Screening for familial and hereditary prostate cancer.

Prostate cancer (PC) has the highest degree of genetic transmission of any form of malignancy. In some families, the hereditary pattern is so strong as to mimic an autosomal dominance trait. We reviewed the known predisposing genetic markers to assess possible strategies for screening of families at risk. We carried out a systematic literature search using the Pubmed service of the National Center for Biotechnology Information (NCBI) and several gene libraries, including the NCBI SNP Library, the Online Mendelian Inheritance in Man® Catalog of Human Genes and Genetic Disorders (OMIM) and SNPedia to obtain known gene loci, SNPs and satellite markers associated with PC. We further cross referenced information on identified loci comparing data from different articles and gene reference sites. Whenever possible, we recorded the odds ratio (OR) for the allele associated with PC. In multiple different linkage studies, many independent PC associated loci have been identified on separate chromosomes. Genome-wide association studies have added many more markers to the set derived from linkage investigations. A subset of the alleles is associated with early onset and aggressive cancer. Due to the great heterogeneity, the OR for any one allele predicting future development of this malignancy is low. The strongest predictors are the BRCA2 mutations, and the highly penetrant G84E mutation in HOXB13. The presence of multiple risk alleles is more highly predictive than a single allele. Technical limitations on screening large panels of alleles are being overcome. It is appropriate to begin supplementing prostate specific antigen testing with alleles, such as BRCA2 and HOXB13, disclosed by targeted genomic analysis in families with an unfavorable family cancer history. Future population studies of PC should include genomic sequencing protocols, particularly in families with a history of PC and other malignancies.

Urban Minority Community Safety and its Impact on Physical Activity: The Center for Promoting Health and Health Equity-Racial and Ethnic Approaches to Community Health (CPHHE-REACH) Initiative.

BACKGROUND/PURPOSE: Daily physical activity is known to improve personal health and well-being and can often be influenced by one's living environment. A qualitative secondary data analysis of a focus group study, performed by the Creighton University Center for Promoting Health and Health Equity (CPHHE) - Racial and Ethnic Approaches to Community Health (REACH), assesses behavioral changes in individuals who participated in newly established physical activities in faith-based organizations, local residential towers, and the local community health center. METHOD: Applying thematic analysis within the Health Belief Model framework, the investigators further investigated the relationships between its constructs and levels of physical activity in urban minority neighborhoods. RESULTS: Results indicated that residents who perceived their neighborhoods as unsafe had a negative attitude toward physical activity. In contrast, building social relationships and camaraderie that enhanced social cohesion were major themes that increased participants' self-efficacy, resulting in positive changes in health behavior. CONCLUSION: Community partnerships had a positive impact on motivating individuals to live healthier lifestyles. An interesting concept was that of community efficacy, which reflects the community's confidence in its ability to generate behavioral changes in individuals.

The Value of Mobile Ultrasound Services in Rural Communities in South-South Nigeria.

AIM: This paper examines the activities of mobile services units including ultrasound services in rural and urban communities in the Calabar region of South-South, Nigeria. MATERIALS AND METHODS: Consenting individuals were invited and attended five medical outreach activities in rural and urban areas of the Calabar region between January and June 2016. Abdomino-pelvic scans were done. Subsequently the results were analyzed. RESULTS: Five hundred and seventy-four (574) individuals had Abdomino-pelvic scans done, using a curvilinear probe to assess the abdomino-pelvic organs. The female to male ratio was 1.46:1. The age ranged from 1-78 years with a mean of 40.63 (standard deviation of 17.5). The commonest sonographic finding was uterine fibroids, 21 (8.1%). Fifty-four percent of the scans were normal. The commonest sonographic finding in men was prostatic enlargement. CONCLUSION: Medical outreach activities provided by mobile units provide much needed ultrasound services in poor resource settings in Nigeria. Significant clinical pathologies were identified at fairly high rates.

Mentoring for women and underrepresented minority faculty and students: experience at two institutions of higher education.

Women and minority faculty and students are seriously underrepresented in university and academic healthcare institutions. The role of mentoring has been identified as one of the significant factors in addressing this underrepresentation. We have described the mentoring efforts at two institutions of higher learning in assisting women and minority students and faculty in being accomplished in their academic pursuits. One-hundred-thirty students and >50 women and minority faculty have participated in the mentoring programs described. The number of participants has increased dramatically over the years and continues to evolve positively. These programs appear to be quite successful in the short term. Further evaluation of measurable outcomes will be necessary to fully determine their true impact. The mentoring models for women and underrepresented minority faculty and students at Creighton University Health Sciences Schools and Wake Forest University School of Medicine will serve as a guide for other Health Sciences Schools.

Proximal versus distal influences on underrepresented minority students pursuing health professional careers.

The Health Careers Opportunities Program (HCOP) at Creighton University provides an important illustration of the short- and long-term successes of pipeline programming. The Pipeline to Success program at Creighton University provides exposure and enrichment activities to participants beginning in middle school and continuing through a one-year postbaccalaureate component in order to ensure that they are knowledgeable about health professional careers and competitive in applying for these training programs. This study hypothesized that the enrichment activities experienced by participants would have the additional benefit of providing indirect or distal influences to motivate participants to meet their career goals. In partial support of this hypothesis, a MANOVA demonstrated that the middle-school participants demonstrated a different pattern of influence from the other program components. Results indicate that as participants progressed through the Pipeline to Success HCOP at Creighton University, the program resources impacted their desire to pursue health professional careers in addition to positively preparing them for health professional training programs. We conclude that these findings have particular importance for planning and implementing student education programs.

