Human Papillomavirus (HPV)-Associated Cancers Among Hispanic Males in the United States: Late-Stage Diagnosis by Country of Origin.

INTRODUCTION: The epidemiology of human papillomavirus (HPV)-associated cancers has changed since the development of the multivalent vaccine. This is evidenced by the decline in incidence of cervical cancers in the post-vaccine era. By contrast, studies have reported the rise in incidence of these cancers in males. Though little is known regarding HPV-associated cancers in males, Hispanic males have been largely excluded from research on these cancers. OBJECTIVE: The purpose of this study was to examine the differences in late-stage diagnosis of HPV-associated cancers (oropharyngeal, anorectal, or penile) among subgroups of Hispanic males in the U.S. METHODS: We performed a population-based retrospective cohort study using the 2005-2016 North American Association of Central Cancer Registries Cancer in North America Deluxe data file (n = 9242). Multivariable logistic regression modeling was used in studying late-stage diagnosis. RESULTS: There were no differences in late-stage diagnosis of oropharyngeal cancer between Hispanic subgroups. Higher odds of late-stage penile cancers were observed among Mexican and Puerto Rican males relative to European Spanish males. Lower odds of late-stage anorectal cancers were observed among Central or South American and Puerto Rican males. Having Medicaid or no insurance were associated with late-stage diagnosis for all cancers. CONCLUSION: Certain subgroups of Hispanic males have higher odds of late-stage HPV-associated cancer diagnosis based on country of origin and insurance status. These findings call for improved efforts to increase HPV vaccination, particularly among these subgroups of Hispanic males. Efforts to improve health care access and early detection from health care providers are also needed.

More than cervical cancer: Understanding racial/ethnic disparities in oropharyngeal cancer outcomes among males by HPV status.

Context: Over the last two decades the incidence of male oropharyngeal cancers (OPCa) has increased rapidly in the United States, yet OPCa is mostly preventable. Differences in OPCa incidence and outcomes by race/ethnicity and human papillomavirus (HPV) status have not been previously studied. Objective: Examine racial/ethnic disparities in HPV-related and non-HPV related OPCa outcomes among males. Study Design: Nationwide population-based retrospective cohort study. Setting or Dataset: North American Association of Central Cancer Registries' Cancer in North America Deluxe dataset, covering 93% of the U.S. population. Population studied: Males diagnosed with OPCa in the U.S. between January 2005 and December 2016 (N=175,843). Outcome Measures: OPCa incidence rates by race/ethnicity [Non-Hispanic White, Non-Hispanic Black, Hispanic, Non-Hispanic Other] and HPV status (HPV-related or non-HPV-related); late-stage diagnosis; mean and cumulative survival; cancer-specific mortality. Results: Most male OPCa were HPV-related (92.2%) and in Whites (83.6%), with over 50% increase from 2005 to 2016 in age-adjusted incidence of late-stage HPV-related OPCa among Whites. There was no difference in late-stage diagnosis between Whites and Blacks (aOR, 0.99, 95% CI, 0.94-1.05) or Hispanics (aOR, 0.96, 95% CI, 0.89-1.03), while Other race had 15% lower odds of late-stage diagnosis (95% CI, 0.79-0.95). Independent predictors of late-stage disease included having Medicaid (aOR, 1.37, 95% CI, 1.28-1.46) or no insurance (aOR, 1.44, 95% CI, 1.32-1.57) and HPV-related OPCa (aOR, 3.53, 95% CI, 3.37-3.70). Lower mean survival in HPV-related OPCa compared with Whites (99.63 months, 95% CI, 99.18-100.07) was seen among Blacks (69.72 months, 95% CI, 68.14-71.31) and Hispanics (91.89 months, 95% CI, 89.87-93.91; p < 0.01). Blacks had lowest adjusted cumulative survival for HPV and non-HPV related OPCa (p<0.001). Blacks (aHR, 1.78, 95% CI, 1.70-1.87), Hispanics (aHR, 1.11, 95% CI, 1.03-1.19), and HPV-related OPCa (aHR, 1.25, 95% CI, 1.17-1.34) had higher cancer-specific mortality. Adjusting for treatment eliminated the higher mortality among Hispanics, but not in Blacks. Conclusions: To decrease incidence rates of late stage OPCa, HPV vaccination and possibly, HPV OPCa screening should be advocated, especially in White males. Further research to explicate possible biologic mechanisms and behaviors or comorbidities contributing to the higher OPCa mortality among Black males is needed.

