Urban/rural residence moderates effect of race on receipt of surgery in patients with nonmetastatic breast cancer: a report from the South Carolina central cancer registry.

BACKGROUND: Surgical resection is the cornerstone of therapy in patients with nonmetastatic breast cancer. Previous studies have reported underuse of adjuvant therapy among African Americans (AA). This study explores the independent effect of race on surgical resection in a recent, population-based sample of breast cancer patients. METHODS: All cases of nonmetastatic breast cancer reported to the our state Cancer Registry between 1996 and 2002 were identified and linked to the state Inpatient/Outpatient Surgery Files and the 2000 Census. Characteristics between Caucasian and AA patients were compared using Student's t and chi-square tests. Odds ratios (OR) of resection and 95% confidence intervals (CI) were calculated using logistic regression. RESULTS: We identified 12,404 Caucasian and 3,411 AA women. AA patients were more likely to be younger, non-married, have greater comorbidity, reside in rural communities, be less educated, live in poverty, and be uninsured or covered by Medicaid (all P < 0.0001). AA patients were slightly less likely to undergo resection compared to Caucasian patients (94.9% versus 96.4%, P < 0.0001). An interaction effect between race and urban/rural patient residence was observed (P = 0.003). After controlling for other factors, the adjusted OR for resection for urban AA patients was 0.58 (95% CI 0.41-0.82). In contrast, race had no effect on resection among rural patients (OR = 1.02; 95% CI 0.70-1.47). CONCLUSIONS: AA race is an independent predictor of underuse of surgery among urban patients with breast cancer, while rural residence is associated with underuse of surgery, irrespective of race. Interventions designed to optimize surgical cancer care should target these vulnerable populations.

Applying a Conceptual Framework to Maximize the Participation of Diverse Populations in Cancer Clinical Trials.

The underrepresentation of ethnically diverse populations in cancer clinical trials results in the inequitable distribution of the risks and benefits of this research. Using a case study approach, we apply a conceptual framework of factors associated with the participation of diverse population groups in cancer clinical trials developed by Dr. Jean Ford and colleagues to increase understanding of the specific strategies, and barriers and promoters addressed by these strategies, that resulted in marked success in accrual of racially and ethnically diverse populations in cancer clinical research. Results indicate that the studies presented were able to successfully engage minority participants due to the creation and implementation of multilevel, multifaceted strategies that included: culturally and linguistically appropriate outreach, education, and research studies that were accessible in local communities; infrastructure to support engagement of key stakeholders, clinicians, and organizations serving minority communities; testimonials by ethnically diverse cancer survivors; availability of medical interpretation services; and providing infrastructure that facilitated the engagement in clinical research of clinicians who care for minority patient populations. These strategic efforts were effective in addressing limited awareness of trials, lack of opportunities to participate, and acceptance of engagement in cancer clinical trials. Careful attention to the context and population characteristics in which cancer clinical trials are conducted will be necessary to address disparities in research participation and cancer outcomes. These studies illustrate that progress on minority accrual into clinical research requires intentional efforts to overcome barriers at all three stages of the accrual process: awareness, opportunity, and acceptance of participation.

Disparities in Obesity, Physical Activity Rates, and Breast Cancer Survival.

The significantly higher breast cancer (BCa) mortality rates of African-American (AA) women compared to non-Hispanic (NHW) white women constitute a major US health disparity. Investigations have primarily focused on biological differences in tumors to explain more aggressive forms of BCa in AA women. The biology of tumors cannot be modified, yet lifestyle changes can mitigate their progression and recurrence. AA communities have higher percentages of obesity than NHWs and exhibit inefficient access to care, low socioeconomic status, and reduced education levels. Such factors are associated with limited healthy food options and sedentary activity. AA women have the highest prevalence of obesity than any other racial/ethnic/gender group in the United States. The social ecological model (SEM) is a conceptual framework on which interventions could be developed to reduce obesity. The SEM includes intrapersonal factors, interpersonal factors, organizational relationships, and community/institutional policies that are more effective in behavior modification than isolation from the participants' environmental context. Implementation of SEM-based interventions in AA communities could positively modify lifestyle behaviors, which could also serve as a powerful tool in reducing risk of BCa, BCa progression, and BCa recurrence in populations of AA women.