Race, ethnicity and prevalence of primary open-angle glaucoma.

BACKGROUND: Recently, some authors pooled data from studies on the Dutch, Australians and Americans of European origin in an attempt to predict the prevalence of primary open-angle glaucoma (POAG) in the United States. PURPOSE: To examine potential ethnic diversity in the prevalence of POAG among populations of the "same race." METHODS: Medical literature was searched, and 11 population-based studies on populations of African origin and five on populations of European origin were identified. RESULTS: The prevalence of POAG was significantly higher in white Australians than in the Dutch (p<0.001) and was significantly lower (p<0.001) among black populations in South Africa, Nigeria, Tanzania and the United States than in Ghana, St. Lucia or Barbados. Notably, the prevalence was significantly lower in Afro Caribbeans living in London than in St. Lucia or Barbados (p<0.001). There was, however, inconsistency in the definition of POAG among the different studies. CONCLUSIONS: There is a wide range in the prevalence of POAG among populations of the same "race," which might be attributed to the different methodology and definition of POAG; potential difference in social, behavioral and environmental factors; and/or genetic predisposition. Scrutiny is warranted when pooling data from different ethnic groups of the "same race" in meta-analyses.

Self-assessment of cultural attitudes and competence of clinical investigators to enhance recruitment and participation of minority populations in research.

Reduction of health disparities in the United States is a high priority. One means of effecting such a reduction is to enroll persons of groups that are subject to health disparities in clinical trials. One barrier to minorities enrolling in clinical research is distrust of the medical establishment based on past abuses and perceived discrimination. We hypothesized that another barrier is a lack of investigators' understanding and skill in effectively communicating with members of minority cultures. We therefore assessed the cultural competency of faculty and staff involved in clinical care and research at Creighton University Medical Center (CUMC). Thirty-seven faculty and staff members participated. We found that the majority are reasonably culturally competent, but there are areas in which proficiency can be enhanced and recruitment of participants in clinical research can be improved. Most CUMC faculty and staff respect and have reasonable knowledge of the several cultures of the patients for whom they provide care and with whom they conduct research. But there is a need for continued cultural sensitivity/competency training to enhance understanding of certain aspects of minority cultures, group and interpersonal relationships, perceptions of disease and wellness and to improve their access to minority communities.

Satisfaction with and perceived cultural competency of healthcare providers: the minority experience.

It is well known that nonwhite minority participation in clinical research is lower than their representation in the community. The goal of this study was to assess satisfaction of minority community members in Omaha with the care received and cultural competency of healthcare providers. We sought input from Omaha minority communities on how to improve the care they received and asked why they did not participate in healthcare research. Seventy-two minority members representing African Americans, Hispanic Americans, Native Americans, Sudanese, and Vietnamese; and eight whites were surveyed. The results of this study indicated that the majority of our respondents were satisfied with the care they received, but for a small percentage, language, communication and/or culture contributed to dissatisfaction. In addition, some respondents did not think the provider was culturally competent, i.e., not sufficiently knowledgeable about their racial, ethnic and/or cultural background. Some participants indicated that they preferred a provider of similar racial, ethnic and/or cultural background, and/or thought some diseases were better treated by a provider of the same racial, ethnic and/or cultural background. Regardless of the cultural competency of the provider, the overwhelming majority of our respondents (with the exception of African Americans) indicated a willingness to participate in healthcare research. In conclusion, this study found that satisfaction with healthcare providers was not associated with perceived cultural competency and that the cultural competency of the provider did not affect patient willingness to participate in healthcare research; however, we acknowledge that the Hawthorne effect may be in operation.

Teacher education professionals as partners in health science outreach.

Medical school and other health science outreach programs to educate and recruit precollege students always have relied on successful collaborative efforts. Creighton University shares the value, significance, and strategies of involving teacher education professionals in several of its current outreach programs, including HPPI, Brains Rule! Neuroscience Expositions, and HHMI Build a Human Project. The education department partner serves as an essential team member in the development, implementation, assessment, and dissemination of these projects to promote science and mathematics achievement and interest in medical careers. Specific examples and mistakes to avoid are included.

Genetic dissection of myocilin glaucoma.

Primary open-angle glaucoma (POAG) is a complex disease with unknown causes. However, in the past decade, POAG has been linked to six chromosomal regions, of which the gene MYOC encoding myocilin and the gene OPTN encoding optineurin have been identified to harbor causal mutations (disease-causing variants, DCV). POAG caused by DCV at MYOC has been termed "myocilin glaucoma". Clinically, DCV at MYOC may manifest as a typical POAG, normal tension glaucoma, or ocular hypertension without glaucoma. Individuals with the Arg46Stop mutation that almost knocks out the entire coding sequence may have severe glaucoma or no glaucoma. Genetically, myocilin glaucoma follows autosomal dominant, recessive or no pattern of inheritance. DCV at MYOC cause POAG in interaction with environmental factors and DCV at other loci. Most DCV at MYOC are relatively young, and the Gln368Stop mutation is exclusively European in origin. The overall frequency of DCV at MYOC is similar among African, Caucasian and Asian probands with POAG. Because of this fact and the higher prevalence of POAG in African descendants compared with Caucasians or Asians, the overall frequency of DCV at MYOC is several-fold higher in the general population of African descendants, which is in part responsible for their higher prevalence of POAG. Although the Arg46Stop mutation was often observed in normal controls, Arg46Stop carriers tend to have higher risk of developing POAG. Polymorphisms at several loci including MYOC are associated with POAG, and play an important role in the pathogenesis of POAG.