most of the sample was 10+ years since diagnosis (n = 722; 60.2%); 392 respondents were 5 to < 10 years since diagnosis (29.6%); and 120 were < 5 years since diagnosis (10.2%). Common cancers included male reproductive (n = 304; 24.6%), female breast (n = 284; 23.0%), melanoma (n = 119; 9.6%), and gastrointestinal (n = 106; 8.6%). Tumors were mostly localized (67.8%; n = 833), with 22.4% (n = 282) regional, 6.2% (n = 72) distant, and 3.7% (n = 47) unknown. HINTS-SEER data are available by request and may be used for secondary analyses to examine a range of social, behavioral, and healthcare outcomes among cancer survivors.

Patient-Centered Communication (PCC) scale: Psychometric analysis and validation of a health survey measure.

INTRODUCTION: Patient-centered communication (PCC) is one important component of patient-centered care and seen as a goal for most clinical encounters. Previous research has shown that higher PCC is related to an increase in healthy behaviors and less morbidity, among other outcomes. Given its importance, the National Cancer Institute (NCI) commissioned a monograph in 2007 to synthesize the existing literature on PCC and determine measurement objectives and strategies for measuring this construct, with a particular focus on cancer survivors. Based on this effort, a seven-item PCC scale was included on the Health Information National Trends Survey (HINTS), a probability-based survey of the US adult population. This study used HINTS data collected in 2018 to evaluate the psychometric properties of the PCC scale for the general US adult population including measures of reliability and validity. RESULTS: Through an exploratory factor analysis, the seven-item PCC scale was shown to be unidimensional with good internal consistency (Cronbach's alpha = .92). A confirmatory factor analysis verified the factor structure. Other construct validity metrics included known groups and discriminant validity. Known group comparisons were conducted for several sociodemographic factors and health self-efficacy confirming a priori assumptions. Discriminant validity tests with measures of social support and anxiety/depression showed relatively weak associations. CONCLUSIONS: The psychometric properties of this scale demonstrate its scientific utility for both surveillance research and other smaller-scale studies. Given its association with many health outcomes, it can also be used to better understand the dynamics in a clinical encounter.

Awareness of Alcohol and Cancer Risk and the California Proposition 65 Warning Sign Updates: A Natural Experiment.

In 1986, California enacted Proposition 65 (P65), requiring businesses to display warning signs informing consumers that specific chemicals and alcohol exposure increase the risk of cancer and reproductive harm. In 2018, the P65 alcohol warning signs were updated to include an informational P65 website link, and the update was associated with media coverage and increased enforcement of warning requirements. This study examines knowledge of the association between alcohol use and cancer risk in California compared to the rest of the US before and after the 2018 P65 update. We analyzed state-level data on alcohol and cancer knowledge from the Health Information National Trends Survey from 2017 (n = 3285), 2019 (n = 5438), and 2020 (n = 3865). We performed multinomial logistic regressions to examine knowledge levels by survey year and location (California vs. all other states) and reported the predicted marginals of knowledge by survey year and location. The adjusted prevalence of respondents who reported an association between alcohol and cancer risk was higher in California (41.6%) than the remaining states (34.1%) (p = 0.04). However, knowledge levels decreased significantly over survey years, and there was no evidence for an effect of the P65 update on knowledge in California compared to other states based on the testing of an interaction between state and year (p = 0.32). The 1986 warning signs may have had an enduring effect on awareness, though the update, so far, has not. Further efforts are needed to determine how to increase alcohol and cancer knowledge to address the burden of alcohol-attributable cancers.

Correction: Access to Electronic Personal Health Records Among Patients With Multiple Chronic Conditions: A Secondary Data Analysis.

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Correction: Tracking Healthy People 2020 Internet, Broadband, and Mobile Device Access Goals: An Update Using Data From the Health Information National Trends Survey.

[This corrects the article DOI: 10.2196/13300.].

Associations Between State Laws Governing Recess Policy with Children's Physical Activity and Health.

