Temporal and Isoform-Specific Expression of CTBP2 Is Evolutionarily Conserved Between the Developing Chick and Human Retina.

Complex transcriptional gene regulation allows for multifaceted isoform production during retinogenesis, and novel isoforms transcribed from a single locus can have unlimited potential to code for diverse proteins with different functions. In this study, we explored the CTBP2/RIBEYE gene locus and its unique repertoire of transcripts that are conserved among vertebrates. We studied the transcriptional coregulator (CTBP2) and ribbon synapse-specific structural protein (RIBEYE) in the chicken retina by performing comprehensive histochemical and sequencing analyses to pinpoint cell and developmental stage-specific expression of CTBP2/RIBEYE in the developing chicken retina. We demonstrated that CTBP2 is widely expressed in retinal progenitors beginning in early retinogenesis but becomes limited to GABAergic amacrine cells in the mature retina. Inversely, RIBEYE is initially epigenetically silenced in progenitors and later expressed in photoreceptor and bipolar cells where they localize to ribbon synapses. Finally, we compared CTBP2/RIBEYE regulation in the developing human retina using a pluripotent stem cell derived retinal organoid culture system. These analyses demonstrate that similar regulation of the CTBP2/RIBEYE locus during chick and human retinal development is regulated by different members of the K50 homeodomain transcription factor family.

Social networks of experientially similar others: formation, activation, and consequences of network ties on the health care experience.

Research documents that interactions among experientially similar others (individuals facing a common stressor) shape health care behavior and ultimately health outcomes. However, we have little understanding of how ties among experientially similar others are formed, what resources and information flows through these networks, and how network embeddedness shapes health care behavior. This paper uses in-depth interviews with 76 parents of pediatric cancer patients to examine network ties among experientially similar others after a serious medical diagnosis. Interviews were conducted between August 2009 and May 2011. Findings demonstrate that many parents formed ties with other families experiencing pediatric cancer, and that information and resources were exchanged during the everyday activities associated with their child's care. Network flows contained emotional support, caregiving strategies, information about second opinions, health-related knowledge, and strategies for navigating the health care system. Diffusion of information, resources, and support occurred through explicit processes (direct information and support exchanges) and implicit processes (parents learning through observing other families). Network flows among parents shaped parents' perceptions of the health care experience and their role in their child's care. These findings contribute to the social networks and social support literatures by elucidating the mechanisms through which network ties among experientially similar others influence health care behavior and experiences.

The dynamics and processes of social support: families' experiences coping with a serious paediatric illness.

A large body of research has revealed that social support helps buffer the negative consequences of stressful life events. Yet research also suggests that social support exchanges involve complex interpersonal dynamics. Using in-depth interview data from 76 parents of paediatric cancer patients in the US, the findings demonstrate that parents experienced difficulty sustaining support after the diagnosis crisis, uncertainty about how to ask for the support they needed and challenges managing support efforts. Given these complexities in negotiating social support, this article examines the mechanics of effective social support exchanges. The findings show the importance of the nature of the pre-existing relationship between the support recipient and provider, as well as the interactions throughout the period of support. For example, parents found support efforts that involved frequent interactions and involvement in families' daily lives (such as help with childcare) most effective when the support provider was a close network member. In contrast, support offered from members of extended networks was most effective when the effort required little marshalling from the parents, did not need to be asked for and did not intrude in the families' private lives. These findings contribute to the medical sociology and social support literature by analysing the conditions under which effective support efforts are marshalled.

Social networks, social support and burden in relationships, and mortality after breast cancer diagnosis.

Though larger social networks are associated with reduced breast cancer mortality, there is a need to clarify how both social support and social burden influence this association. We included 4,530 women from the Women's Health Initiative who were diagnosed with breast cancer between 1993 and 2009, and provided data on social networks (spouse or intimate partner, religious ties, club ties, and number of first-degree relatives) before diagnosis. Of those, 354 died during follow-up, with 190 from breast cancer. We used Cox proportional hazards regression to evaluate associations of social network members with risk of post-diagnosis mortality, further evaluating associations by social support and social burden (caregiving, social strain). In multivariate-adjusted analyses, among women with high but not low social support, being married was related to lower all-cause mortality. By contrast, among women with high but not low social burden, those with a higher number of first-degree relatives, including siblings, parents, and children, had higher all-cause and breast cancer mortality (among caregivers: 0-3 relatives (ref), 4-5 relatives, HR = 1.47 (95% CI: 0.62-3.52), 6-9 relatives, HR = 2.08 (95% CI: 0.89-4.86), 10+ relatives, HR = 3.55 (95% CI: 1.35-9.33), P-continuous = 0.02, P-interaction = 0.008). The association by social strain was similar though it was not modified by level of social support. Other social network members were unrelated to mortality. Social relationships may have both adverse and beneficial influences on breast cancer survival. Clarifying these depends on understanding the context of women's relationships.

The devil you know: parents seeking information online for paediatric cancer.

