Delayed breast cancer presentation, diagnosis, and treatment in Kenya.

PURPOSE: In this mixed-methods study, we evaluated the factors that contribute to delayed breast cancer (BC) diagnosis and treatment at a Kenyan hospital. METHODS: Individuals with a diagnosis of BC, either as a referral or index patient, were recruited to participate in this study through convenience sampling. Data were collected on sociodemographics, health history, and cancer history, diagnosis, and treatment of patients at Kenyatta National Hospital (KNH). For the quantitative analyses, the relationship between sociodemographic and health history factors with stage at diagnosis, number of visits before diagnosis, time to diagnosis, and time to initial intervention, stratified by time to onset of symptoms, were examined using regression analyses. For the qualitative analysis, in-depth interviews of every fifth patient were completed to assess reasons for delayed diagnosis and treatment. RESULTS: The final analytic sample comprised of 378 female BC patients with an average age of 50. These females were generally of lower SES: 49.2% attained no or only primary-level education, 57.4% were unemployed, and the majority (74.6%) had a monthly household income of < 5000 Kenyan shillings (equivalent to ~ $41 USD). The median time from BC symptom onset to presentation at KNH was 13 (IQR = 3-36) weeks, from presentation to diagnosis was 17.5 (IQR = 7-36.5) weeks, and from diagnosis to receipt of the initial intervention was 6 (IQR = 3-13) weeks. Female BC patients who were never/unmarried, less educated, less affluent, users of hormonal contraception, and had ≥ 3 children were more likely to experience diagnosis and treatment delays. Qualitative data showed that financial constraints, lack of patient BC awareness, and healthcare practitioner misdiagnosis and/or strikes delayed patient diagnosis and treatment. CONCLUSIONS: BC patients experience long healthcare system delays before diagnosis and treatment. Educating communities and providers about BC and expediting referrals may minimize such delays and subsequently BC mortality rates in Kenya.

Leukocyte Telomere Length Is Unrelated to Cognitive Performance Among Non-Demented and Demented Persons: An Examination of Long Life Family Study Participants.

OBJECTIVE: Leukocyte telomere length (LTL) is a widely hypothesized biomarker of biological aging. Persons with shorter LTL may have a greater likelihood of developing dementia. We investigate whether LTL is associated with cognitive function, differently for individuals without cognitive impairment versus individuals with dementia or incipient dementia. METHOD: Enrolled subjects belong to the Long Life Family Study (LLFS), a multi-generational cohort study, where enrollment was predicated upon exceptional family longevity. Included subjects had valid cognitive and telomere data at baseline. Exclusion criteria were age ≤ 60 years, outlying LTL, and missing sociodemographic/clinical information. Analyses were performed using linear regression with generalized estimating equations, adjusting for sex, age, education, country, generation, and lymphocyte percentage. RESULTS: Older age and male gender were associated with shorter LTL, and LTL was significantly longer in family members than spouse controls (p < 0.005). LTL was not associated with working or episodic memory, semantic processing, and information processing speed for 1613 cognitively unimpaired individuals as well as 597 individuals with dementia or incipient dementia (p < 0.005), who scored significantly lower on all cognitive domains (p < 0.005). CONCLUSIONS: Within this unique LLFS cohort, a group of families assembled on the basis of exceptional survival, LTL is unrelated to cognitive ability for individuals with and without cognitive impairment. LTL does not change in the context of degenerative disease for these individuals who are biologically younger than the general population.

Correction to: Flipping for success: evaluating the effectiveness of a novel teaching approach in a graduate level setting.

Following publication of the original article [1], author 2 pointed out that his name has since changed from Adiba Islam to Adiba Ashrafi.

Hair Dye and Relaxer Use among Cisgender Women in Embu and Nakuru Counties, Kenya: Associations with Perceived Risk of Breast Cancer and Other Health Effects.