Genome structure of mycobacteriophage D29: implications for phage evolution.

Mycobacteriophage D29 is a lytic phage that infects both fast and slow-growing mycobacterial species. The complete genome sequence of D29 reveals that it is a close relative of the temperate mycobacteriophage L5, whose sequence has been described previously. The overall organization of the D29 genome is similar to that of L5, although a 3.6 kb deletion removing the repressor gene accounts for the inability of D29 to form lysogens. Comparison of the two genomes shows that they are punctuated by a large number of insertions, deletions, and substitutions of genes, consistent with the genetic mosaicism of lambdoid phages.

Genomic sequences of bacteriophages HK97 and HK022: pervasive genetic mosaicism in the lambdoid bacteriophages.

We report the complete genome DNA sequences of HK97 (39,732 bp) and HK022 (40,751 bp), double-stranded DNA bacteriophages of Escherichia coli and members of the lambdoid or lambda-like group of phages. We provide a comparative analysis of these sequences with each other and with two previously determined lambdoid family genome sequences, those of E. coli phage lambda and Salmonella typhimurium phage P22. The comparisons confirm that these phages are genetic mosaics, with mosaic segments separated by sharp transitions in the sequence. The mosaicism provides clear evidence that horizontal exchange of genetic material is a major component of evolution for these viruses. The data suggest a model for evolution in which diversity is generated by a combination of illegitimate and homologous recombination and mutational drift, and selection for function produces a population in which most of the surviving mosaic boundaries are located at gene boundaries or, in some cases, at protein domain boundaries within genes. Comparisons of these genomes highlight a number of differences that allow plausible inferences of specific evolutionary scenarios for some parts of the genome. The comparative analysis also allows some inferences about function of genes or other genetic elements. We give examples for the generalized recombination genes of HK97, HK022 and P22, and for a putative headtail adaptor protein of HK97 and HK022. We also use the comparative approach to identify a new class of genetic elements, the morons, which consist of a protein-coding region flanked by a putative delta 70 promoter and a putative factor-independent transcription terminator, all located between two genes that may be adjacent in a different phage. We argue that morons are autonomous genetic modules that are expressed from the repressed prophage. Sequence composition of the morons implies that they have entered the phages' genomes by horizontal transfer in relatively recent evolutionary time.

Genomic sequence and analysis of the atypical temperate bacteriophage N15.

N15 is a temperate bacteriophage that forms stable lysogens in Escherichia coli. While its virion is morphologically very similar to phage lambda and its close relatives, it is unusual in that the prophage form replicates autonomously as a linear DNA molecule with closed hairpin telomeres. Here, we describe the genomic architecture of N15, and its global pattern of gene expression, which reveal that N15 contains several plasmid-derived genes that are expressed in N15 lysogens. The tel site, at which processing occurs to form the prophage ends is close to the center of the genome in a similar location to that occupied by the attachment site, attP, in lambda and its relatives and defines the boundary between the left and right arms. The left arm contains a long cluster of structural genes that are closely related to those of the lambda-like phages, but also includes homologs of umuD', which encodes a DNA polymerase accessory protein, and the plasmid partition genes, sopA and sopB. The right arm likewise contains a mixture of apparently phage- and plasmid-derived genes including genes encoding plasmid replication functions, a phage repressor, a transcription antitermination system, as well as phage host cell lysis genes and two putative DNA methylases. The unique structure of the N15 genome suggests that the large global population of bacteriophages may exhibit a much greater diversity of genomic architectures than was previously recognized.

Rat mitochondrial ATP synthase ATP5G3: cloning and upregulation in pancreas after chronic ethanol feeding.

Individuals with chronic excessive alcohol ingestion are put at the risk of acute and chronic pancreatitis. Underlying molecular mechanisms are unknown. Differential gene expression in the pancreas was profiled using mRNA differential display by comparison between control and ethanol-consuming rats. Male Wistar rats were fed with diets containing 6.7% (vol/vol) ethanol for 4 wk. A cDNA tag that was overexpressed in the pancreas of rats fed ethanol was isolated. A 723-bp cDNA was cloned from a rat pancreatic cDNA library, which encodes a novel rat mitochondrial ATP synthase subunit 9, isoform 3 (ATP5G3), which is homologous to a human ATP5G3 gene. Real-time PCR demonstrated that all three nuclear gene isoforms (ATP5G1, ATP5G2, and ATP5G3) were consistently upregulated in the pancreas of alcohol-consuming rats, parallel with mitochondrial injury. The cellular response to mitochondrial damage and metabolic stress may reflect an adaptive process for mitochondrial repair in pancreatic acinar cells during chronic ethanol ingestion.

