Innovating Qualitative Framing Analysis for Purposes of Media Analysis Within Public Health Inquiry.

Public health is said to lack methodological diversity and creativity in media analysis. Although the framing paradigm offers important conceptual and operational insights for undertaking media analysis in public health research, frames are described as "elusive" to measure with their analysis a "methodological black box." With this article, we aim to foster creative thinking around media analysis in public health and to make the "black box" of framing analysis more transparent, by illustrating the innovation and application of a qualitative framing analysis technique in original public health research. We provide a "how to" guide for this framing analysis method and use data to illustrate methodological challenges encountered during the research. The findings drawn from this method are contrasted with findings gained from thematic analysis applied to the same data. The article concludes by considering the benefits of this type of framing analysis within public health scholarship.

Stability and partitioning of ß-carotene in whey protein emulsions during storage.

Varying the ß-carotene (0.1-0.3 g kg-1) and whey protein isolate (WPI) (2-20 g kg-1) concentrations in an oil-in-water (O/W) emulsion influenced the partitioning and stability of ß-carotene upon 30 d storage at 25 and 40 °C. The total ß-carotene in the emulsion was extracted with a solvent and quantified using UV/visible spectroscopy. The ß-carotene in oil phase was obtained using in situ Raman micro-spectroscopy. The ß-carotene in the aqueous phase was obtained by difference. Increasing ß-carotene concentration resulted in increased partitioning of ß-carotene into the aqueous phase whereas increasing WPI concentration had the opposite effect. With all freshly made emulsions, there was a higher proportion of ß-carotene found in the oil phase. At the end of the storage period, the higher proportion and concentration of ß-carotene was in the aqueous phase. This suggested that oxidation of ß-carotene occurred faster in the oil phase and that WPI in the aqueous phase protected ß-carotene against oxidation. This work informs the formulation of protein-based emulsions for the delivery of ß-carotene.

Understanding the links between resilience and type-2 diabetes self-management: a qualitative study in South Australia.

BACKGROUND: Research conducted by Ward, Muller, Tsourtos, et al. (Soc Sci Med 72(7):1140-1148, 2011) has led to the development of the psycho-social interactive model of resilience, which reveals the interaction between individual resilience factors (i.e. coping, confidence and self esteem) and external resilience environments (i.e. employment, supportive family environments and health promoting policies) in facilitating the development of resilience. This present study explored the utility of this model of resilience for understanding how people self-manage type-2 diabetes. METHODS: Data were collected via 14 semi-structured life-history interviews with women and men living with type-2 diabetes mellitus (T2DM). Participants varied according to socio-demographics (gender, age, education level, income) and were recruited based on their self-reported management (or lack thereof) of T2DM. RESULTS: The inter-play of internal traits and external resources with additive and subtractive resilience strategies were consistent with the psycho-social interactive model of resilience. Self-management was influenced by life history. Differences in self-management and material disadvantage were also identified. Alongside increased disadvantage are higher levels of external barriers to self-management practices. CONCLUSIONS: This paper supports the concepts of additive and subtractive resilience strategies for use with diabetes populations; providing health professionals and policy makers with an increased understanding of how to recognize and foster patient resilience for the improvement of self-care, disease management and ultimately health outcomes.

A Thirty-year Review of Vulvar Cancer in Jamaica, 1978 to 2007.

OBJECTIVE: To evaluate the trends in vulvar cancer between 1978 and 2007 in Kingston and St Andrew, Jamaica, with respect to age-standardized rates and histologic types. METHODS: All cases of vulvar cancer recorded in the Jamaica Cancer Registry from 1978 to 2007 were extracted and analysed for age distribution and histologic type. RESULTS: There were 78 cases (one person of unknown age) of vulvar cancer recorded over the 30-year period. Sixty per cent of the affected patients were between 50 and 80 years old. The most common histologic type of vulvar malignancy was squamous cell carcinoma (82%). There was a decline in age-standardized incidence rates of both vulvar cancers overall and vulvar squamous cell carcinoma over the 30-year period. CONCLUSION: Squamous cell carcinoma is the most common vulvar malignancy in the Jamaican population, and affects primarily older women. Despite high prevalence rates of high-risk human papillomavirus infection, no increase in the age-standardized incidence of vulvar squamous cell carcinoma was identified.

Trends in incidence and age distribution of oral cavity and oropharyngeal squamous cell carcinomas, kingston and st andrew, Jamaica, 1978-2007.

