Sequential compression devices in postoperative urologic patients: an observational trial and survey study on the influence of patient and hospital factors on compliance.

BACKGROUND: Sequential compression devices (SCDs) are commonly used for thromboprophylaxis in postoperative patients but compliance is often poor. We investigated causes for noncompliance, examining both hospital and patient related factors. METHODS: 100 patients undergoing inpatient urologic surgery were enrolled. All patient had SCD sleeves placed preoperatively. Postoperative observations determined SCD compliance and reasons for non-compliance. Patient demographics, length of stay, inpatient unit type, and surgery type were recorded. At discharge, a patient survey gauged knowledge and attitudes regarding SCDs and bother with SCDs. Statistical analysis was performed to correlate SCD compliance with patient demographics; patient knowledge and attitudes regarding SCDs; and patient self-reported bother with SCDs. RESULTS: Observed overall compliance was 78.6%. The most commonly observed reasons for non-compliance were SCD machines not being initially available on the ward (71% of non-compliant observations on post-operative day 1) and SCD use not being restarted promptly after return to bed (50% of non-compliant observations for entire hospital stay). Mean self-reported bother scores related to SCDs were low, ranging from 1-3 out of 10 for all 12 categories of bother assessed. Patient demographics, knowledge, attitudes and bother with SCD devices were not significantly associated with non-compliance. CONCLUSIONS: Patient self-reported bother with SCD devices was low. Hospital factors, including SCD machine availability and timely restarting of devices by nursing staff when a patient returns to bed, played a greater role in SCD non-compliance than patient factors. Identifying and addressing hospital related causes for poor SCD compliance may improve postoperative urologic patient safety.

Two-photon excited fluorescence imaging of endogenous contrast in a mouse model of ovarian cancer.

BACKGROUND AND OBJECTIVE: Ovarian cancer has an extremely high mortality rate resulting from poor understanding of the disease. In order to aid understanding of disease etiology and progression, we identify the endogenous fluorophores present in a mouse model of ovarian cancer and describe changes in fluorophore abundance and distribution with age and disease. STUDY DESIGN/MATERIALS AND METHODS: A mouse model of ovarian cancer was created by dosing with 4-vinylcyclohexene diepoxide, which induces follicular apoptosis (simulating menopause), and 7,12-dimethylbenz[a]anthracene, a known carcinogen. Imaging of ovarian tissue was completed ex vivo with a multiphoton microscope using excitation wavelength of 780 nm and emission collection from 405 to 505 nm. Two-photon excited fluorescence images and corresponding histologic sections with selective stains were used to identify endogenous fluorophores. RESULTS: The majority of collected fluorescence emission was attributed to NADH and lipofuscin, with additional contributions from collagen and elastin. Dim cellular fluorescence from NADH did not show observable changes with age. Changes in ovarian morphology with disease development frequently caused increased fluorescence contributions from collagen and adipose tissue-associated NADH. Lipofuscin fluorescence was much brighter than NADH fluorescence and increased as a function of both age and disease. CONCLUSIONS: Our finding of NADH fluorescence patterns similar to that seen previously in human ovary, combined with the observation of lipofuscin accumulation with age and disease also seen in human organs, suggests that the findings from this model may be relevant to human ovarian disease. Increased lipofuscin fluorescence might be used as an indicator of disease in the ovary and this finding warrants further study.

Effectiveness of a social marketing media campaign to reduce oral cancer racial disparities.

OBJECTIVES: The purpose of this study was to provide a systematic evaluation of a theory-driven oral cancer awareness media campaign. METHODS: We surveyed a cohort of residents in an intervention city (250) and a control city (250) immediately prior to and after the media campaign. Participants (125 black/African American and 125 white) in each city completed surveys at baseline and follow-up. Oral cancer campaign awareness was assessed in both cities, along with 4 hypothetical health campaigns. Oral cancer awareness, oral cancer exam awareness, intent to receive an oral cancer exam, interest in exam, and receipt of exam were also assessed in both cities, both at baseline and follow-up. RESULTS: Intervention city residents showed a significant increase in recognition of the campaign, awareness of the oral cancer exam, and interest in getting an exam, while no significant changes in those topics were found for the control city. Blacks/African Americans in the intervention city were significantly more likely than whites to demonstrate increases in awareness of the campaign, oral cancer awareness, and interest in receiving an oral cancer exam. CONCLUSIONS: A theory-driven media campaign was successful in increasing awareness of the oral cancer exam and interest in the exam among blacks/African Americans.

