Understanding sleep disturbances in African-American breast cancer survivors: a pilot study.

OBJECTIVES: The goals of this study were (i) to report the prevalence and nature of sleep disturbances, as determined by clinically significant insomnia symptoms, in a sample of African-American breast cancer survivors; (ii) to assess the extent to which intrusive thoughts about breast cancer and fear of recurrence contributes to insomnia symptoms; and (iii) to assess the extent to which insomnia symptoms contribute to fatigue. METHODS: African-American breast cancer survivors completed surveys pertaining to demographics, medical history, insomnia symptoms, and intrusive thoughts about breast cancer, fear of cancer recurrence, and fatigue. Hierarchical regression models were performed to investigate the degree to which intrusive thoughts and concerns of cancer recurrence accounted for the severity of insomnia symptoms and insomnia symptom severity's association with fatigue. RESULTS: Forty-three percent of the sample was classified as having clinically significant sleep disturbances. The most commonly identified sleep complaints among participants were sleep maintenance, dissatisfaction with sleep, difficulty falling asleep, and early morning awakenings. Intrusive thoughts about breast cancer were a significant predictor of insomnia symptoms accounting for 12% of the variance in insomnia symptom severity. After adjusting for covariates, it was found that insomnia symptom severity was independently associated with fatigue accounting for 8% of variance. CONCLUSIONS: A moderate proportion of African-American breast cancer survivors reported significant problems with sleep. Sleep disturbance was influenced by intrusive thoughts about breast cancer, and fatigue was associated with the severity of participants' insomnia symptoms. This study provides new information about sleep-related issues in African-American breast cancer survivors.

An exploratory analysis of fear of recurrence among African-American breast cancer survivors.

BACKGROUND: Fear of recurrence (FOR) is a psychological concern that has been studied extensively in cancer survivors but has not been adequately examined in African-American breast cancer survivors. PURPOSE: This exploratory study describes the extent and nature of FOR in African-American breast cancer survivors. FOR is examined in relation to socio-demographic characteristics, treatment-related characteristics, psychological distress, and quality of life (QOL). METHODS: Participants completed questionnaires assessing FOR, psychological distress, QOL, and demographic and treatment characteristics. Pearson r correlations, t tests, and ANOVAs were used to determine the association between FOR and demographic and treatment-related characteristics. Hierarchical multiple regression models were performed to investigate the degree to which FOR dimensions account for the variance in QOL and psychological distress. RESULTS: Fifty-one African-American breast cancer survivors participated in this study. The mean age of participants was 64.24 (SD = 12.3). Overall fears as well as concerns about death and health were rated as low to moderate. Role worries and womanhood worries were very low. Inverse relationships were observed between age and FOR dimensions. FOR was positively correlated with measures of psychological distress and negatively correlated with QOL. FOR significantly accounted for a portion of the variance in QOL and distress after controlling for other variables. CONCLUSIONS: This study suggests that African-American women in this sample demonstrated some degree of FOR. Results indicate that FOR among African-American breast cancer survivors decreases with age and time since diagnosis and co-occurs with psychological distress as well as diminished quality of life.

Physical activity reduces breast cancer risk in African American women.

OBJECTIVE: To examine the relationship between physical activity and breast cancer in African American women. DESIGN: A population-based case-control study was conducted with 199 women (97 cases and 102 controls) from the Washington, DC metro area. A physical activity questionnaire elicited responses on frequency of walking for exercise and vigorous physical activity (eg, running, aerobics) in the past year. Responses were used to calculate a metabolic equivalent (MET) score (MET-hours/week = hours/week vigorous activity x 7 + hours/week walking x 3). The MET score was categorized into low, medium, and high tertiles. Multivariate logistic regression examined the association between physical activity and breast cancer. RESULTS: African American women who engaged in vigorous physical activity (> or = 2 hours/week in the past year) had a 64% reduced risk of breast cancer compared to those who did not participate in any vigorous activity (odds ratio, OR = .36; 95% confidence interval, CI = .17-.75). We also found a 64% reduced breast cancer risk in women with a high vs low tertile of total activity (OR = .36; 95% CI = .16-.79). For postmenopausal women, vigorous physical activity and total activity (high vs low tertile) also had an inverse relationship with breast cancer (P<.05). CONCLUSION: Data regarding the association of physical activity and breast cancer have been equivocal and lacking for African American women. This study found that modest levels of physical activity reduced breast cancer risk in this group. Targeted efforts are needed to encourage more African American women to engage in physical activity.