OBJECTIVE: Several countries have reported increasing incidence of oral cavity and oropharyngeal (OCOP) squamous cell carcinoma (SCC) over recent years, particularly among young men and primarily in tongue and tonsil subsites, attributed to human papillomavirus (HPV) infection. This study examines trends in incidence and age distribution of OCOP SCC in Jamaica over a 30-year period. METHODS: We extracted all cases of OCOP SCC archived in the Jamaica Cancer Registry files over the 30 year-period from 1978 to 2007 and grouped them according to anatomical site (International Classification of Diseases; ICD-9), age and gender. The data were used to calculate age standardized rates (ASRs) and age-specific incidence rates (ASIRs). RESULTS: There were 384 patients (age range 21 to 94 years; male to female ratio 2.6:1) with OCOP SCC; the majority (85.4%) was > 50 years. Age standardized rates of all OCOP SCC combined were higher in males than in females and there was a decrease in both genders over the study period. Tongue and tonsil were the commonest subsites, and males showed decreasing ASR in both. Females showed decreasing ASR in tongue and fluctuation in tonsil SCCs. The highest ASIRs for tongue and tonsil SCC were consistently seen in patients older than 50 years of age. CONCLUSION: The incidence of OCOP SCC is decreasing and continues to predominate among older men. The decreasing trend in incidence of tongue and tonsil SCC is unlike that reported elsewhere. This may be due to differences in sexual practices, small size of this study, or a lag time in emergence of a new trend.

Progress in Fourier transform infrared spectroscopic imaging applied to venereal cancer diagnosis.

Fourier transform infrared imaging spectroscopy is a powerful technique that provides molecular and spatial information at the single-cell level. We report on the progress of this technology in the field of cancer research, focusing on human cervical cancer because of the inherent difficulty in grading this type of cancer and as a model for venereal cancers in dogs. Using a suite of multivariate imaging processing techniques, we demonstrate the potential of this technique to identify histologic features in the normal epithelium and cervical intraepithelial neoplasia stages I and III. We highlight the advantages and detail the barriers that need to be overcome before implementation of this technology in the clinical environment.

Cutaneous Malignant Melanoma in Jamaica, 1958 to 2007.

OBJECTIVE: To document the epidemiology of cutaneous malignant melanoma (CMM) in Jamaica over the 50-year period, 1958-2007. METHODS: All cases of CMM recorded in the Jamaica Cancer Registry (JCR), for the period 1958-2007, were collected. For each case, we documented method of ascertainment, age, gender and anatomical location. Age standardized incidence rates (ASRs) for the seven five-year periods from 1973-2007 were also obtained from the JCR. RESULTS: There were 220 cases of CMM from 218 patients (131 females, 87 males; male:female ratio 1:1.5), ranging in age from 21 to 98 years (median age 62 years). The majority of cases (94%) were ascertained via biopsy. The ASRs fluctuated around 0.9 per 100 000 per year from 1973 to 2007, ranging from 0.6-1.4 per 100 000 per year in females and 0.5-1.1 per 100 000 per year in males. Cutaneous malignant melanoma was most common in the lower limb (59% of males and 69% of females). The foot was the most common lower limb site (female: 77%, male: 83%) and the commonest site overall (female: 53%, male: 49%). CONCLUSION: In Jamaica, CMM is more common in females than in males. In both genders, the ASRs were noted to be low and fluctuated around 0.9 per 100 000 per year since 1973. The lower limb is the commonest anatomical site, with the majority of cases involving the foot. These findings are similar to those documented in other predominantly Black populations.

Cancer in adolescents and young adults, Kingston and St Andrew, Jamaica, 1988-2007.

OBJECTIVE: To determine the distribution of malignancies in adolescents and young adults (AYA; 15 to 29 years) in Jamaica. METHODS: All cases of malignancies diagnosed in AYA in the period 1988-2007, were extracted from the files of the Jamaica Cancer Registry. For each case, age, gender and diagnosis were recorded and the diagnoses categorized according to the recently proposed diagnostic groups for cancers in AYA. The data were used to calculate incidence rates and relative frequencies. RESULTS: Among males, the age-specific incidence rate for the oldest age group (25-29 years) was higher than that recorded for each of the younger groups. In females, there was a progressive increase in incidence with increasing age. The age-standardized rates (ASRs) per million were 131.4 (males) and 226.1 (females). In males, the highest ASRs (per million) were those for lymphoma (34.7), carcinoma (29.3) and soft tissue sarcoma (17.2), and in females, carcinoma (121.6), lymphoma (31.4) and germ cell and trophoblastic neoplasms (14.6). Lymphoma was the commonest diagnosis in younger males, and ranked second to carcinoma in the oldest. Carcinoma and lymphoma were the commonest and second commonest diagnoses, respectively, among all three age groups in females, with carcinomas accounting for progressively greater proportions of tumours with increasing age. CONCLUSION: The incidence of malignancy in AYA in Jamaica is higher in females than in males. In both genders, increasing age is accompanied by increasing incidence and a shift from non-epithelial to epithelial malignancies. This shift occurs at an earlier age in females.

