Patient factors associated with discrepancies between patient-reported and clinician-documented peripheral neuropathy in women with breast cancer receiving paclitaxel: A pilot study.

PURPOSE: Discrepancies between clinicians' assessment of chemotherapy-induced peripheral neuropathy (CIPN) and patient-reported outcomes (PRO) have been described, though the underlying reasons are unknown. Our objective was to identify potential patient-specific factors associated with under-describing of CIPN to clinicians in women with non-metastatic breast cancer treated with paclitaxel. METHODS: Patients enrolled in an observational study (n = 60) completed weekly CIPN PRO using the EORTC CIPN20. Clinician-documented CIPN using the NCI CTCAE were abstracted from the electronic medical record and paired with CIPN20 data at weeks 7 and 10. Patients were classified as under-describers if their CIPN20 was above the 80th percentile of the CIPN20 distribution for that CTCAE grade from an independent clinical trial (N08CA). Demographics, Assessment of Survivor Concerns (ASC), Trust in Oncologist Scale (TiOS), and health literacy assessment were collected post-treatment via survey. Repeated measures cumulative logistic regression models were used to identify factors associated with under-describing CIPN. RESULTS: Forty-two women completed the survey (response rate 70%). Three and 9 patients were categorized as under-describers at weeks 7 and 10, respectively. Women who were not working (OR = 9.00, 95%CI 1.06-76.15), had lower income (OR = 7.04, 95%CI 1.5-32.99), and displayed higher trust in their oncologist's competence (OR = 1.29, 95%CI 1.03-1.62 for a 0.1-unit increase in score) were more likely to under-describe CIPN symptoms. CONCLUSIONS: This preliminary study identified non-working status, low income and trust in oncologist's competence as potential factors influencing under-description of CIPN to the clinical team. Further work is needed to clarify these relationships and test additional factors.

Where's the wine? Heavy social drinkers show attentional bias towards alcohol in a visual conjunction search task.

BACKGROUND AND AIMS: Research indicates that high consumers of alcohol exhibit attentional bias (AB) towards alcohol-related cues, suggestive of a cognitive mechanism that might drive substance seeking. Many tasks that measure AB (e.g. visual probe, addiction Stroop), however, are limited by their reliance on non-appetitive control cues, the serial presentation of stimuli and their poor internal reliability. The current study employed a visual conjunction search (VCS) task capable of presenting multiple alcoholic and non-alcoholic appetitive cues simultaneously to assess whether social drinkers attend selectively to alcoholic stimuli. To assess the construct validity of this task, we examined whether alcohol consumption and related problems, subjective craving and drinking motives predict alcohol-specific AB. DESIGN AND SETTING: A VCS task was performed in a laboratory setting, which required participants to detect the presence of appetitive alcoholic (wine, beer) and non-alcoholic (cola, lemonade) targets within arrays of matching and non-matching distractors. PARTICIPANTS: Data from 99 participants were assessed [meanage  = 20.77, standard deviation (SD) = 2.98; 64 (65%) females], with 81.8% meeting the threshold for harmful alcohol consumption (meanAUDIT  = 12.89, SD = 5.79). MEASUREMENTS: Self-reports of alcohol consumption and related problems [Alcohol Use Disorders Identification Test (AUDIT)], subjective craving (Alcohol Craving Questionnaire Short Form) and drinking motives (Drinking Motives Questionnaire Short Form) were obtained, and the VCS task measured response times for the correct detection of alcoholic and non-alcoholic targets. FINDINGS: Participants were significantly quicker to detect alcoholic relative to non-alcoholic appetitive targets (P < 0.001, dz  = 0.41), which was predicted positively by AUDIT scores (P = 0.013, R2  = 0.06%). The VCS task achieved excellent reliability (α > 0.79), superior to other paradigms. CONCLUSIONS: The visual conjunction search task appears to be a highly reliable method for assessing alcohol-related attentional bias, and shows that heavy social drinkers prioritize alcoholic cues in their immediate environment.

Reporting of paclitaxel-induced peripheral neuropathy symptoms to clinicians among women with breast cancer: a qualitative study.

