Practices of disciplinary symbiosis: (Re)blending theory and method, anthropology and public health.

BACKGROUND: If you are dually trained in anthropology and public health and your goal is an academic career, in what academic unit should you make your professional home? Should you be a public health-trained academic anthropologist or an anthropologist in a public health school or program? AIMS: Associate Professor of Public Health Anne Sebert Kuhlmann and Assistant Professor of Anthropology Stephanie McClure see their dual training as essential to enacting the career goal of fostering understanding of and positively affecting health in people's everyday lives and preparing students to do the same. "We credit our dual training for our robust perspectives on the nature and causes of health and illness and our recognition that theory and methods are complementary tools in teaching and research. We also recognize that though dual training brings conceptual power and functional applicability to our work, it can also be a challenge to navigate a career path that effectively blends the two. Conventional hierarchies in academia and in public health practice can position the two disciplines for conflict rather than complementarity". MATERIALS AND METHODS: In this article, the two first review the complementarity and conflict between anthropology and public health. DISCUSSION: Next, shifting to a conversational mode, they compare their paths to dual training, their attempts and successes at bringing those blended perspectives to bear in their current positions, and their ideas about more robustly inhabiting (within themselves) and fostering (between the disciplines) public health/anthropology collaborations.

On body economics and fitting in: upward mobility and obesity stigma in Jamaica.

Introduction: Jamaican culture is considered 'fat-loving,' and thus less likely to foster obesity stigma. However, the importance of tourism to Jamaica's economy, global trends toward a thinness aesthetic and extant ethos' of both bodily self-acceptance and status-based bodily critique suggest that obesity stigma may exist in Jamaica - particularly in the context of class status aspiration.Objective: This pilot study examined the relationship between upward mobility and fat stigma in Kingston, Jamaica in two samples.Design: The first sample - nineteen college-enrolled 18-25 year olds - completed an online survey. Responses were grouped by perceived wealth status.Results: No relationship was found between wealth status and obesity stigma. There was no association between wealth group and body ideal - whether slender or curvaceous. However, responses to questions concerning the value of having an ideal body differed by wealth grouping. Those with lower perceived wealth tended to cite 'fitting in to society' as a benefit of having an ideal body. Half (5 of 10) the lower wealth group ranked having an ideal body 'very important;' one person in the higher wealth group did so. Findings from twenty ethnographic interviews conducted in Kingston's public spaces with 18-25 year olds confirmed the obesity stigma/social aspiration relationship. Having an ideal body was associated with greater economic and social opportunity and a sense of 'fitting in.'Conclusion: These findings suggest that though (1) there seems to be no singular, size-related aesthetic in Jamaica; (2) obesity stigma does exist; and (3) experience of stigma may be affected by socio-economic status and socio-economic aspiration.

The Role of Social Issues on Food Procurement among Corner Store Owners and Shoppers.

OBJECTIVE: We assessed corner store shopper and owner perceptions, barriers, and enablers related to food procurement in a sample of neighborhood corner stores where over 50% of families are SNAP eligible. DESIGN: We conducted semi-structured interviews to identify inventory stocking, shopping and marketing approaches, and perspectives on healthy eating. PARTICIPANTS: Five corner store owners and 20 corner store shoppers. RESULTS: Corner store owners: 1) did not feel as though they belonged to the community where their corner store was located; 2) had difficulty in becoming authorized WIC retailers because of the perceived complexity of the process, and 3) stated tobacco products and hot food items are their best-selling items; fruits and vegetables were perceived as unmarketable. Corner store shoppers preferred shopping at local corner stores because: 1) lack of transportation made corner stores easier to access than full-service grocery stores; 2) hot foods are readily available and inexpensive; 3) some home kitchens lacked an oven or stovetop for meal preparation; 4) they need to shop daily for children or other family members. CONCLUSIONS: Social issues such as housing quality, corner store owner sense of community, and acculturation should be addressed when considering food environment in limited resource communities.

Examining peer support and survivorship for African American women with breast cancer.