Incidence of childhood cancer in Kingston and St Andrew, Jamaica, 1983-2002 / Incidencia de cáncer infantil en Kingston y Saint Andrew, Jamaica, 1983-2002

OBJECTIVES: There have been several modifications to the classification of childhood cancers since the first report (1968-1981) specific to the Jamaican paediatric population was published in 1988. This paper reports on paediatric cancer incidence in Kingston and St Andrew, Jamaica, for the 20-year period 1983-2002 based on these modifications. METHODS: All cases of cancer diagnosed in children (0-14 years), between 1983 and 2002 were extracted from the Jamaica Cancer Registry archives and classified using the International Classification of Childhood Cancer, third edition. Incidence figures were calculated as per the International Agency for Research on Cancer (IARC) reporting format for childhood cancer. RESULTS: There were 272 cases (133 males, 139 females) of childhood cancer identified in the 20-year period. The overall age standardized rate (ASR) was 69.4 per million; that for males was 67.8 per million, and for females, 70.9 per million. The three most common malignancies overall were leukaemia (21.3%), lymphoma (15.8%) and brain and spinal neoplasms (14.0%). In males, the highest ASRs were seen for leukaemia (14.8 per million), lymphoma (12.7 per million), and brain and spinal neoplasms (8.2 per million), and in females, leukaemia (14.4 per million), nephroblastoma (11.3 per million), and brain and spinal neoplasms (10.6 per million). CONCLUSIONS: The rankings of the most common childhood malignancies in Jamaica (leukaemia, brain and spinal neoplasms and lymphomas) have shown few changes since the last review. However, there are differences in frequency and gender distribution of nephroblastoma and brain and spinal neoplasms.

OBJETIVOS: Ha habido varias modificaciones a la clasificación de los cánceres infantiles desde que el primer informe (1968-1981) específico para la población pediátrica jamaicana fue publicado en 1988. Este artículo reporta la incidencia de cáncer pediátrico en Kingston y Saint Andrew, Jamaica, en el período de 20 años de1983-2002, basado en estas modificaciones. MÉTODOS: Todos los casos de cáncer diagnosticados en niños (0-14 años) entre 1983 y 2002 fueron extraídos de los archivos del Registro de Cáncer en Jamaica, y clasificados utilizando la tercera edición de la Clasificación Internacional del Cáncer Infantil. Las cifras de incidencia fueron calculas siguiendo el formato de reporte de cáncer infantil de la Agencia Internacional para la Investigación del Cáncer (IARC, siglas en inglés). RESULTADOS: Hubo 272 casos de cáncer infantil (133 varones y 139 hembras) identificados en el período de 20 años. La tasa general de incidencia estandarizada por edad (ASR. siglas en inglés) fue 69.4 por millón; para los varones fue 67.8 por millón, y para las hembras, 70.9 por millón. En general, los tres tumores malignos más comunes fueron la leucemia (21.3%), el linfoma (15.8%) y las neoplasias del cerebro y la médula espinal (14.0%). En los varones, las tasas de ASR más altas fueron las observadas en relación con la leucemia (14.8 por millón), los linfomas (12.7 por millón), y las neoplasias del cerebro y la médula (8.2 por millón); en las hembras, la leucemia (14.4 por millón), los nefroblastomas (11.3por millón), y las neoplasias de cerebro y médula (10.6por millón). CONCLUSIÓN: Las clasificaciones por nivel de incidencia de los tumores malignos infantiles más comúnes en Jamaica (la leucemia, las neoplasias del cerebro y la médula espinal, y los linfomas) han mostrado pocos cambios desde la última revisión. Sin embargo, existen diferencias en la frecuencia así como en la distribución por sexo con respecto a los nefroblastomas y las neoplasias del cerebro y la médula.

Cancer in adolescents and young adults, Kingston and St Andrew, Jamaica, 1988-2007 / Cáncer en los adolescentes y adultos jóvenes, Kingston y Saint Andrew, Jamaica, 1988-2007

OBJECTIVE: To determine the distribution of malignancies in adolescents and young adults (AYA; 15 to 29 years) in Jamaica. METHODS: All cases of malignancies diagnosed in AYA in the period 1988-2007, were extracted from the files of the Jamaica Cancer Registry. For each case, age, gender and diagnosis were recorded and the diagnoses categorized according to the recently proposed diagnostic groups for cancers in AYA. The data were used to calculate incidence rates and relative frequencies. RESULTS: Among males, the age-specific incidence rate for the oldest age group (25-29 years) was higher than that recorded for each of the younger groups. In females, there was a progressive increase in incidence with increasing age. The age-standardized rates (ASRs) per million were 131.4 (males) and 226.1 (females). In males, the highest ASRs (per million) were those for lymphoma (34.7), carcinoma (29.3) and soft tissue sarcoma (17.2), and in females, carcinoma (121.6), lymphoma (31.4) and germ cell and trophoblastic neoplasms (14.6). Lymphoma was the commonest diagnosis in younger males, and ranked second to carcinoma in the oldest. Carcinoma and lymphoma were the commonest and second commonest diagnoses, respectively, among all three age groups in females, with carcinomas accounting for progressively greater proportions of tumours with increasing age. CONCLUSION: The incidence of malignancy in AYA in Jamaica is higher in females than in males. In both genders, increasing age is accompanied by increasing incidence and a shift from non-epithelial to epi-thelial malignancies. This shift occurs at an earlier age in females.

