Impact of a Cancer Health Education Curriculum Among Milwaukee Public High School Students.

In Milwaukee and nationwide, cancer incidence, late-stage diagnosis, and mortality are notably higher among some racial/ethnic populations. Cancer education has the potential to impact cancer burden and reduce cancer disparities. In particular, the addition of a service-learning component to academic curriculums has been shown to improve student learning as well as positively impact the surrounding community. This study implemented a cancer health education curriculum (CHEC) at a Milwaukee public high school with the goal of addressing cancer knowledge, fear and fatalism beliefs, and risk behaviors. The curriculum included interactive learning sessions and a service-learning final project. Five-hundred twenty-one students also completed pre- and post-surveys assessing cancer knowledge, fear and fatalism, risk behaviors, cancer-related communication, and a qualitative question asking what they hoped to gain (pre) or did gain (post) from the course. Results indicate (1) a significant improvement in cancer knowledge (p < 0.0001), (2) a decrease in cancer fear and fatalism (p < 0.0001), (3) an increase in fruit consumption (p < 0.0001), (4) a decrease in screen time (p = 0.0004), and (5) an increase in how often students spoke with their family about cancer (p < 0.0001). Qualitative data reflect important gains such as increased interest in sharing their knowledge about cancer with their community. Providing cancer education and leveraging a service-learning requirement led to notable changes in high school students' cancer knowledge, fear and fatalism, and risk behaviors. Students also communicated more with family/friends about cancer. Such efforts could have broader implications for student, family, and community cancer burden.

A Mixed-Methods Feasibility Study: Eliciting ICU Experiences and Measuring Outcomes of Family Caregivers of Patients Who Have Undergone Hematopoietic Stem Cell Transplantation.

The impact of an intensive care unit (ICU) admission on family caregivers of patients who have undergone hematopoietic stem cell transplantation (HSCT) has not been well described. Aims of this study were to determine the feasibility of conducting research with family caregivers of HSCT patients during an ICU admission and generate preliminary data about their experiences and engagement in care. Using a mixed-methods, repeated measures design, we collected data from family caregivers after 48 hr in the ICU (T1) and at 48 hr after transferring out of ICU (T2). Enrolling HSCT caregivers in research while in the ICU was feasible (10/13 consented; 9/10 completed data collection at T1); however, data collection at T2 was not possible for most caregivers. Caregiver distress levels were high, and engagement in care was moderate. The three themes that emerged from interviews (n = 5) highlighted that although HSCT family caregivers faced many challenges and received limited support during their ICU experience, they were able to access their own personal resources and demonstrated resilience.

Exploring health behaviors and the feasibility of a lifestyle intervention for patients with multiple myeloma.

PURPOSE: Multiple myeloma (MM) is the second most common hematologic malignancy in the USA, with higher rates observed in older adults and African Americans (AA). Survivors experience fatigue, bone pain, reduced functioning, and obesity, highlighting the value of developing lifestyle interventions for this diverse group. This study explores lifestyle behaviors and supportive care needs to inform future programs tailored to the MM community. METHODS: MM survivors, ≥ 100 days post autologous stem cell transplant (ASCT) with a BMI ≥ 20 kg/m2, were recruited from two university hospitals. Diet, physical activity, and quality of life (QOL) were measured using validated measures. Qualitative interviews gathered information on survivorship needs and interests related to supportive interventions. Quantitative data was analyzed using descriptive statistics; qualitative data were analyzed using deductive strategies. RESULTS: Seveny-two MM survivors participated (65% white, 35% black). Participants were 62.5 ± 15.8 years of age. Fifty percent were classified as obese and 65% were insufficiently active. Participants reported diets high in added sugars and saturated fats. QOL measures indicated clinically significant challenges in physical and sexual function. Most (87%) were interested in a lifestyle program. Predominant themes regarding survivors' desires for a lifestyle program included social support, guided exercise, meal preparation support, and disease management information. CONCLUSION: This study demonstrates the need for and interest in lifestyle change support among a racially diverse sample of MM survivors. Interventions that are group-based, target knowledge gaps, social connections, accountability, and provide structured framework with professional instruction will best address the needs of this survivor population.

Environmental health literacy for Anishinaabe (Great Lakes Native American) fish consumers: A randomized control trial.