Despite widespread use of hair products globally, little is known about the prevalence and patterns of use in populations outside the United States. As some hair products contain endocrine-disrupting chemicals (EDCs) and EDCs have been linked to breast cancer, which is increasing globally, in this study, we addressed key knowledge gaps about hair product use and practices, and perceptions of use among women in two counties in Kenya. Using community-engaged approaches in Embu and Nakuru, Kenya, we recruited women aged 15-50 years to complete a questionnaire that ascertained hair product use in the last 7-14 days, ever using hair dyes and chemical relaxers, and participants' perceptions or harm around hair product use. In multivariable-adjusted regression models, we evaluated associations between participants' sociodemographic characteristics and perceptions of hair product use in relation to if they have ever used hair dyes and relaxers. In our sample of 746 women (mean age, 30.4 ± 8.1 years), approximately one-third of participants reported ever using permanent and/or semi-permanent hair dyes, with approximately one-fifth reporting current use. Almost 60% reported ever using chemical relaxers, with a little over one-third reporting current use. Increasing age and having an occupation in the sales and service industry were statistically significant predictors of hair dye use (OR 1.04, 95% CI: 1.02-1.06 and OR 2.05, 95% CI: 1.38-3.03, respectively) and relaxer use (OR 1.03, 95% CI: 1.01-1.06 and OR 1.93, 95% CI: 1.30-2.87). On average, participants reported moderate-to-high levels of concern about exposures and general health effects from using hair products, and relatively high levels of perceived risk of breast cancer related to hair product use. However, in contrast to our hypotheses, we observed mixed evidence regarding whether higher levels of perceived risk were associated with lower odds of ever using hair dyes and relaxers. These findings add new knowledge to the extant literature on hair product use among women in Kenya, where breast cancer incidence rates are increasing. Improving the understanding of patterns of use of specific products and their chemical ingredients-which may be hormone disruptors or carcinogens-and exploring the role of environmental health literacy are critical for developing interventions to reduce potentially harmful exposures found in these products.

Evaluation of Inequities in Cancer Treatment Delay or Discontinuation Following SARS-CoV-2 Infection.

Importance: There is a disproportionately greater burden of COVID-19 among Hispanic and non-Hispanic Black individuals, who also experience poorer cancer outcomes. Understanding individual-level and area-level factors contributing to inequities at the intersection of COVID-19 and cancer is critical. Objective: To evaluate associations of individual-level and area-level social determinants of health (SDOH) with delayed or discontinued cancer treatment following SARS-CoV-2 infection. Design, Setting, and Participants: This retrospective, registry-based cohort study used data from 4768 patients receiving cancer care who had positive test results for SARS-CoV-2 and were enrolled in the American Society for Clinical Oncology COVID-19 Registry. Data were collected from April 1, 2020, to September 26, 2022. Exposures: Race and ethnicity, sex, age, and area-level SDOH based on zip codes of residence at the time of cancer diagnosis. Main Outcomes and Measures: Delayed (≥14 days) or discontinued cancer treatment (any cancer treatment, surgery, pharmacotherapy, or radiotherapy) and time (in days) to restart pharmacotherapy. Results: A total of 4768 patients (2756 women [57.8%]; 1558 [32.7%] aged ≥70 years at diagnosis) were included in the analysis. There were 630 Hispanic (13.2%), 196 non-Hispanic Asian American or Pacific Islander (4.1%), 568 non-Hispanic Black (11.9%), and 3173 non-Hispanic White individuals (66.5%). Compared with non-Hispanic White individuals, Hispanic and non-Hispanic Black individuals were more likely to experience a delay of at least 14 days or discontinuation of any treatment and drug-based treatment; only estimates for non-Hispanic Black individuals were statistically significant, with correction for multiple comparisons (risk ratios [RRs], 1.35 [95% CI, 1.22-1.49] and 1.37 [95% CI, 1.23-1.52], respectively). Area-level SDOH (eg, geography, proportion of residents without health insurance or with only a high school education, lower median household income) were associated with delayed or discontinued treatment. In multivariable Cox proportinal hazards regression models, estimates suggested that Hispanic (hazard ratio [HR], 0.87 [95% CI, 0.71-1.05]), non-Hispanic Asian American or Pacific Islander (HR, 0.79 [95% CI, 0.46-1.35]), and non-Hispanic Black individuals (HR, 0.81 [95% CI, 0.67-0.97]) experienced longer delays to restarting pharmacotherapy compared with non-Hispanic White individuals. Conclusions and Relevance: The findings of this cohort study suggest that race and ethnicity and area-level SDOH were associated with delayed or discontinued cancer treatment and longer delays to the restart of drug-based therapies following SARS-CoV-2 infection. Such treatment delays could exacerbate persistent cancer survival inequities in the United States.