OBJETIVO: Determinar la distribución de enfermedades malignas en los adolescentes y los adultos jóvenes (abreviado AJA; 15 a 29 años) en Jamaica. MÉTODOS: Todos los casos de enfermedades malignas diagnosticadas en AJA en el periodo 1988-2007, fueron extraídos de los archivos del Registro de Cáncer en Jamaica. Para cada caso, se registraron la edad, el sexo, y el diagnóstico. Los diagnósticos fueron clasificados de acuerdo con los grupos de diagnóstico recientemente propuestos para los cánceres en AJA. Los datos fueron usados para calcular las tasas de incidencia y las frecuencias relativas. RESULTADOS: Entre los varones, la tasa de incidencia específica por edad para el grupo etario de más edad (25-29 años) fue más alta que la obtenida en cada uno de los grupos más jóvenes. Entre las hembras, se produjo un aumento progresivo de la incidencia paralelo con el aumento de la edad. Las tasas estandarizadas por edad (TEE) por millón fueron 131.4 (varones) y 226.1 (hembras). En los varones, las TEE más altas (por millón) fueron las correspondientes al linfoma (34.7), el carcinoma (29.3) y el sarcoma de tejido blando (17.2), en tanto que en las hembras correspondieron al carcinoma (121.6), el linfoma (31.4) y las neoplasias trofoblásticas y los tumores de células germinales (14.6). El linfoma fue el diagnóstico más común en los varones más jóvenes, y ocupó el segundo lugar con respecto al carcinoma en los de más edad. El carcinoma y el linfoma fueron el primero y el segundo diagnósticos más comunes respectivamente, entre los tres grupos etarios de las hembras, representando los carcinomas cada vez más la mayor proporción de tumores a medida que era mayor la edad. CONCLUSIÓN: La incidencia de enfermedades malignas en los AJA en Jamaica es más alta en las hembras que en los varones. En ambos géneros, a mayor edad existe una mayor incidencia, así como un desplazamiento de tumores no epiteliales malignos a tumores epiteliales malignos. Este cambio ocurre a una edad más temprana en las hembras.

Incidence of childhood cancer in Kingston and St Andrew, Jamaica, 1983-2002.

OBJECTIVES: There have been several modifications to the classification of childhood cancers since the first report (1968-1981) specific to the Jamaican paediatric population was published in 1988. This paper reports on paediatric cancer incidence in Kingston and St Andrew, Jamaica, for the 20-year period 1983-2002 based on these modifications. METHODS: All cases of cancer diagnosed in children (0-14 years), between 1983 and 2002 were extracted from the Jamaica Cancer Registry archives and classified using the International Classification of Childhood Cancer, third edition. Incidence figures were calculated as per the International Agency for Research on Cancer (IARC) reporting format for childhood cancer. RESULTS: There were 272 cases (133 males, 139 females) of childhood cancer identified in the 20-year period. The overall age standardized rate (ASR) was 69.4 per million; that for males was 67.8 per million, and for females, 70.9 per million. The three most common malignancies overall were leukaemia (21.3%), lymphoma (15.8%) and brain and spinal neoplasms (14.0%). In males, the highest ASRs were seen for leukaemia (14.8 per million), lymphoma (12.7 per million), and brain and spinal neoplasms (8.2 per million), and in females, leukaemia (14.4 per million), nephroblastoma (11.3 per million), and brain and spinal neoplasms (10.6 per million). CONCLUSIONS: The rankings of the most common childhood malignancies in Jamaica (leukaemia, brain and spinal neoplasms and lymphomas) have shown few changes since the last review. However, there are differences in frequency and gender distribution of nephroblastoma and brain and spinal neoplasms.

Structural, vibrational, and rovibrational analysis of tetrafluoroethylene.

High resolution FTIR spectra of (13)C enriched tetrafluoroethylene (C(2)F(4)) were measured at 150 K at the Australian Synchrotron. Rovibrational transitions were assigned in the a-type symmetric and b-type antisymmetric CF(2) stretches of (12)C(13)CF(4) and (13)C(2)F(4) near 1170 cm(-1) and 1300 cm(-1), respectively. Ground vibrational state spectroscopic constants for both molecules were determined in addition to the upper state constants for ν(11) and ν(9) of (13)C(2)F(4) and ν(11), ν(2)+ν(6), and ν(5) of (12)C(13)CF(4). The ground state constants, along with those determined for the (12)C(2)F(4) isotopologue from previously published data, were used to determine a semi-experimental r(e) structure r(CC) = 132.36 ± 0.37 pm, r(CF) = 131.11 ± 0.23 pm, α(FCC) = 123.3 ± 0.3° in excellent agreement with ab initio structures. Lower resolution FTIR spectra were measured between 100 and 5000 cm(-1) at room temperature and band centres obtained for all modes of the three isotopologues; although only 5 out of 12 modes in (12)C(2)F(4) and (13)C(2)F(4) are infrared (IR) active, the others were inferred from combination and hot-band positions. A number of modes are observed to be infrared active only in the (12)C(13)CF(4) isotopologue due to its lower symmetry. Most notably, decoupling of the antisymmetric CF(2) motions in the two halves of (12)C(13)CF(4) results in 2 strongly IR active modes that involve motion at one carbon or the other.

