Oncotype DX Test Receipt among Latina/Hispanic Women with Early Invasive Breast Cancer in New Jersey: A Registry-Based Study.

Oncotype DX® (ODX) is a valid test of breast cancer (BC) recurrence risk and chemotherapy benefit. The purpose of this study was to examine prevalence of and factors associated with receipt of ODX testing among eligible Latinas/Hispanics diagnosed with BC. Sociodemographic and tumor data of BC cases diagnosed between 2008 and 2017 among Latina/Hispanic women (n = 5777) were from the New Jersey State Cancer Registry (NJSCR). Eligibility for ODX testing were based on National Comprehensive Cancer Network guidelines. Multivariable logistic regression models of ODX receipt among eligible women were used to estimate adjusted odds ratios (AOR) and 95% confidence intervals (CI) by demographic and clinicopathologic factors. One-third of Latinas/Hispanics diagnosed with BC were eligible for ODX testing. Among the eligible, 60.9% received ODX testing. Older age (AOR 0.08, 95% CI: 0.04, 0.14), low area-level SES (AOR 0.58, 95% CI: 0.42, 0.52), and being uninsured (AOR 0.58, 95% CI: 0.39, 0.86) were associated with lower odds of ODX testing. While there was relatively high ODX testing among eligible Latina/Hispanic women with BC in New Jersey, our findings suggest that age, insurance status, and area-level SES contribute to unequal access to genetic testing in this group, which might impact BC outcomes.

Abdominal wall reconstruction after cytoreduction surgery-hyperthermic intraperitoneal chemotherapy.

BACKGROUND: Cytoreduction surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) improve survival and decrease recurrence of peritoneal metastasis in a select population of patients. Abdominal wall resection is often needed to achieve complete CRS and the extent of abdominal wall resection may necessitate abdominal wall reconstruction (AWR). We sought to investigate if postoperative morbidity and mortality was increased in patients who underwent AWR with CRS-HIPEC (AWR group) compared to CRS-HIPEC without AWR (non-AWR group) and to identify if patient, tumor, and operative risk factors were associated with poor outcomes following AWR. We postulate that AWR is a safe and viable treatment option in appropriately selected patients with peritoneal disease. METHODS: A retrospective chart review was conducted from 2012 to 2015. Demographics, comorbidities, intraoperative variables, and postoperative outcomes were analyzed and compared between the non-AWR group and the AWR group. RESULTS: A total of 30 patients underwent CRS-HIPEC at our institution; 19 recruited in non-AWR group and 11 in the AWR arm. Median follow-up was 19.1 mo for the non-AWR group and 15.6 mo for AWR. Overall survival and complications were not significantly different between groups. Six patients in the non-AWR group and three patients in AWR group died during the follow-up period (32% versus 27%, P = 0.75). Grade III/IV Clavien-Dindo complications were similar in AWR compared to non-AWR group (64% versus 50%, P = 0.46) however estimated blood loss (1000 mL versus 450 mL, P = 0.01) and operative time (663 min versus 510 min, P = 0.02) were significantly increased in the AWR group. CONCLUSIONS: The results of this study demonstrate that AWR is a safe and viable option and can improve wound closure and strength in select patient populations undergoing CRS-HIPEC. AWR is not associated with an increase in mortality or complication rate. Future studies will need larger sample sizes and randomization to identify patient and operative factors that increase morbidity with AWR and identify the ideal timing of AWR.

Suicidal ideation among suburban adolescents: The influence of school bullying and other mediating risk factors.