BACKGROUND: Fish consumption comprises an important part of what the Anishinaabe (Great Lakes Native Americans) call "minobimaadiziiwin" which translates roughly to "living in a good way". Industrial activity leading to the accumulation of persistent contaminants in fish disrupts minobimaadiziiwin. Our team of academic and Anishinaabe scientists co-developed a fish consumption advisory for the Anishinaabe using software that can be accessed via mobile phones and/or the internet. OBJECTIVES: The software, Gigiigoo'inaan ("our fish") is designed to improve environmental health literacy using culturally congruent messaging and aesthetics. We tested the following hypotheses: 1) the Gigiigoo'inaan would encourage consumption of fish high in Polyunsaturated Omega-3 fatty acids (PFUA-3) whilst minimizing contaminant intake (methylmercury (MeHg) and Polychorinated Biphenyls (PCBs)); and 2) intervention participants will be more likely than controls to achieve a favorable n-3 PUFA/MeHg consumption ratios. METHODS: We conducted a randomized controlled trial with prospective self-reported fish consumption using automated email surveys. One-month pre and one month post, control and intervention outcome variables were calculated per participant as µg/kg/day of MeHg, µg/kg/day of PCB, g of fish, and mg/day of EPA+DHA. These were modeled using an analysis of covariance (ANCOVA) with a-priori covariates: age, sex, and tribal affiliation. RESULTS: Most participants in both trial arms reported eating relatively elevated amounts of fish yet remained within advisory guidelines for contaminants. EPA+DHA:MeHg ratios were also favorable in most participants. Advisory limits for contaminants were exceeded by relatively few participants in the study. DISCUSSION: Gigiigoo'inaan was previously reported to increase confidence, the current user feedback confirms this. Most participants ate fish but did not exceed the advisory limits, which demonstrates Environmental Health Literacy progress in the region despite a lack of observed behavior change during the trial. A small number of participants exceeded contaminant intake guidelines which matches the pilot work for this study.

Every Day Counts: a randomized pilot lifestyle intervention for women with metastatic breast cancer.

PURPOSE: To explore the feasibility, adherence, safety and potential efficacy of Every Day Counts; a randomized pilot trial designed for women with metastatic breast cancer (MBC) framed by the American Cancer Society nutrition and physical activity (PA) guidelines METHODS: Women with clinically stable MBC were recruited to complete an interview, dual energy X-ray absorptiometry imaging and phlebotomy at baseline and post-intervention. Multidimensional quality of life, symptom burden, lifestyle behaviors (nutrition and PA) and biomarkers of prognosis were procured and quantified. Women were randomized to the immediate intervention or a waitlist control arm. The 12-week intervention included a curriculum binder, lifestyle coaching (in-person and telephone-based sessions) and intervention support (activity monitor, text messaging, cooking classes.) Women in the waitlist control were provided monthly text messaging. RESULTS: Forty women were recruited within 9 months (feasibility). Women in the immediate intervention attended 86% of all 12 weekly coaching sessions (adherence) and showed significant improvements in general QOL (p = 0.001), and QOL related to breast cancer (p = 0.001), endocrine symptoms (p = 0.002) and fatigue (p = 0.037), whereas the waitlist control did not (all p values ≥ 0.05) (efficacy). PA significantly increased for women in the intervention compared to control (p < 0.0001), while dietary changes were less evident across groups due to high baseline adherence. No significant changes in biomarkers or lean mass were noted, yet visceral adipose tissue declined (p = 0.001). No intervention-related injuries were reported (safety). Qualitative feedback strongly supports the desire for a longer intervention with additional support. CONCLUSIONS: Lifestyle interventions are of interest, safe and potentially beneficial for women with MBC. A larger trial is warranted.

The impact of standing desks on cardiometabolic and vascular health.