A fifty-year review of soft tissue sarcomas in Jamaica: 1958-2007 / Cincuenta años de revisión de los sarcomas de tejidos blandos en Jamaica: 1958-2007

OBJECTIVE: To determine the distribution of histologic subtypes of soft tissue sarcomas (STS) in Kingston and St Andrew, Jamaica, according to age and topography. METHODS: From the Jamaica Cancer Registry (JCR) archives, all cases of STS diagnosed between 1958 and 2007 were extracted. For each case, age, gender, histological diagnosis and anatomical site of tumour were recorded. Patients were categorized according to age at diagnosis as: children (0-14 years) and adults (> 14 years), and the distribution of histologic diagnoses with respect to age and anatomical site were analysed. RESULTS: There were 432 cases (67 children, 364 adults, one person of unknown age) of STS recorded in the JCR over the 50-year period (218 males, 214 females). The commonest STS in adults were "sarcoma, not otherwise specified [NOS]" (20.1%), malignant fibrous histiocytoma [MFH] (17.9%), fibrosarcoma (12.4%), liposarcoma (10.7%) and malignant peripheral nerve sheath tumour [MPNST] (10.2%). In children, they were neuroblastoma (38.8%), rhabdomyosarcoma (23.9%), "sarcoma, NOS" (9%), fibrosarcoma (6%) and MFH (6%). In adults, the lower limb was the commonest location, followed by trunk and/or upper limb for MFH, fibrosarcoma and liposarcoma, and head and neck for MPNST. In children, head and neck was the commonest site for rhabdomyosarcoma, head and neck and upper limb for MFH, retroperitoneum for neuroblastoma and trunk for fibrosarcoma. CONCLUSION: A high proportion of soft tissue sarcomas in Jamaica are unclassified and the anatomical distribution of common classified sarcomas shows some differences with the literature. Limited access to immunohistochemistry/molecular diagnostics and increasing core biopsy diagnosis may contribute to these phenomena.

OBJETIVO: Determinar la distribución de subtipos histológicos de sarcomas de tejido blando (STB) en Kingston y Saint Andrew, Jamaica, según la edad y la topografía. MÉTODOS: De los archivos del Registro de Cáncer de Jamaica, se extrajeron todos los casos de STB diagnosticados entre 1958 y 2007. Para cada uno de los casos, se registró la edad, el género, el diagnóstico histológico, y el sitio anatómico del tumor. Los pacientes fueron clasificados de acuerdo con la edad en el momento del diagnóstico, bajo las categorías de niños (0-14 años) y adultos (> 14 años), y se analizó la distribución de diagnósticos histológicos con respecto a la edad y el sitio anatómico. RESULTADOS: Se registraron 432 casos de STB (67 niños, 364 adultos, una persona de edad desconocida) en el JCR en un período de 50 años (218 varones, 214 hembras). Los STB más comunes en los adultos fueron "el sarcoma no especificado [NE]" (20.1%), el histiocitoma fibroso maligno [HFM] (17.9%), el fibrosarcoma (12.4%), el liposarcoma (10.7%), y el tumor maligno de la vaina del nervio periférico [TMVNP] (10.2%). En los niños, se trató de los neuroblastomas (38.8%), los rabdomiosarcomas (23.9%), "los sarcomas NE" (9%), los fibrosarcomas (6%), y los HFM (6%). En los adultos, los miembros inferiores fueron el lugar más común, seguido del tronco y/o los miembros superiores para el HFM, el fibrosarcoma y el liposarcoma; y la cabeza y el cuello para el TMVNP. En los niños, la cabeza y el cuello fueron el sitio más común para el rabdomiosarcoma; la cabeza, el cuello y los miembros superiores para el HFM; el retroperitoneo para el neuroblastoma; y el tronco para el fibrosarcoma. CONCLUSIÓN: Una proporción alta de sarcomas de tejidos blandos en Jamaica no están clasificados, y la distribución anatómica de sarcomas clasificados comunes muestran algunas diferencias con la literatura. El acceso limitado a los diagnósticos moleculares/inmunohistoquímicos, y el aumento de los diagnósticos centrales, pueden contribuir a estos fenómenos.

A fifty-year review of soft tissue sarcomas in Jamaica: 1958-2007.

OBJECTIVE: To determine the distribution of histologic subtypes of soft tissue sarcomas (STS) in Kingston and St Andrew, Jamaica, according to age and topography. METHODS: From the Jamaica Cancer Registry (JCR) archives, all cases of STS diagnosed between 1958 and 2007 were extracted. For each case, age, gender, histological diagnosis and anatomical site of tumour were recorded. Patients were categorized according to age at diagnosis as: children (0-14 years) and adults (> 14 years), and the distribution of histologic diagnoses with respect to age and anatomical site were analysed. RESULTS: There were 432 cases (67 children, 364 adults, one person of unknown age) of STS recorded in the JCR over the 50-year period (218 males, 214 females). The commonest STS in adults were "sarcoma, not otherwise specified [NOS]" (20.1%), malignant fibrous histiocytoma [MFH] (17.9%), fibrosarcoma (12.4%), liposarcoma (10.7%) and malignant peripheral nerve sheath tumour [MPNST] (10.2%). In children, they were neuroblastoma (38.8%), rhabdomyosarcoma (23.9%), "sarcoma, NOS" (9%), fibrosarcoma (6%) and MFH (6%). In adults, the lower limb was the commonest location, followed by trunk and/or upper limb for MFH, fibrosarcoma and liposarcoma, and head and neck for MPNST. In children, head and neck was the commonest site for rhabdomyosarcoma, head and neck and upper limb for MFH, retroperitoneum for neuroblastoma and trunk for fibrosarcoma. CONCLUSION: A high proportion of soft tissue sarcomas in Jamaica are unclassified and the anatomical distribution of common classified sarcomas shows some differences with the literature. Limited access to immunohistochemistry/molecular diagnostics and increasing core biopsy diagnosis may contribute to these phenomena.