The effect of a supervised exercise trial on exercise adherence among African American Men: a pilot study.

OBJECTIVE: The objective of this pilot study was to determine the effect of a supervised short-term exercise trial on exercise adherence in a sample of African American males. METHODS: We observed exercise adherence rates among a group of African American men in response to an exercise intervention. Exercise adherence was determined by dividing the total number of actual sessions attended by the total number of possible sessions (12 sessions). A participant was classified as an adherer if they completed 9 out of 12 exercise sessions (75%). RESULTS: Seventy-one percent of the study participants (12/17) completed at least 75% of the study sessions and therefore adhered to the study protocol. Among the adherers, 7 out of 12 (58%) had adherence rates of 100%. Five participants withdrew from the exercise group due to lack of time and lack of interest. CONCLUSION: Exercise adherence rates among African-American men in this study were favorable during this supervised exercise intervention and were comparable to adherence rates observed in other supervised exercise interventions. Recommendations based on this pilot study are provided to reduce participant withdrawal and to inform future large-scale studies.

A quality improvement project to decrease utilization of multilumen peripherally inserted central catheters.

We performed a quality improvement project to decrease utilization of multilumen peripherally inserted central catheters (PICCs) in favor of single-lumen PICCs and midline catheters. Through optimization of electronic orders, education and decision support, we decreased utilization of multilumen PICCs, changed provider ordering patterns, and showed a downward trend in CLABSIs.

Untreated Takayasu arteritis: an unusual case of widespread disease.

A 38-year-old man with no medical history presented with bilateral flank and epigastric abdominal pain. CT abdomen and pelvis demonstrated diffuse nodules and lymphadenopathy, which were biopsied and showed chronic inflammatory changes. He later presented with pleuritic chest pain and was sent for a CT chest angiogram, which revealed perivascular inflammation involving the thoracic aortic arch, supra-aortic branch vessels and descending thoracic aorta. Further work-up showed vasculitic involvement of the coeliac, superior mesenteric and femoral arteries with heavy collateralisation. These findings were most consistent with widespread Takayasu arteritis that had been untreated for nearly 20 years. It was necessary to define the degree of active inflammation and need for immediate therapy, as the patient had a concomitant latent tuberculosis infection that precluded the use of immunosuppressive medications. This report illustrates an unusual case of Takayasu arteritis and highlights the presentation, diagnosis and work-up of suspected cases.

Severe neck pain and odynophagia secondary to acute calcific longus colli tendinitis: a case report.

BACKGROUND: Acute calcific longus colli tendinitis is a rare, noninfectious inflammatory condition caused by the deposition of calcium crystals. The condition is self-limiting, yet commonly misdiagnosed. Here we report a case of a patient with severe neck pain and odynophagia initially misdiagnosed as a retropharyngeal abscess before establishing the correct diagnosis of acute calcific longus colli tendinitis. CASE PRESENTATION: A 60-year-old Caucasian man presented to an outside emergency department with a 5-day history of neck pain and odynophagia. The neck pain was severe and aggravated by movement. Laboratory evaluation revealed leukocytosis and elevated C-reactive protein. Computed tomography of his neck soft tissues was initially interpreted as a retropharyngeal abscess. Antibiotic therapy with piperacillin/tazobactam was initiated, and the patient was transferred to our tertiary care center for further evaluation and treatment. On physical examination, the patient's neck range of motion was significantly diminished, and bilateral neck tenderness was present. An otolaryngologist performed an examination with laryngoscopy, the result of which was unremarkable. A radiologist at our facility interpreted his outside magnetic resonance imaging as showing "calcification in the prevertebral muscles at C1-C2, inflammation with edema of the prevertebral muscles, and retropharyngeal space edema/effusion," consistent with acute calcific longus colli tendinitis. His antibiotics were discontinued, and he was started on intravenous ketorolac. He had significant improvement in his neck range of motion, and his pain diminished greatly. He was discharged on a 10-day course of diclofenac (50 mg three times daily). At 1-week follow-up, the patient was doing well; he had returned to work, and his pain was well controlled. CONCLUSIONS: This case report details the presentation, characteristic radiographic findings, and management of a patient with an extremely rare condition of neck pain and odynophagia that could be treated with nonsteroidal anti-inflammatory drugs.