Sedentary behavior is associated with cardiovascular disease (CVD) and mortality, independent of physical activity. The biological mechanisms underlying these associations are largely unknown. We hypothesized that obese subjects with sedentary desk jobs, when assigned a sit-stand desk, will reduce daily sedentary time, and show improvement in arterial flow-mediated dilation (FMD), an early indicator of CVD. Overweight and obese subjects without known CVD were recruited at our institution and given an adjustable sit-stand desk at work. Activities were quantified with an accelerometer for 7 days at baseline and during the intervention. FMD of the brachial and superficial femoral arteries, fasting lipids, insulin and glucose labs, and anthropometrics were measured at baseline, and 12 and 24 weeks. Repeated one-way ANOVA tests were used to compare measurements over time. Fifteen participants were enrolled (93% female, mean age 40 ± 5 years, mean body mass index [BMI] 33 ± 5). Mean daily sedentary time at work decreased by 90 minutes from baseline (385 ± 49 minutes) to 12 weeks (297 ± 80 minutes, p = 0.002) and 24 weeks (295 ± 127 minutes, p = 0.015). Femoral FMD increased from baseline (4.9 ± 1.7%) to 12 weeks (6.4 ± 2.3%, p = 0.043) and further to 24 weeks (8.1 ± 3.2%, p = 0.009). Significant improvement in fasting triglycerides and insulin resistance occurred. There was no change in brachial FMD, exercise activity, step counts, weight, or BMI. A significant reduction in sedentary time during working hours was identified with utilization of a sit-stand desk and sustained over 24 weeks. Improvements in FMD, triglycerides, and insulin resistance provide insight into mechanisms of adverse health risks associated with sedentary behavior.

Multimedia Evaluation of EMT-Paramedic Assessment and Management of Pediatric Respiratory Distress.

BACKGROUND: The prehospital care of asthma, bronchiolitis and croup is directed by evidence-based Emergency Medical Services (EMS) protocols. Determining the appropriate intervention for these conditions requires Emergency Medical Technicians-Paramedics (EMT-Ps) to correctly differentiate asthma/bronchospasm, bronchiolitis, and croup. The diagnostic accuracy of EMT-Ps for these pediatric respiratory distress conditions is unknown. OBJECTIVE: We hypothesized increasing provider age, years of provider experience, higher volume of pediatric cases, self-reported comfort with pediatric patients, and having children of one's own would be associated with increased accuracy in diagnosis on a validated multimedia questionnaire. METHODS: This is a cross-sectional study of paramedics from a single EMS agency who completed a validated, case-based questionnaire between July and September 2018. The multimedia questionnaire consisted of four cases, each of which included patient videos and lung sound recordings. Paramedics were asked to assess the severity of distress and ascribe the correct diagnosis and prehospital intervention for each case. Each paramedic completed the questionnaire independently. We defined high questionnaire performance a priori as correctly identifying the diagnosis for ≥75% of cases and used multivariate regression to assess factors associated with high questionnaire performance. Provider age and EMS experience were reported in years and analyzed as continuous variables. Volume of pediatric cases was dichotomized to <1 and ≥1 case per shift and having children was dichotomized to either having children or not having children. RESULTS: Of 514 paramedics, 420 (82%) completed the questionnaire. Overall, paramedics correctly assessed the severity of respiratory distress 92% of the time. However, they only ascribed the correct diagnosis 50% and selected the correct intervention(s) 38% of the time. Increasing age, years of experience, higher volume of pediatric cases, self-reported comfort with pediatric patients, and having children of their own were not associated with questionnaire performance. CONCLUSION: Paramedics accurately assessed severity of distress in multimedia cases of asthma/bronchospasm, bronchiolitis and croup in children, but showed significant room for improvement in correctly identifying the diagnosis and in selecting appropriate intervention(s). Age, years of EMS experience, higher volume of clinical pediatric cases, self-reported comfort with pediatric patients, and having children of their own were not associated with questionnaire performance.

Ixazomib for Chronic Graft-versus-Host Disease Prophylaxis following Allogeneic Hematopoietic Cell Transplantation.