OBJECTIVE: More than 3.5 million female breast cancer (BrCa) survivors live in the United States, and the number continues to grow. Health status and quality of life among survivors are variable, and African American (AA) survivors suffer disproportionately from BrCa morbidity and mortality. Emerging evidence suggests that peer support is an effective strategy to promote positive survivorship outcomes for AA BrCa survivors. This study aimed to explore the role of peer support in the BrCa experiences of AA survivors. METHODS: Working collaboratively with The Breakfast Club, Inc. (BCI), a community-based BrCa peer support organization, we conducted a quasiexperiment to compare the BrCa experiences of AA survivors. We conducted in-depth interviews with two survivor groups (N = 12 per group), categorized according to receiving peer support during their BrCa experiences. RESULTS: Survivors who received peer support reported greater access to and utilization of alternative support sources, more capacity to process BrCa-related stress, and improved quality of life and adjustment to life as BrCa survivors compared with those who did not receive peer support. CONCLUSIONS: Peer relationships provide consistent, quality social support. Consistent peer support helps survivors cope with the continued stress of BrCa, with implications for psychosocial health and quality of life. Findings expand our current understanding of peer support and may enable public health and clinical practitioners to better recognize and intervene with those for whom additional support services are needed.

Designing a Situational Judgment Test for Use in Medical School Admissions.

ABSTRACT: It has long been acknowledged that professional competencies are required for success in medical school, residency training, and medical practice. Over the last decade, medical schools have begun to introduce standardized assessments of professional competencies, but many still rely on interviews to assess these competencies, which occur after about half of the applicant pool has already been screened out. In this article, the authors discuss the development, evaluation, and launch of the Association of American Medical Colleges (AAMC) situational judgment test (SJT) for use in medical school admissions. The AAMC SJT is designed to assess an examinee's understanding of effective and ineffective behaviors related to the core competencies for entering medical students, including service orientation, social skills, cultural competence, teamwork, ethical responsibility to self and others, reliability and dependability, resilience and adaptability, and capacity for improvement. The authors evaluate the evidence for the need for SJTs in medical school admissions by exploring common derailers in medical school, gaps in the admissions process regarding information about professional competencies, and the challenge of conducting holistic review in a high-volume context. They summarize existing research from the employment, international medical education, and residency selection contexts suggesting that SJT scores are positively associated with subsequent performance and may add value to the admissions process. The authors discuss 5 goals that were the foundation for developing the AAMC SJT: (1) assess the professional competencies needed for success in medical school using a proven method, (2) enable holistic review in a high-volume admissions context, (3) create and share a program of research to support the appropriate use of SJT scores, (4) signal the need for preparation in professionalism to learners, and (5) balance the need for a new assessment with minimizing the burden and risk for applicants.

Lessons learned from a decade of focused recruitment and training to develop minority public health professionals.

From 1999 to 2009, the Eliminating Health Disparities Pre-doctoral Fellowship Program provided specialized education and mentoring to African American graduate students in public health. Fellows received a public health degree, coursework in understanding and eliminating health disparities, experiential learning, mentored research, and professional network building with African American role models. We describe successful strategies for recruiting and training fellows and make 5 recommendations for those seeking to increase workforce diversity in public health: (1) build a community of minority students, not a string of individual recruits; (2) reward mentoring; (3) provide a diverse set of role models and mentors; (4) dedicate staffing to assure a student-centered approach; and, (5) commit to training students with varying levels of academic refinement.

Investigating Group Differences in Examinees' Preparation for and Performance on the New MCAT Exam.

In 2015, the Medical College Admission Test (MCAT) was redesigned to better assess the concepts and reasoning skills students need to be ready for the medical school curriculum. During the new exam's design and rollout, careful attention was paid to the opportunities examinees had to learn the new content and their access to free and low-cost preparation resources. The design committee aimed to mitigate possible unintended effects of the redesign, specifically increasing historical mean group differences in MCAT scores for examinees from lower socioeconomic status (SES) backgrounds and races/ethnicities underrepresented in medicine compared with those from higher SES backgrounds and races/ethnicities not underrepresented in medicine.In this article, the authors describe the characteristics and scores of examinees who took the new MCAT exam in 2017 and compare those trends with historical ones from 2013, presenting evidence that the diversity and performance of examinees has remained stable even with the exam's redesign. They also describe the use of free and low-cost MCAT preparation resources and MCAT preparation courses for examinees from higher and lower SES backgrounds and who are enrolled in undergraduate institutions with more and fewer resources, showing that examinees from lower SES backgrounds and who attend institutions with fewer resources use many free and low-cost test preparation resources at lower rates than their peers. The authors conclude with a description of the next phase of this research: to gather qualitative and quantitative data about the preparation strategies, barriers, and needs of all examinees, but especially those from lower SES and underrepresented racial/ethnic backgrounds.