PURPOSE: Cases of chemotherapy-induced peripheral neuropathy (CIPN) under-reporting have been sporadically described in the literature, but no studies have focused on actively examining this behavior. Our primary aim was to identify women who purposefully under-reported CIPN, along with reasons for doing so. A secondary aim was to explore factors enabling or hindering communication of CIPN to clinicians. METHODS: Semi-structured interviews were conducted with women with breast cancer who had received paclitaxel in a prospective observational study. The interview guide was developed based on factors hypothesized to influence side effect disclosure to clinicians. Interviews were recorded, transcribed verbatim, and thematically content analyzed. RESULTS: Thirty-four women were interviewed. Three main themes emerged from the analysis: (1) enablers of CIPN reporting (e.g., positive relationship with the oncology team, sufficient appointment time, existence of alternative communication channels to office visits, expectation of CIPN as a side effect); (2) deterrents to CIPN reporting (e.g., perception of need to complete the full course of therapy, fear of treatment discontinuation, lack of knowledge of long-term consequences of CIPN); and (3) balancing survival versus functional impairment due to CIPN. Women prioritized efficacy over CIPN until physical functioning was meaningfully affected. No patients reported purposeful CIPN under-reporting, but three women admitted having considered doing so. CONCLUSIONS: Despite the lack of evidence of CIPN withholding, women considered both the effectiveness and the toxicity of paclitaxel treatment, as well as beliefs about treatment and long-term consequences of CIPN and relationship with the oncology team, when deciding whether to report CIPN symptoms.

Use of a best practice alert linking Clostridioides difficile infection test results to a severity-based treatment order set.

We evaluated provider adherence to practice guidelines for inpatients diagnosed with Clostridoides difficile infection (CDI) before and after implementation of a best practice alert (BPA) linking a positive test result to guideline-based orders. After implementation of the BPA, guideline-based prescribing increased from 39.4% in 2013 to 67.7% in 2016 (P = .014).

Awareness of High Blood Pressure by Nativity Among Black Men: Implications for Interpreting the Immigrant Health Paradox.

INTRODUCTION: Differences in the social determinants of health and cardiovascular health outcomes by nativity have implications for understanding the immigrant health paradox among black immigrants. We aimed to understand whether blood pressure awareness, a precursor to achieving blood pressure control among hypertensive patients, varied by nativity among a sample of black men. METHODS: Data were collected from 2010 through 2014. In 2016, we conducted logistic regression models using data from a large sample of urban-dwelling middle-aged and older black men. All men in the study had measured high blood pressure at the time of enrollment and were also asked whether they were aware of having high blood pressure. Independent variables included demographics, socioeconomic status, access to care, and health-related behaviors. RESULTS: Foreign-born participants were significantly less likely than US-born participants to report awareness of having high blood pressure (P < .001). We observed a significant positive relationship between proportion of life spent in the US and being aware of having hypertension (ß = 0.863; 95% CI, 0.412-1.314; P < .001). This relationship remained after adjusting the model for salient independent variables (ß = 0.337; 95% CI, 0.041-0.634; P = .03). CONCLUSIONS: Difference in hypertension awareness by nativity may skew surveillance estimates used to track health disparities by large heterogeneous racial categories. Our results also indicate that prior health care experience and circumstances should be considered when studying the immigrant health paradox.

Attribution Patterns in Men Who Ejaculate Before They Desire: An Internet Survey.

Men with erectile problems tend to attribute negative sexual experiences to themselves, in contrast with sexually functional individuals who tend to attribute negative experiences to external factors such as the circumstance or relationship. In this study, we investigated attribution patterns in men with premature ejaculation (PE) symptoms-a group not yet investigated in this regard-to determine whether they follow patterns similar to men with erectile problems. Using an Internet-based approach, we compared attribution responses of 289 men with PE symptoms with 433 sexually functional men on a series of five sexual scenarios (two presenting a positive experience and three presenting a negative experience). Men with PE symptoms were more likely to take blame for any negative sexual experience, including ones unrelated to ejaculating quickly, whereas functional men were more likely to attribute blame to the partner, circumstance, or relationship. Men with PE symptoms also took less credit for positive sexual experiences than functional counterparts, attributing them to the partner or circumstance. These results point out similarities across men with a variety of sexual problems, but also raise questions regarding differences between men with erectile problems and men with problems of ejaculating before desired. Several therapeutic strategies are offered.

Duration of immunity in red wolves (Canis rufus) following vaccination with a modified live parvovirus and canine distemper vaccine.

