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2.
J Prev Health Promot ; 3(3): 271-299, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38566802

RESUMO

Low-income women of color receive fewer cancer screenings and have higher rates of depression, which can interfere with cancer screening participation. This study assessed the comparative effectiveness of two interventions for improving colorectal, breast, and cervical cancer screening participation and reducing depression among underserved women in Bronx, NY, with depression. This comparative effectiveness randomized controlled trial (RCT) with assessments at study entry, 6, and 12 months utilized an intent-to-treat statistical approach. Eligible women were aged 50 to 64, screened positive for depression, and were overdue for ≥ 1 cancer screening (colorectal, breast, and/or cervical). Participants were randomized to a collaborative depression care plus cancer screening intervention (CCI + PCM) or cancer screening intervention alone (PCM). Interventions were telephone-based, available in English or Spanish, delivered over 12 months, and facilitated by a skilled care manager. Cancer screening data were extracted from electronic health records. Depression was measured with a validated self-report instrument (PHQ-9). Seven hundred fifty seven women consented and were randomized (CCI + PCM, n = 378; PCM, n = 379). Analyses revealed statistically significant increases in up-to-date status for all three cancer screenings; depression improved in both intervention groups. There were no statistically significant differences between the interventions in improving cancer screening rates or reducing depression. CCI and PCM both improved breast, cervical, and colorectal cancer screening and depression in clinical settings in underserved communities; however, neither intervention showed an advantage in outcomes. Decisions about which approach to implement may depend on the nature of the practice and alignment of the interventions with other ongoing priorities and resources.

3.
J Health Care Poor Underserved ; 32(4): 1907-1934, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34803050

RESUMO

BACKGROUND: Low-income and minority women are significantly more likely to be diagnosed with preventable, late-stage cancers and suffer from depression than the general population. Intervention studies aiming to reduce depression to increase cancer screening among underserved minority women are sparse. METHODS: This patient-centered outcomes trial compared Collaborative Care Intervention plus Cancer Prevention Care Management (CCI+PCM) versus PCM alone. Participants from six Federally Qualified Health Centers (FQHCs) were interviewed at baseline, 6-and 12-month follow-up to monitor adherence to screening guidelines, depressive symptoms, quality of life, barriers to screening, and other psychosocial and health-related variables. RESULTS: Participants included 757 English-or Spanish-speaking women (ages 50-64) who screened positive for depression on the Patient Health Questionnaire (PHQ)-9 and were not up-to-date for breast, cervical, and/or colorectal cancer screening. CONCLUSIONS: Study methodology and baseline participant characteristics are reported to contribute to the literature on evidence-based interventions for cancer screening among underserved, depressed women.


Assuntos
Serviços de Saúde Mental , Neoplasias , Depressão/diagnóstico , Detecção Precoce de Câncer , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias/diagnóstico , Assistência Centrada no Paciente , Atenção Primária à Saúde , Qualidade de Vida
4.
Prog Community Health Partnersh ; 13(3): 273-282, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31564668

RESUMO

BACKGROUND: Collaborations between community health and academic partners hold promise for improving community health through research. OBJECTIVES: To develop, implement, and evaluate a partnership to build capacity for community-based research. METHODS: Development of the partnership was based on a participatory model that aimed to nurture strong infrastructure, clear communication, and trust between partners. Research training was individualized to assessed needs. Methods of evaluation included online surveys of partnership members comparing years 1 and 2 and appreciative inquiry (AI) interviews in year 3.Results and Lessons Learned: Course corrections from year 1 responses were implemented, and reflected in improvements on the second survey. Interviews highlighted mutual benefits of infrastructure developed in partnership; threats to sustainability were identified. Lessons learned included the importance of early course correction based on feedback, opportunities for communication, and building trust and a shared language. CONCLUSIONS: Partnerships develop through commitment and trust. Routine assessments and course correction may enable productive research partnerships.


Assuntos
Serviços de Saúde Comunitária/organização & administração , Pesquisa Participativa Baseada na Comunidade/organização & administração , Relações Comunidade-Instituição , Pesquisa sobre Serviços de Saúde/organização & administração , Universidades/organização & administração , Serviços de Saúde Comunitária/métodos , Pesquisa Participativa Baseada na Comunidade/métodos , Acessibilidade aos Serviços de Saúde/organização & administração , Pesquisa sobre Serviços de Saúde/métodos , Humanos , Relações Interinstitucionais , Cidade de Nova Iorque , Qualidade da Assistência à Saúde/organização & administração
5.
Public Health Rep ; 131 Suppl 1: 11-20, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26862226