BACKGROUND: State-level laws governing recess policies vary widely across the United States. We characterize the presence of such laws and assess their associations with child-level outcomes. METHODS: The presence of a state recess law was determined using the Classification of Laws Associated with School Students (CLASS) database. Parents of 6- to 11-year-old children reported physical activity, overall health, school absences, school-related problems, and ability to make/keep friends as part of the National Survey of Children's Health (NSCH). Logistic regression was used to compare outcomes in states with and without recess laws cross-sectionally in 2018 and between 2003 and 2011/2012 using a difference-in-differences analysis. RESULTS: In 2018, 20 states had a law recommending or requiring recess. Cross-sectionally, the odds of being physically active every day (odds ratio, 95% confidence interval: 2.8, 1.2-6.5) and having no difficulty making or keeping friends (2.9, 1.2-7.2) were significantly higher for children residing in states with versus without a recess law. There were no significant associations in the difference-in-differences model. CONCLUSIONS: Significant cross-sectional associations in 2018 were not confirmed by a difference-in-differences analysis of two waves of the NSCH. Short follow-up time and the apparent weakness of existing state laws warrant further assessment of state-level recess law.

Behavioral Research in Cancer Prevention and Control: Emerging Challenges and Opportunities.

It is estimated that behaviors such as poor diet, alcohol consumption, tobacco use, sedentary behavior, and excessive ultraviolet exposure account for nearly one-half of all cancer morbidity and mortality. Accordingly, the behavioral, social, and communication sciences have been important contributors to cancer prevention and control research, with methodological advances and implementation science helping to produce optimally effective interventions. To sustain these contributions, it is vital to adapt to the contemporary context. Efforts must consider ancillary effects of the 2019 coronavirus disease pandemic, profound changes in the information environment and public understanding of and trust in science, renewed attention to structural racism and social determinants of health, and the rapidly increasing population of cancer survivors. Within this context, it is essential to accelerate reductions in tobacco use across all population subgroups; consider new models of energy balance (diet, physical activity, sedentary behavior); increase awareness of alcohol as a risk factor for cancer; and identify better communication practices in the context of cancer-related decisions such as screening and genetic testing. Successful integration of behavioral research and cancer prevention depends on working globally and seamlessly across disciplines, taking a multilevel approach where possible. Methodological and analytic approaches should be emphasized in research training programs and should use new and underused data sources and technologies. As the leadership core of the National Cancer Institute's Behavioral Research Program, we reflect on these challenges and opportunities and consider implications for the next phase of behavioral research in cancer prevention and control.

Neuroticism, cancer mortality salience, and physician avoidance in cancer survivors: Proximity of treatment matters.

OBJECTIVE: To examine if the relationship between neuroticism and physician avoidance/physician visit concerns are mediated by perceptions that cancer is associated with death ("cancer mortality salience"; CMS) for cancer survivors to inform public health interventions and tailored health communications. METHODS: Cancer survivors comprised 42.3% of the total sample (n = 525). Participants completed a 4-item neuroticism scale, 4-item cancer perceptions scale, and 4-item physician avoidance and concerns scale. Multiple linear regression models were used to assess relationships among variables for cancer survivors and separately for those without a history of cancer. RESULTS: Neuroticism was positively associated with CMS for cancer survivors, b = 0.26, (p < 0.001), and those without cancer, b = 0.22, (p < 0.001). There was an association between neuroticism and physician avoidance among cancer survivors with temporally distant treatment courses after controlling for CMS, b = 0.56 (p = 0.006), but not for those currently or recently having had undergone treatment (p = 0.949). There was also an indirect relationship between neuroticism and physician visit concerns that was mediated by CMS for cancer survivors, b = 0.07, CI = [0.03, 0.13], but this relationship was again driven by cancer survivors with more distal treatment courses. CONCLUSIONS: High neuroticism in cancer survivors is associated with physician avoidance and physician visit concerns when treatment is temporally distant. Interventions aimed at decoupling the association between cancer and death can help increase the willingness of cancer survivors to attain cancer care follow-ups and healthcare more generally.

Comparative route of administration studies using therapeutic siRNAs show widespread gene modulation in Dorset sheep.

siRNAs comprise a class of drugs that can be programmed to silence any target gene. Chemical engineering efforts resulted in development of divalent siRNAs (di-siRNAs), which support robust and long-term efficacy in rodent and nonhuman primate brains upon direct cerebrospinal fluid (CSF) administration. Oligonucleotide distribution in the CNS is nonuniform, limiting clinical applications. The contribution of CSF infusion placement and dosing regimen on relative accumulation, specifically in the context of large animals, is not well characterized. To our knowledge, we report the first systemic, comparative study investigating the effects of 3 routes of administration - intrastriatal (i.s.), i.c.v., and intrathecal catheter to the cisterna magna (ITC) - and 2 dosing regimens - single and repetitive via an implanted reservoir device - on di-siRNA distribution and accumulation in the CNS of Dorset sheep. CSF injections (i.c.v. and ITC) resulted in similar distribution and accumulation across brain regions. Repeated dosing increased homogeneity, with greater relative deep brain accumulation. Conversely, i.s. administration supported region-specific delivery. These results suggest that dosing regimen, not CSF infusion placement, may equalize siRNA accumulation and efficacy throughout the brain. These findings inform the planning and execution of preclinical and clinical studies using siRNA therapeutics in the CNS.