There is a growing interest in understanding the effect that online information-seeking has on patients' experiences, empowerment and interactions with healthcare providers. This mixed-methods study combines surveys and in-depth interviews with 41 parents of paediatric cancer patients in the USA to examine how parents think about, evaluate, access and use the internet to seek information related to their child's cancer. We find that, during the acute crisis of a child being diagnosed with cancer, parents preferred to receive information related to their child's diagnosis, prognosis and treatment options from a trusted healthcare provider rather than through the internet. We find that access to medically related cancer information through the internet was deemed to be untrustworthy and frightening. Parents' reasons for avoiding online information-seeking included fear of what they might find out, uncertainty about the accuracy of information online, being overloaded by the volume of information online and having been told not to go online by oncologists. Some parents also had logistical barriers to accessing the internet. While most parents did not turn to the internet as a source of health-related information, many did use it to connect with sources of social support throughout their child's illness.

Structuring survivorship care: discipline-specific clinician perspectives.

INTRODUCTION: Several models for survivorship care are prominent within the cancer literature; however, there is little empirical research that examines what oncology clinicians perceive to be the best approach to caring for cancer survivors, what services survivorship programs should include, and how prepared they feel to care for cancer survivors. METHODS: An IRB approved web-based survey of all clinical staff was conducted at a NCI designated comprehensive cancer center with a 49.8% response rate (N = 377). Data were summarized using frequencies and relative frequencies, and pairwise tests of statistical significance were utilized to evaluate differences between clinician type groups. RESULTS: Overall, the largest proportion of respondents preferred a disease-specific survivorship model (37.6%). This preference was specifically observed in oncology physicians and nurses. When asked where specific survivorship services should be provided, respondents indicated a preference for services directly related to survivors' medical treatment (i.e. information about late effects) to be delivered in a disease-specific survivorship clinic, and ancillary services (i.e. nutrition and fertility counseling) to be housed in a centralized comprehensive survivorship clinic. Physicians felt that they have significantly more information, training, and resources to care for cancer survivors than did oncology nurses. DISCUSSION/CONCLUSION: These results indicate that oncology clinicians prefer a combination of survivorship care delivery models where continuing medical needs are met in disease-specific clinics, and comprehensive wellness services are offered in a centralized comprehensive survivorship clinic. Results also suggest that planning for survivorship initiatives should include additional resources, education, and training for clinical staff. IMPLICATIONS FOR CANCER SURVIVORS: These findings underscore the need for a universally accepted definition of cancer survivorship, and support a model for delivering care to cancer survivors that is a blend of the disease-specific and comprehensive survivorship programs.

Esperanza y Vida: training lay health advisors and cancer survivors to promote breast and cervical cancer screening in Latinas.

The use of lay health advisors (LHAs) to promote community-based health education programs is well documented and is considered an effective way to reach underserved communities. Esperanza y Vida (Hope & Life) is an educational outreach program to increase breast and cervical cancer screening for diverse Latinas. It incorporates Latino LHAs (men and women) and cancer survivor role models, sobrevivientes, in the program delivery. An interactive training program, conducted by bilingual staff across three sites (Little Rock, Arkansas; Buffalo, New York and New York City) included 74 sobrevivientes and LHAs who were recruited and trained. All training attendees completed an initial application assessing socio-demographics, experience and availability as well as, true/false surveys at the beginning (pre-) and end of the training (post-) measuring knowledge levels of breast and cervical cancer health. Data analysis indicated a significant increase of both breast and cervical cancer knowledge for attendees trained as LHAs (pre = 60%; post = 80%; p = 0.000), whereas sobrevivientes had a higher baseline knowledge of breast health (74%), and therefore did not show a significant increase following training (79%). However, sobrevivientes did display a significant increase in cervical cancer knowledge (p = 0.003). These findings demonstrate the impact of training and how LHAs may be recruited at different levels of knowledge and experience and be successfully trained in key program elements. Moreover, results indicate that sobrevivientes may be impacted differently, or require variations in training approaches. This information can be useful in developing and customizing curriculum for future lay health training programs.

Contextualizing diversity and culture within cancer control interventions for Latinas: changing interventions, not cultures.

While there is a growing interest in the development of cancer control intervention initiatives, there continues to be a need to understand how the nuances of different Latino cultures translate to opportunities and barriers for access to cancer screening and care. The diversity by country of origin for Latinas in the United States is often overlooked in cancer control initiatives, and the application of qualitative research can expose processes of inequity and cultural variation to improve these initiatives. This paper presents an interpretation of diverse Latina immigrants' perceptions, experiences and knowledge about breast and cervical cancer screening and demonstrates the use of the PEN-3 model to analyze these data to develop an effective outreach intervention. We conducted 13 focus groups consisting of a total of 112 Latinas in New York City (nine groups) and rural and urban sites in Arkansas (four groups) in 2003 through 2004. Through nonprobability theoretical sampling, we included women from Puerto Rico, the Dominican Republic and Mexico in New York and recent Mexican immigrants in Arkansas. Findings demonstrated that country of origin and current geographic residency in the U.S. were significant determinants of women's perspectives on community-based religious organizations, knowledge of anatomy, experiences with the medical system, and access to services which are essential factors to consider in developing effective cancer control interventions. Although breast and cervical cancer are considered women's health issues, they cannot be addressed outside the sociopolitical structures of local communities, especially for the most recent immigrant women. Applying the PEN-3 framework to these data demonstrated a valuable method to interpret and transform qualitative data into intervention content and structure that responds to characteristics and perspectives within diverse Latino communities, such as gender relations, religious affiliations and experiences.

