Rural-urban disparities in psychosocial functioning in epithelial ovarian cancer patients.

OBJECTIVE: Although rural residence has been related to health disparities in cancer patients, little is known about how rural residence impacts mental health and quality of life (QOL) in ovarian cancer patients over time. This prospective longitudinal study investigated mental health and QOL of ovarian cancer patients in the first-year post-diagnosis. METHOD: Women with suspected ovarian cancer completed psychosocial surveys pre-surgery, at 6 months and one-year; clinical data were obtained from medical records. Histologically confirmed high grade epithelial ovarian cancer patients were eligible. Rural/urban residence was categorized from patient counties using the USDA Rural-Urban Continuum Codes. Linear mixed effects models examined differences in psychosocial measures over time, adjusting for covariates. RESULTS: Although disparities were not observed at study entry for any psychosocial variable (all p-values >0.22), urban patients showed greater improvement in total distress over the year following diagnosis than rural patients (p = 0.025) and were significantly less distressed at one year (p = 0.03). Urban patients had a more consistent QOL improvement than their rural counterparts (p = 0.006). There were no differences in the course of depressive symptoms over the year (p = 0.17). Social support of urban patients at 12 months was significantly higher than that of rural patients (p = 0.04). CONCLUSION: Rural patients reported less improvement in psychological functioning in the year following diagnosis than their urban counterparts. Clinicians should be aware of rurality as a potential risk factor for ongoing distress. Future studies should examine causes of these health disparities and potential long-term inequities and develop interventions to address these issues.

Community-Driven Conversations: Partnership Building through CHEC-Ins.

BACKGROUND: Chicago's systemically underserved communities have disproportionately high cancer rates. The Chicago Cancer Health Equity Collaborative (ChicagoCHEC) brings together academic and community partners to address these health inequities. The community conversations known as "CHEC-Ins" provide a space for community members to voice their experiences and needs and for ChicagoCHEC to fulfill its commitment to advancing health equity through collaboration and action. OBJECTIVE: This paper presents a community-generated approach to social networking about cancer health issues known as CHEC-Ins. Through this innovative approach, community members and organizations share cancer related information and experiences, as well as needs and concerns, which are then channeled to ChicagoCHEC academic and administrative members who incorporate them into outreach and research activities. In this way, community members set the agenda and the process and collect the information they deem relevant and important. This paper describes the process of organizing and conducting two pilot CHEC-Ins and the model of this approach, which we intend to employ moving forward to advance partnership building and collaborative research practice between academic institutions and community partners and organizations. This paper contributes a unique model of community-generated and led outreach as a cornerstone of the ChicagoCHEC approach to community engagement. METHODS: The leaders of the ChicagoCHEC Community Steering Committee spearheaded the design and implementation of CHEC-Ins, including developing the question guide and hosting events within their organizations. LESSONS LEARNED: CHEC-Ins proved to be a valuable strategy for defining the role of community partners and establishing the basis for a bi-directional flow of information, resources, and productive action. The two pilot CHEC-Ins revealed important insights related to sources of cancer information, meanings and associated attitudes, barriers to access and use of health services, and social support systems in the communities where ChicagoCHEC works. We will implement this approach and continue to refine it as we conduct CHECIns moving forward.

An EHR-automated and theory-based population health management intervention for smoking cessation in diverse low-income patients of safety-net health centers: a pilot randomized controlled trial.

This study tested the preliminary effectiveness of an electronic health record (EHR)-automated population health management (PHM) intervention for smoking cessation among adult patients of a federally qualified health center in Chicago. Participants (N = 190; 64.7% women, 82.1% African American/Black, 8.4% Hispanic/Latino) were self-identified as smokers, as documented in the EHR, who completed the baseline survey of a longitudinal "needs assessment of health behaviors to strengthen health programs and services." Four weeks later, participants were randomly assigned to the PHM intervention (N = 97) or enhanced usual care (EUC; N = 93). PHM participants were mailed a single-page self-determination theory (SDT)-informed letter that encouraged smoking cessation or reduction as an initial step. The letter also addressed low health literacy and low income. PHM participants also received automated text messages on days 1, 5, 8, 11, and 20 after the mailed letter. Two weeks after mailing, participants were called by the Illinois Tobacco Quitline. EUC participants were e-referred following a usual practice. Participants reached by the quitline were offered behavioral counseling and nicotine replacement therapy. Outcome assessments were conducted at weeks 6, 14, and 28 after the mailed letter. Primary outcomes were treatment engagement, utilization, and self-reported smoking cessation. In the PHM arm, 25.8% of participants engaged in treatment, 21.6% used treatment, and 16.3% were abstinent at 28 weeks. This contrasts with no quitline engagement among EUC participants, and a 6.4% abstinence rate. A PHM approach that can reach all patients who smoke and address unique barriers for low-income individuals may be a critical supplement to clinic-based care.