Predictors of Patient-Centered Communication among U.S. Adults: Analysis of the 2017-2018 Health Information National Trends Survey (HINTS).

An essential component of patient-centered care is the communication between patients and their providers, which can affect patients' health outcomes A cancer care model, developed by Epstein and Street, includes a multi-dimensional patient-centered communication (PCC) framework with six functions: foster healing relationships, exchange information, respond to emotions, manage uncertainty, make decisions, and enable patient self-management. Seven domains that describe the functions were included on the Health Information National Trends Survey (HINTS) to assess PCC. We examined the association between sociodemographic and health-related factors and PCC as well as how U.S. adults, by different age groups, ranked different domains of PCC.Nationally representative data (n = 5,738) from 2017 to 2018 HINTS were merged to examine predictors of PCC among U.S. adults. Weighted statistics describe the study sample and prevalence for ratings of PCC domains. A multivariate linear regression model was computed to assess associations among predictors and PCC.Participants rated their communication with doctors in the last year with an overall mean of 80 out of 100. Older age, those reporting excellent health, and those with higher confidence in taking care of one's health predicted better PCC. Individuals who reported being non-Hispanic Asian and having lower household income were associated with poorer communication. Participants' lowest rating of PCC concentrated on providers dealing with their emotional needs.Findings suggest that many patients do not feel that their providers adequately manage, communicate, nor respond to their emotional needs. Future efforts should enhance interpersonal exchanges among sub-populations who report poorer communication with providers during clinical visits.

Associations of Prostate-Specific Antigen (PSA) Testing in the US Population: Results from a National Cross-Sectional Survey.

Prostate-specific antigen (PSA) testing is one of the standard screening methods for prostate cancer (PC); however, a high proportion of men with abnormal PSA findings lack evidence for PC and may undergo unnecessary treatment. Furthermore, little is known about the prevalence of PSA testing for US men, after the US Preventive Services Task Force (USPSTF) recommended against routine PSA screening in 2012. Our objectives were to: (1) examine the self-reported patterns of PSA testing following a change in the USPSTF prostate cancer screening recommendations and (2) to determine the associated socio-demographic factors. Data were from the 2010 and 2015 National Health Interview Surveys. Men were ages ≥ 40 years and responded to the question "Ever had a PSA test?". Multivariable logistic regression was used to examine PSA testing prevalence in 2010 and 2015, and their associated socio-demographic factors. The analytic sample contained 15,372 men. A majority (75.2%) identified as non-Hispanic (NHW) and 14.2% were foreign-born. Those surveyed in 2015 were less likely to report ever having had a PSA test when compared to those in 2010. Compared to US-born and older NHW men, PSA testing was statistically significantly lower among foreign-born men and men belonging to all other racial categories. Fewer men reported PSA testing following the USPSTF 2012 recommendations. Associated socio-demographic factors included nativity, age, race/ethnicity, educational attainment and type of health insurance. Further studies are required to elucidate our findings and their health implications for the US native and foreign-born population.

Perceptions of cancer as a death sentence: Tracking trends in public perceptions from 2008 to 2017.

OBJECTIVE: There has been steady progress in reducing cancer mortality in the United States; however, this progress hasn't been evenly distributed across regions. This paper assesses trends in cancer mortality salience (CMS), that is, agreeing that getting cancer is a death sentence, over time in the United States and examines correlates of CMS. METHODS: Data from three administrations of the Health Information National Trends Survey (HINTS), gathered in 2008, 2013, and 2017, were merged, resulting in a total sample of 10,063 respondents. Trends in changes in CMS over time were examined as well as maps of the distribution of CMS in the United States. A logistic regression model was conducted, regressing CMS on a set of sociodemographic, psychological, health-related, and environmental predictors. RESULTS: The aggregated percentage of US adults who agreed with the CMS statement changed over time and was modified by age. Geographic distribution of agreement with CMS was inconsistent across the United States. In the adjusted logistic model, perceived health (worse health), cancer prevention, fatalism, and confusion, and cancer status (no cancer) were all significantly associated with CMS. There was also a significant interaction between survey year and age. CONCLUSION: Despite recent information that cancer mortality rates are decreasing, most US adults still see cancer as a death sentence and this is especially an issue in certain subgroups. These findings have ramifications for groups of people who may be at risk for developing cancer given their attitudes and beliefs that there isn't much they can do to prevent or control it.