Examining the most relevant conceptualization of the socioeconomic status construct for cancer research.

BACKGROUND: Although previous research has established a link between socioeconomic status (SES) and cancer outcomes, there is still little understanding of the processes that contribute to these outcome disparities. OBJECTIVE: This study aimed to describe the ways a family's SES influences their healthcare behavior after a child is diagnosed with cancer. METHODS: The sample included 5 case study families and in-depth interviews with 21 parents. Case study families were interviewed and observed once a month for 6 months. RESULTS: Parents' finances influenced their ability to maintain household expenses and to pay for healthcare expenses and household help. Wealth and help from friends and family are important aspects of families' financial statuses. Parents' educational attainment affected their ability to understand diagnosis and treatment options, their confidence and communication with healthcare professionals, and the utility of their social networks. Parents' occupation influenced their work schedule flexibility, fringe benefits, and their access to and quality of employer-sponsored health insurance. CONCLUSIONS: Findings suggest that 3 overarching domains of SES (eg, financial, education, and occupation) have important implications for parents' healthcare navigation. This study underscores the need to use a nuanced set of SES measures (beyond income and education) in future research to enhance our understanding of how SES affects healthcare navigation and refine intervention initiatives designed to help reduce health disparities. IMPLICATIONS FOR PRACTICE: Cancer education initiatives should focus on enhancing patient-provider interactions, health communication, accessing health information, and resolving work and financial barriers to cancer care.

Gender attitudes and sexual behaviors: comparing center and marginal athletes and nonathletes in a collegiate setting.

This research examines the impact of participating in different sports on male athletes' gender attitudes, hegemonic masculinity, sexual behavior, and sexual aggression. Expanding on past research that compares athletes with nonathletes, this research finds differences between collegiate athletes and men who do not participate in collegiate sports, as well as between men who play different collegiate sports. Athletes in center sports (such as football) scored significantly higher on hyper-masculinity scales, had lower attitudes toward women, and displayed more sexual aggression and more sexual activity than men who competed in marginal sports (e.g., track and field) or not at all.

The spiritual and religious identities, beliefs, and practices of academic pediatricians in the United States.

PURPOSE: Physicians' spiritual and religious identities, beliefs, and practices are beginning to be explored. The objective of this study was to gather descriptive information about personal religion and spirituality from a random sample of academic American pediatricians and to compare this information with similar data from the public. METHOD: In 2005, a Web-based survey of a random sample of 208 pediatrician faculty from 13 academic centers ranked by the US News & World Report as "honor roll" hospitals was conducted. Surveys elicited information about personal beliefs and practices as well as their influence on decisions about patient care and clinical practice. Multiple questions were replicated from the General Social Survey to enable comparisons with the public. Descriptive statistics were generated, and logistic regression analyses were conducted on relevant variables. RESULTS: Nearly 88% of respondents were raised in a religious tradition, but just 67.2% claimed current religious identification. More than half (52.6%) reported praying privately; additional spiritual practices reported included relaxation techniques (38.8%), meditation (29.3%), sacred readings (26.7%), and yoga (19%). The majority of academic pediatricians (58.6%) believed that personal spiritual or religious beliefs influenced their interactions with patients/colleagues. These odds increased 5.1-fold when academic pediatricians attended religious services monthly or more (P < .05). CONCLUSIONS: Compared with the American public, a notably smaller proportion of academic pediatricians reported a personal religious identity. The majority believed spiritual and religious beliefs influenced their practice of pediatrics. Whether secular or faith-based belief systems measurably modify academic pediatric practice is unknown.

The religious and spiritual beliefs and practices of academic pediatric oncologists in the United States.

OBJECTIVES: Religion and spirituality are increasingly recognized as important in the care of seriously ill patients. This study evaluates religious and spiritual beliefs and practices among pediatric oncology faculty and compares their religiosity and spirituality to the general public. METHODS: Information was gathered from a sampling frame of all pediatric oncology faculty working in 13 US News and World Report's "honor role" hospitals. These data were compared with the general public (using the General Social Survey), through frequency distributions, descriptive crosstabs, and tests of significance, including chi(2) statistics. RESULTS: Eighty-five percent of pediatric oncology faculty described themselves as spiritual. In all, 24.3% reported attending religious services 2 to 3 times a month or more in the past year. Twenty-seven percent of pediatric oncologists believed in God with no doubts. In all, 52.7% believed their spiritual or religious beliefs influence interactions with patients and colleagues. Among the general public 40.1% reported attending religious services 2 to 3 times a month or more in the past year (P<0.01) and 60.4% believed in God with no doubts (P<0.001). CONCLUSIONS: Although many have no traditional religious identity, large fractions of pediatric oncology faculty described themselves as spiritual. This may have implications for the education of pediatric oncologists and the spiritual care of seriously ill children and their families.