Problem Stabilization: A Metric for Problem Improvement in Home Visiting Clients.

BACKGROUND: Public health nurse (PHN) home visiting programs have been widely employed to improve life course trajectories for high risk mothers. Home visiting programs are often lengthy, during which PHNs simultaneously address multiple problems using diverse interventions over several client encounters. To manage PHN caseloads it is critical to understand the trajectory of client improvement and the optimal duration or services. PHN documentation data enable intervention trajectory research for specific client problems. A new metric called problem stabilization is proposed for evaluating interim improvement during PHN home visiting. Problem stabilization is an intervention pattern for a client problem that is characterized by co-occurring actions (i.e. teaching, guidance, and counseling; treatments and procedures; case management; and/or surveillance) during a client encounter; followed by surveillance actions only for that problem during a subsequent client encounter. The purpose of the study was to investigate problem stabilization during home visiting services for high risk mothers. METHODS: A retrospective cohort was created using family home visiting intervention documentation data from a local Midwest public health agency over a six year period (2000-2005). The data set consisted of Omaha System interventions for 720 high risk mothers. Analysis was conducted using descriptive statistics and Kaplan Meier curves. RESULTS: On average 30.1% of the time, client problems stabilized before discharge. Stabilization patterns differed by problem. Time to stabilization was longest for Caretaking/parenting and Antepartum/postpartum problems, and shortest for Residence and Mental health problems. CONCLUSIONS: Problem stabilization, a proposed intermediate outcome of PHN home visiting care, appears to be meaningful in describing client response to PHN intervention. This metric is an example of meaningful use of structured clinical electronic health record data for program evaluation and clinical decision support.

Comparative analysis of thyroid carcinomas in Kingston and St Andrew, Jamaica, between two consecutive 15-year periods / Análisis comparativo de carcinomas de tiroides en Kingston y Saint Andrew, Jamaica, entre dos período consecutivos de 15 años

OBJECTIVE: To compare the distribution of histological subtypes of thyroid cancer in Kingston and St Andrew (KSA), Jamaica, within two consecutive 15-year periods. METHODS: We extracted all cases of thyroid carcinoma archived in the Jamaica Cancer Registry files over the 30-year period from 1978 to 2007. The cases were separated into two groups: 1978-1992 (Group I) and 1993-2007 (Group II). We analysed age, gender and histological subtype distribution within each group, and then made comparative analyses between the two periods. RESULTS: There were 311 cases in which the histological subtype was documented. The patients ranged in age from 12 to 94 years, with male to female ratios of 1:4.2 (group I) and 1:5.6 (group II). The highest frequencies of cases occurred in patients between the ages of 20 and 59 years. The commonest histological subtype in group I was follicular (52.7%); in group II, it was papillary (60%), followed by follicular (26.7%) and medullary (6.7%). There was an overall 263% increase in the papillary to follicular cancer ratio from group I (0.62) to group II (2.25). The increase in papillary carcinomas was statistically significant (p < 0.001) overall, and in patients less than 50 years of age (p < 0.001). CONCLUSION: The recent KSA thyroid cancer data show a histological profile similar to that described globally, with papillary carcinomas being commonest, followed by follicular and then medullary. The significant increase in papillary cancer frequency in KSA is most likely the result of gradual recognition of the entity follicular variant of papillary cancer.

OBJETIVO: Comparar la distribución de subtipos histológicos del cáncer tiroideo en Kingston y Saint Andrew (KSA), Jamaica, dentro de dos períodos consecutivos de 15 años. MÉTODOS: Se extrajeron todos los casos de carcinoma de la tiroides registrados en los archivos del Registro de Cáncer de Jamaica por un periodo de 30 años, de 1078 a 2007. Los casos estaban separados en dos grupos: 1978-1992 (Grupo I) y 1993-2007 (Grupo II). Se analizó la edad, el género y la distribución de subtipos histológicos dentro de cada grupo, y se llevó a cabo entonces un análisis comparativo entre los dos períodos. RESULTADOS: Hubo 311 casos en los que se documentó el subtipo histológico. La edad de los pacientes fluctuó de 12 a 94 años, con una proporción varón/hembra de 1:4.2 (grupo I) y 1:5.6 (grupo II). Las frecuencias más altas de casos ocurrieron en pacientes entre 20 y 59 años de edad. El subtipo histológico más común en el grupo I fue el folicular (52.7%), en tanto que en el grupo II fue el papilar (60%), seguido del folicular el (26.7%) y medular (6.7%). Se produjo un incremento general de 263% en la proporción de cáncer papilar frente al folicular del grupo I (0.62) al grupo II (2.25). El aumento en los carcinomas papilares fue estadísticamente significativo (p < 0.001) de manera general y en los pacientes con menos de 50 años de edad (p < 0.001). CONCLUSIÓN: Los datos recientes del cáncer de tiroides en KSA muestran un perfil histológico similar al que se describe globalmente, siendo los carcinomas papilares los más comunes, seguidos por el folicular y luego el medular. El aumento significativo en la frecuencia de cáncer papilar en KSA es muy probablemente el resultado del reconocimiento gradual de la variante de la entidad folicular del cáncer papilar.