Surgical resection and long-term survival for octogenarians who undergo surgery for non-small-cell lung cancer.

PURPOSE: An increasing proportion of newly diagnosed non-small-cell lung cancer (NSCLC) patients are octogenarians. It has been questioned whether older patients benefit from surgical resection of lung cancer to the same extent as younger patients. PATIENTS AND METHODS: We conducted a single-institution, retrospective analysis of patients newly diagnosed with NSCLC from 2000-2006, who underwent surgical resection of their lung cancer in Hoag Hospital. We compared resection and survival rates for patients who were age 80 years or older to younger cohorts and determined their stage distribution, rates of surgery, and actuarial survival by age-defined cohort. Of 1293 total patients, 17.2% were age 80 years or older; 36.1%, age 70-79 years; 29.2%, age 60-69 years; 12.9%, age 50-59 years; and 4.6%, under age 50. Of these patients, 482 underwent surgical resection. Surgical procedures included 400 lobectomies, 23 pneumonectomies, and 59 wedge resections. RESULTS: The proportion of patients who had local disease at diagnosis was higher for octogenarians compared with younger patients (33.6% vs. 26.6%; P = .021), but the resection rate for octogenarians was lower (64% vs. 83%; P = .0003). For patients determined to have local- or regional-stage disease, resection rates were 52% versus 67.9% (P = .0007). However, survival curves for patients who underwent surgical resection were similar for all five cohorts with 5-year survival rates of 62%, 53%, 63%, 63%, and 79% from oldest to youngest. CONCLUSION: Non-small-cell lung cancer patients < 80 years of age were less likely to undergo potentially curative surgery, but survival for octogenarians who did undergo surgical resection was comparable to younger age groups. Such patients should not be denied potentially curative surgery simply because of age.

Changing the conversation about prostate cancer among African Americans: results of formative research.

OBJECTIVES: To understand obstacles to and opportunities for improving prostate cancer communication to and within African American communities. DESIGN: Researchers conducted interviews with 19 community leaders and five focus groups with healthy men and survivors. The team also conducted process evaluations of two outreach projects in which survivors spoke to African American men about prostate cancer and screening. RESULTS: Three levels of obstacles to prostate cancer screening and treatment were identified. Individual-level obstacles included limited knowledge about the condition, about prevention and treatment, and fear of cancer. Socio-cultural barriers included distrust of the medical system, lack of a provider for routine and preventive care, reluctance to talk about cancer, and aversion to aspects of screening. Institutional deficits included the scarcity of educational efforts targeting prostate cancer. Outreach project evaluations suggested that survivors can be effective in building prostate cancer knowledge, promoting positive attitudes toward screening, and fostering conversations about prostate cancer. Educational efforts included little information about screening risks and decision-making however. CONCLUSIONS: The findings suggest that most potent interventions may combine survivor-led education with mass media and institution-based outreach. Such comprehensive programs could shift social norms that inhibit conversation and foster fear, leading in turn to more informed decisions and better treatment outcomes.

Variability in Weight Concern and Physical Activity Engagement Among African American Adolescent Girls.

Lower rates of recreational physical activity (PA) among African American (AA) adolescent girls relative to other US age/race/gender groups are assumed to reflect within-race similarity in PA attitudes and practices. However, variability in PA attitudes and practices among AA adolescent girls is not well studied. To address this, a class-diverse sample of 51 AA adolescent girls' responses to survey items querying weight concern (WC) and PA was examined for sub-groupings using cluster analysis. Three clusters were identified [L/H-low WC, high PA; H/L-high WC, low PA; and L/L-low WC and PA]. Survey item response means were examined by cluster. L/L differed visibly, but not significantly, from L/H and H/L on items assessing PA engagement. The same was true for H/L with WC items. Cluster identification and trends in response differences by cluster have potential implications for targeted PA promotion efforts. Further investigation with larger, representative samples is warranted.