Insights from the shadows: exploring deservingness of care in the emergency department and language as a social determinant of health.

This study addresses the existing gap in literature that ethnographically examines the experiences of Spanish-speaking patients with limited English proficiency in clinical spaces. All of the participants in this study presented to the emergency department (ED) for evaluation of non-urgent health conditions. Patient shadowing was employed to explore the challenges that this population face in unique clinical settings like the ED. This relatively new methodology facilitates obtaining nuanced understandings of clinical contexts under study in ways that quantitative approaches and survey research do not. Drawing from the field of medical anthropology and approach of narrative medicine, the collected data are presented through the use of clinical ethnographic vignettes and thick description. The conceptual framework of health-related deservingness guided the analysis undertaken in this study. Structural stigma was used as a complementary framework in analysing the emergent themes in the data collected. The results and analysis from this study were used to develop an argument for the consideration of language as a distinct social determinant of health.

Application of a Health Literacy Framework to Explore Patients' Knowledge of the Link between HPV and Cancer.

The human papillomavirus (HPV) is a sexually transmitted infection and causes most oropharyngeal (e.g., throat) and anogenital (e.g., anal, cervical) cancers. Research indicates low knowledge about the link between HPV and cancer among the general population, and similar low knowledge of HPV among individuals diagnosed with HPV-associated cancers. This is important because HPV status can have implications for treatment, prognosis, and future sexual decisions. Using a health literacy framework, this study explored how patients diagnosed with HPV-associated cancers accessed, understood, appraised, and applied HPV information. We conducted 27 in-depth interviews with patients seeking care at a comprehensive cancer center; and data were analyzed using applied thematic analysis. Findings revealed that patients' primary source of HPV information was medical providers (access); and many patients exhibited limited understanding of HPV and its role in their cancer diagnosis (understand). Most patients (17 of 27) did not mention HPV as the cause of their cancer. Many patients displayed difficulty connecting HPV with their lifestyles (appraise); and few discussed plans to engage in HPV prevention practices going forward (apply). Future research should focus on strategies to improve understanding of HPV which could increase vaccine uptake, reduce stigma, and enhance informed decision-making among HPV-associated cancer patients.

Long term follow-up of a tobacco prevention and cessation program in cystic fibrosis patients. / Seguimiento a largo plazo de un programa de prevención y cesación tabáquica en pacientes con fibrosis quística.

This study evaluates the impact over time of a telephone-based intervention in tobacco cessation and prevention targeting patients with cystic fibrosis (CF) in the Mediterranean region of Murcia, Spain. We conducted an experimental prospective study with a cohort of CF patients using an integrative smoking cessation programme, between 2008 and 2013. The target population included family members and patients from the Regional CF unit. The study included an initial tobacco exposure questionnaire, measurement of lung function, urinary cotinine levels, anthropomorphic measures and the administered intervention at specific time intervals. Of the 88 patients tracked through follow-up, active smoking rates were reduced from 10.23% to 4.55% (p = 0.06). Environmental tobacco exposure was reduced in non-smoker patients from 62.03% to 36.90% (p < 0.01) during the five year follow-up. Significant reductions in the gradient of household tobacco smoke exposure were also observed with a decrease of 12.60%, from 31.65% (n = 25/79) to 19.05% (n = 16/84) in 2013 (p = <0.01). Cotinine was significantly correlated with both active and passive exposure (p<0.01) with a significant reduction of cotinine levels from 63.13 (28.58-97.69) to 20.56 (0.86-40.27) ng/ml (p<0.01). The intervention to significantly increase the likelihood of family quitting (smoke-free home) was 1.26 (1.05-1.54). Telephone based interventions for tobacco cessation and prevention is a useful tool when applied over time. Trained intervention professionals in this area are needed in the environmental health approach for the treatment of CF.