RESUMO

OBJECTIVE: One in seven of the 1.1 million people living in the United States infected with HIV are not aware of their HIV status. At the same time, many clinical settings have not adopted routine HIV screening, which promotes linkage to specialist medical care. We sought to improve HIV screening in a large community health center network by using a data-driven, collaborative learning approach and system-wide modifications, where counselor-based HIV screening and testing were replaced by health-care providers and medical assistants. METHODS: Urban Health Plan, Inc., a network of federally qualified health centers in the boroughs of the Bronx and Queens in New York City, provided HIV screening training for its health-care providers. In January 2011, it modified its electronic medical record system to incorporate HIV test offering. This study compared the 2010 baseline year with the three-year implementation follow-up period (January 2011 through December 2013) to determine the number of eligible individuals for HIV testing, HIV tests offered and performed, HIV-positive individuals, and HIV cases linked to specialty care. RESULTS: A total of 26,853 individuals at baseline and 100,369 individuals in the implementation period were eligible for HIV testing. HIV testing was performed on 2,079 (8%) of 26,853 eligible individuals in 2010 and 49,646 (50%) of 100,369 eligible individuals from 2011 through 2013. HIV-positive status was determined in 19 (0.9%) of 2,079 tested individuals in 2010 and 166 (0.3%) of 49,646 tested individuals from 2011 through 2013. Linkage to care was observed in all 19 eligible individuals and 127 (77%) of 166 eligible individuals who tested HIV positive in 2010 and 2011-2013, respectively. CONCLUSION: This study enabled routine HIV implementation testing at a community health center network, which resulted in enhanced HIV testing, an increased number of HIV-positive cases identified, and a rise in the number of patients linked to HIV specialist care.


Assuntos
Sorodiagnóstico da AIDS , Centros Comunitários de Saúde/organização & administração , Programas de Rastreamento/organização & administração , Sorodiagnóstico da AIDS/estatística & dados numéricos , Adolescente , Adulto , Continuidade da Assistência ao Paciente/organização & administração , Comportamento Cooperativo , Testes Diagnósticos de Rotina , Registros Eletrônicos de Saúde/organização & administração , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Humanos , Relações Interinstitucionais , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Adulto Jovem
6.
Cutis ; 87(2): 96-103, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21416778

RESUMO

Brittle nail syndrome refers to nails that exhibit surface roughness, raggedness, and peeling. It is a common problem, with a higher prevalence among elderly patients. The goal of this study was to determine if tazarotene cream 0.1% ameliorates the signs and symptoms of brittle nails. In this open-label, single-center trial, participants applied tazarotene cream to the nails twice daily for 24 weeks. Signs and symptoms were rated by the investigators and by the participants during treatment and 12 weeks after discontinuation. Twenty participants were enrolled in the study; 1 participant withdrew prior to the 4-week followup visit. Of the 18 participants available for analysis (1 participant was excluded because baseline photographs were not available) for the primary end point of improvement in the physician global improvement assessment (PGIA), all 18 participants achieved improvement of the target nails at week 12 as well as 16 participants (88.9%) at week 24. All 18 participants had improvement in the PGIA score 12 weeks posttreatment at week 36. The physician global assessment (PGA) improved for 14 of 19 participants (73.7%) at both weeks 12 and 24; at week 24, 4 of 19 participants had achieved a PGA score of none. At week 36, 17 of 19 participants (89.5%) agreed that their nails had improved overall. Only 1 participant (5.3%) reported mild local irritation. This study demonstrated that tazarotene improves some of the changes noted in conjunction with brittle nail syndrome with minimal to no irritation.


Assuntos
Ceratolíticos/uso terapêutico , Doenças da Unha/tratamento farmacológico , Ácidos Nicotínicos/uso terapêutico , Administração Tópica , Idoso , Feminino , Humanos , Ceratolíticos/administração & dosagem , Masculino , Pessoa de Meia-Idade , Ácidos Nicotínicos/administração & dosagem , Projetos Piloto , Resultado do Tratamento
7.
Cancer Prev Res (Phila) ; 3(1): 25-34, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20051370