OBJECTIVE: Prior research has identified multiple factors that influence suicidal ideation (SI) among bullied youth. The effects of school bullying on SI cannot be considered in isolation. In this study, we examined the influence of school bullying on SI, through a constellation of risks, which include depressive and anxiety symptoms, family conflict, and alcohol, tobacco, and other drug (ATOD) use. We also provide recommendations for therapists working with bullied youth. METHOD: Our sample consisted of 488 adolescents (ages 10-18 years) from a northern New Jersey, United States suburban community. Students were recruited through the district's physical education and health classes. Students responded to multiple measures, which included family cohesion/conflict, ATOD use, mental health indicators, SI, and school bullying experiences. Following preliminary analyses, several logistic regression models were used to assess the direct influence of bullying on SI, as well as the unique effects of family conflict, depressive and anxiety symptoms, and substance use. In addition, a parallel multiple mediating model with the PROCESS macro in SPSS was used to further assess mediating effects. RESULTS: Logistic regression results indicated that school bullying increased the odds of SI among males and females and that when mediating variables were added to the model, bullying no longer had a significant influence on SI. Overall, these results display that for both males and females, school bullying was a significant contributor to SI. Results from the parallel multiple mediating model further illustrated the mediating effects that family conflict, depression, and ATOD use had between bullying and SI. Some variation was noted based on gender. CONCLUSION: This study draws attention to the multiple experiences associated with school bullying on SI, and how these results may differ by gender. The results of this study are particularly important for those working directly and indirectly with bullied youth. Therapists that engage bullied youth need to consider the multiple spheres of influence that may increase SI among male and female clients. To holistically and adequately assess SI among bullied youth, therapists must also consider how these mechanisms vary between gender groups.

Prevalence and risk factors for vitamin D insufficiency and deficiency at birth and associated outcome.

BACKGROUND: Occurrence and consequence of cord blood (CB) vitamin D insufficiency/deficiency has not been adequately explored despite rising concern regarding this topic in pediatrics. This study was designed to determine the rate, maternal risk factors, and clinical outcomes in infants in association with vitamin D insufficient/deficient status at birth. METHODS: American Academy of Pediatrics (AAP) defined levels (ng/mL) were utilized to categorize the vitamin D status in CB samples as deficient (5-15), insufficient (16-20), and sufficient (21-100). We used descriptive statistics and multiple regression models to identify the rate and factors associated with vitamin D deficiency/insufficiency and related outcomes in the enrolled mother-infant pairs. RESULTS: This prospective study was conducted at a single center on postpartum women and their infants. Vitamin D deficiency and insufficiency was recorded in 38.9 and 29.8% respectively of the 265 CB samples. Deficient CB vitamin D levels in infants were associated with maternal Black, Hispanic, or Asian race/ethnicity, younger age, and increased number of pregnancies. The likelihood for infants to be born with an insufficient vitamin D level increases with younger maternal age and the number of pregnancies as well as Asian ethnicity. We did not find an association between the vitamin D status at birth and pre-discharge clinical characteristics of the neonates. CONCLUSIONS: The likelihood for an infant to be born with vitamin D deficiency/insufficiency is relatively high and is related mainly to younger maternal age, gravidity, and non-White race/ethnicity. Our findings raise a question regarding the adequacy of the AAP recommended vitamin D supplementation requirements without knowing the infant's vitamin D status at birth.

Health-Related Quality of Life in Overweight/Obese Children Compared With Children With Inflammatory Bowel Disease.

PURPOSE: This study examined the health-related quality of life (HRQOL) of pediatric patients with overweight/obesity compared with that of patients with inflammatory bowel disease. METHODS: Differences between disease groups in their PedsQL 4.0 HRQOL survey scores were analyzed using unpaired t tests and analyses of variance. RESULTS: Scores of patients with overweight/obesity were as low as scores of patients with inflammatory bowel disease. Parent/guardian-proxy social functioning scores of the overweight/obese group were statistically significantly lower than scores of the inflammatory bowel disease group, and the parents/guardians reported significantly lower HRQOL scores than the patients. CONCLUSIONS: Overweight/obese children have HRQOL scores as impaired as those of children with inflammatory bowel disease. According to proxy-reported scores, overweight/obesity is associated with lower social functioning. Thus, it is important for health care providers to recognize obesity's relationship to patients' psychosocial health and provide holistic care that addresses the severity of this disease.

Swimming facilities and work-related asthma.