Analysis of the hereditary pancreatitis-associated cationic trypsinogen gene mutations in exons 2 and 3 by enzymatic mutation detection from a single 2.2-kb polymerase chain reaction product.

BACKGROUND: Hereditary pancreatitis is associated with at least 2 mutations in the cationic trypsinogen gene. The purpose of the present study is to test the utility of T4 endonuclease VII for the detection of cationic trypsinogen R117H mutations. In addition, the possibility of screening for R117H, N21I, and A8V mutations in a single 2.2-kb polymerase chain reaction (PCR) product using T4 endonuclease VII was investigated. METHODS: Twenty-nine DNAs from control patients and patients with known cationic trypsinogen R117H, A8V, or N21I mutations were selected from the ongoing hereditary pancreatitis study of the Midwest Multicenter Pancreatic Study Group. The samples were coded and randomized, and a 911-bp sequence containing exon 3 or a 2,212- bp sequence containing exons 2 and 3 were amplified by PCR using fluorescent- labeled primers. The PCR products were digested with T4 endonuclease VII and screened for mutations on an automated DNA sequencer. RESULTS: In all cases with a mutation, a cleavage fragment on the direct and/or complementary DNA strand could easily be visualized, and its approximate size correlated with the predicted location of the known mutations within the PCR product. When the code for affected status was broken, there was 100% correlation between previous DNA sequence or restriction fragment length polymorphism findings and the T4 endonuclease VII digestion results for all 29 DNAs. CONCLUSION: T4 endonuclease VII accurately identified the known cationic trypsinogen gene mutations in exons 2 and 3. Enzymatic mutation detection appears to be an accurate and useful method for screening individuals for known trypsinogen gene mutations and may be useful in identifying previously unidentified mutations within large regions of interest.

Factors governing the effective remediation of negative affect and its cognitive and behavioral consequences.

The present experiment tested the hypothesis that the remediation of negative emotion will be most effective when the remedial procedure matches the experience or cognition that induced the negative state--process-specificity hypothesis. Other hypotheses examined were that negative states induced by cognitive reflection related to the self would be resistant to remediation, even by a same-process positive procedure, and that changes in emotional expressions may make it appear that a negative state has been effectively remediated when lingering effects on behavior and cognition indicate that it has not. Negative emotional states were induced in second-grade children by one of four processes, all of which involved social rejection content: cognition that focused on (a) the self (thinking about oneself being rejected by a peer) or (b) another person (thinking about a peer being rejected); or experience that related to (c) oneself (actually being socially rejected) or (d) observing another (vicarious: seeing a peer be socially rejected). These inductions were then followed by a positive, remedial induction whose content was the reverse (social acceptance) and whose process did or did not match that of the negative induction. As predicted, except for negative self-cognitions, it was found that the behavioral (altruism) and cognitive (performance on a block design task) consequences of negative emotion were alleviated when the positive remediation was of the same type as the original induction. Emotional expressions were consistently positive following remediation, regardless of their type. The results are discussed in terms of differing processes for maintaining negative emotion as a function of the character of induction, and the implications for the understanding of clinical depression in children are noted.

Psychological stress and myocardial perfusion in coronary disease patients and healthy controls.

This study examined the effect of two different psychological stressors on regional cardiac perfusion in six men with coronary heart disease (CHD) and nine healthy controls. Subjects recalled an anger experience and an anger plus helpless (i.e., Desperation Recall Task) experience during positron emission tomography (PET). Emotional reactivity, blood pressure, and heart rate were also assessed. Experimental manipulations generated significant emotional and cardiovascular reactivity. Cardiac perfusion to diseased myocardial segments failed to show any significant differences between CHD patients' diseased segments and controls' healthy segments for the Anger Recall task or the Desperation Recall Task. Results failed to confirm previous findings of coronary artery constriction while reliving an angry experience, yet are consistent with other studies utilizing mental arithmetic. Vasoactive medication use, sample size, and perfusion variability may have contributed to these findings.