Improving survival for patients with breast cancer compared with intramural and extramural benchmarks.

BACKGROUND: Advances in the early detection and treatment of breast cancer during the past 20 years should have been associated with increased survival. PATIENTS AND METHODS: We examined outcomes for patients with invasive breast cancer diagnosed before and after opening a hospital-affiliated comprehensive community cancer center and compared rates of improvement in survival with national benchmarks. Survival data for patients with invasive cancer were obtained from the Hoag Hospital tumor registry. National Surveillance Epidemiology and End Results (SEER) survival data for all eras reported for 1981-2001 were used for extramural comparisons. RESULTS: Observed 5-year survival improved from 79% to 84% (P=0.003) for patients diagnosed with invasive breast cancer during 1986-1991 compared with 1992-1999, the eras immediately before and after opening Hoag Cancer Center. During 1981-1993, relative 5-year survival rates increased slowly, nationally and locally, with both at 86% for 1986-1993. Since then, Hoag relative 5-year survival rates have steadily increased to 97% compared with 88% for SEER during 1995-2001. Improved survival for Hoag patients was observed for all general stages of disease and associated with increased use of systemic treatment and radiation therapy in addition to surgery. CONCLUSION: The existence of Hoag Cancer Center has been associated with improved survival for patients with invasive breast cancer and for all stages of disease. The rate of improvement has been more rapid than observed nationally. Systematic dissemination of new information might have resulted in earlier adoption of improved screening and diagnostic and multidisciplinary treatment approaches that led to higher survival rates.

Perceptions of the religion-health connection among African American church members.

In this qualitative study, the authors examine perceptions of the religiosity-health connection among African American church members. They conducted 33 interviews with members of predominately African American churches. The clergy and members from each congregation completed semistructured interviews. Participants described the religiosity-health connection in their own words and talked about whether and how their religious beliefs and practices affect their health. The authors derived an open coding scheme from the data using an inductive process. Themes that emerged spontaneously and consistently included but were not limited to spiritual health, mental health's effects on physical health, importance of the church family, giving problems up to God, and the body as a temple of God. These religion-health themes might hold promise for integration into church-based health promotion interventions for this population.

Interprofessional Collaborative Practice: An Oral Health Paradigm for Women.

Interprofessional collaborative practice (IPC) is paramount to the future of oral health education. As such, it is critical that today's health care education continues to expand its curriculum to promote oral health as an essential component in the IPC approach to women's health. This article explores models that can be implemented using an IPC framework to foster better approaches in the delivery of care to female patients.

Steadily improving survival in lung cancer.

BACKGROUND: National data demonstrate minimal improvement in survival for patients diagnosed with lung cancer despite a number of apparent advances during the past 3 decades. We wished to know how demographic characteristics, staging, therapy, and survival have changed over time for patients with lung cancer who were accessioned to the cancer registry of a large community hospital in southern California. PATIENTS AND METHODS: Clinical features and survival data were collected on patients diagnosed during each of the successive 6-year eras of 1986 to 1991 (n = 812), 1992 to 1997 (n = 1072), 1998 to 2003 (n = 1209), and 2004 to 2009 (n = 1365). RESULTS: Median survival improved from 11 to 13 to 16 to 26 months and overall 5-year survival steadily improved from 16.5% to 19.1% to 24.0% to 31.1%. The proportion of patients with localized disease at diagnosis increased from 18.4% to 24.1% to 24.9% to 31.6%. Improvements in relative survival were much greater than have occurred nationally. Other obvious trends over time were increasing age of patients, increasing proportions with diagnoses of adenocarcinoma with concomitant decreases in squamous cell and small cell histologies, and decreases in the proportion of large cell carcinoma with reciprocal increases in neuroendocrine diagnoses. The use of chemotherapy for patients with local disease tripled in the most recent era. CONCLUSION: Survival has steadily improved for patients in this community who were diagnosed with lung cancer. The explanations for this improvement are multifactorial, but include earlier stage at diagnosis, decreases in histologic types associated with active smoking, and increased use of systemic therapies.