Chronic graft-versus-host disease (cGVHD) is major cause of morbidity and mortality following allogeneic hematopoietic cell transplantation (HCT). Ixazomib is an oral, second-generation, proteasome inhibitor that has been shown in preclinical models to prevent GVHD. We conducted a phase I/II trial in 57 patients to evaluate the safety and efficacy of ixazomib administration for cGVHD prophylaxis in patients undergoing allogeneic HCT. Oral ixazomib was administered on a weekly basis for a total of 4 doses, beginning days +60 through +90, to recipients of matched related donor (MRD, n = 25) or matched unrelated donor (MUD, n = 26) allogeneic HCT in phase II portion of the study, once the recommended phase II dose of 4 mg was identified in phase I (n = 6). All patients received peripheral blood graft and standard GVHD prophylaxis of tacrolimus and methotrexate. Ixazomib administration was safe and well tolerated, with thrombocytopenia, leukopenia, gastrointestinal complaints, and fatigue the most common adverse events (>10%). In phase II (n = 51), the cumulative incidence of cGVHD at 1 year was 36% (95% confidence interval [CI], 19% to 54%) in the MRD cohort and 39% (95% CI, 21% to 56%) in the MUD cohort. One-year cumulative incidence of nonrelapse mortality (NRM) and relapse was 0% and 20% (95% CI, 8% to 36%) in the MRD cohort, respectively. In the MUD cohort, the respective NRM and relapse rates were 4% (0% to 16%) and 34% (17% to 52%). The outcomes on the study were compared post hoc with contemporaneous matched Center for International Blood and Marrow Transplant Research (CIBMTR) controls. This post hoc analysis showed no significant improvement in cGVHD rates in both the MRD (hazard ratio [HR] = 0.85, P = .64) or MUD cohorts (HR = 0.68, P = .26) on the study compared with CIBMTR controls. B cell activating factor plasma levels were significantly higher after ixazomib dosing in those who remained cGVHD free compared with those developed cGVHD. This study shows that the novel strategy of short-course oral ixazomib following allogeneic HCT is safe but did not demonstrate significant improvement in cGVHD incidence in recipients of MRD and MUD transplantation compared with matched CIBMTR controls. This study is registered at www.clinicaltrials.gov as NCT02250300.

A high mitotic score in breast cancer after neoadjuvant chemotherapy is predictive of outcome and associated with a distinct morphology.

AIMS: Neoadjuvant chemotherapy (NAC) is frequently used for the treatment of breast cancer. We sought to analyse the clinical, morphological and immunohistochemical features of tumours from patients who did not achieve pathological complete response following NAC. METHODS AND RESULTS: We identified stage I-III post-NAC breast cancers from surgical resections (2000-2016) with evaluable residual invasive carcinoma [ypT1a(m) or greater and ≥15% tumour cellularity]. One hundred and forty-three tumours from 142 patients were included. On univariable analysis, a high (score 3) post-NAC mitotic score (as compared with 1 or 2) was significantly associated with invasive ductal carcinoma (IDC) subtype (P = 0.023), high grade, pushing borders with zones of necrosis, hormone receptor and triple-negative status, lack of hormonal therapy, higher cellularity (P < 0.001), and a higher percentage of tumour-infiltrating lymphocytes (P = 0.016). Multivariable analysis showed a high post-NAC mitotic score to be significantly associated with recurrence, distant metastasis, and shortened survival (hazard ratios of 5.73, 4.49, and 3.68, respectively). High post-NAC mitotic score tumours (n = 32) were IDC and had a high Ki67 proliferation index (median, 55%). Of these, 24 (75%) had pushing borders with zones of necrosis; 19 (79.2%) of these had necrosis on preoperative imaging, and 24 (75%), 15 (46.9%) and four (12.5%) lacked androgen receptor, GATA-3 and cytokeratin 18 expression, respectively. CONCLUSIONS: High post-NAC mitotic score breast cancers cause high morbidity and mortality, frequently have pushing borders and zones of necrosis, and may show loss of common 'breast cancer markers'. Our findings support that necrosis in pretreatment studies and post-NAC mitotic score should be routinely reported, as they offer significant additional prognostic information to guide management.

Adolescents' Awareness of and Attitudes Toward Expedited Partner Therapy Provided in the Emergency Department.