Thirty-year trends in incidence and age-distribution of prostate cancer in Kingston and St Andrew, Jamaica, 1978-2007.

OBJECTIVE: To investigate the trends in incidence and age-distribution of prostate cancer in Kingston and St Andrew (KSA), Jamaica, over the 30-year period 1978-2007. METHODS: From published Jamaica Cancer Registry (JCR) data, we extracted age-standardized rates of prostate cancer for the six 5-year reporting periods that comprised the 30-year study span, and from the archived files of the JCR, the patient ages at diagnosis for all prostate cancer cases recorded over the 30-year period were extracted. The results were compared with data from other black populations. RESULTS: The incidence of prostate cancer in KSA, Jamaica, is lower than that in black men in the United States and United Kingdom. The KSA incidence showed a progressive increase since the 1983-1987 reporting period, and the greatest 5-year percentage increases were seen over the period 1983 to 1997. Men in the 60-74-year age group were the commonest contributors to prostate cancer total in all 5-year periods examined, and between 1988 and 2007, there were increases in the proportionate contributions from the 25-59 and 60-74-year age groups, and a decrease in contribution from men aged 75 years and older. CONCLUSION: The incidence of prostate cancer in KSA, Jamaica, has been progressively increasing since 1983, and there has been a concomitant increase in the proportionate contribution from younger men. Continued increase is likely over the next several years, but KSA currently appears to be a relatively low-risk region for prostate cancer, compared to black populations in developed Western countries.

Thirty-year trends in incidence and age-distribution of prostate cancer in Kingston and St Andrew, Jamaica, 1978-2007 / Treinta años de tendencias en la incidencia y distribución por edad del cáncer de próstata e en Kingston y Saint Andrew, Jamaica, 1978-2007

OBJECTIVES: To investigate the trends in incidence and age-distribution of prostate cancer in Kingston and St Andrew (KSA), Jamaica, over the 30-year period 1978-2007. METHODS: From published Jamaica Cancer Registry (JCR) data, we extracted age-standardized rates of prostate cancer for the six 5-year reporting periods that comprised the 30-year study span, and from the archived files ofthe JCR, the patient ages at diagnosis for all prostate cancer cases recorded over the 30-year period were extracted. The results were compared with data from other black populations. RESULTS: The incidence of prostate cancer in KSA, Jamaica, is lower than that in black men in the United States and United Kingdom. The KSA incidence showed a progressive increase since the 1983-1987 reporting period, and the greatest 5-year percentage increases were seen over the period 1983 to 1997. Men in the 60-74-year age group were the commonest contributors to prostate cancer total in all 5-year periods examined, and between 1988 and 2007, there were increases in the proportionate contributions from the 25-59 and 60-74-year age groups, and a decrease in contribution from men aged 75 years and older. CONCLUSION: The incidence of prostate cancer in KSA, Jamaica, has been progressively increasing since 1983, and there has been a concomitant increase in the proportionate contribution from younger men. Continued increase is likely over the next several years, but KSA currently appears to be a relatively low-risk region for prostate cancer, compared to black populations in developed Western countries.

OBJETIVO: Investigar las tendencias en la incidencia y distribución por edad del cáncer de próstata en Kingston y Saint Andrew (KSA), Jamaica, por un período de 30 años, 1978-2007. MÉTODO: De la publicación de Registro de Cáncer de Jamaica (JCR), se extrajeron datos de tasas estandarizadas por edad del cáncer de próstata durante los seis períodos quinquenales que comprenden el espacio de 30 años del estudio, y de los archivos del JCR, se registraron las edades de los pacientes en el momento del diagnóstico en todos los casos de cáncer de próstata, por espacio de 30 años. Los resultados se compararon con los datos de otras poblaciones negras. RESULTADOS: La incidencia del cáncer de próstata en KSA, Jamaica, es menor que la existente entre la población masculina negra de Estados Unidos y el Reino Unido. La incidencia en KSA mostró un aumento progresivo a partir del período reportado de 1983-1987, y los más grandes aumentos de porcentaje en 5 años, fueron vistos en el periodo de 1983 a 1997. Los hombres en el grupo etario de 60-74 años fueron quienes más comúnmente contribuyeron a engrosar el total de total de cáncer de próstata en todos los periodos quinquenales examinados, y entre 1988 y 2007, se produjeron aumentos en las contribuciones proporcionales de los grupos etáreos de 25-59 y 60-74 años, así como una disminución en la contribución de los hombres de 75 años o más. CONCLUSIÓN: La incidencia de cáncer de próstata en KSA, Jamaica, ha estado aumentando progresivamente desde 1983, y ha habido un aumento concomitante en la contribución proporcional de los hombres más jóvenes. Es probable que en el curso de los próximos años continúe un aumento progresivo, pero KSA parece ser una región relativamente de bajo riesgo en lo que se refiere al cáncer de próstata, en comparación con las poblaciones negras de los países occidentales desarrollados.