High-dose IL2 in metastatic melanoma: better survival in patients immunized with antigens from autologous tumor cell lines.

Abstract Various published data show that in patients with metastatic melanoma, high-dose interleukin-2 (IL2) is associated with 5-year survival rates of 15% from treatment initiation. We previously reported a median survival of 15.6 months, and a 20% 5-year survival rate for 150 patients who were treated with inpatient IL2 (Cancer Biother Radiopharm 2012;27:337). In the current study, we sought to determine whether treatment with active specific immunotherapy (ASI) with patient-specific tumor stem cell vaccines derived from autologous tumor cell (TC) lines contributed to the survival result. Existing databases revealed that 32/149 IL2-treated patients also received ASI, while 117 did not. ASI was given within 12 months of IL2 therapy in 19/32 patients. Patients who received IL2 plus ASI had better overall survival (p<0.001) with longer median survival (39.5 vs. 12.0 months) and a higher 5-year survival rate (39% vs. 13%). Survival was better even after exclusion of 55 IL2-alone patients who died before 12 months of follow-up (p=0.12). In subset analyses, survival was longer for 25 patients who received ASI after IL2 than for 7 who received ASI before IL2 (5-year survival 46% vs. 14%, p<0.001) and for 16 patients who received a dendritic cell/TC-based ASI compared with 16 injected with irradiated TC (p=0.17). This retrospective study suggests that receipt of IL2 followed by a patient-specific melanoma stem cell vaccine is associated with better survival than IL2 alone.

Adolescent self-defined neighborhoods and activity spaces: spatial overlap and relations to physical activity and obesity.

Defining the proper geographic scale for built environment exposures continues to present challenges. In this study, size attributes and exposure calculations from two commonly used neighborhood boundaries were compared to those from neighborhoods that were self-defined by a sample of 145 urban minority adolescents living in subsidized housing estates. Associations between five built environment exposures and physical activity, overweight and obesity were also examined across the three neighborhood definitions. Limited spatial overlap was observed across the various neighborhood definitions. Further, many places where adolescents were active were not within the participants׳ neighborhoods. No statistically significant associations were found between counts of facilities and the outcomes based on exposure calculations using the self-defined boundaries; however, a few associations were evident for exposures using the 0.75mile network buffer and census tract boundaries. Future investigation of the relationship between the built environment, physical activity and obesity will require practical and theoretically-based methods for capturing salient environmental exposures.

Should high-dose interleukin-2 still be the preferred treatment for patients with metastatic melanoma?

For more than 20 years interleukin-2 (IL2) was the preferred treatment for medically fit metastatic melanoma patients, but recently two new agents, ipilimumab and vemurafenib, were approved for stage IV disease. Single-institution data were used to determine the long-term survival rate for IL2-treated melanoma patients, and whether use of inpatient IL2 had declined recently. Between May 1987 and April 2010, 150 patients were hospitalized for high-dose, intravenous (i.v.) IL2. The average number of IL2 patients increased from 5.4 per year during 1987-1991 to 5.8 during 1992-1997 after regulatory approval of IL2, to 8.3 during 1998-2006 after a marketing indication in metastatic melanoma was granted, but dropped to 3.0 during 2007-2010. At the time of treatment, median age was 52 years; 27% were 60 years of age or older. At the time of analysis 122 patients were deceased. Median survival from the start date of IL2 treatment was 15.6 months, with a 20% 5-year survival. Among patients enrolled in clinical trials, there were as many nonresponders who survived 5 years as responders, which is consistent with a delayed immunotherapy benefit. In the absence of long-term survival data for these newer agents, IL2 probably should still be the preferred initial treatment for most patients with metastatic melanoma who are medically fit.

Overall survival benefit from postoperative radiation therapy for organ-confined, margin-positive prostate cancer.