BACKGROUND: Adolescents and young adults account for half of the 20 million new cases of sexually transmitted infections each year. Expedited partner therapy (EPT) has been shown to decrease reinfection rates and is recommended by the Centers for Disease Control and Prevention. We aimed to (1) assess adolescents' awareness of EPT, (2) assess their likelihood of giving EPT received in the pediatric emergency department (PED) to their partner(s), and (3) identify factors associated with increased likelihood of giving EPT to their partner(s). METHODS: Adolescents and young adults aged 14 to 22 years seeking care in 2 PEDs participated in a survey. Main outcomes were EPT awareness and likelihood of giving EPT to his/her partner(s). Patients were dichotomized into likely and not likely to provide partner(s) with EPT based on answers to a 5-point Likert scale question. χ and t tests were used to analyze the data. RESULTS: Three hundred ninety-three participants were included. Only 11% (n = 42) were aware of EPT; however, 80% (n = 316) reported to be likely to give EPT received in the PED to his/her partner(s). Study site, being sexually active, and engaging in high-risk sexual behaviors were associated with an increased likelihood of giving EPT to their partner(s) (P < 0.05). CONCLUSIONS: Many adolescents are not aware of EPT; however, most were theoretically likely to give EPT received in the PED to his/her partner(s). With increasing rates of sexually transmitted infections and high utilization of the PED for adolescent reproductive health services, efforts to incorporate the use of EPT in PED workflows would be beneficial.

The association between timely opioid administration and hospitalization in children with sickle cell disease presenting to the emergency department in acute pain.

INTRODUCTION: The National Heart, Lung, and Blood Institute guidelines for sickle cell disease (SCD) pain crisis management recommend opioids within 60 minutes of emergency department (ED) registration and every 30 minutes thereafter until acute pain is managed. These guidelines are based on expert opinion without published, supporting data. OBJECTIVE: To evaluate the association between timely ED opioid administration and hospitalization rates in children with SCD. METHODS: Retrospective cohort of children presenting to a children's hospital ED with SCD pain between January 1, 2014, and April 30, 2018. Visits were extracted using ICD codes, chief complaints, and receipt of at least one opioid, and then reviewed to confirm the visit was an uncomplicated pain crisis. The primary outcome was hospitalization, yes or no. Generalized estimating equations were used to determine adjusted odds of hospitalization for the timely administration of initial and second doses of opioids. RESULTS: Of the 902 eligible visits, 368 (40.8%) resulted in hospitalization. The mean (SD) age was 11.9 (± 5.2) years. The first opioid was administered within 60 minutes of arrival in 601 (66.6%) visits. The second opioid was administered within 30 minutes of the first in 84 (12.3%) visits. Receipt of the first opioid within 60 minutes of arrival was not associated with decreased hospitalization (1.30 [0.96-1.76]). However, receipt of the second dose within 30 minutes of the first was associated with decreased hospitalization (0.56 [0.33-0.94]). CONCLUSION: This study suggests an association between children with SCD receiving a second dose within 30 minutes of the first opioid dose and decreased hospitalizations.

Exploring health behaviors, quality of life, and support needs in African-American prostate cancer survivors: a pilot study to support future interventions.

PURPOSE: Prostate cancer incidence and mortality rates are highest among African-American men. Comorbidity burden and quality of life (QOL) challenges are also high. Many factors drive these differences; health behaviors are important modifiable contributors. Studies document positive results for lifestyle interventions targeting NHW prostate cancer survivors, but inclusion of African-Americans is limited. We conducted an exploratory mixed-methods study with AAPCS to inform the development of a culturally relevant lifestyle intervention. METHODS: Twenty-two AAPCS completed questionnaires and a discussion group on dietary and physical activity patterns, QOL, and unmet needs related to lifestyle changes. RESULTS: Seventy-five percent of the participants were overweight or obese, 82% had physical activity patterns considered insufficiently active and only 10% did resistance training at least twice weekly in accordance with current survivorship guidelines. Diets were high in saturated fat and sugar, low in fiber, fruit, and vegetable intake. PROMIS-29 scores indicated that AAPCS had worse physical functioning, pain interference, and sexual functioning, but less social isolation compared to the general population. Compared to other prostate cancer survivors, participants reported poorer status on all domains. Qualitative data highlighted barriers to healthy lifestyles including access, knowledge, and skills, as well as motivators including health benefits and building strength to feel more "manly." Participants shared high interest in programs to exercise, learn about affordable healthy eating, and bring survivors together to discuss survivorship issues. CONCLUSIONS: Lifestyle interventions targeting AAPCS are warranted. To increase impact of these efforts, consideration of environmental, cultural, and survivor contexts will be key.

Insights from pharmacists and pharmacy technicians about expedited partner therapy.