BACKGROUND: Exposure to chlorinated water in swimming facilities may aggravate preexisting asthma or cause new onset asthma. This may be a particular problem for individuals who work and therefore spend prolonged time at swimming facilities. Chloramines formed by the interaction of chlorine-based disinfection products with the nitrogen in water from human sweat, urine and skin cells are the suspected causal agents. METHODS: Cases were reviewed from the state surveillance systems in California (CA), Michigan (MI) and New Jersey (NJ) to identify individuals with confirmed work-related asthma (WRA) attributed to exposures in swimming pools, water parks or hydrotherapy spas. A standardized method was used to confirm cases. RESULTS: A total of 44 confirmed cases of WRA were identified; 17 from 1994 to 2011 in CA, 15 from 1991 to 2012 in MI and 12 from 1990 to 2011 in NJ. A majority (52.2%) of the cases were new onset; 31.8% secondary to an acute exposure incident and 20.4% to repeated exposure. These represented 0.3-1.6% of all confirmed cases of WRA received during these time periods. Maintenance workers (34.9%) and lifeguards (31.8%) were the most common occupations. CONCLUSIONS: Swimming pool workers were identified from three states where the pool environment was either a trigger of preexisting asthma or associated with new onset of WRA. Regulations to require air monitoring and improvements in ventilation are recommended to reduce exposure levels of chloramines, the presumed etiologic agents. Clinical assessment of patients with asthma should include consideration of the effect on respiratory symptoms from exposures in a swimming pool environment.

Associations between ozone, PM2.5, and four pollen types on emergency department pediatric asthma events during the warm season in New Jersey: a case-crossover study.

BACKGROUND: Asthma is one of the most common chronic diseases among school-aged children in the United States. Environmental respiratory irritants exacerbate asthma among children. Understanding the impact of a variety of known and biologically plausible environmental irritants and triggers among children in New Jersey - ozone, fine particulate matter (PM2.5), tree pollen, weed pollen, grass pollen and ragweed - would allow for informed public health interventions. METHODS: Time-stratified case-crossover design was used to study the transient impact of ozone, PM2.5 and pollen on the acute onset of pediatric asthma. Daily emergency department visits were obtained for children aged 3-17 years with a primary diagnosis of asthma during the warm season (April through September), 2004-2007 (inclusive). Bi-directional control sampling was used to select two control periods for each case for a total of 65,562 inclusion days. Since the period of exposure prior to emergency department visit may be the most clinically relevant, lag exposures were investigated (same day (lag0), 1, 2, 3, 4, and 5 as well as 3-day and 5-day moving averages). Multivariable conditional logistic regression controlling for holiday, school-in-session indicator, and 3-day moving average for temperature and relative humidity was used to examine the associations. Odds ratios are based on interquartile range (IQR) increases or 10 unit increases when IQR ranges were narrow. Single-pollutant models as well as multipollutant models were examined. Stratification on gender, race, ethnicity and socioeconomic status was explored. RESULTS: The associations with ozone and PM2.5 were strongest on the same day (lag0) of the emergency department visit (RR IQR=1.05, 95% CI 1.04-1.06) and (RR IQR=1.03, 95% CI 1.02-1.04), respectively, with a decreasing lag effect. Tree and weed pollen were associated with pediatric ED visits; the largest magnitudes of association was with the 5-day average (RR IQR=1.23, 95% CI 1.21-1.25) and (RR 10=1.13, 95% CI 1.12-1.14), respectively. Grass pollen was only minimally associated with the outcome while ragweed had a negative association. CONCLUSIONS: The ambient air pollutant ozone is associated with increases in pediatric emergency department asthma visits during the warm weather season. The different pollen types showed different associations with the outcome. High levels of tree pollen appear to be an important risk factor in asthma exacerbations.

Phytoestrogen consumption from foods and supplements and epithelial ovarian cancer risk: a population-based case control study.