The influence of active coping and perceived stress on health disparities in a multi-ethnic low income sample.

BACKGROUND: Extensive research has shown that ethnic health disparities are prevalent and many psychological and social factors influence health disparities. Understanding what factors influence health disparities and how to eliminate health disparities has become a major research objective. The purpose of this study was to examine the impact of coping style, stress, socioeconomic status (SES), and discrimination on health disparities in a large urban multi-ethnic sample. METHODS: Data from 894 participants were collected via telephone interviews. Independent variables included: coping style, SES, sex, perceived stress, and perceived discrimination. Dependent variables included self-rated general and oral health status. Data analysis included multiple linear regression modeling. RESULTS: Coping style was related to oral health for Blacks (B = .23, p < .05) and for Whites there was a significant interaction (B = -.59, p < .05) between coping style and SES for oral health. For Blacks, active coping was associated with better self-reported health. For Whites, low active coping coupled with low SES was significantly associated with worse oral health. Coping style was not significantly related to general health. Higher perceived stress was a significant correlate of poorer general health for all ethnoracial groups and poorer oral health for Hispanics and Blacks. SES was directly related to general health for Hispanics (.B = .27, p < .05) and Whites (B = .23, p < .05) but this relationship was mediated by perceived stress. CONCLUSION: Our results indicate that perceived stress is a critical component in understanding health outcomes for all ethnoracial groups. While SES related significantly to general health for Whites and Hispanics, this relationship was mediated by perceived stress. Active coping was associated only with oral health.

Oral cancer in African Americans: addressing health disparities.

OBJECTIVES: To explore factors underlying African Americans' perceptions of oral cancer and the oral cancer exam. Study findings were used to guide development of oral cancer messages designed to increase oral cancer exams among African Americans. METHODS: Focus groups were conducted to understand African Americans' attitudes and expectations regarding oral cancer and oral cancer exams. RESULTS: Respondents lacked knowledge of personal susceptibility to and the severity of a late-stage oral cancer diagnosis. Participants had limited knowledge of risk factors. DISCUSSION: Findings point to the need for improved patient education and communication between the public and dental providers.

Gambling behavior of student-athletes and a student cohort: what are the odds?

This study investigated the prevalence of gambling, gambling related NCAA violations, and disordered gambling in student-athletes (n = 736) with a comparison cohort of students (n = 1,071) at four universities. Student-athletes reported similar rates of gambling frequency, use of a bookmaker, and disordered gambling as students. After accounting for demographic differences, student-athletes were less likely to engage in sports wagering than students. Several risk factors for disordered gambling were identified, including being male and reporting at least one parent with a history of gambling problems. These findings suggest that problems associated with gambling are a university-wide issue with student-athletes meriting additional attention because of implications for the integrity of intercollegiate sports. Improved prevention and intervention efforts for collegiate gambling are recommended.

Rural Kentucky High School Students' Exposure to All-Terrain Vehicle Riding and Injuries.

From 1982 to 2007, Kentucky had 459 deaths related to all-terrain vehicles (ATVs), fifth highest among US states. By 2012, Kentucky ranked fourth highest, with 578 ATV-related deaths. Following the sentinel event of an ATV-related traumatic brain injury to an unhelmeted high school student, the authors developed a 19-item survey that collected data regarding rural Kentucky high school students' years of ATV driving, second-rider frequency, typical duration of riding events, estimated weekly number of riding events, and frequency of helmet use. Of the 159 students involved, males scored significantly higher on each of these items, except frequency of any ATV driving and frequency of helmet use, which showed no gender differences. Overall, 9.3% of students reported always wearing a helmet when driving and/or riding; 61.2% reported never wearing a helmet; 132 (83.0%) reported that they either drove ATVs or rode as a second rider, and 72 of these (57.1%) reported having had an ATV incident, 33 (45.8%) of which resulted in an injury. Twenty-one of these were serious injuries, including concussions; unconsciousness; fractures to skull, nose, collarbones, arms, ribs, and legs; elbow and hip dislocations; lacerations to head, eyes, arms, legs, and back; and multiple contusions and sprains. Findings have implications for the design of responsibility to protect (R2P) interventions that will reduce exposure and prevent ATV injury and fatality. A method that leverages the relevance of a sentinel event as a community public-health surveillance opportunity is described. Study surveillance data showed higher exposure to ATV hazards than previously reported.