Manejo anestésico en neonatos con tumoraciones pulmonares / Anesthetic management in neonates with lung tumors

Resumen: Introducción: Los tumores pulmonares congénitos son patologías poco frecuentes; asimismo, cuando requieren intervención quirúrgica, el médico anestesiólogo se enfrenta a un reto en el manejo de estos pacientes. Presentación del caso: En este artículo describimos el caso y el manejo anestésico de un recién nacido de 37.5 semanas de gestación (SDG) y 26 días de vida extrauterina, programado para toracotomía posterolateral izquierda más lobectomía inferior izquierda y colocación de catéter venoso central bajo anestesia combinada (anestesia general balanceada más bloqueo caudal con bupivacaína y morfina). Conclusiones: Las consideraciones anestésicas para los procedimientos quirúrgicos en neonatos y/o pacientes pediátricos se convierten en un reto para el anestesiólogo, debido a la inmadurez de algunos de los sistemas, se considera que la técnica anestésica idónea para el adecuado manejo de los pacientes neonatales sigue siendo la técnica combinada. El anestesiólogo debe mantener en mente dicha técnica así como los eventos y/o efectos secundarios que se puedan derivar de la misma y de este modo instaurar de manera oportuna el tratamiento pertinente.

Abstract: Introduction: Congenital lung tumors are rare pathologies, likewise when surgical intervention is required, the anesthesiologist faces a challenge in the anesthetic management of these patients. Presentation of the case: The following article describes the case of a 26-day-old newborn child scheduled for left posterolateral thoracotomy plus lower left lobectomy and central venous catheter placement under combined anesthesia (balanced general anesthesia plus caudal block with bupivacaine and morphine). Conclusions: Anesthetic considerations for surgical procedures in neonates and/or pediatric patients become a challenge for the anesthesiologist, due to the immaturity of some of the systems, thus considering that the ideal anesthetic technique for the proper management of in neonatal patients, the combined technique continues, with epidural blocks for the management of peri- and postoperative pain. The anesthesiologist must keep in mind this technique as well as the events and/or side effects that may derive from it, thus establishing the pertinent treatment in a timely manner.

Rural residence is related to shorter survival in epithelial ovarian cancer patients.

OBJECTIVE: Rural residence has been related to health disparities and greater mortality risk in cancer patients, including gynecologic cancer patients. Lower survival rates for rural cancer survivors have been attributed to limited access to specialized healthcare, including surgery. Here, we examined whether a rural/urban survival gap existed in ovarian cancer patients receiving surgery at tertiary-care facilities, and potential causes for this gap, including educational attainment. METHODS: Rural and urban patients with high grade invasive ovarian cancer (n = 342) seeking treatment at two midwestern tertiary-care university hospitals were recruited pre-surgery and followed until death or censoring date. Rural/urban residence was categorized using the USDA Rural-Urban Continuum Codes. Stratified Cox proportional hazards regression analyses, with clinical site as strata, adjusting for clinical and demographic covariates, were used to examine the effect of rurality on survival. RESULTS: Despite specialized surgical care, rural cancer survivors showed a higher likelihood of death compared to their urban counterparts, HR = 1.39 (95% CI: 1.04, 1.85) p = 0.026, adjusted for covariates. A rurality by education interaction was observed (p = 0.027), indicating significantly poorer survival in rural vs. urban patients among those with trade school/some college education, adjusted HR = 2.49 (95% CI: 1.44, 4.30), p = 0.001; there was no rurality survival disparity for the other 2 levels of education. CONCLUSIONS: Differences in ovarian cancer survival are impacted by rurality, which is moderated by educational attainment even in patients receiving initial care in tertiary settings. Clinicians should be aware of rurality and education as potential risk factors for adverse outcomes and develop approaches to address these possible risks.

SSRI use and clinical outcomes in epithelial ovarian cancer.

Selective serotonin reuptake inhibitor (SSRI) use is common among ovarian cancer patients. We examined the effect of SSRIs on survival and progression in ovarian cancer patients and effects of 5-HT on ovarian cancer cell (OCC) proliferation. Ovarian cancer patients from a 6-site study between 1994 and 2010 were included. Cox proportional hazards models were used for multivariate analysis. SSRI use was associated with decreased time to disease recurrence (HR 1.3, CI 1.0-1.6, p=0.03), but not overall survival (HR 1.1, CI 0.9-1.3, p=0.56). Compared to normal ovarian cells, most OCCs had elevated 5-HT2A receptor mRNA expression (up to 1600 fold greater expression). Clonogenic survival increased in cells treated with 10 uM (1.6 fold, p<0.001) and 20uM (1.9 fold, p=0.018) 5-HT. Mice receiving 5-HT injections had increases in tumor weight (p=0.07) and nodules (p=0.08) with increased Ki67 expression. Injections with sertraline doubled mean tumor weight in mice (p=0.16). 5-HT and sertraline both increased Ki67 expression in mouse tumors (p < 0.001).Patients using SSRIs had significantly decreased time to disease progression. It is possible that SSRIs alter serotonin levels in the tumor microenvironment, resulting in activation of proliferation pathways. Further characterization of serotonergic pathways in ovarian cancer is recommended to demonstrate safety of these medications.

