Racial and geographic disparities in stage-specific incidence and mortality in the colorectal cancer hotspot region of eastern North Carolina, 2008-2016.

BACKGROUND: Despite improvements in colorectal cancer (CRC) outcomes, geographic disparities persist. Spatial mapping identified distinct "hotspots" of increased CRC mortality, including 11 rural counties in eastern North Carolina (ENC). The primary aims of this study were to measure CRC incidence and mortality by stage and determine if racial disparities exist within ENC. METHODS: Data from 2008 to 2016 from the NC Central Cancer Registry were analyzed by stage, race, and region. Age-adjusted incidence and death rates (95% CI) were expressed per 100,000 persons within hotspot counties, all ENC counties, and Non-ENC counties. RESULTS: CRC incidence [43.7 (95% CI 39.2-48.8) vs. 38.4 (95% CI 37.6-39.2)] and mortality rates [16.1 (95% CI 16.6-19.7) vs. 13.9 (95% CI 13.7-14.2)] were higher in the hotspot than non-ENC, respectively. Overall, localized, and regional CRC incidence rates were highest among African Americans (AA) residing in the hotspot compared to Whites or Non-ENC residents. Incidence rates of distant disease were higher among AA but did not differ by region. CRC mortality rates were highest among AA in the hotspot (AA 22.0 vs. Whites 15.8) compared to Non-ENC (AA 19.3 vs. Whites 13.0), although significant stage-stratified mortality differences were not observed. CONCLUSIONS: Patients residing in the hotspot counties have higher age-adjusted incidence of overall, localized, regional, and distant CRC and mortality rates than patients in non-hotspot counties. Incidence and mortality rates remain highest among AA residing in the hotspot. IMPACT: Increased CRC incidence and mortality rates were observed among all patients in the hotspot and were highest among AA, suggestive of ongoing racial and geographic disparities.

Work Safety Climate, Safety Behaviors, and Occupational Injuries of Youth Farmworkers in North Carolina.

OBJECTIVES: The aims of this project were to describe the work safety climate and the association between occupational safety behaviors and injuries among hired youth farmworkers in North Carolina (n = 87). METHODS: We conducted personal interviews among a cross-sectional sample of youth farmworkers aged 10 to 17 years. RESULTS: The majority of youths reported that work safety practices were very important to management, yet 38% stated that supervisors were only interested in "doing the job quickly and cheaply." Few youths reported appropriate work safety behavior, and 14% experienced an injury within the past 12 months. In bivariate analysis, perceptions of work safety climate were significantly associated with pesticide exposure risk factors for rewearing wet shoes (P = .01), wet clothes (P = .01), and shorts (P = .03). CONCLUSIONS: Youth farmworkers perceived their work safety climate as being poor. Although additional research is needed to support these findings, these results strengthen the need to increase employer awareness to improve the safety climate for protecting youth farmworkers from harmful exposures and injuries.

Work safety culture of youth farmworkers in North Carolina: a pilot study.

OBJECTIVES: We analyzed aspects of the behavioral, situational, and psychological elements of work safety culture of hired youth farmworkers in North Carolina. METHODS: Data were from interviewer-administered questionnaires completed with 87 male and female hired farmworkers aged 10 to 17 years in North Carolina in 2013. We computed means, SDs, and Cronbach α values for the perceived work safety climate and safety perception summary scores. RESULTS: Hired youth farmworkers in North Carolina described a negative work safety culture. Most engaged in unsafe general and unsafe work behaviors, few received training, and many were sexually harassed at work. They had mixed safety attitudes and knew that their employment was precarious. They reported a poor perceived work safety climate characterized by the perception that their supervisors "are only interested in doing the job fast and cheaply." However, we could not detect statistically significant associations between work safety culture and injuries among these farmworkers. CONCLUSIONS: Increased scrutiny of agriculture as a suitable industry for workers as young as 10 years and additional regulations to protect hired youth farmworkers, if not to remove them from this environment, are warranted. Additional research is needed.

Presentation, response to lansoprazole therapy, and outcome of Zollinger-Ellison syndrome-like gastric acid hypersecretors.