Background Expedited partner therapy (EPT) is an effective method to treat sexually transmissible infections (STIs) and prevent re-infections. Pharmacy staff play a vital role in the success of EPT. This study aims to assess pharmacy staff knowledge of EPT and identify potential barriers to filling EPT prescriptions. METHODS: The study was a cross-sectional, Internet-based survey distributed to members of the Pharmacy Society of Wisconsin. Non-retired pharmacists and pharmacy technicians were eligible. EPT knowledge was dichotomised into 'yes' versus 'no/unknown'. Statistical analyses included the χ2 test and Student's two-sided t-test; using an α of 0.05. RESULTS: Ninety-four questionnaires were analysed: 74 pharmacists, 20 pharmacy technicians. Overall, 73 (78%) knew EPT is legal in Wisconsin, 86% of pharmacists versus 45% of pharmacy technicians, P < 0.01. The mean time from graduation/training was less for participants who knew EPT is legal versus those who did not (12.8 years vs 20.2 years, P < 0.01). Sixty-four (68%) participants worked in an outpatient setting, of which 12 (19%) knew of a formal workplace EPT policy. Thirty-two (40%) of the 81 participants who had heard of EPT thought nameless EPT prescriptions should not be legal, commonly citing patient safety concerns. CONCLUSIONS: This study demonstrated inconsistent knowledge of EPT between pharmacists and pharmacy technicians. Knowledge of workplace EPT policies and patient safety concerns were barriers to EPT. Addressing these knowledge and policy barriers will be vital to improve the utilisation of EPT.

Community Breast Health Education for Immigrants and Refugees: Lessons Learned in Outreach Efforts to Reduce Cancer Disparities.

Community-academic partnerships are vital to address cancer disparities in geographic areas with diverse socioeconomic, language, and cultural barriers. Regarding breast health, immigrant and refugee women are a particularly vulnerable population, with considerably lower mammography rates than most communities, including racial and ethnic minorities. To promote health care equity in this high-risk population, we developed a community-academic partnership (CAP) model to promote breast health education at community faith-based centers in the city of Milwaukee, WI. In this paper, we describe the success of our partnerships, our lessons learned, and future directions.

Foveal Development in Infants Treated with Bevacizumab or Laser Photocoagulation for Retinopathy of Prematurity.

PURPOSE: To characterize and quantify early foveal development in preterm infants and to compare this development between eyes treated with intravitreal bevacizumab or laser photocoagulation (LPC) and untreated eyes. DESIGN: Observational case series. PARTICIPANTS: One hundred thirty-one preterm infants undergoing retinopathy of prematurity (ROP) screenings. METHODS: Handheld OCT imaging was performed longitudinally on all patients. Thickness measurements of the inner and outer retinal layers were obtained at the foveal center and the nasal and temporal foveal rims. Comparisons between treated and untreated eyes were adjusted for age and other confounding variables. MAIN OUTCOME MEASURES: Weekly change in inner and outer retinal thickness and presence of inner retinal layers, ellipsoid zone (EZ), and cystoid macular changes (CMCs). RESULTS: Outer retinal thickness at the foveal center increased by 3.1 µm/week in untreated eyes and 7.2 µm/week in bevacizumab-treated eyes (P = 0.038). Eyes treated with LPC had a lower probability of having all inner retinal layers present at the foveal center (odds ratio, 0.04; P = 0.001) and a lower probability of having the EZ present at the foveal center (odds ratio, 0.07; P = 0.024) compared with untreated eyes. Cystoid macular changes were found in 53% of patients and 22% of imaging sessions. The age-adjusted incidence of CMCs was not correlated with bevacizumab or LPC treatment. CONCLUSIONS: Intravitreal bevacizumab therapy for ROP is associated with more rapid outer retinal thickening at the foveal center, whereas LPC is associated with earlier extrusion of the inner retinal layers and delayed development of the EZ at the foveal center. Long-term follow-up is needed to determine the visual significance of these findings.

Expedited Partner Therapy: Pharmacist Refusal of Legal Prescriptions.