BACKGROUND: While there is extensive literature evaluating the impact of phytoestrogen consumption on breast cancer risk, its role on ovarian cancer has received little attention. METHODS: We conducted a population-based case-control study to evaluate phytoestrogen intake from foods and supplements and epithelial ovarian cancer risk. Cases were identified in six counties in New Jersey through the New Jersey State Cancer Registry. Controls were identified by random digit dialing, CMS (Centers for Medicare and Medicaid Service) lists, and area sampling. A total of 205 cases and 390 controls were included in analyses. Unconditional logistic regression analyses were conducted to examine associations with total phytoestrogens, as well as isoflavones (daidzein, genistein, formononetin, and glycitein), lignans (matairesinol, lariciresinol, pinoresinol, secoisolariciresinol), and coumestrol. RESULTS: No statistically significant associations were found with any of the phytoestrogens under evaluation. However, there was a suggestion of an inverse association with total phytoestrogen consumption (from foods and supplements), with an odds ratio (OR) of 0.62 (95% CI: 0.38-1.00; p for trend: 0.04) for the highest vs. lowest tertile of consumption, after adjusting for reproductive covariates, age, race, education, BMI, and total energy. Further adjustment for smoking and physical activity attenuated risk estimates (OR: 0.66; 95% CI: 0.41-1.08). There was little evidence of an inverse association for isoflavones, lignans, or coumestrol. CONCLUSIONS: This study provided some suggestion that phytoestrogen consumption may decrease ovarian cancer risk, although results did not reach statistical significance.

Phytoestrogen consumption and endometrial cancer risk: a population-based case-control study in New Jersey.

Phytoestrogens have been shown to exert anti-estrogenic and estrogenic effects in some tissues, including the breast. However, only a few studies have evaluated their role in endometrial cancer risk. We evaluated this association in a population-based case-control study in New Jersey. A total of 424 cases and 398 controls completed an interview, including a food frequency questionnaire with supplemental questions for phytoestrogen foods. Risk estimates were derived using an unconditional logistic regression, adjusting for major risk factors for endometrial cancer. There was some suggestion of a decreased risk with quercetin intake (OR: 0.65; 95% CI: 0.41-1.01 for the highest compared to the lowest quartile; p for trend: 0.02). We found a limited evidence of an association with any of the lignans evaluated, total lignans, coumestrol, individual isoflavones, total isoflavones, or total phytoestrogens. However, there was some suggestion of an inverse association with total isoflavone intake limited to lean women (BMI <25; OR for the highest tertile: 0.50; 95% CI: 0.25-0.98) and those with a waist-to-hip ratio

Reflections on the 1976 swine flu vaccination program.

In 1976, 2 recruits at Fort Dix, New Jersey, had an influenza like illness. Isolates of virus taken from them included A/New Jersey/76 (Hsw1n1), a strain similar to the virus believed at the time to be the cause of the 1918 pandemic, commonly known as swine flu. Serologic studies at Fort Dix suggested that >200 soldiers had been infected and that person-to-person transmission had occurred. We review the process by which these events led to the public health decision to mass-vaccinate the American public against the virus and the subsequent events that led to the program's cancellation. Observations of policy and implementation success and failures are presented that could help guide decisions regarding avian influenza.

Do sociocultural factors predict suicidality among persons of African descent living in the U.S.?

Given that researchers have found increased risk for suicidality and other psychiatric problems among acculturated individuals, we predicted similar results for African-descended people living in the U.S. We surveyed a community sample of 423 adult men and women of African descent to determine acculturation's relationship to Black suicide. Participants completed the African American Acculturation Scale, the Multi-Dimensional Support Scale, and a subscale of the Spiritual Well-Being Scale. Suicidal ideation and history of suicide attempt were defined as a "yes" response to the questions, "have you ever considered taking your own life?" and "have you ever attempted to take your own life?" We found that religious well-being (not acculturation) was predictive of both suicidal ideation and history of suicide attempt.

Effect of weed pollen on children's hospital admissions for asthma during the fall season.