Patient Reports of Involvement in Health Care Decisions: Falling Short of Healthy People 2020 Objectives.

The Healthy People 2020 (HP 2020) initiative delineates objectives for improving population health in the United States. The National Cancer Institute's Health Information National Trends Survey (HINTS) has served as an important data source for tracking several HP 2020 Health Communication and Health Information Technology objectives, including patient perceptions of involvement in health-care decisions. We analyzed data from six cross-sectional administrations of HINTS (2008 to 2017; N = 25,410) to assess progress toward the HP 2020 objective of increasing the proportion of persons reporting that their health-care providers always involved them in decisions about their health care. In each survey year, just over half the population (range = 51.6 to 54.6) reported that their health-care providers always involved them in health-care decisions; the observed percentages over a 10-year period remained below the HP 2020 goal of 56.8% and did not show significant improvement. Results show a lack of progress toward this HP 2020 goal despite increased attention to patient engagement in health care over the last several decades.

Characterizing the US Population by Patterns of Mobile Health Use for Health and Behavioral Tracking: Analysis of the National Cancer Institute's Health Information National Trends Survey Data.

BACKGROUND: Multiple types of mobile health (mHealth) technologies are available, such as smartphone health apps, fitness trackers, and digital medical devices. However, despite their availability, some individuals do not own, do not realize they own, or own but do not use these technologies. Others may use mHealth devices, but their use varies in tracking health, behaviors, and goals. Examining patterns of mHealth use at the population level can advance our understanding of technology use for health and behavioral tracking. Moreover, investigating sociodemographic and health-related correlates of these patterns can provide direction to researchers about how to target mHealth interventions for diverse audiences. OBJECTIVE: The aim of this study was to identify patterns of mHealth use for health and behavioral tracking in the US adult population and to characterize the population according to those patterns. METHODS: We combined data from the 2017 and 2018 National Cancer Institute Health Information National Trends Survey (N=6789) to characterize respondents according to 5 mutually exclusive reported patterns of mHealth use for health and behavioral tracking: (1) mHealth nonowners and nonusers report not owning or using devices to track health, behaviors, or goals; (2) supertrackers track health or behaviors and goals using a smartphone or tablet plus other devices (eg, Fitbit); (3) app trackers use only a smartphone or tablet; (4) device trackers use only nonsmartphone or nontablet devices and do not track goals; and (5) nontrackers report having smartphone or tablet health apps but do not track health, behaviors, or goals. RESULTS: Being in the mHealth nonowners and nonusers category (vs all mHealth owners and users) is associated with males, older age, lower income, and not being a health information seeker. Among mHealth owners and users, characteristics of device trackers and supertrackers were most distinctive. Compared with supertrackers, device trackers have higher odds of being male (odds ratio [OR] 2.22, 95% CI 1.55-3.19), older age (vs 18-34 years; 50-64 years: OR 2.83, 95% CI 1.52-5.30; 65+ years: OR 6.28, 95% CI 3.35-11.79), have an annual household income of US $20,000 to US $49,999 (vs US $75,000+: OR 2.31, 95% CI 1.36-3.91), and have a chronic condition (OR 1.69, 95% CI 1.14-2.49). Device trackers also have higher odds of not being health information seekers than supertrackers (OR 2.98, 95% CI 1.66-5.33). CONCLUSIONS: Findings revealed distinctive sociodemographic and health-related characteristics of the population by pattern of mHealth use, with notable contrasts between those who do and do not use devices to track goals. Several characteristics of individuals who track health or behaviors but not goals (device trackers) are similar to those of mHealth nonowners and nonusers. Our results suggest patterns of mHealth use may inform how to target mHealth interventions to enhance reach and facilitate healthy behaviors.

Trust in Health Information Sources among Underserved and Vulnerable Populations in the U.S.

The purpose of this study was to examine trust in health information sources among underserved and vulnerable populations. Data (N=8,759) were from the Health Information National Trends Survey. Differences were assessed across the following subgroups: ethnoracial minorities, immigrants, rural residence, people with limited English proficiency, and sexual minorities. Trust was highest for doctors, followed by government, family/friends, charities, and religious organizations. In adjusted regression models, trusting health information from charitable and religious organizations was higher in ethnoracial minorities and immigrants. Individuals with limited English proficiency also had higher trust in religious organizations compared with those fluent in English. Trusting health information from doctors was lower among individuals with limited English proficiency. There was evidence in support of additive and multiplicative intersectional frameworks for understanding trust in vulnerable and underserved populations; however, the extent to which differences in trust explain disparities in health behaviors and outcomes should be examined.

