Place of birth, cancer beliefs and being current with colon cancer screening among US adults.

BACKGROUND: Historically, studies suggested that immigrants acquire the risk of colorectal cancer (CRC) as US-born persons within the same generation. CRC risk of immigrants is largely unknown in this era of cancer screening and widespread immigration. We investigated the association of place of birth and cancer beliefs with uptake of CRC screening. METHODS: The 2007 Health Information National Trends Survey was used and 4,299 respondents (weighted population size=81,896,392) who were 50 years and older (3,960 US-born and 339 foreign-born) were identified. We defined being current with CRC screening guidelines as the use of fecal occult blood test within 1 year, sigmoidoscopy within 5 years, or colonoscopy within 10 years. We compared being up-to-date with CRC screening among foreign-born versus US-born respondents. Logistic regression models were used to calculate odds ratios (OR) and 95% confidence intervals (CI). RESULTS: Overall, 2,594 (63.3%) US-born and 208 (52.8%) foreign-born respondents were current with CRC screening. Foreign-born respondents were less current in unadjusted model (OR 0.65; 95% CI: 0.50-0.85) but became non-statistically significant after adjustment (OR 0.79; 95% CI: 0.51-1.24). Respondents who believed that screening finds cancer when it is easy to treat (OR 2.85; 95% CI: 1.44-3.61), those who believed that cancer can be cured when detected early (OR 1.56; 95% CI: 1.20-2.00), and those who worry about getting cancer (OR 1.34; 95% CI: 1.10-1.61) were likely to be current with CRC screening. However, respondents with fatalistic beliefs were borderline less likely to be current (OR 0.82; 95% CI: 0.65-1.04). CONCLUSION: There is a need to improve education on CRC screening, particularly among foreign-born adults.

Obesity and Weight Loss Attempts among Subjects with a Personal History of Cancer.

OBJECTIVES: Obesity is a risk factor for many cancers and obese cancer patients have a poorer prognosis. This study aimed to evaluate the prevalence of obesity and attempts to lose weight among cancer survivors. The effects of cancer treatment and time since cancer treatment were also evaluated. METHODS: The 2007 Health Information National Trends Survey data were analysed between 2011 and 2013; respondents with (n = 966) and without (n = 6,093) a personal history of cancer were identified. Each respondent's body mass index (BMI) was calculated using self-reported height and weight measurements and categorised as normal (<25 kg/m(2)), overweight (25-29.9 kg/m(2)) or obese (≥30 kg/m(2)). RESULTS: Cancer survivors were older (mean age = 63.4 versus 44.7 years for those with no history of cancer). Overall, there were similar percentages of overweight (37.6% versus 34.1%; relative risk ratio [RRR] = 0.99; 95% confidence interval [CI]: 0.75-1.31) and obese (31.4% versus 27.5%; RRR = 1.04; 95% CI: 0.79 1.39) respondents among both cancer survivors and those without a history of cancer. Among overweight and obese participants, cancer survivors did not demonstrate increased weight loss attempts compared to those without a history of cancer (61.6% versus 66.3%; odds ratio = 0.94; 95% CI: 0.73 1.20). CONCLUSION: A high prevalence of overweight and obese cancer survivors were identified without any association with cancer treatment. However, cancer survivors did not demonstrate increased attempts to lose weight in comparison to those without a history of cancer despite awareness of their degree of body fatness. Increased efforts to promote the maintenance of a healthy weight among cancer survivors are needed.

Anti-plasmodial activity of aroylhydrazone and thiosemicarbazone iron chelators: effect on erythrocyte membrane integrity, parasite development and the intracellular labile iron pool.

Iron chelators inhibit the growth of the malaria parasite, Plasmodium falciparum, in culture and in animal and human studies. We previously reported the anti-plasmodial activity of the chelators, 2-hydroxy-1-naphthylaldehyde isonicotinoyl hydrazone (311), 2-hydroxy-1-naphthylaldehyde 4-methyl-3-thiosemicarbazone (N4mT), and 2-hydroxy-1-naphthylaldehyde 4-phenyl-3-thiosemicarbazone (N4pT). In fact, these ligands showed greater growth inhibition of chloroquine-sensitive (3D7) and chloroquine-resistant (7G8) strains of P. falciparum in culture compared to desferrioxamine (DFO). The present study examined the effects of 311, N4mT and N4pT on erythrocyte membrane integrity and asexual parasite development. While the characteristic biconcave disk shape of the erythrocytes was unaffected, the chelators caused very slight hemolysis at IC50 values that inhibited parasite growth. The chelators 311, N4mT and N4pT affected all stages of the intra-erythrocytic development cycle (IDC) of P. falciparum in culture. However, while these ligands primarily affected the ring-stage, DFO inhibited primarily trophozoite and schizont-stages. Ring, trophozoite and schizont-stages of the IDC were inhibited by significantly lower concentrations of 311, N4mT, and N4pT (IC50=4.45±1.70, 10.30±4.40, and 3.64±2.00µM, respectively) than DFO (IC50=23.43±3.40µM). Complexation of 311, N4mT and N4pT with iron reduced their anti-plasmodial activity. Estimation of the intracellular labile iron pool (LIP) in erythrocytes showed that the chelation efficacy of 311, N4mT and N4pT corresponded to their anti-plasmodial activities, suggesting that the LIP may be a potential source of non-heme iron for parasite metabolism within the erythrocyte. This study has implications for malaria chemotherapy that specifically disrupts parasite iron utilization.

Screening, brief intervention, and referral to treatment: public health training for primary care.

OBJECTIVES: The purpose of this study was to elucidate changes in attitudes, experiences, readiness, and confidence levels of medical residents to perform screening, brief intervention, and referral to treatment (SBIRT) and factors that moderate these changes. METHODS: A cohort of 121 medical residents received an educational intervention. Self-reported experience, readiness, attitude, and confidence toward SBIRT-related skills were measured at baseline and at follow-up. Analyses were conducted to evaluate the effects of medical specialization. RESULTS: The intervention significantly increased experience (P<.001), attitude (P<.05), readiness (P<.001), and confidence (P<.001). Residents were more likely to report that their involvement influenced patients' substance use. However, experience applying SBIRT skills varied by country of birth, specialty, and baseline scores. CONCLUSIONS: This study suggested that SBIRT training was an effective educational tool that increased residents' sense of responsibility. However, application of skills might differ by specialization and other variables. Future studies are needed to explore and evaluate SBIRT knowledge obtained, within the context of cultural awareness and clinical skills.

The relevance of occupational medicine to primary care in the 21st century.

The relatively infrequent incidence of dramatic outbreaks of occupational disease, as occurred in the past, along with economic downturns, have lowered the medical altitude of the workplace as a risk factor for or determinant of disease and disability. However, in 2007 alone, there were more than 4 million nonfatal occupational illnesses in the United States. Equally relevant is the explosion in 2010 at a coal mine in West Virginia that left 29 workers dead. Not to be overlooked are the ongoing challenges to medical practitioners of managing workers' compensation cases. At the same time, the convergence of demographic changes, changes in the workplace structure, and emerging technologies are reinforcing the views of occupational medicine clinicians and other practitioners that occupational health must be integrated into primary care systems and that total separation of work-caused and nonwork-caused care is counterproductive and arbitrary. Therefore, basic principles, concepts, and procedures of occupational medicine must be integrated into the substrate of information and experience upon which students must depend on entering a medical career.