Physician-patient interaction and depression among African-American women: a national study.

OBJECTIVE: To examine the relationship between physician-patient interaction and depression among African-American women. DESIGN: Cross-sectional survey. PARTICIPANTS: 1,411 African-American women completed a mailed 46-item survey on psychological well-being. MAIN OUTCOME MEASURES: The independent variables included demographics and depressive symptomatology as measured by the CES-D. The dependent variable was the mean score on an 8-item measure of physician-patient interaction, and other factors associated with physician-patient interaction. RESULTS: Overall, even after accounting for demographic variables, the higher scores on the CES-D were associated with lower scores on physician-patient interaction (B=1.11, 95% CI=1.06, 1.16). Depression was positively associated with: difficulty in talking to physicians, likelihood of discussing problems with physicians, reporting that a physician had made offensive comments, and the likelihood of changing physicians due to dissatisfaction (all P values <.01). CONCLUSIONS: These results suggest that depressive symptomatology may be an important factor to consider in physicians' interaction with African-American women.

Teaching Brief Interventions for Smoking Cessation via an Interactive Computer-based Tutorial.

Many current smokers do not plan on quitting any time soon. For these smokers, the immediate treatment goal is not a quit attempt, but an increase in readiness to stop smoking. In the present study we developed an interactive multimedia simulation and tutoring environment that teaches healthcare professionals to provide brief motivational interviewing-based smoking cessation interventions tailored to the patient's current readiness to change. This tutorial utilizes a cognitive science-derived learning approach that provides tailored feedback and lessons based on learners' pre-existing knowledge, is highly interactive and allows learners to practice skills in simulated clinical situations. Results from two pilot studies indicate that healthcare professionals and students found the software easy and enjoyable to use and successfully learned MI-based strategies for smoking cessation.

In vivo time-serial multi-modality optical imaging in a mouse model of ovarian tumorigenesis.

Identification of the early microscopic changes associated with ovarian cancer may lead to development of a diagnostic test for high-risk women. In this study we use optical coherence tomography (OCT) and multiphoton microscopy (MPM) (collecting both two photon excited fluorescence [TPEF] and second harmonic generation [SHG]) to image mouse ovaries in vivo at multiple time points. We demonstrate the feasibility of imaging mouse ovaries in vivo during a long-term survival study and identify microscopic changes associated with early tumor development. These changes include alterations in tissue microstructure, as seen by OCT, alterations in cellular fluorescence and morphology, as seen by TPEF, and remodeling of collagen structure, as seen by SHG. These results suggest that a combined OCT-MPM system may be useful for early detection of ovarian cancer.

Diagnostic potential of multimodal imaging of ovarian tissue using optical coherence tomography and second-harmonic generation microscopy.

Ovarian cancer is particularly deadly because it is usually diagnosed after it has metastasized. We have previously identified features of ovarian cancer using optical coherence tomography (OCT) and second-harmonic generation (SHG) microscopy (targeting collagen). OCT provides an image of the ovarian microstructure while SHG provides a high-resolution map of collagen fiber bundle arrangement. Here we investigated the diagnostic potential of dual-modality OCT and SHG imaging. We conducted a fully crossed, multi-reader, multi-case study using seven human observers. Each observer classified 44 ex vivo mouse ovaries (16 normal and 28 abnormal) as normal or abnormal from OCT, SHG, and simultaneously viewed, co-registered OCT and SHG images and provided a confidence rating on a six-point scale. We determined the average receiver operating characteristic (ROC) curves, area under the ROC curves (AUC), and other quantitative figures of merit. The results show that OCT has diagnostic potential with an average AUC of 0.91 ± 0.06. The average AUC for SHG was less promising at 0.71 ± 0.13. The average AUC for simultaneous OCT and SHG was not significantly different from OCT alone, possibly due to the limited SHG field of view. The high performance of OCT and co-registered OCT and SHG warrants further investigation.

Simultaneous multiplane imaging of human ovarian cancer by volume holographic imaging.