Consensus-Building efforts to identify best tools for screening and assessment for supportive services in oncology.

Purpose: To build consensus around an optimal patient-reported outcome measure of cancer symptoms and patient needs to facilitate patient-provider communication and trigger referrals to supportive services.Methods and materials: The Grid-Enabled Measures platform was used to crowdsource and facilitate collaboration to achieve consensus. Respondents were invited to nominate and independently rate the usefulness of measures that: (1) have been actively used at a healthcare institution, (2) have a multiple choice or yes/no type format, (3) are applicable to adults with cancer, (4) are patient-reported, and 5) have psychometric data if possible. Discussion boards within the GEM workspace allowed respondents to identify barriers to implementing patient assessment and referral systems.Results: 166 individuals from various disciplines from 25 organizations participated. Six instruments were nominated, and 553 rating surveys were submitted. The three most highly-rated overall instruments were the Distress Thermometer, the James Supportive Case Screening, and the Functional Assessment of Cancer Therapy-General. Participants noted that wide-scale implementation of this process requires both identifying problems and providing clinicians with algorithms to facilitate appropriate referrals.Conclusions: Consensus reported three most highly-related measures as optimal for comprehensive screening and identification for referral by assessing multiple domains of functioning and quality of life.Implications for RehabilitationGaining consensus on the best patient reported outcome measures is an important step towards improving access to cancer rehabilitation services.A consensus agreed on several measures to use for cancer rehabilitation screening. Functional Assessment of Cancer Therapy-General, National Comprehensive Cancer. Network Distress Thermometer and the James Instrument.The selected measures do not put undue burden on clinicians and patients.

Sociodemographic correlates of cancer fatalism and the moderating role of religiosity: Results from a nationally-representative survey.

In general, it has been found that cancer fatalism is negatively associated with important cancer prevention and control behaviors, whereas religiosity is positively associated with these behaviors. Yet, the notion that religiosity gives rise to fatalistic beliefs that may discourage health behaviors is deeply ingrained in the public health literature. In addition, racial/ethnic group membership is associated with higher reports of cancer fatalism, though this association may be confounded by socioeconomic status (SES). A better understanding of the relationships between racial/ethnic group membership, SES, and religiosity may contribute to the development of effective interventions to address cancer fatalism and improve health behaviors. In this study, we examined associations between racial/ethnic group membership, SES, and cancer fatalism as the outcome. In addition, we tested whether religiosity (as measured by religious service attendance) moderated these relationships.

Prospective follow-up of quality of life for participants undergoing risk-reducing salpingo-oophorectomy or ovarian cancer screening in GOG-0199: An NRG Oncology/GOG study.

BACKGROUND: Risk-reducing salpingo-oophorectomy (RRSO) and ovarian cancer screening (OCS) are management options for women at increased risk of ovarian cancer. Long-term effects of these interventions on quality of life (QOL) are not well understood. METHODS: GOG-0199 is a prospective cohort study of women at increased ovarian cancer risk who chose either RRSO or OCS as their risk management intervention. At study entry, 6, 12, 24 and 60 months of follow-up, participants completed the QOL questionnaire, which included the Medical Outcome Study Short Form-36, the Impact of Events Scales, the Center for Epidemiological Studies Depression Scale, the State-Trait Anxiety Inventory, the Functional Assessment of Cancer Therapy - Endocrine Subscale, and the Sexual Activity Questionnaire. QOL measures were compared between the RRSO and OCS cohort at baseline and over time. RESULTS: Five-hundred-sixty-two participants in the RRSO cohort and 1,010 in the OCS completed the baseline and at least one follow-up questionnaire. At baseline, participants selecting RRSO reported lower health-related QOL (HRQOL), greater ovarian cancer-related stress, greater anxiety, and more depressive symptomatology, which improved during follow-up, especially for ovarian cancer-related stress. Screening was not found to adversely impact HRQOL. Hormone-related menopausal symptoms worsened and sexual functioning declined during follow-up in both cohorts, but more so among participants who underwent RRSO. CONCLUSIONS: HRQOL improved after surgery among women who chose RRSO and remained stable among participants undergoing screening. The adverse effects of RRSO and screening on short-term and long-term sexual activity and sexual functioning warrant consideration in the decision-making process for high-risk women.