There is growing information available regarding duration of immunity for core vaccines in both domestic and nondomestic species. Vaccination protocols in nondomestic canids have frequently followed guidelines developed for the domestic dog; however, these protocols can be inappropriate for nondomestic canids such as the African wild dog (Lycaon pictus), leaving some animals susceptible to infectious disease and others at risk for contracting vaccine-induced disease. In this study, red wolves (Canis rufus) were vaccinated against canine distemper virus (CDV) and canine parvovirus (CPV) and vaccination titers were followed annually for 3 yr. One hundred percent of wolves developed and maintained a positive titer to CDV for 3 yr and 96.9% of wolves developed and maintained a positive titer to CPV for 3 yr. Seroconversion for canine adenovirus was sporadic. The results of this study support decreasing the frequency of vaccine administration in the red wolf population to a triennial basis.

Capitalizing on Nigeria's demographic dividend: reaping the benefits and diminishing the burdens.

Nigeria is the most populous country in Africa and the eighth most populous country in the world, yet there is a dearth of published research about its demography. As Nigeria enters a period of potentially rapid economic growth due to the increase in the working-age population, it is critical to understand the demographic trends in the country. This paper examines the age and sex composition of Nigeria as it relates to various population characteristics using the two most recent Demographic and Health Surveys for Nigeria (2003 and 2008), as well as some data from the 2006 Census. It also highlights Nigeria's demographic composition and trends using United Nations population projection data, and its implications for the country reaping the demographic dividend. Finally, it draws some conclusions and makes some policy recommendations based on the findings.

Understanding Subgroup Fertility Differentials in Nigeria.

As Nigeria enters a period of potentially rapid economic growth due to the increase in the working age population, it is critical to understand why fertility remains so high there. Nigeria's current total fertility rate (TFR) of 5.5 (0.2 fewer children per woman than the TFR of 5.7 reported in both the 2003 and 2008 NDHS surveys) is projected to continue to decline, but questions remain about whether this decline is inevitable and whether it will continue apace. Regardless, Nigeria's population growth will continue through at least 2050 due to simple population momentum. Other challenges are the persistent and vast fertility differentials; many groups remain above replacement fertility across various social and geographical sub-units of the country. Using data primarily from the 2013 Demographic and Health Survey (DHS), as well as from 2003 and 2008 surveys, we document that many population subgroups and zones of the country are finally beginning to show signs of fertility convergence and decline. Nevertheless, some population subgroups still have higher fertility, especially: Hausa/Fulani/Kanuri women, women who live in the North West geopolitical zone, Muslim and traditionalist women, women who live in poor households, women who have lower levels of education, women who are opposed to family planning, women who marry early, and women who give birth early. In order for the projected decline in the TFR to continue, these subgroups must be highlighted, understood, and targeted with fertility- and poverty-reducing interventions.

Hemorrhagic diathesis in avian species following intramuscular administration of polysulfated glycosaminoglycan.

Polysulfated glycosaminoglycans (PSGAGs) have been used for decades in a variety of species for the management of osteoarthritic pain. However, reports on the use of PSGAGs in avian species are scarce. In domestic cats and dogs, PSGAG injections have caused prolongation of clotting times but are considered to be an efficacious drug with a wide margin of safety. This publication documents four cases of fatal coagulopathies in different avian species (one coraciiforme, two raptors, and one psittacine) following the intramuscular administration of PSGAG. All affected birds received varying dosages and dosing intervals of PSGAG. Three of the four birds experienced fatal hemorrhage into the pectoral muscle, while the fourth bled continuously from the injection site. Only one bird had chronic, severe pre-existing disease; the remainder were being managed for osteoarthritis. This report highlights the importance of species-specific dosing of PSGAG and warrants further investigation into the etiopathogenesis of this process.

Moving across boundaries: migration in South Africa, 1950-2000.

Existing knowledge about historical patterns of black internal migration in South Africa is incomplete, primarily because of the lack of good life course studies as well as the apartheid government's suppression and censoring of data. This article provides a comprehensive picture of historical internal migration patterns with an analysis of a unique individual retrospective life history data set. This sample of the black population, collected in 2000, is the only known nationally representative life history data for South Africa; it includes all residential moves for each individual during his/her lifetime. Various mobility outcomes are analyzed: moves within/across provinces, moves within/across rural and urban areas, forced moves, moves with a nuclear family, and individual moves. The results indicate that migration significantly increased among black South Africans during the last half of the twentieth century, and that this increase began before the Pass Laws were repealed in 1986 and well before the official end of apartheid in 1991 or the first free election in 1994. The timing of this increase in migration rates suggests that migration in defiance of the Pass Laws (albeit a dangerous and desperate proposition) was a way of life for many black South Africans.

Men's and women's migration in coastal Ghana: An event history analysis.