Beauty Beware: Associations between Perceptions of Harm and Safer Hair-Product-Purchasing Behaviors in a Cross-Sectional Study of Adults Affiliated with a University in the Northeast.

(1) Background: Widespread personal care product (PCP) use can expose individuals to endocrine-disrupting chemicals (EDCs) associated with adverse health outcomes. This study investigated the association between harm perceptions and hair-product-purchasing behaviors in adults enrolled in a cross-sectional study. (2) Methods: Respondents rated their agreement with five PCP-related harm statements using a five-point Likert scale. Multivariable-adjusted logistic regression models were used to examine the associations between harm perceptions with hair-product-purchasing behaviors and hair product use (i.e., number of products used). (3) Results: Among 567 respondents (non-Hispanic White, 54.9%; non-Hispanic Black, 9.5%; Hispanic/Latinx, 10.1%; Asian American/Pacific Islander, 20.1%; and multiracial/other, 5.5%), stronger harm perceptions around PCP use were associated with potentially "safer" hair-product-purchasing behaviors. Respondents who strongly agreed that consumers should be concerned about the health effects of PCPs had more than fourfold increased odds of always/usually using healthy product apps (OR 4.10, 95% CI: 2.04-8.26); reading ingredient labels (OR 4.53, 95% CI: 2.99-6.87); and looking for natural, non-toxic, or eco-friendly product labels (OR 4.53, 95% CI: 2.99-6.88) when buying hair products. (4) Conclusions: Promoting environmental health literacy and raising awareness of potential PCP use-related harms might encourage healthier hair product use behaviors.

Sociodemographic and Health Correlates of Multiple Health Behavior Adherence among Cancer Survivors: A Latent Class Analysis.

The study aimed to (a) assess current levels of adherence to the National Comprehensive Cancer Network's multiple health behavior guidelines and (b) identify characteristics of cancer survivors associated with different adherence levels. Cancer survivors (N = 661) were identified through the state registry and completed questionnaires. Latent class analysis (LCA) was used to identify patterns of adherence. Associations between predictors with the latent classes were reported as risk ratios. LCA identified three classes: lower- (39.6%), moderate- (52.0%), and high-risk lifestyle (8.3%). Participants in the lower-risk lifestyle class had the highest probability of meeting most of the multiple health behavior guidelines compared to participants in the high-risk lifestyle class. Characteristics associated with membership in the moderate-risk lifestyle class included self-identifying as a race other than Asian/Asian American, being never married, having some college education, and having been diagnosed with later stage colorectal or lung cancer. Those in the high-risk lifestyle class were more likely to be male, never married, have a high school diploma or less, diagnosed with colorectal or lung cancer, and diagnosed with pulmonary comorbidities. Study findings can be used to inform development of future interventions to promote multiple health behavior adherence among higher risk cancer survivors.

Bullying victimization among preadolescents in a community-based sample in Canada: a latent class analysis.

OBJECTIVE: Bullying victimization among adolescents has been well-recognized as a behavior associated with adverse psychological and mental health outcomes. Most studies on bullying victimization have focused on adolescents, but research is sparse regarding school victimization among preadolescents before they transition to adolescence. This study sought to identify latent classes of different types of co-occurring bullying victimization, based on a sample of 3829 school students in grades 5-8, ages 9-14 in the year of 2011 from the Saskatoon Health Region, Saskatchewan, Canada. RESULTS: Using a latent class analysis approach, the results uncovered three groups of victimized students, including those who were aggressively victimized (7.2%), moderately victimized (34.6%) and non-victimized (58.2%). Younger age and being overweight was associated with a higher likelihood of bullying victimization. Moderately and aggressively victimized students had greater probabilities of feeling like an outsider, experiencing anxiety, depressed moods, engaging in suicidal ideation and drinking when compared to non-victimized students. Peer and parent supports had significant protective effects against being victimized. Given the negative consequences of recurrent victimization among the preadolescents, it is imperative to address bullying incidents as they occur to prevent repeated transgressions, especially for those who suffer from multiple types of victimization.