PURPOSE: Radical prostatectomy for invasive prostate cancer is associated with positive margin rates in 10% to 50% of resected specimens. Postoperative radiation therapy may benefit patients who have organ-confined prostate cancer with positive margins. METHODS AND MATERIALS: We performed a retrospective analysis to examine whether adjunctive radiation therapy enhanced long-term survival for prostate cancer patients who underwent prostatectomy for localized prostate cancer but with positive margins. We used the Hoag Cancer Center database to identify patients diagnosed with invasive prostate cancer. Relative and overall survival rates were calculated. RESULTS: Among 1,474 patients diagnosed with localized invasive prostate cancer during the years 1990 to 2006 and undergoing prostatectomy, 113 (7.7%) were identified who had positive margins and did not have local extension of disease, positive lymph nodes, or distant metastases. A total of 17 patients received adjunctive radiation therapy (Group A), whereas 96 did not (Group B; 3 received hormonal therapy). Both groups had a median age of 64 years and median follow-up of 7.5 years. In Group A, no patients have died as of last follow-up, but in Group B, 18 have died. Estimated 10-year and 15-year overall survival rates were both 100% for Group A compared with 85% and 57% respectively for Group B (p2=0.050, log rank). Relative 10- and 15 year survival rates were both 100% for Group A compared with 100% and 79% respectively for Group B. CONCLUSIONS: This retrospective analysis suggests that prostate cancer patients with localized disease but positive margins do derive a survival benefit from adjuvant radiation therapy.

Should high-dose interleukin-2 still be the preferred treatment for patients with metastatic renal cell cancer?

Interleukin-2 (IL-2) was the preferred treatment for medically fit patients with advanced kidney cancer, but recently, several targeted therapies have been approved for metastatic renal cell carcinoma. We wished to determine the long-term survival rate for patients with kidney cancer treated with IL-2 and whether the use of intense inpatient IL-2 has declined since the introduction of targeted therapies. Patients who received IL-2 were identified from clinical trial enrollment, pharmacy logs, and financial billing records. Survival was determined from the earliest date of IL-2 therapy. There were 79 patients hospitalized for high-dose infusional IL-2 between March 1989 and March 2009. Median age was 58 years, and 27% were older than 65 years at the time of treatment. At the time of this analysis, 72 patients had deceased. Median survival was 9.9 months, but 5-year survival was 19.4%. The average number of patients with IL-2 increased from 2.2 per year during 1989-1992 to 5.6 during 1993-2001 after FDA approval, but dropped to 2.0 during 2002-2009. High-dose IL-2 is associated with a 5-year survival rate that is higher than objective response rates, suggesting a delayed immunotherapy benefit for some patients. The use of intensive IL-2 has declined dramatically in recent years, but unless a long-term survival benefit can be shown for these new targeted products, we feel that inpatient IL-2 remains the preferred initial treatment.

Identification of 12 or more lymph nodes in resected colon cancer specimens as an indicator of quality performance.

BACKGROUND: : Identification of > or =12 lymph nodes in resected colon cancer specimens has been endorsed as a quality indicator. METHODS: : The Hoag Hospital cancer registry was used to identify patients diagnosed with colon cancer. The proportion of colon cancer specimens for which > or =12 lymph nodes were identified was determined by anatomic location, stage of disease, patient age, and operating surgeon. Survival was correlated with stage and with whether > or =12 lymph nodes were identified. RESULTS: : Pathology procedural changes in 1998 were associated with an increase in the average number of lymph nodes identified from 8.0 to 14.5 (P < .0001); therefore, analysis was limited to 574 patients who underwent surgical resection of colon adenocarcinoma during 1998 to 2005. Identification of > or =12 lymph nodes varied from 57% to 83% by 7 anatomic locations (P < .0001), from 65% to 75% by 5 age cohorts (P = .027), from 59% to 73% by 4 general stages of disease (P = .004), and from 53% to 80% among 12 surgeons who performed at least 17 resections (P = .014). The proportion of resections in which > or =12 lymph nodes were identified was higher for 3 colorectal fellowship-trained surgeons compared with the other 9 surgeons (77% vs 63%, P = .0007), and with 30 surgeons who each performed <10 resections (77% vs 51%, P < .0001). Identification of > or =12 lymph nodes was associated with better survival for patients with stage I (P = .016) and stage II (P = .021) disease. CONCLUSIONS: : Anatomic location, colorectal surgical training, and case volume were strongly correlated with the number of lymph nodes identified. Cancer 2009. (c) 2009 American Cancer Society.