Attenuation of exaggerated exercise blood pressure response in African-American women by regular aerobic physical activity.

INTRODUCTION: A hyperreactive blood pressure response to exercise is a predictor of developing hypertension. The present study determined the influence of physical activity on an exaggerated exercise blood pressure response (EEBPR) in normotensive African-American women. METHODS: We screened 36 women 18-26 years of age for EEBPR defined as a > or = 50 mm Hg difference in systolic blood pressure at rest and during exercise at 50% peak oxygen uptake (VO2peak). Seven subjects demonstrated an EEBPR and participated in the study. Study participants trained for eight weeks on a bicycle ergometer at a work intensity of 70% VO2peak. Blood pressure, heart rate, cardiac output (CO), stroke volume (SV), and total peripheral vascular resistance (TPR) were determined at baseline and during submaximal exercise at power outputs of 30 W and 50% VO2peak. Subjects served as their own controls, and data were evaluated by using a paired t test at P<.05. RESULTS: Effectiveness of the intervention was shown by a significantly greater VO2peak associated with significant decrements in systolic and mean arterial pressures at power outputs of 30 W and 50% VO2peak. A significant decrement in heart rate was observed during exercise at 30 W. Significant increments in CO and SV and decrement in TPR were found during exercise at 50% VO2peak. CONCLUSION: The reduction in TPR associated with regular aerobic physical activity may attenuate the EEBPR and decrease the risk for hypertension in normotensive, young-adult, African-American women.

The role of exergaming in improving physical activity: a review.

BACKGROUND: The high prevalence of obesity in America can be attributed to inadequate energy expenditure as a result of high levels of physical inactivity. This review presents an overview of the current literature on physical activity, specifically through active videogame systems (exergaming) and how these systems can help to increase physical activity levels. METHODS: The search strategy for this review was to identify previous studies that investigated energy expenditure levels using a single active video game or a combination of active videogames. RESULTS: Based on data from 27 studies, a strong correlation exists between exergaming and increased energy expenditure (up to 300% above resting levels). The majority of active videogames tested were found to achieve physical activity levels of moderate intensity, which meet American College of Sports Medicine guidelines for health and fitness. CONCLUSIONS: Exergaming is a new and exciting strategy to potentially improve physical activity levels and reduce obesity among Americans.

Low incidence of fatigue after hypofractionated stereotactic body radiation therapy for localized prostate cancer.

BACKGROUND: Fatigue is a common side effect of conventional prostate cancer radiation therapy. The increased delivery precision necessitated by the high dose per fraction of stereotactic body radiation therapy (SBRT) offers the potential of reduce target volumes and hence the exposure of normal tissues to high radiation doses. Herein, we examine the level of fatigue associated with SBRT treatment. METHODS: Forty patients with localized prostate cancer treated with hypofractionated SBRT, and a minimum of 12 months follow-up were included in this analysis. Self-reported fatigue and other quality of life measures were assessed at baseline and at 1, 3, 6, 9, and 12 months post-SBRT. RESULTS: Mean levels of fatigue were elevated at 1 month post-SBRT compared to baseline values (P = 0.02). Fatigue at the 3-month follow-up and later were higher but not statistically significantly different compared to baseline. African-American patients reported higher fatigue post-SBRT than Caucasian patients. Fatigue was correlated with hormonal symptoms as measured by the Expanded Prostate Cancer Index Composite (EPIC) quality of life questionnaire, but not with urinary, bowel, or sexual symptoms. Age, co-morbidities, smoking, prostate specific antigen (PSA) levels, testosterone levels, tumor stage, and treatment variables were not associated with fatigue. CONCLUSION: This is the first study to investigate fatigue as a side effect of SBRT. In contrast to standard radiation therapy, results suggest SBRT-related fatigue is short-term rather than a long-term side effect of SBRT. These results also suggest post-SBRT fatigue to be a more frequent complication in African-Americans than Caucasians.