The authors analyzed temporal variations in asthma hospital admissions for New Jersey children (0-14 years of age) over a 3-year period. Significant spikes in children's asthma hospital admissions occurred during late September and early October of each of the 3 years of the study. The authors report on an in-depth analysis of the fall peak periods, in an effort to determine whether there was an association between children's asthma hospital admissions and environmental variables. Hospital admission peaks occurred approximately 3 weeks after school started and before heating systems were turned on in New Jersey public schools. They also preceded the point at which schools begin to report increased absences that are due to infectious illnesses. An examination of environmental variables showed only weed pollen as a statistically significant predictor of children's asthma hospital admissions during the fall peaks (p < .001). The counseling of parents about children's exposure to pollen and possible ways to reduce such exposure should be part of the asthma management protocols for children living in high-pollen environments.

Vitamin profile of 563 gravidas during trimesters of pregnancy.

OBJECTIVE: Gestation imposes metabolic stress on the mother which heightens as pregnancy progresses. The need for quantifying circulating vitamins is important for identifying pitfalls in metabolic imbalance and nutritional status. For this reason we wanted to analyze blood vitamin concentrations of B12, thiamin, biotin, pantothenate, B6, niacin, riboflavin, folate, vitamins A, C, E and total carotenes to determine if imbalances occur during the trimesters of pregnancy. METHODS: We randomly selected 563 gravidas who volunteered for this study from the obstetrical clinic of New Jersey Medical School; 132 were in 1st trimester, 198 were in 2nd trimester, and 233 were in 3rd trimester. All were healthy, taking a good diet and supplemented with vitamins. Blood, from an antecubital vein, was analyzed for thiamin, biotin, B12, B6, pantothenate, riboflavin, nicotinate, folates, vitamins A, E, C and total carotenes. Gravidas were classified as being normovitaminemic, hypervitaminemic or hypovitaminemic compared with blood vitamins seen in healthy non-pregnant, non-vitamin supplemented women. RESULT: Hypervitaminemic levels of folate, biotin, pantothenate and riboflavin were found during any trimester of pregnancy due to vitamin supplementation. Despite the vitamin supplementation, a high percent of vitamin A, B6, niacin. thiamin and B 12 hypovitaminemia was noted during pregnancy trimesters. An especially high percentage of niacin deficiency was seen during the 1st trimester; it worsened in later trimesters; B12 deficits increased during the late trimesters. Combination deficits of niacin, thiamin, vitamins A, B6, B12 were noted in each of the trimesters. CONCLUSIONS: Despite vitamin supplementation, a vitamin profile of pregnancy indicates that vitamin deficits exist during the trimesters. Also, combination hypovitaminemias of deficient vitamins were noted; this indicates that a vitamin deficit during pregnancy does not occur in isolation.

Update: Investigation of bioterrorism-related anthrax and interim guidelines for exposure management and antimicrobial therapy, October 2001.

Since October 3, 2001, CDC and state and local public health authorities have been investigating cases of bioterrorism-related anthrax. This report updates previous findings, provides new information on case investigations in two additional areas, presents the susceptibility patterns of Bacillus anthracis isolates, and provides interim recommendations for managing potential threats and exposures and for treating anthrax.

Nutrient intake and risk of subtypes of esophageal and gastric cancer.

Incidence rates for adenocarcinoma of the esophagus and gastric cardia have been rising rapidly. We examined nutrient intake as a risk factor for esophageal and gastric cancers in a population-based case-control study in Connecticut, New Jersey, and western Washington state. Interviews were completed for cases with histologically confirmed esophageal adenocarcinoma (n = 282), adenocarcinoma of the gastric cardia (n = 255), esophageal squamous cell carcinoma (n = 206), and noncardia gastric adenocarcinoma (n = 352), along with population controls (n = 687). Associations between nutrient intake and risk of cancer were estimated by adjusted odds ratios (ORs), comparing the 75th versus the 25th percentile of intake. The following nutrients were significantly inversely associated with risk of all four tumor types: fiber, beta-carotene, folate, and vitamins C and B6. In contrast, dietary cholesterol, animal protein, and vitamin B12 were significantly positively associated with risk of all four tumor types. Dietary fat [OR, 2.18; 95% confidence interval (CI), 1.27-3.76] was significantly associated with risk of esophageal adenocarcinoma only. Dietary nitrite (OR, 1.65; 95% CI, 1.26-2.16) was associated with noncardia gastric cancer only. Vitamin C supplement use was associated with a significantly lower risk for noncardia gastric cancer (OR, 0.60; 95% CI, 0.41-0.88). Higher intake of nutrients found primarily in plant-based foods was associated with a reduced risk of adenocarcinomas of the esophagus and gastric cardia, whereas higher intake of nutrients found primarily in foods of animal origin was associated with an increased risk.