RESUMO

In vitro and epidemiologic studies favor the efficacy of nonsteroidal anti-inflammatory drugs (NSAID) in preventing skin squamous photocarcinogenesis, but there has been relatively little study of their efficacy in preventing the more common skin basal cell carcinoma (BCC) carcinogenesis. We first compared the relative anti-BCC effects of genetic deletion and NSAID pharmacologic inhibition of cyclooxygenase (COX) enzymes in the skin of Ptch1(+/-) mice. We then assessed the effects of celecoxib on the development of BCCs in a 3-year, double-blinded, randomized clinical trial in 60 (PTCH1(+/-)) patients with the basal cell nevus syndrome. In Ptch1(+/-) mice, genetic deletion of COX1 or COX2 robustly decreased (75%; P < 0.05) microscopic BCC tumor burden, but pharmacologic inhibition with celecoxib reduced microscopic BCCs less efficaciously (35%; P < 0.05). In the human trial, we detected a trend for oral celecoxib reducing BCC burden in all subjects (P = 0.069). Considering only the 60% of patients with less severe disease (<15 BCCs at study entry), celecoxib significantly reduced BCC number and burden: subjects receiving placebo had a 50% increase in BCC burden per year, whereas subjects in the celecoxib group had a 20% increase (P(difference) = 0.024). Oral celecoxib treatment inhibited BCC carcinogenesis in PTCH1(+/-) mice and had a significant anti-BCC effect in humans with less severe disease.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Carcinoma Basocelular/prevenção & controle , Predisposição Genética para Doença , Pirazóis/uso terapêutico , Receptores de Superfície Celular/genética , Neoplasias Cutâneas/prevenção & controle , Sulfonamidas/uso terapêutico , Animais , Síndrome do Nevo Basocelular/complicações , Síndrome do Nevo Basocelular/tratamento farmacológico , Síndrome do Nevo Basocelular/genética , Carcinoma Basocelular/genética , Celecoxib , Quimioprevenção , Ciclo-Oxigenase 1/genética , Ciclo-Oxigenase 2/genética , Método Duplo-Cego , Heterozigoto , Humanos , Camundongos , Camundongos Mutantes , Receptores Patched , Receptor Patched-1 , Neoplasias Cutâneas/genética
8.
Dermatol Surg ; 32(1): 1-6, 2006 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-16393591

RESUMO

BACKGROUND: Liposomal lidocaine 4% (L.M.X.4 cream, Ferndale Laboratories Inc., Ferndale, MI, USA) has been proposed as a more rapidly acting topical anesthetic than the eutectic mixture of lidocaine 2.5% and prilocaine 2.5% (EMLA cream, AstraZeneca LP, Wilmington, DE, USA) for venipuncture and laser procedures. However, their anesthetic efficacy has not been previously compared for electrosurgical destruction of superficial skin lesions. OBJECTIVE: To test the hypothesis that L.M.X.4 and EMLA differ in anesthetic efficacy when applied under occlusion for 30 minutes prior to electrodesiccation of papules of dermatosis papulosa nigra. METHODS: Forty adults were randomly assigned to treatment with either agent for 30 minutes under Tegaderm. The study drug was administered for an additional 30 minutes if the electrodesiccation of the first few papules was too painful. RESULTS: One subject treated with EMLA versus none treated with L.M.X.4 experienced complete anesthesia after a single 30-minute application. Nineteen of 20 (95%) subjects treated with EMLA versus 18 of 20 (90%) subjects treated with L.M.X.4 required only a single application (p = .49). Pain scores after the initial 30-minute application (scale: 0 = none to 10 = very severe) were EMLA 3.3 +/- 2.2 (mean +/- SD) versus L.M.X. 4 2.9 +/- 2.0 (p = .46). CONCLUSION: EMLA and L.M.X.4 provide comparable levels of anesthesia after a single 30-minute application under occlusion prior to electrodesiccation of superficial skin lesions.


Assuntos
Anestesia Local , Anestésicos Locais/administração & dosagem , Eletrocirurgia , Hiperpigmentação/cirurgia , Lidocaína/administração & dosagem , Prilocaína/administração & dosagem , Administração Cutânea , Adulto , Dessecação , Método Duplo-Cego , Feminino , Humanos , Combinação Lidocaína e Prilocaína , Lipossomos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
9.
Immunol Allergy Clin North Am ; 25(3): 557-80, 2005 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16054543

RESUMO

The dermatologic anachronistic adage, "If wet--dry it, if dry--wet it!" has bee perhaps justifiably replaced by "Call the dermatologist to prescribe a steroid!" To say this without knowledge of the contents of this article and more importantly, to accept such cliches, is a disservice to the patient and a litigious liability to the prescriber. Recognizing the risk/benefit ratio of the most commonly used anti-inflammatory agents is essential. All therapies are most effective when used for their specific diagnosis. This article attempts to provide an update on the geometrically progressing knowledge regarding the uses and misuses of GCSs for the eye and skin.


Assuntos
Anti-Inflamatórios/farmacologia , Olho/efeitos dos fármacos , Glucocorticoides/farmacologia , Pele/efeitos dos fármacos , Administração Tópica , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/efeitos adversos , Oftalmopatias/tratamento farmacológico , Glucocorticoides/administração & dosagem , Glucocorticoides/efeitos adversos , Humanos , Dermatopatias/tratamento farmacológico , Síndrome de Abstinência a Substâncias
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