Habilidades de la enfermera en UCI, para establecer una relación interpersonal con la persona en situación crítica y su familia / Skills of the nurse in the ICU, to establish an interpersonal relationship with the person in a critical situation and their family

Introducción: Describe habilidades de la enfermera en una relación interpersonal, con pacientes en situación crítica de salud, en la Unidad de Cuidados Intensivos (UCI), con la aplicación del instrumento denominado Valoración de Habilidades en la Relación Interpersonal con el Paciente y la Familia en UCI - VHERI-UCI. Objetivo: Describir las habilidades de relación interpersonal de las enfermeras, con la persona en situación crítica de salud y su familia en la UCI, en una relación de Cuidado, en una Institución de Prestación de Servicios de Salud (IPS), de la ciudad de Bogotá D.C. Metodología: Estudio descriptivo de corte transversal, con una muestra aleatoria simple de 38 enfermeras de la UCI de la IPS elegida. Resultados: Se aplicaron 38 cuestionarios, base para el análisis de acuerdo a dos enfoques, los niveles de dominio o profundización de las competencias, básico, intermedio y avanzado, y según la estructura del cuestionario por categorías de análisis para las respuestas. Discusión: Medir las habilidades de la enfermera, conductas específicas encaminadas a mantener un estilo de comunicación asertivo en la interacción con los demás y orientada hacia un intercambio satisfactorio entre ella, la persona en estado crítico y su familia, es indispensable para fortalecer las competencias de la enfermera en la UCI. Conclusiones: La evidencia demuestra que una relación interpersonal entre la enfermera en UCI con el paciente y su familia, requiere de habilidades específicas que son el punto de partida en una relación, fomentando el primer momento del cuidado humano de enfermería.

Introducción: Describe habilidades de la enfermera en una relación interpersonal, con pacientes en situación crítica de salud, en la Unidad de Cuidados Intensivos (UCI), con la aplicación del instrumento denominado Valoración de Habilidades en la Relación Interpersonal con el Paciente y la Familia en UCI - VHERI-UCI. Objetivo: Describir las habilidades de relación interpersonal de las enfermeras, con la persona en situación crítica de salud y su familia en la UCI, en una relación de Cuidado, en una Institución de Prestación de Servicios de Salud (IPS), de la ciudad de Bogotá D.C. Metodología: Estudio descriptivo de corte transversal, con una muestra aleatoria simple de 38 enfermeras de la UCI de la IPS elegida. Resultados: Se aplicaron 38 cuestionarios, base para el análisis de acuerdo a dos enfoques, los niveles de dominio o profundización de las competencias, básico, intermedio y avanzado, y según la estructura del cuestionario por categorías de análisis para las respuestas. Discusión: Medir las habilidades de la enfermera, conductas específicas encaminadas a mantener un estilo de comunicación asertivo en la interacción con los demás y orientada hacia un intercambio satisfactorio entre ella, la persona en estado crítico y su familia, es indispensable para fortalecer las competencias de la enfermera en la UCI. Conclusiones: La evidencia demuestra que una relación interpersonal entre la enfermera en UCI con el paciente y su familia, requiere de habilidades específicas que son el punto de partida en una relación, fomentando el primer momento del cuidado humano de enfermería.

P2Y2 receptor desensitization on single endothelial cells.

Receptor desensitization, or decreased responsiveness of a receptor to agonist stimulation, represents a regulatory process with the potential to have a significant impact on cell behavior. P2Y(2), a G-protein-coupled receptor activated by extracellular nucleotides, undergoes desensitization at many tissues, including the vascular endothelium. Endothelial cells from a variety of vascular beds are normally exposed to extracellular nucleotides released from damaged cells and activated platelets. The purpose of the present study was to compare P2Y(2) receptor desensitization observed in endothelial cells derived from bovine retina, a model of microvascular endothelium, and human umbilical vein endothelial cells (HUVECs), a model of a large blood vessel endothelium. P2Y(2) receptor desensitization was monitored by following changes in UTP-stimulated intracellular free Ca(2 +) in single cells using fura-2 microfluorometry. Both endothelial cell models exhibited desensitization of the P2Y(2) receptor after stimulation with UTP. However, the cells differed in the rate, dependence on agonist concentration, and percentage of maximal desensitization. These results suggest differential mechanisms of P2Y(2) receptor desensitization and favors heterogeneity in extracellular nucleotide activity in endothelial cells according to its vascular bed origin.