Ovarian cancer is the most deadly gynecologic cancer, a fact which is attributable to poor early detection and survival once the disease has reached advanced stages. Intraoperative laparoscopic volume holographic imaging has the potential to provide simultaneous visualization of surface and subsurface structures in ovarian tissues for improved assessment of developing ovarian cancer. In this ex vivo ovarian tissue study, we assembled a benchtop volume holographic imaging system (VHIS) to characterize the microarchitecture of 78 normal and 40 abnormal tissue specimens derived from ovarian, fallopian tube, uterine, and peritoneal tissues, collected from 26 patients aged 22 to 73 undergoing bilateral salpingo-oophorectomy, hysterectomy with bilateral salpingo-oophorectomy, or abdominal cytoreductive surgery. All tissues were successfully imaged with the VHIS in both reflectance- and fluorescence-modes revealing morphological features which can be used to distinguish between normal, benign abnormalities, and cancerous tissues. We present the development and successful application of VHIS for imaging human ovarian tissue. Comparison of VHIS images with corresponding histopathology allowed for qualitatively distinguishing microstructural features unique to the studied tissue type and disease state. These results motivate the development of a laparoscopic VHIS for evaluating the surface and subsurface morphological alterations in ovarian cancer pathogenesis.

Analysis of second-harmonic-generation microscopy in a mouse model of ovarian carcinoma.

Second-harmonic-generation (SHG) imaging of mouse ovaries ex vivo was used to detect collagen structure changes accompanying ovarian cancer development. Dosing with 4-vinylcyclohexene diepoxide and 7,12-dimethylbenz[a]anthracene resulted in histologically confirmed cases of normal, benign abnormality, dysplasia, and carcinoma. Parameters for each SHG image were calculated using the Fourier transform matrix and gray-level co-occurrence matrix (GLCM). Cancer versus normal and cancer versus all other diagnoses showed the greatest separation using the parameters derived from power in the highest-frequency region and GLCM energy. Mixed effects models showed that these parameters were significantly different between cancer and normal (P<0.008). Images were classified with a support vector machine, using 25% of the data for training and 75% for testing. Utilizing all images with signal greater than the noise level, cancer versus not-cancer specimens were classified with 81.2% sensitivity and 80.0% specificity, and cancer versus normal specimens were classified with 77.8% sensitivity and 79.3% specificity. Utilizing only images with greater than of 75% of the field of view containing signal improved sensitivity and specificity for cancer versus normal to 81.5% and 81.1%. These results suggest that using SHG to visualize collagen structure in ovaries could help with early cancer detection.

In vivo, dual-modality OCT/LIF imaging using a novel VEGF receptor-targeted NIR fluorescent probe in the AOM-treated mouse model.

PURPOSE: Increased vascular endothelial growth factor (VEGF) receptor expression has been found at the sites of angiogenesis, particularly in tumor growth areas, as compared with quiescent vasculature. An increase in VEGF receptor-2 is associated with colon cancer progression. The in vivo detection of VEGF receptor is of interest for the purposes of studying basic mechanisms of carcinogenesis, making clinical diagnoses, and monitoring the efficacy of chemopreventive and therapeutic agents. In this study, a novel single chain (sc)VEGF-based molecular probe is utilized in the azoxymethane (AOM)-treated mouse model of colorectal cancer to study delivery route and specificity for disease. PROCEDURES: The probe was constructed by site-specific conjugation of a near-infrared fluorescent dye, Cy5.5, to scVEGF and detected in vivo with a dual-modality optical coherence tomography/laser-induced fluorescence (OCT/LIF) endoscopic system. A probe inactivated via excessive biotinylation was utilized as a control for nonreceptor-mediated binding. The LIF excitation source was a 633-nm He:Ne laser, and red/near-infrared fluorescence was detected with a spectrometer. OCT was used to obtain two-dimensional longitudinal tomograms at eight rotations in the distal colon. Fluorescence emission levels were correlated with OCT-detected disease in vivo. OCT-detected disease was verified with hematoxylin and eosin stained histology slides ex vivo. RESULTS: High fluorescence emission intensity from the targeted probe was correlated with tumor presence as detected using OCT in vivo and VEGFR-2 immunostaining on histological sections ex vivo. The inactivated probe accumulated preferentially on the surface of tumor lesions and in lymphoid aggregate tissue and was less selective for VEGFR-2. CONCLUSION: The scVEGF/Cy probe delivered via colonic lavage reaches tumor vasculature and selectively accumulates in VEGFR-2-positive areas, resulting in high sensitivity and specificity for tumor detection. The combination of OCT and LIF imaging modalities may allow the simultaneous study of tumor morphology and protein expression for the development of diagnostic and therapeutic methods for colorectal cancer.