The physical attractiveness of facially deformed patients before and after craniofacial surgery.

The present experiment investigated whether the physical attractiveness of craniofacially deformed children and adolescents could be improved by surgical procedures. Twenty patients between the ages of 5 months and 17 years were randomly selected from patient files. Patient diagnoses included facial clefts, hypertelorism, Treacher Collins syndrome, and craniofacial dysostosis (Crouzon's and Apert's syndromes). Rigorously standardized photographs of patients taken before and after surgery were shown to 40 "naive" raters ranging in age from 17 to 52 years. Raters analyzed the photographs with regard to global physical attractiveness. These ratings indicated that the patients' physical attractiveness was reliably (62 percent) improved following surgery. The results are discussed in light of recent evidence that untreated craniofacial patients may be at risk for psychosocial disorders and in terms of the growing evidence of the importance of physical appearance for the development of cognitive and social-emotional competence. In addition, a standardized assessment system is described that can be used to facilitate the compilation of actuarial data predicting surgical outcomes. Finally, the importance of empirically evaluating the effectiveness of surgical procedures and practitioners on a continuing basis is emphasized.

Emotional and behavioral reactions to facially deformed patients before and after craniofacial surgery.

The present experiment investigated whether observers' emotional and behavioral reactions to facially deformed patients could be substantially improved by surgical procedures conducted by well-trained specialists in an experienced multidisciplinary team. Also investigated was the hypothesis that emotional states mediate the effects of physical attractiveness and facial deformity on social interaction. Twenty patients between the ages of 3 months and 17 years were randomly selected from over 2000 patients' files of Kenneth E. Salyer of Dallas, Texas. Patient diagnoses included facial clefts, hypertelorism, Treacher Collins syndrome, and craniofacial dysostoses (Crouzon's and Apert's syndromes). Rigorously standardized photographs of patients taken before and after surgery were shown to 22 "naive" raters ranging in age from 18 to 54 years. Raters were asked to predict their emotional and behavioral responses to the patients. These ratings indicated that observers' behavioral reactions to facially deformed children and adolescents would be more positive following craniofacial surgery. Similarly, the ratings indicated that observers' emotional reactions to these patients would be more positive following surgery. The results are discussed in terms of current sociopsychologic theoretical models for the effects of attractiveness on social interaction. A new model is presented that implicates induced emotional states as a mediating process in explaining the effects of attractiveness and facial deformity on the quality of social interactions. Limitations of the current investigation and directions for future research are also discussed.

Social support among African-American adults with diabetes. Part 1: Theoretical framework.

Diabetes mellitus affects African Americans in disproportionate numbers relative to whites. Proper management of this disease is critical because of the increased morbidity and mortality associated with poor diabetes management. The role of social support in promoting diabetes management and improved glycemic control among African Americans is a little-explored area. This article, the first in a two-part series, provides a theoretical framework for examining the relationship between social support and glycemic control among African-American adults.

Social support among African-American adults with diabetes, Part 2: A review.

Diabetes mellitus affects African Americans in disproportionate numbers relative to whites. Proper management of this disease is critical because of the increased morbidity and mortality associated with poor diabetes management. The role of social support in promoting diabetes management and improved glycemic control among African Americans is a little-explored area. This review, the second in a two-part series, examines the relationship between social support and glycemic control among African-American adults with diabetes. The main findings of the study are that African Americans tend to rely more heavily than whites on their informal social networks to meet their disease management needs and that social support is significantly associated with improved diabetes management among members of this population. However, there remains a critical need to systematically include substantial numbers of African-American respondents in studies examining the relationship between social support and glycemic control. Only then can the effects of age, gender, socioeconomic status, and other variables on this relationship in African Americans become clear and interventions incorporating relevant aspects of social support be developed.

Effect of social support on informed consent in older adults with Parkinson disease and their caregivers.

