Predictors and Barriers to Hepatitis B Screening in a Midwest Suburban Asian Population.

Despite guidelines recommending hepatitis B virus (HBV) screening among the Asian population, not all Asians are screened. We assessed barriers to and factors predicting HBV screening in Michigan. Adults residing in Southeast Michigan self-identifying as Asian were surveyed at Asian grocery stores, restaurants, churches, and community events. 404 persons participated in the survey, 54 % were women, median age was 51 years, 63 % were Chinese, and 93.8 % were born outside the U.S. 181 (44.8 %) had not or could not recall having been screened for HBV. Of these, 89 % said their primary care physicians (PCP) had never brought up screening. Unscreened participants were more likely to think HBV is genetically inherited and cannot be treated than those who had been screened. They were also more likely to think they should avoid close contact with others, would bring shame to their families, and lose their job, if found to be infected with HBV. Among 223 (55.2 %) who had been screened, 48 % said their PCP had the greatest influence in their decision to be screened and 70.9 % said they were screened at a doctor's visit. Screened participants were more likely to know someone with HBV, have a PCP, and have health insurance. Logistic regression analysis showed knowing someone with HBV was the only predictor for screening. Despite guidelines for HBV screening, only half of the Asian Americans surveyed had been screened. Increasing awareness among PCPs is needed to increase HBV screening in this population.

Farmers' perceived risks of climate change and influencing factors: a study in the Mekong Delta, Vietnam.

Many countries are confronting climate change that threatens agricultural production and farmers' lives. Farmers' perceived risks of climate change and factors influencing those perceived risks are critical to their adaptive behavior and well-planned adaptation strategies. However, there is limited understanding of these issues. In this paper, we attempt to quantitatively measure farmers' perceived risks of climate change and explore the influences of risk experience, information, belief in climate change, and trust in public adaptation to those perceived risks. Data are from structured interviews with 598 farmers in the Mekong Delta. The study shows that perceived risks to production, physical health, and income dimensions receive greater priority while farmers pay less attention to risks to happiness and social relationships. Experiences of the events that can be attributed to climate change increase farmers' perceived risks. Information variables can increase or decrease perceived risks, depending on the sources of information. Farmers who believe that climate change is actually happening and influencing their family's lives, perceive higher risks in most dimensions. Farmers who think that climate change is not their concern but the government's, perceive lower risks to physical health, finance, and production. As to trust in public adaptation, farmers who believe that public adaptive measures are well co-ordinated, perceive lower risks to production and psychology. Interestingly, those who believe that the disaster warning system is working well, perceive higher risks to finance, production, and social relationships. Further attention is suggested for the quality, timing, and channels of information about climate change and adaptation.

A Rare Syndrome in a Rare Carcinoma: A Case of Spontaneous Tumor Lysis Syndrome in Small-Cell Liver Carcinoma.

Spontaneous tumor lysis syndrome (STLS) is a rare, oncologic emergency, consisting of life-threatening acute renal failure, hyperuricemia, hyperkalemia, and hyperphosphatemia, prior to the initiation of cytotoxic therapy. Here, we describe a case of STLS in a patient with newly diagnosed small-cell liver carcinoma (SCLC). A 64-year-old female with no significant past medical history presented with a one-month history of jaundice, pruritus, pale stools, dark urine, and right upper quadrant pain. CT of the abdomen revealed a heterogeneous-enhancing intrahepatic mass. CT-guided biopsy of the mass revealed SCLC. At follow-up, labs were significant for potassium 6.4 mmol/L, phosphorus 9.4 mg/dL, uric acid 21.4 mg/dL, calcium 9.0 mg/dL, and creatinine 6.9 mg/dL. She was admitted and treated with aggressive fluid rehydration and rasburicase, with eventual improvement in renal function and normalization of electrolytes and uric acid levels. On the rare occasion that STLS occurs in solid tumors, lung, colorectal, and melanoma are most common, with liver metastases occurring in 65% of cases. Our patient's SCLC was a primary liver malignancy with a large tumor burden, both of which may have predisposed her to develop STLS. Rasburicase is the first line in the treatment of acute tumor lysis syndrome as it quickly decreases uric acid. Identifying SCLC as a risk factor for STLS is key. Due to the high morbidity and mortality associated with this rare phenomenon, a prompt diagnosis is required.

Structure-activity studies of RFamide-related peptide-1 identify a functional receptor antagonist and novel cardiac myocyte signaling pathway involved in contractile performance.

Human RFamide-related peptide-1 (hRFRP-1, MPHSFANLPLRF-NH(2)) binds to neuropeptide FF receptor 2 (NPFF(2)R) to dramatically diminish cardiovascular performance. hRFRP-1 and its signaling pathway may provide targets to address cardiac dysfunction. Here, structure-activity relationship, transcript, Ca(2+) transient, and phospholabeling data indicate the presence of a hRFRP-1 pathway in cardiomyocytes. Alanyl-substituted and N-terminal truncated analogues identified that R(11) was essential for activity, hRFRP-1((8-12)) mimicked hRFRP-1, and [A(11)]hRFRP-1((8-12)) antagonized the effect of hRFRP-1 in cellular and integrated cardiac performance. RFRP and NPFF(2)R transcripts were amplified from cardiomyocytes and heart. Maintenance of the Ca(2+) transient when hRFRP-1 impaired myocyte shortening indicated the myofilament was its primary downstream target. Enhanced myofilament protein phosphorylation detected after hRFRP-1 treatment but absent in [A(11)]hRFRP-1((8-12))-treated cells was consistent with this result. Protein kinase C (PKC) but not PKA inhibitor diminished the influence of hRFRP-1 on the Ca(2+) transient. Molecules targeting this pathway may help address cardiovascular disease.