Prevalence of Risk Factors and Lifestyle Choices Associated with Increased Cancer in Participants in Trinidad and Tobago

In the Caribbean, cancer has been identified as the second leading cause of death and has created an immense challenge for healthcare services and expenses throughout the region. According to the World Health Organization (WHO), cancer incidence will increase by 58%, from 2015 to 2035, and cancer mortality throughout this period will increase by 67%. This research project outlined the socio-demographic risk factors and lifestyle choices known to increase the risk of developing various forms of cancer that are present in the population of Trinidad & Tobago. Knowledge of these risk factors will allow members of the public to evaluate their lifestyles. Subsequently, they can determine if they are putting themselves at risk for certain malignancies, since different types of cancers have specific socio- demographic factors and lifestyle choices associated with them.

Perceived discrimination and well-being among unauthorized Hispanic immigrants: The moderating role of ethnic/racial group identity centrality.

OBJECTIVES: We investigated the association between perceived ethnic discrimination with psychological well-being and life satisfaction among a community sample of unauthorized Hispanic immigrants in the United States. We also assessed whether ethnic/racial group identity centrality moderated this relationship. METHOD: A community sample of self-reported unauthorized Hispanics (N = 140) completed questionnaires assessing perceived ethnic discrimination, ethnic/racial group identity centrality, psychological well-being, and life satisfaction. RESULTS: Discrimination negatively predicted psychological well-being and life satisfaction, and ethnic/racial group identity centrality moderated these relationships. High ethnic/racial group identity centrality reduced the association of discrimination with psychological well-being and life satisfaction. Ethnic/racial identity centrality lent psychological protection for those who reported higher levels of discrimination. CONCLUSION: Ethnic discrimination is a salient stressor for unauthorized Hispanic immigrants. Yet high ethnic/racial group identity centrality may protect these individuals from the negative effects of discrimination by providing a sense of belonging, acceptance, and social support in the face of rejection. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Coping Styles and Depression Among Undocumented Hispanic Immigrants.

This cross-sectional study examined coping strategies and their relationship with depression among undocumented Hispanic immigrants. A community sample of 122 self-identified undocumented Hispanics filled out questionnaires measuring coping and depression. The authors categorized coping strategies as problem-focused, active-emotional, or avoidant-emotional. Findings indicated that coping through "prayer and meditation" (problem-focused), "get comfort from someone" (active-emotional), and "see bad things positively" (active-emotional) were more frequently used by undocumented Hispanics. Contrary to past research and predictions, problem-focused and active-emotional coping were both positively related to depression. What is more, problem-focused coping accounted for additional variance of depression above and beyond active-emotional coping. The insoluble nature of many of the problems faced by undocumented immigrants may explain the counterintuitive finding that as problem-focused and active-emotional coping increased, so too did depression.

Surgeon-controlled ultrasound-guided core biopsies in the breast--a prospective study and a new use for surgeons in the clinic.

AIMS: This study was to assess the accuracy of a surgeon performing ultrasound-guided core biopsies of the breast. METHODS: A prospective audit was carried out of 555 patients who underwent an ultrasound-guided core biopsy for a discrete solid mass [under 30 mm maximum diameter] by a single surgeon. The surgeon controlled the core biopsy needle and an ultrasonographer or radiologist provided the imaging with ultrasound. RESULTS: The accuracy of the surgeon in sampling the lesions [n = 555 core biopsies] was independent of the size of the lesion. This saved 272 patients having unnecessary surgery for a benign lesion. CONCLUSION: The practical involvement by the surgeon in breast ultrasound and performing core biopsies has reduced pressure on the breast radiologists, reduced the number of diagnostic surgical open biopsies and made the clinic more interesting for the surgeon. With increased surgical confidence in breast ultrasound, most small and impalpable cancers have pre-operative skin marking rather than X-ray wire localization prior to undergoing wide local excision. Trainee breast surgeons should be encouraged to learn breast ultrasound and core biopsies.

Missed lumbar transverse process fractures in a high school football player.

OBJECTIVE: To discuss the case of a football player who had suffered a transverse process fracture of the lumbar spine that was overlooked on initial chiropractic and medical examination. CLINICAL FEATURES: A 17-year-old male football player had been speared in the back by another player. He reported severe initial pain that caused him to fall to the ground, and there was a moderate degree of pain at the time of his chiropractic examination 1 week after injury. INTERVENTION AND OUTCOME: Initial chiropractic treatment consisted of spinal manipulation to the lumbar spine. Follow-up care consisted of lumbar spine radiographs that showed evidence of a lumbar transverse process fracture at 2 levels. The boy was referred to his medical doctor, who was not convinced of the presence of a fracture and returned him to play. A computed tomography scan was subsequently performed; this confirmed fractures of the transverse processes of L2 and L3. The patient was precluded from contact sports for 4 weeks. Chiropractic care 3 weeks after injury included physiotherapy and drop table mobilization to the sacroiliac joints. The patient returned to play 4 weeks after the injury. CONCLUSION: Transverse process fractures commonly occur secondary to blunt trauma in contact sports such as football. With high-force direct trauma, radiographs should be performed to rule out fracture before returning the athlete to play or commencing spinal manipulation.