Comparative analysis of thyroid carcinomas in Kingston and St Andrew, Jamaica, between two consecutive 15-year periods.

OBJECTIVE: To compare the distribution of histological subtypes of thyroid cancer in Kingston and St Andrew (KSA), Jamaica, within two consecutive 15-year periods. METHODS: We extracted all cases of thyroid carcinoma archived in the Jamaica Cancer Registry files over the 30-year period from 1978 to 2007. The cases were separated into two groups: 1978-1992 (Group I) and 1993-2007 (Group II). We analysed age, gender and histological subtype distribution within each group, and then made comparative analyses between the two periods. RESULTS: There were 311 cases in which the histological subtype was documented. The patients ranged in age from 12 to 94 years, with male to female ratios of 1:4.2 (group I) and 1:5.6 (group II). The highest frequencies of cases occurred in patients between the ages of 20 and 59 years. The commonest histological subtype in group I was follicular (52.7%); in group II, it was papillary (60%), followed by follicular (26.7%) and medullary (6.7%). There was an overall 263% increase in the papillary to follicular cancer ratio from group I (0.62) to group II (2.25). The increase in papillary carcinomas was statistically significant (p < 0.001) overall, and in patients less than 50 years of age (p < 0.001). CONCLUSION: The recent KSA thyroid cancer data show a histological profile similar to that described globally, with papillary carcinomas being commonest, followed by follicular and then medullary. The significant increase in papillary cancer frequency in KSA is most likely the result of gradual recognition of the entity follicular variant of papillary cancer

Age-specific incidence of cancer in Kingston and St Andrew, Jamaica, 2003 - 2007 / Incidencia específica por edad del cáncer en Kingston y Saint Andrew, Jamaica, 2003 - 2007

A total of 4981 cancers were recorded in Kingston and St Andrew during the period 2003 - 2007: 2536 in males and 2445 in females. Age standardized rates per 100 000 per year (ASR) were 188.8 and 144.2 for males and females respectively, and are relatively unchanged, compared to the previous report (188.6 for males and 144.2 for females, 1998 - 2002). In males, the leading sites for cancer were prostate, bronchus and large bowel, while in females, they were breast, cervix uteri and large bowel. The leading sites for both genders have been maintained in the same order as in the previous report, but for males, there were increases in the incidence of prostate (ASR 65.5 vs 78.1 per 100 000 per year) and colorectal (ASR 13.7 vs 17.2 per 100 000 per year) cancers and a decrease in the incidence of cancer of the bronchus (ASR 22.8 vs 18.6 per 100 000 per year). For females, there was a modest decrease in incidence of cervical cancer (ASR 19 vs 17.4 per 100 000 per year) while the incidence of cancers of the breast and large bowel remained relatively stable (ASR 40.1 vs 43 per 100 000 per year for breast and ASR 13 vs 12.8 per 100 000 per year for colorectal cancer). These data support the need for urgent institution of formal programmes for prevention and control of cancers of the breast and large bowel in the Jamaican population. Malignancies of unknown primary site were common in both genders and require further investigation.

Un total de 4981 cánceres se registraron en Kingston y Saint Andrew durante el periodo 2003-2007. El número de casos en los varones fue 2536 y 2445 en las hembras. Las tasas estandarizadas por edad (ASR) por 100 000 por año fueron 188.8 y 144.2 para varones y hembras respectivamente, y permanecen relativamente sin cambios en comparación con el informe previo (188.6 para los varones y 144.2 para las hembras, 1998-2002). En los varones, los sitios principales del cáncer fueron la próstata, los bronquios y el intestino grueso, mientras que en las hembras fueron las mamas, el cuello del útero, y el intestino grueso. Los sitios principales para ambos géneros se han mantenido en el mismo orden presentado en el informe anterior, pero para los varones, hubo aumentos en la incidencia del cáncer de próstata (ASR 65.5 vs 78.1 por 100 000 por año) y el cáncer colorrectal (ASR 13.7 vs 17.2 por 100 000 por año), y una disminución en la incidencia del cáncer de bronquios (ASR 22.8 vs 18.6 por 100 000 por año). Para las mujeres, hubo una disminución modesta en la incidencia de cáncer cervical o del cuello uterino (ASR 19 vs 17.4 por 100 000 por año) mientras la incidencia de los cánceres de mama y el intestino grueso permanecía relativamente estable (ASR 40.1 vs 43 por 100 000 por año para el cáncer de mama y ASR 13 vs 12.8 por 100 000 por año para el cáncer colorrectal). Estos datos subrayan la necesidad de instituir de manera urgente programas formales para la prevención y control cánceres de mama e intestino grueso en la población jamaicana. Tumores malignos de sitio primario desconocido fueron comunes en ambos géneros y requieren investigación extensa.