This article uses life history calendar (LHC) data from coastal Ghana and event history statistical methods to examine inter-regional migration for men and women, focusing on four specific migration types: rural-urban, rural-rural, urban-urban, and urban-rural. Our analysis is unique because it examines how key determinants of migration- including education, employment, marital status, and childbearing-differ by sex for these four types of migration. We find that women are significantly less mobile than men overall, but that more educated women are more likely to move (particularly to urban areas) than their male counterparts. Moreover, employment in the prior year is less of a deterrent to migration among women. While childbearing has a negative effect on migration, this impact is surprisingly stronger for men than for women, perhaps because women's search for assistance in childcare promotes migration. Meanwhile, being married or in union appears to have little effect on migration probabilities for either men or women. These results demonstrate the benefits of a LHC approach and suggest that migration research should further examine men's and women's mobility as it relates to both human capital and household and family dynamics, particularly in developing settings.

Does where you live influence what you know? Community effects on health knowledge in Ghana.

This paper examines community effects on health knowledge in a developing country setting. We examine knowledge about the etiology and prevention of child illnesses using a unique 2002 representative survey of communities and households in Ghana. We find that community context matters appreciably, even after adjusting for the anticipated positive effects of an individual's education, literacy, media exposure and household socioeconomic status. The proportion of literate adults and the presence of a market in a community positively influence a person's health knowledge. In other words, even if a person herself is not literate, living in a community with high levels of literacy or a regular market can still positively affect her health knowledge. Our results suggest that social networks and diffusion play a key role in these community effects. In turn, these results offer policy implications for Ghana and sub-Saharan Africa.

Urbanization and fertility: an event-history analysis of coastal Ghana.

In this article, we undertake an event-history analysis of fertility in Ghana. We exploit detailed life history calendar data to conduct a more refined and definitive analysis of the relationship among personal traits, urban residence, and fertility. Although urbanization is generally associated with lower fertility in developing countries, inferences in most studies have been hampered by a lack of information about the timing of residence in relationship to childbearing. We find that the effect of urbanization itself is strong, evident, and complex, and persists after we control for the effects of age, cohort, union status, and education. Our discrete-time event-history analysis shows that urban women exhibit fertility rates that are, on average, 11% lower than those of rural women, but the effects vary by parity. Differences in urban population traits would augment the effects of urban adaptation itself Extensions of the analysis point to the operation of a selection effect in rural-to-urban mobility but provide limited evidence for disruption effects. The possibility of further selection of urbanward migrants on unmeasured traits remains. The analysis also demonstrates the utility of an annual life history calendar for collecting such data in the field.

Community and household determinants of water quality in coastal Ghana.

Associations between water sources, socio-demographic characteristics and household drinking water quality are described in a representative sample of six coastal districts of Ghana's Central Region. Thirty-six enumeration areas (EAs) were randomly chosen from a representative survey of 90 EAs in rural, semi-urban and urban residence strata. In each EA, 24 households were randomly chosen for water quality sampling and socio-demographic interview. Escherichia coli per 100 ml H2O was quantified using the IDEXX Colilert system and multi-stage regression models estimated cross-sectional associations between water sources, sanitation and socio-demographic factors. Almost three quarters, 74%, of the households have > 2 E. coli /100 ml H2O. Tap water has significantly lower E. coli levels compared with surface or rainwater and well water had the highest levels. Households with a water closet toilet have significantly lower E. coli compared with those using pit latrines or no toilets. Household size is positively associated, and a possessions index is negatively associated, with E. coli. Variations in community and household socio-demographic and behavioural factors are key determinants of drinking water quality. These factors should be included in planning health education associated with investments in water systems.

Problem behavior interventions for young children with autism: a research synthesis.

This paper provides a summary of research on behavioral interventions for children with autism 8 years of age or younger published between 1996 and 2000. The analysis is divided into four sections: (1) emerging themes in the technology of behavior support, (2) a review of existing research syntheses focusing on behavioral interventions, (3) a new literature review of current pertinent research, and (4) an evaluative discussion of the synthesis results and the field's future needs to develop effective behavioral interventions for young children with autism. The authors offer recommendations for strengthening the existing research base and advancing behavioral technology to meet the needs of the defined target population.

Forced migration and mortality

Millions of people uprooted by war, famine or natural disasters are on the move in countries across the world, seeking shelter, food and other necessities of life. Using case studies from Cambodia, Kosovo, North Korea and Rwanda, a new collection of papers from the National Research Council examines mortality patterns during recent forced migrations and suggests how these patterns may change during this century.