Factors associated with early-stage diagnosis of oral and pharyngeal cancer.

OBJECTIVES: The objective of this study was to examine the characteristics and treatment-seeking behaviors of patients diagnosed with oral and pharyngeal cancer (OPC) and to determine whether seeing an oral healthcare provider in the preceding year was associated with an earlier stage of diagnosis. METHODS: Trained interviewers administered a pretested survey instrument to a sample of 131 patients newly diagnosed with OPC at two cancer centers in Florida. Analyses were conducted to compare characteristics of patients by cancer summary stage (early or advanced) on receipt of OPC examination, patterns of dental care, and number of initial signs and symptoms. In addition, analyses were also conducted for characteristics of patients' dental care utilization (regular primary care dentist, time of most recent dental visit, and regular dental care) by receipt of OPC examination. RESULTS: Overall, 25.3% of participants reported receiving an OPC examination at their last dental visit and participants who received an OPC examination were significantly more likely (79%) to be diagnosed at early stages than those who did not receive an oral cancer examination (48%). Patients with a regular primary care dentist were more likely to be diagnosed at early stages (65%) than those without a regular primary care dentist (41%). Factors significantly associated with receiving an OPC examination included having a regular primary care dentist (P < 0.001), having a dental visit in the preceding 12 months (P < 0.001), and receiving regular care (P < 0.001). The number of signs or symptoms reported by the patient was significantly associated with the stage at diagnosis (P = 0.002) and the most common initial symptom reported by patients was soreness in the mouth. CONCLUSIONS: These results emphasize the importance of periodic and thorough OPC examinations.

Race, socioeconomic status, and perceived discrimination among healthy women.

OBJECTIVES: Perceived discrimination and socioeconomic status (SES) have been found to be related to health problems. However, little is known about how SES and ethnicity relate to perception and responses to discrimination. This study examined the relationship between race and a set of SES indicators, perceived discrimination (race and gender), and responses to perceived discrimination among healthy women. METHODS: The sample consisted of 460 women between the ages of 18 and 39 (194 black and 266 white). The independent variables included income, education, occupation, and race. The dependent variables included perceived discrimination (race/color and gender) and responses to unfair treatment. RESULTS: Income and education were both directly related to perceived racial discrimination. However, the relationship between education and perceived discrimination was modified by race. For white women, only higher education was related to less perceived discrimination, and there was no significant difference across education levels for black women. Education was the only variable significantly associated with perceived gender discrimination (more highly educated women reported more discrimination). Occupation and race were both related to responses to perceived discrimination. Black women were significantly less likely to talk to someone when treated unfairly than white women (OR = 0.37, 95% confidence interval [CI] = 0.191, 0.716), and women in managerial/professional positions were significantly more likely to do something about being treated unfairly than women in service occupations (OR = 4.76, CI = 2.14, 10.61). CONCLUSIONS: Our results suggest that both SES and race play important roles in women's perceptions of and responses to perceived discrimination.

Relationships among smoking status, ethnicity, socioeconomic indicators, and lifestyle variables in a biracial sample of women.

BACKGROUND: Smoking prevalence rates remain high among women and smoking initiation has increased for young adults. Little is known about the unique patterns of smoking, risk factors, and correlates of quitting in Black versus White women of child-bearing age. METHOD: This study examined the relationships among smoking, ethnicity, socioeconomic status (SES), and lifestyle variables among 715 women (43.6% Blacks and 56.4% Whites). Stringent inclusion criteria were used for ethnicity, which allows for distinct comparisons but may reduce generalizability of results. RESULTS: Black current smokers smoked fewer cigarettes per day and reported initiating smoking at a later age than Whites. Current versus never smoking was associated with income, education, and caffeine intake. There was a significant ethnicity by alcohol interaction (at lower levels of alcohol intake Whites were more likely to smoke but at higher levels of alcohol there were no ethnic differences). Former smoking versus current smoking was associated with alcohol intake, education, and pack years of smoking. CONCLUSIONS: The results of the study suggest several ethnic differences in smoking patterns as well as several correlates of smoking status. These results have implications for the tailoring of interventions and illustrate the association of other health risk factors with smoking status.