The N-terminal domain of human topoisomerase IIalpha is a DNA-dependent ATPase.

We have constructed clones encoding N-terminal fragments of human DNA topoisomerase IIalpha. We show that the N-terminal domain (approximately 50 kDa) has an intrinsic ATPase activity that can be stimulated by DNA. The enzyme obeys Michaelis-Menten kinetics showing a approximately 6-fold increase in kcat in the presence of DNA. Cross-linking studies indicate that the N-terminal domain is a dimer in the absence and presence of nucleotides. Using site-directed mutagenesis, we have identified the catalytic residue for ATP hydrolysis as Glu86. Phosphorylation of the N-terminal domain with protein kinase C does not affect the ATPase activity. The ATPase domain of human topoisomerase IIalpha shows significant differences from its counterpart in DNA gyrase and we discuss the mechanistic implications of these data.

Prediction of hospital failure: a post-PPS analysis.

This study investigates the ability of discriminant analysis to provide accurate predictions of hospital failure. Using data from the period following the introduction of the Prospective Payment System, we developed discriminant functions for each of two hospital ownership categories: not-for-profit and proprietary. The resulting discriminant models contain six and seven variables, respectively. For each ownership category, the variables represent four major aspects of financial health (liquidity, leverage, profitability, and efficiency) plus county marketshare and length of stay. The proportion of closed hospitals misclassified as open one year before closure does not exceed 0.05 for either ownership type. Our results show that discriminant functions based on a small set of financial and nonfinancial variables provide the capability to predict hospital failure reliably for both not-for-profit and proprietary hospitals.

Micro-trabeculae, macro-plaques or mini-basement membranes in human term fetal membranes?

Immunocytochemical confocal laser scanning microscopy and ultrastructural analysis, including immunoelectron microscopy, reveals the distribution of structures in human term amniochorion similar in some respects to basement membranes but with unusually restricted dimensions. On the basis of their immunoreactivity, these trabecular structures, found on the fibroblast layer side of the spongy layer of human term amniochorion and adjacent reticular layer, have been shown to contain type IV collagen, laminin, and nidogen. The origin of these components may be from primitive epithelial structures which pumped fluid into the lakes that eventually coalesced to form the extraembryonic coelom separating the extraembryonic somatic mesoderm from the extraembryonic splanchnic mesoderm. Such a theory of their origin might link them with the mysterious 'cellular layer', a single-cell-thick layer of cells which is usually no longer present in fetal membranes at term. The similarity in composition but not in size of these structures to anchoring plaques for type VII collagen is possible support for the view that these structures are integrators of extracellular matrix polymeric proteins. The 'pseudobasement' membrane associated with the trophoblast layer, on investigation, appears to be typical by six criteria. 'Coiled' fibrous structures in the extracellular matrix of the spongy layer may aid adjustments under tension at this shear surface by a detachable 'Velcro' or 'two spring' fastening system. The coils are rich in fibronectin. The suggestion is made that the compact layer is a giant lamina reticularis associated with the amniotic epithelial basement membrane.

Indicators of hospital closure under PPS and Blue Cross/Blue Shield cost-based reimbursements.

Using an adaptation of discriminant analysis on a sample of 120 hospitals in the state of Alabama, this paper illuminates characteristics of hospitals closed due to financial failure under PPS and cost-based Blue Cross/Blue Shield reimbursement systems. The results show high debt levels, poor revenue and cost ratios, poor utilization management, and the inability to collect effectively on outstanding accounts in the year prior to hospital failure.

Confocal and conventional immunofluorescent and immunogold electron microscopic localization of collagen types III and IV in human placenta.

Confocal and conventional indirect immunofluorescence and immunogold electron microscopic methods were applied to examine the distribution of extracellular matrix constituents (collagens types III and IV) in the villi of immature and term human placentae. The immunofluorescence study revealed that collagen type III is more distinct in the villous stroma of term placenta as compared with that of the first trimester. Collagen type IV was detected mainly in endothelial and epithelial basement membranes and interestingly also to a certain extent in the stroma. Results obtained using immunoelectron microscopy support the proposal that collagen types III and IV are characteristic of stromal and basement membranes, respectively. Stromal collagen type IV is apparently localized in association with the interstitial types of collagen (I and III), in the villous stroma of term placenta.

Interferon alfa-n1 (Wellferon) in juvenile onset recurrent respiratory papillomatosis: results of a randomized study in twelve collaborative institutions.

Sixty-six patients with clinically severe juvenile-onset recurrent respiratory papillomatosis (RRP) were entered into a 12-month randomized crossover study to evaluate interferon alpha-n1 Wellferon (WFN) as an adjuvant to CO2 laser surgical excision. Eligibility required disease onset to be before age 16, and an endoscopic excision requirement of at least three operations in the 6 months immediately prior to entry. Patients were randomized to Observation versus WFN at a dose of 5 MU/m2 daily for 28 days and three times weekly for 5 months. The patient groups were comparable in extent of disease at entry. Total extent of disease was determined by a composite score derived from the number of diseased anatomic sites and extent of surface area and lumen encroachment present at each site. Standard endoscopic excisions were performed every 2 months and clinical courses compared on a basis of composite scores determined at each endoscopy. Statistically significant improvement occurred in the patient group which received WFN. We conclude that interferon alpha n-1 is an effective adjuvant to surgery in RRP management.