BACKGROUND: Expedited partner therapy (EPT) is an effective strategy for partner management of sexually transmitted infections. Some states, including Wisconsin, allow EPT prescriptions to be filled without a patient name. This study determined the refusal rates of nameless EPT prescriptions in Milwaukee pharmacies. METHODS: In this cross-sectional study, 3 trained research assistants of different age, sex, and race posed as "patients" and visited 50 pharmacy locations from one pharmacy chain in Milwaukee County, WI, to fill nameless EPT prescriptions. A χ test was used to compare demographics of patients, pharmacists, and pharmacies. Multiple logistic regression was used to identify factors associated with prescription refusal. RESULTS: Twenty-nine (58%) of 50 nameless EPT prescriptions were refused. Univariate analysis showed that prescriptions were more likely to be refused if the pharmacy was in the suburbs (77%) compared with Milwaukee city (43%; P = 0.01), if the pharmacist was older than the patient (82%) compared with being younger (46%) or within the same age group (33%; P = 0.01 for both), and if the patient was white (78%) compared with nonwhite (47%; P = 0.03). Multivariable regression revealed significantly higher refusals for pharmacies located in the suburbs compared with the city (odds ratio, 5.3; 95% confidence interval, 1.4-20.3; P = 0.03) and in patients who were white compared with nonwhite (odds ratio: 4.8; 95% confidence interval, 1.2-19.8; P = 0.01). CONCLUSIONS: More than half of nameless EPT prescriptions were refused in Milwaukee county pharmacies, more frequently at suburban pharmacies and for white patients. Increased pharmacist education regarding EPT is essential to help combat the sexually transmitted infection crisis.

Parents' pain medication underdosing is associated with more emergency department visits in sickle cell disease.

OBJECTIVE: To determine the association between health literacy, medication knowledge, and pain treatment skills with emergency department (ED) use of parents of children with sickle cell disease (SCD). METHODS: Parents of children 1- to 12-years-old with SCD were enrolled. Health literacy was assessed using the Newest Vital Sign. Parents completed a structured interview assessing knowledge of the dosage and frequency of home pain medications and an applied skills task requiring them to dose a prescribed pain medication. Underdosage was defined by too small a dose (dosage error) or too infrequent a dose (frequency error). The association between medication knowledge and applied skills with ED visits for pain over the past year was evaluated using Poisson regression adjusting for genotype. RESULTS: One hundred parent/child pairs were included; 50% of parents had low health literacy. Low health literacy was associated with more underdose frequency errors (38% vs. 19%, P = 0.02) on the skills task. On medication knowledge, underdose dosage errors (adjusted incidence rate ratio [aIRR] 2.0, 95% confidence interval [CI] 1.3-3.0) and underdose frequency errors (aIRR, 1.7, 95% CI 1.2-2.6) were associated with a higher rate of ED visits for pain. On the skills task, underdose dosage errors (aIRR 1.6, 95% CI 1.1-2-.4) and underdose frequency errors were associated with more ED visits (aIRR 1.5, 95% CI 1.1-2.1). CONCLUSIONS: For medication knowledge and skills tasks, children of parents who underdosed pain medication had a higher rate of ED visits for pain. Health literate strategies to improve parents' medication skills may improve pain treatment at home and decrease healthcare utilization.

Association of sex and height with a lower ankle brachial index in the general population.

The ankle-brachial index (ABI) is a predictor of cardiovascular events, mortality and functional status. Some studies have noted a higher prevalence of peripheral artery disease in females compared to males. Differences in height might account for these observed sex differences, but findings are conflicting. The 2003-2004 National Health and Nutrition Examination Survey (NHANES) cohort includes participants from 15 geographic locations, selected annually to represent the general population. Sample-weighted multivariable linear and logistic regression modeling was performed with ABI as the dependent variable and height and sex as primary exposure variables of interest. There were 3052 participants with ABI data (mean age 57 years, 51% female). The mean (±SE) ABI was 1.09 (±0.006) and 1.13 (±0.005) for females and males, respectively ( p < 0.0001). Shorter height was associated with a low ABI (OR 0.91 per 4 cm, 95% CI: 0.86-0.96; p=0.001). In a fully adjusted model, female sex was associated with a low ABI (OR 1.34, 95% CI: 1.04-1.72; p=0.025) independent of height and traditional cardiovascular disease (CVD) risk factors. Age, diabetes, tobacco use, known CVD, hypertension and race were associated with a low ABI (all p < 0.001). The ABI was 0.03 lower in females than in males in the general population and in a healthy cohort. Lower ABI values in healthy females do not appear to be due to occult vascular disease but rather a normal phenomenon with some contribution from height. Therefore, population sex-specific ABI thresholds should be utilized in the diagnosis of peripheral artery disease to account for these intrinsic differences.