Este estudio evalúa el impacto en el tiempo de una intervención telefónica de prevención y cesación tabáquica dirigida a pacientes con fibrosis quística (FQ) en la Región de Murcia, España. Estudio prospectivo experimental en una cohorte de pacientes con FQ utilizando un programa integrativo de cesación tabáquica, entre 2008 y 2013. La población diana incluye a pacientes y familiares de la unidad regional de FQ. El estudio incluyó un cuestionario inicial de exposición al tabaco, medición de la función pulmonar, niveles de cotinina en orina, medidas antropomórficas y la intervención realizada en intervalos de tiempo.De los 88 pacientes seguidos, la tasa de fumadores activos se redujo de 10,23% a 4,55% (p = 0,06). La exposición al humo ambiental de tabaco se redujo en los pacientes no fumadores de 62,03% a 36,90% (p < 0,01) durante los cinco años de seguimiento. Se observaron reducciones significativas en la exposición al humo ambiental de tabaco en los hogares, de 31,65% (n = 25/79) a 19,05% (n = 16/84) en 2013 (p = <0,01). La cotinina se correlacionó significativamente con la exposición al tabaco activa y pasiva (p < 0,01) con una reducción significativa de los niveles de cotinina de 63,13 (28,58-97,69) a 20,56 (0,86-40,27) ng/ml (p < 0,01). La intervención para aumentar significativamente la probabilidad de abandono familiar (hogar libre de humo) fue de 1,26 (1,05-1,54). La intervención telefónica mantenida en el tiempo es una herramienta útil para la prevención y cesación tabáquica. Profesionales entrenados en este modelo de intervención con enfoque en salud medioambiental son necesarios para mejorar el tratamiento de FQ.

Interventions to Mitigate Financial Toxicity in Adult Patients with Cancer in the United States: A Scoping Review.

Financial toxicity adversely affects quality of life and treatment outcomes for patients with cancer. This scoping review examined interventions aimed at mitigating financial toxicity in adult patients with cancer and their effectiveness. We utilized five bibliographical databases to identify studies that met our inclusion criteria. The review included studies conducted among adult patients with cancer in the United States and published in English between January 2011 to March 2023. The review identified eight studies that met the inclusion criteria. Each of the studies discussed the implementation of interventions at the patient/provider and/or health system level. Collectively, the findings from this scoping review highlight both the limited number of published studies that are aimed at mitigating financial toxicity and the need to create and assess interventions that directly impact financial toxicity in demographically diverse populations of adult patients with cancer.

Discordance Between Satisfaction and Health Literacy Among Spanish-Speaking Patients with Limited English-Proficiency Seeking Emergency Department Care.

Introduction: The emergency department (ED) is one clinical setting where issues pertaining to health communication uniquely manifest themselves on a daily basis. This pilot study sought to understand satisfaction with care, perceptions of medical staff concern, awareness, and comprehension of medical care among Spanish-speaking patients with limited English-language proficiency (LEP). Methods: A two-phase, mixed-methods approach was employed among Spanish-speaking patients with LEP that presented to an ED in West Central Florida. The prospective phase consisted of semistructured interviews (n = 25). The retrospective phase analyzed existing patient satisfaction data collected at the study site (n = 4,940). Results: Content analysis revealed several linguistic barriers among this patient population including limited individual autonomy, self-blame for being unable to effectively articulate concerns, and lack of clarity in understanding follow-up care plans. Retrospective analysis suggested differences between responses from Spanish-speaking patients when compared with their English-speaking counterparts. Conclusions: Our findings suggest discordance between satisfaction and health literacy in this unique patient population. Although high satisfaction was reported, this appeared to be secondary to comprehension of follow-up care instructions.

Cultural Relevancy of Culinary and Nutritional Medicine Interventions: A Scoping Review.