Complicated frontal sinusitis: evaluation and management.

The diagnosis and management of complicated cases of frontal sinusitis are challenging problems. Unacceptable mortality and morbidity from delay in diagnosis and treatment must be weighed against the early performance of deforming surgical procedures. Many of these patients require prolonged hospitalization for intravenous antibiotic therapy. The assessment of the optimal time course for such therapy has been difficult. Six illustrative cases of frontal sinusitis, complicated by intracranial suppuration, osteomyelitis, and/or bone erosion, are presented. The use of CT, bone, and gallium scans in the diagnosis of complications--and in the timing of antibiotic therapy and surgical intervention--are discussed. Guidelines are formulated for the evaluation and treatment of complicated frontal sinusitis.

The extended pectoralis major flap in head and neck reconstruction.

Historically, major extirpative surgery for control of head and neck cancer developed well in advance of reconstructive procedures that could provide acceptable functional and cosmetic rehabilitation. Introduction of cutaneous axial and random flaps--followed more recently by the description of musculocutaneous flaps--represented major advances in reconstructive techniques.

Management of giant cystic hygromas in infants.

Giant cystic lymphangioma is a rare lesion that presents major therapeutic challenges. Four infants presented in the first weeks of life with diffuse cysts in the neck. The tongue was involved in three, the mediastinum in one, and the pharynx and supraglottic larynx in two. These lesions are characterized by hundreds of cysts that infiltrate in and around muscles, nerves, and vessels. Complete excision is not possible without damaging the normal structures. All four infants initially had partial removal with unroofing and drainage of the remaining cysts and temporary tracheostomy to protect the airway. One infant died from a thrombosed sagittal sinus. She had severe venous congestion of the head and neck postoperatively which may have been caused by an overzealous attempt to remove all of the cysts. The other three have required nine additional operations for removal of recurrent neck cysts (one operation), removal of mediastinal cysts (one operation), partial glossectomy (three operations), and laser excision of lymphangiomas of the pharynx and supraglottic larynx (four operations). Two patients have required partial glossectomy which should be performed early to protect the airway, to allow normal speech development, and to prevent malocclusion and prognathism from constant pressure of the tongue against the teeth. Removal of wedges of tissue from each side and from the center of the dorsum of the tongue reduces bulk with minimal risk to the lingual arteries and nerves. Recurrent tongue enlargement is common and can be treated by repeated partial glossectomy. Lymphangiomatosis of the pharynx and supraglottic larynx is difficult to treat. The carbon dioxide laser allows very precise excision of individual cysts with minimal drainage to adjacent mucosa, but in our limited experience it has not prevented recurrence. Despite the extensive nature of these lesions, the impossibility of complete excision, and the need for multiple operations, the long-term results in the three surviving patients have been satisfactory. Asymmetry of the neck and face due to lymphedema tends to improve with time. All three children have an acceptable appearance and normal speech for their ages.

Primary tumors of the facial nerve: diagnosis and management.

Benign primary tumors of the facial nerve are frequently misdiagnosed because of variable and subtle clinical manifestations. Three such cases of facial nerve neuroma seen in the past 3 years will be presented. Difficulties in patient assessment including the lack of specificity for topographic testing, as well as the capricious behavior of the facial nerve in these patients will be discussed. The efficacy of diagnostic techniques presently available and in use including computerized tomography and electrodiagnostic studies will be discussed. Diagnosis of these tumors might generally be thought to be straightforward and easier with the advent of new diagnostic techniques, but this has, in fact, not been the case. Techniques for removal and repair will be presented. The combined approach utilizing the mastoid and middle fossa will be presented.

Myocutaneous flaps for challenging problems in head and neck reconstruction.

We treated three cases of recurrent head and neck carcinoma viewed as challenging reconstructive problems because of the extent of the extirpative surgery necessary and the substantial risk of complications that would be associated with previous treatment techniques. In each case, the versatility of myocutaneous flaps is illustrated. In case 1, a double-paddle pectoralis major flap was employed. In case 2, with an exposed infected carotid artery and a failed pectoralis major flap, reconstruction was accomplished by using an ipsilateral trapezius myocutaneous flap. In case 3, for reconstruction of the pharynx with a low esophagostoma, a double-paddle pectoralis major and split-thickness skin graft were used.

Foreign-body aspiration. Potential misdiagnosis.

Clandestine aspiration of foreign bodies lodged high in tracheal airway can mimic subglottic croup. Although this relationship is emphasized in textbooks of otolaryngology, documentation in the recent literature is lacking. This report underscores our awareness of a potentially lethal diagnosis masquerading as a more benign viral infection of the laryngotracheal airway.