Increasing Mammography Uptake Through Academic-Community Partnerships Targeting Immigrant and Refugee Communities in Milwaukee.

INTRODUCTION: Milwaukee, a city characterized by high rates of racial segregation and a growing immigrant population, has large race-based breast cancer survival disparities. To address these disparities, breast health education workshops were offered through a community-academic partnership (CAP) to women from various ethnic backgrounds. This paper explores attendance, satisfaction, and rates of screening mammography among workshop attendees. METHODS: Partnerships were formed with community-based organizations, a mobile mammography unit, and the Wisconsin Well Woman Program, a state-supported program providing free mammograms. Multilingual staff provided monthly breast health education workshops at community settings and coordinated transportation. Participants completed surveys that included demographics, prior screening history, barriers to screening, and program evaluation. Descriptive statistics were used to summarize and analyze data. RESULTS: Over a 24-month period, 493 women-most of whom sought services at partnering organizations that serve primarily immigrants, refugees, and racial minorities-attended breast health workshops, with 374 participants completing surveys (mean age = 45 years). A total of 360 were ≥ 40 years old. Among these women, 188 (113 insured [60%], 75 uninsured [40%]) reported no prior mammogram in the past 2 to 5 years. After attending the workshop, mammogram uptake was 100% among the insured and 80% among the uninsured. Satisfaction with the workshops was high; 73% of attendees rated them highly informative. CONCLUSIONS: Our CAP offered culturally tailored breast health education and access to screening via a mobile unit that was well attended, highly rated, and increased screening mammography.

Recipient Immune Modulation with Atorvastatin for Acute Graft-versus-Host Disease Prophylaxis after Allogeneic Transplantation.

Atorvastatin administration to both the donors and recipients of matched related donor (MRD) allogeneic hematopoietic cell transplantation (allo-HCT) as acute graft-versus-host disease (GVHD) prophylaxis has been shown to be safe and effective. However, its efficacy as acute GVHD prophylaxis when given only to allo-HCT recipients is unknown. We conducted a phase II study to evaluate the safety and efficacy of atorvastatin-based acute GVHD prophylaxis given only to the recipients of MRD (n = 30) or matched unrelated donor (MUD) (n = 39) allo-HCT, enrolled in 2 separate cohorts. Atorvastatin (40 mg/day) was administered along with standard GVHD prophylaxis consisting of tacrolimus and methotrexate. All patients were evaluable for acute GVHD. The cumulative incidences of grade II to IV acute GVHD at day +100 in the MRD and MUD cohorts were 9.9% (95% confidence interval [CI], 0 to 20%) and 29.6% (95% CI,15.6% to 43.6%), respectively. The cumulative incidences of grade III and IV acute GVHD at day +100 in the MRD and MUD cohorts were 3.4% (95% CI, 0 to 9.7%) and 18.3% (95% CI, 6.3% to 30.4%), respectively. The corresponding rates of moderate/severe chronic GVHD at 1 year were 28.1% (95% CI, 11% to 45.2%) and 38.9% (95% CI, 20.9% to 57%), respectively. In the MRD cohort, the 1-year nonrelapse mortality, relapse rate, progression-free survival, and overall survival were 6.7% (95% CI, 0 to 15.4%), 43.3% (95% CI, 24.9% to 61.7%), 50% (95% CI, 32.1% to 67.9%), and 66.7% (95% CI, 49.8% to 83.6%), respectively. The respective figures for the MUD cohort were 10.3% (95% CI, 8% to 19.7%), 20.5% (95% CI, 7.9% to 33.1%), 69.2% (95% CI, 54.7% to 83.7%), and 79.5% (95% CI, 66.8% to 92.2%), respectively. No grade 4 toxicities attributable to atorvastatin were seen. In conclusion, the addition of atorvastatin to standard GVHD prophylaxis in only the recipients of MRD and MUD allo-HCT appears to be feasible and safe. The preliminary efficacy seen here warrants confirmation in randomized trials.