Background. Taking into account the disproportionate impacts of disease burden from chronic conditions by racial and ethnic group, this scoping review sought to examine the extent to which nutritional interventions incorporated culturally relevant topics into their design and analyses. Methods. A literature search of 5 databases was conducted for any peer-reviewed studies on nutritional and culinary medicine interventions published between 2000 and 2019. Results. Studies were divided into 2 categories, medical education interventions (n = 12) and clinical/community interventions (n = 20). The majority of medical education interventions were not culturally tailored and focused on obesity/weight management within the Northeast and Southeast United States. In contrast, clinical/community interventions were primarily culturally tailored for Latinos/Hispanics and African American/Black populations residing in the Northeast and diagnosed with prediabetes/diabetes mellitus or hypertension/cardiovascular disease. Conclusions. This review identified an existent gap and need for inclusive studies that consider the culturally relevant topics into the design and implementation of nutritional intervention studies. Studies within medical education appeared to be the area where these changes can be most beneficial. There may be some value among clinic and communal-based studies in stratifying heterogeneous subgroups because of the missed cultural nuances missed when grouping larger racial cohorts.

"If at Least the Patient Could Not Be Forgotten About": Communication in the Emergency Department as a Predictor of Patient Satisfaction.

Press Ganey survey data are used by institutions to understand patient experiences in the emergency department (ED). The present mixed-methods retrospective cohort study examined the effects of hallway placement, pain management reporting, communication approaches, time spent in the ED, and other demographic variables on predicting satisfaction ratings of doctors, nurses, and overall ED care. A total of 4940 patient responses between January 1, 2012, and December 31, 2017, were analyzed from 2 EDs associated with an academic institution and tertiary care center. Consensus coding was used to qualitatively capture patient responses that relate to communication issues pertaining to care/empathy and understandings of ED procedures. After controlling for multiple factors, hallway placement, pain management, and understanding of ED procedures were associated with higher odds of negative ratings for doctors, nurses, and overall assessment. Issues with patient communication, particularly regarding understanding of ED procedures, were found to be a strong predictor of negative ratings of doctors, nurses, and overall care. These findings point to the improvements in communication as a potential point of intervention in mitigating negative patient experiences.

Minimizing Variability in Interpretation Modality Among Spanish-Speaking Patients With Limited English Proficiency.

INTRODUCTION: Provider-patient language discrepancies can lead to misunderstandings about follow-up care instructions and decreased adherence to treatment that may contribute to disparities in health outcomes among patients with limited English proficiency (LEP). This observational study aimed to understand how emergency department (ED) staff went about treating patients with LEP and examine the impact of consistent interpretation modality on overall patient satisfaction and comprehension. METHOD: A cross-sectional study was conducted among Spanish-speaking patients with LEP presenting to the ED. A survey was administered at two different time points: after patients provided their history of present illness and after the patient received information regarding follow-up treatment. RESULTS: Analysis of average visual analog scale (VAS) scores by consistency of interpretation suggested higher overall scores among participants that received care via the same communication modalities during both the history of present illness and at disposition, when compared with patients that did not. At both time points, video-based interpretation was associated with higher VAS scores in comparison to other modalities, whereas phone-based interpretation was associated with lower VAS scores. CONCLUSION: Providing consistent modes of interpretation to patient's with LEP throughout their ED visits improved their overall satisfaction of care provided and understandings of discharge instructions.

Patient Shadowing: A Useful Research Method, Teaching Tool, and Approach to Student Professional Development for Premedical Undergraduates.

PROBLEM: Questions have been raised about whether undergraduate institutions are effectively preparing premedical students in the sociobehavioral and cognitive reasoning content found on the revised Medical College Admission Test, providing opportunities to understand and apply these sociobehavioral and cognitive reasoning concepts in real-world scenarios, and offering career exploration opportunities. APPROACH: The Research in Physician-Patient Interactions course is a 15-week course designed for premedical students and taught through the collaboration of an emergency medicine physician and an applied medical anthropologist. As of January 2016, the course is offered each spring at the University of South Florida, Tampa, Florida. The course provides opportunities for patient and physician shadowing within the anthropological methodological framework of participant observation. Other qualitative research methods are also taught, and students complete a group patient experience quality improvement project. OUTCOMES: Thematic analysis of students' field notes and reflection essays and follow-up communications with course alumni revealed 3 salient themes regarding the utility of patient shadowing as a research method that provides unique types of qualitative data, as a teaching tool for premedical students to understand the perspectives of patients, and as an approach to developing the professional skills necessary in health care, such as effective communication styles, establishment of rapport, and empathy. NEXT STEPS: Similar courses should be offered at other universities to premedical students. While it appears that patient shadowing experiences have a great impact during premedical education, there may also be value in integrating a similar experience into medical school and residency training.