Mortality among three refinery/petrochemical plant cohorts. I. 1970 to 1982 active/terminated workers.

This study updates mortality rates for 19,075 active and terminated workers at three refinery/petrochemical plants. Mortality rates of the workers were compared with both national and state rates. The results indicated deficits of deaths for all causes, all malignant neoplasms, and respiratory and prostate cancer. The noteworthy finding was a statistically significant increase in leukemia among Louisiana male subjects (standardized mortality ratio [SMR], 181; 95% confidence interval [CI], 122 to 259), which showed suggestive trends of increasing SMRs with increasing tenure. This excess was largely due to increased chronic lymphocytic leukemia (SMR, 351; 95% CI, 168 to 645). The rate of kidney cancer remained elevated among Louisiana male subjects, but this finding was no longer significant, and there were no patterns in SMRs by tenure and latency. Mesothelioma was increased at the Louisiana (SMR, 198; 95% CI, 72 to 430) and Texas (SMR, 246; 95% CI, 99 to 507) locations. The leukemia findings have prompted a study of leukemia incidence at the Louisiana location.

Mortality among three refinery/petrochemical plant cohorts. II. Retirees.

This study updates mortality data for 6238 retirees from three refinery/petrochemical plants. Almost 90% of the cohort was deceased. Deaths from all causes (standardized mortality ratio, 104; 95% confidence interval, 102 to 107) and all cancers (standardized mortality ratio, 109; 95% confidence interval, 102 to 116) were elevated. Increased deaths due to kidney cancer, mesothelioma, and the category of other lymphohemopoietic cancers also were observed. The rate of leukemia was not increased. There was little internal or external consistency to support an occupational relationship for kidney cancer, but findings for mesothelioma and other lymphohemopoietic cancers are consistent with reports for other petroleum cohorts. Analyses by age indicated significantly higher all-cause mortality rates among persons retiring before age 65. The results suggest that continued surveillance of mesothelioma and lymphohemopoietic cancer malignancies in younger workers with more contemporary exposures may be warranted. Furthermore, age at retirement should be considered when analyzing occupational cohorts.

Preventive healthcare in women with multiple sclerosis.

The health maintenance of women with diverse disabilities and chronic disabling conditions has been neglected by medical professionals. Interest in their basic health promotion has been eclipsed by the narrowed focus on their underlying conditions. We surveyed preventive medical practices of 220 women with multiple sclerosis (MS). The objectives of this study were to evaluate the adequacy of preventive healthcare delivery for women with MS and to explore the adequacy of the detection, prevention, and treatment of osteoporosis in this high-risk population. Our survey revealed that 50% of the women do not get regular medical preventive checkups. Twenty-five percent do not have regular pelvic examinations, and 11% have not had a Pap smear within 3-5 years. In women over 40 years old, 52% do not have yearly mammograms. Risk factors for premature osteoporosis in our sample included impaired mobility (53%), corticosteroid use (82%), and vitamin D deficiency as a result of avoidance of sunlight. Despite these risks, 85% have never had bone density testing, 50% are not taking calcium supplements, and 71% are not taking vitamin D. Among the postmenopausal sample, 81% have never had bone density testing, 50% are not taking calcium supplements, and 70% are not receiving hormone replacement therapy (HRT). Only 1% are taking bone resorption inhibitors. The benefits of preventive healthcare and cancer prevention screening should be stressed to women with MS. Referrals should be facilitated by neurologists for dignified, knowledgeable examinations in fully accessible facilities. Osteoporosis prevention, screening, and treatment protocols must be part of the medical plan for all women with MS.