PURPOSE: To evaluate the effects of social support on comprehension and recall of consent form information in a study of Parkinson disease patients and their caregivers. DESIGN AND METHODS: Comparison of comprehension and recall outcomes among participants who read and signed the consent form accompanied by a family member/friend versus those of participants who read and signed the consent form unaccompanied. Comprehension and recall of consent form information were measured at one week and one month respectively, using Part A of the Quality of Informed Consent Questionnaire (QuIC). RESULTS: The mean age of the sample of 143 participants was 71 years (SD = 8.6 years). Analysis of covariance was used to compare QuIC scores between the intervention group (n = 70) and control group (n = 73). In the 1-week model, no statistically significant intervention effect was found (p = 0.860). However, the intervention status by patient status interaction was statistically significant (p = 0.012). In the 1-month model, no statistically significant intervention effect was found (p = 0.480). Again, however, the intervention status by patient status interaction was statistically significant (p = 0.040). At both time periods, intervention group patients scored higher (better) on the QuIC than did intervention group caregivers, and control group patients scored lower (worse) on the QuIC than did control group caregivers. IMPLICATIONS: Social support played a significant role in enhancing comprehension and recall of consent form information among patients.

Primary prevention: Key issues and a competence perspective.

At a superficial level, one might characterize the primary prevention debate as centering on the question of whether primary prevention has been demonstrated to be an effective means of promoting mental health. This interpretation is supported by the clarity and strength of the confident generalizations of primary prevention proponents such as Dr. Albee ("We have a lot of evidence on the effectiveness of primary prevention ... it is available in the literature for all to read") and primary prevention critics such as Dr. Lamb ("... The major functional mental illnesses, as well as the frequently occurring diagnosable minor illnesses, remain untouched by efforts to strengthen mental health."). However, it seems clear that the disagreement is not primarily a matter of differences in data interpretation (although this is clearly a part of the problem). Rather, it seems to be mostly a function of differences at the level of basic assumptions about the nature of mental illness and the appropriate scope of activity for mental health professionals.

Gas chromatographic separation of substituted pyridines.

Capillary gas chromatographic methodology for separation of complex mixtures of substituted pyridines has been demonstrated on polar (CAM) and non-polar (DB-5) columns. Separations are characterized by high resolution, high sensitivity, a wide dynamic detector range, and good reproducibility. For the first time, Kováts retention indices have been calculated for pyridine and substituted pyridines. Correlations of retention indices with physico-chemical properties, such as hydrogen bonding, pyridine pKa and Hammett substituent constants are discussed.

Assessing the reliability of the EORTC QLQ-C30 in a sample of older African American and Caucasian adults.

The purpose of this study was to examine the structure and reliability of the EORTC QLQ-C30. This 30-item instrument has five functional scales (physical, role, cognitive, emotional, and social), three symptom scales (fatigue, pain, and nausea and vomiting) and a global health and quality of life scale. Confirmatory factor analysis and Cronbach's alpha estimates were used to assess the functioning of the EORTC QLQ-C30 in a sample of 489 African American (n = 255) and Caucasian (n = 234) adults aged 50 + years. Seven of the nine EORTC QLQ-C30 scales showed good reliability for both the African Americans and the Caucasians in the sample (Cronbach's alpha > 0.75). In contrast, the cognitive functioning scale had a reliability coefficient of only 0.69 for the African Americans and 0.40 for the Caucasians, and the nausea and vomiting scale had a reliability coefficient of only 0.49 for the African Americans and 0.51 for the Caucasians. In summary, although the overall reliabilities of seven of the scales showed good fit, many of the item-to-scale correlations did not. Researchers planning to use the EORTC QLQ-C30 might first consider conducting separate analyses on the different racial or ethnic subgroups in their study populations to determine whether a common set of factors or scales is available for further analysis.

The linkage model for delivering mental health services in rural communities: benefits and challenges.

Growing recognition of the interconnections between physical and mental health has generated interest in finding ways to link these sectors of care. An interorganizational linkage model that places mental health staff within general health care settings potentially can improve the linkage between mental and general health care. This article presents the results of a study involving 28 mental health staff placed in these arrangements in rural health centers. Staff identified roles, benefits, and barriers to linkages. Benefits included increased access and coordination and promotion of a more holistic sense of health care. Barriers were lack of space, differences among health disciplines, and administrative logistic problems. Social workers need good clinical and communication skills to work effectively in these programs.