Sociocultural aspects of drug dependency during early pregnancy and considerations for screening: Case studies of social networks and structural violence.

OBJECTIVE: To contribute in closing the current gap in literature that holistically examines sociocultural influences on perinatal drug dependency. This article draws from social network theory and structural violence to qualitatively consider the contextual components of addiction and substance use during pregnancy, which purposefully moves away from situating this issue from solely being within the contexts of pathologized disorders or products of social inequalities. DESIGN: Face-to-face semi-structured interviews with drug-dependent pregnant women identified during a reproductive environmental health consultation. SETTING: Interviews were conducted at a university hospital in southeastern Spain between October 2015 and June 2016. PARTICIPANTS: 10 pregnant women with confirmed perinatal substance use and/or drug dependency. FINDINGS: The sociocultural perspective offers a useful lens by which providers can understand the reasons for initial substance use and progress of multi-drug dependency as way of individually tailoring intervention strategies for expecting mothers. This perspective draws from the frameworks of social network analysis (SNA) and structural violence to dialectically examine drug dependency in this unique patient population not to be solely an individual occurrence, but rather a combination of macro and micro-level factors at play. KEY CONCLUSIONS: The sociocultural approach in examining maternal health allows for the holistic exploration of the already taboo and symbolically paradoxical phenomenon of drug dependency in pregnant women. IMPLICATIONS FOR PRACTICE: The "Hoja Verde" and similar perinatal screening methods that comprehensively assess for the potential of environmental risks can be a key instrument in the practice of preventing developmental issues of children as early as pregnancy and into adolescence.

R248G cystic fibrosis transmembrane conductance regulator mutation in three siblings presenting with recurrent acute pancreatitis and reproductive issues: a case series.

BACKGROUND: Mutational combinations of the cystic fibrosis transmembrane conductance regulator, CFTR, gene have different phenotypic manifestations at the molecular level with varying clinical consequences for individuals possessing such mutations. Reporting cystic fibrosis transmembrane conductance regulator mutations is important in understanding the genotype-phenotype correlations and associated clinical presentations in patients with cystic fibrosis. Understanding the effects of mutations is critical in developing appropriate treatments for individuals affected with cystic fibrosis, non-classic cystic fibrosis, or cystic fibrosis transmembrane conductance regulator-related disorders. This is the first report of related individuals possessing the R248G missense cystic fibrosis transmembrane conductance regulator mutation and we present their associated clinical histories. CASE PRESENTATION: All three patients are of Spanish descent. Deoxyribonucleic acid analysis revealed that all three siblings possessed a novel c.742A>G mutation, resulting in a p.Arg248Gly (R248G) amino acid change in exon 6 in trans with the known N1303K mutant allele. Case 1 patient is a 39-year-old infertile man presenting with congenital unilateral absence of the vas deferens and recurrent episodes of epigastric pain. Case 2 patient is a 32-year-old woman presenting with periods of infertility, two previous spontaneous abortions, recurrent epigastric pain, and recurrent pancreatitis. Case 3 patient is a 29-year-old woman presenting with recurrent pancreatitis and epigastric pain. CONCLUSIONS: We report the genotype-phenotype correlations and clinical manifestations of a novel R248G cystic fibrosis transmembrane conductance regulator mutation: congenital unilateral absence of the vas deferens in males, reduced female fertility, and recurrent acute pancreatitis. In addition, we discuss the possible functional consequences of the mutations at the molecular level.