OBJECTIVE: To evaluate the clinical characteristics, response to treatment and outcome of Zollinger?Ellison syndrome (ZES)-like gastric acid hypersecretors. METHODS: Over a 20-year period, patients with gastric acid hypersecretion in the absence of ZES were enrolled in an open label prospective trial evaluating the efficacy of lansoprazole. Following baseline evaluations, patients were treated with escalating doses of lansoprazole based on the results of gastric acid analysis. Following stabilization, patients were followed on a 6 monthly basis with interval history, physical examination, endoscopy with gastric biopsies, gastric acid analysis, and laboratory studies. RESULTS: The study group represented 21 patients (median age 47 years, 86% male, 91% Caucasian). Historically, complicated ulcer disease was frequent and symptoms had been present for a median of 10 years before study entry. All patients responded to lansoprazole (median dose 90 mg/day) with excellent control of gastric acid hypersecretion. Mucosal relapse was infrequent and no major complications developed while on therapy. CONCLUSIONS: ZES-like gastric acid hypersecretion presents similarly to the classic syndrome. Lansoprazole titrated to gastric acid output is effective in healing mucosal disease and preventing relapse.

Safety and injury characteristics of youth farmworkers in North Carolina: a pilot study.

Agriculture is a unique US industry in how youth are involved. Youth employed in agriculture experience high rates of injury, and youth migrant and seasonal farmworkers may be extremely vulnerable. The primary aim for this analysis is to describe the personal characteristics, work characteristics, occupational safety behaviors, and occupational injuries of North Carolina youth farmworkers. This pilot study uses data from interviewer-administered questionnaires with 87 youth farmworkers. Participants included males (62.1%) and females (37.9%), with 26.4% aged 10-13 years, 39.1% 14-15 years, and 34.5% 16-17 years. The majority (78.2%) were born in the United States. Most worked in tobacco (46.0%), sweet potatoes (28.7%), and berries (28.7%). They were paid by the hour (54.0%) and piece rate (55.2%); 21.8% reported a problem getting paid the amount earned. Three quarters wore a hat, and 63.2% wore gloves while working. Five (5.7%) had received pesticide use training in the past year. Over half reported a musculoskeletal injury (54.0%), a traumatic injury (60.9%), or a dermatological injury (72.4%) in the last year. Six of the injuries led to medical treatment, and 10 resulted in missed school or work. Farmworker youth in North Carolina are at times not treated fairly when they work, occupational safety behaviors are limited (increasing exposure to pesticides and other environmental hazards), and they commonly experience injuries. Research on the occupational exposures and health experienced by youth farmworkers is needed to inform policy. Changes in policy are warranted to improve the safety of youth farmworkers.

Zollinger-Ellison syndrome: presentation, response to therapy, and outcome.

BACKGROUND: Recent series describing the clinical presentation, response to therapy, and long-term outcome of Zollinger-Ellison syndrome are limited. AIMS: To assess the clinical characteristics and long-term outcome of patients with Zollinger-Ellison syndrome. METHODS: Over a 20-year period, patients with Zollinger-Ellison syndrome were enrolled in a prospective trial evaluating the efficacy of lansoprazole. Following dose stabilization, patients were followed on a 6-monthly basis with interval history, physical examination, endoscopy with gastric biopsies, gastric acid analysis and laboratory studies. RESULTS: 72 patients (mean age 54±12 years, % male 58%, % Caucasian 69%) were prospectively enrolled. The clinical presentation was stereotypical for Zollinger-Ellison syndrome. Symptoms had been reported for a median of 9 years prior to diagnosis. Cross-sectional abdominal imaging was often negative for demonstrable tumour. All patients had gastric acid hypersecretion controlled with variable doses of lansoprazole (median dose 60 mg/day, range 15-480 mg/day). The median survival from the time of diagnosis was 6.6 years; only two of 19 deaths were due to metastatic gastrinoma. CONCLUSIONS: The clinical presentation of Zollinger-Ellison syndrome was similar to prior reports. Acid hypersecretion was controlled in all patients with variable doses of lansoprazole. Long-term survival was principally related to underlying co-morbidity.