A systematic review of literature to compare the fertility desires among HIV positive women and cancer survivors

Background. Decision-making on reproductive issues is influenced by an interplay of individual, familial, medical, religious and socio-cultural factors. Women with chronic medical illnesses such an HIV infection and cancers are often fraught with decisional conflicts about child-bearing. With increase in the incidence of these illnesses as well as improvement in survival rates, there is a need to pay due attention to the issue of reproductive decision-making. Examining the prevalence and determinants of fertility desires in the two groups in a comparative manner would help bring to light perception of the medical community and the society in general on the two illnesses and the issue of motherhood. ^ Methods. Systematic literature search was undertaken using databases such as MEDLINE (PubMED), MEDLINE (Ovid), PsycInfo and Web of Science. Articles published in English and English language abstracts for foreign articles were included. Studies that explore ‘fertility desires’ as the outcome variable were included. Quantitative studies which have assessed the prevalence of fertility desires as well as qualitative studies which have provided a descriptive understanding of factors governing reproductive desires were included in the review. ^ Results. A total of 34 articles (29 studies examining HIV and 5 studies examining cancer in relation to fertility desires). Variables such as age, stage of illness, support of spouse and family, perception of the medical community and one’s own view of motherhood were key determinants among both groups. ^ Conclusion. There is a need for uniform, systematic research in this field. It is important that health care workers acknowledge these decisional conflicts, include them as part of the medical care of these patients and provide guidance with the right balance of information, practicality and compassion.^

Hearing aid use and adherence: A systematic review of the literature concerning the socioeconomic and psychological influences on hearing aid use and barriers to use

The current hearing health situation in the United States does not provide adequate support to individuals with hearing loss. More research is needed to give more support to these individuals. By conducting a systematic review of relevant literature from 1990 to present, I identified many factors that influence an individual's use of hearing aids. There are two research questions in this study: 1. Does the provision of screening and access to hearing aids decrease the negative effects of hearing loss? 2. Why is it difficult for people with hearing loss to adapt to and use hearing aids? The population of interest was adults (>18 years old) with hearing loss. Factors that influenced use of hearing aids for this population included age, gender, socioeconomic status, education, perceived severity of hearing loss, cost of hearing aids, screening, perceived benefit, stigmatization, perceived control, cognitive capability, personality, and social support. Research suggests that more efficient screening of at-risk individuals and the provision of better access to these individuals would prevent many of the negative effects of hearing loss.^

THE ASSOCIATION BETWEEN CANCER-RELATED-FATIGUE, RESPONSE TO FATIGUE TREATMENT, AND CYTOKINES AND THEIR RECEPTORS, IN PATIENTS WITH ADVANCED CANCER

Background: Inflammation is implicated in the development of cancer related fatigue (CRF). However there is limited literature on the mediators of inflammation (namely), cytokines and their receptors, associated with clinically significant fatigue and response to treatment. Methods: We reviewed 37 advanced cancer patients with fatigue (≥4/10), who participated in two Randomized Controlled Trials, of anti-inflammatory agents (Thalidomide and Dexamethasone) for CRF. Responders showed improvement in FACIT-F subscale at the end of study (Day 15). Baseline patient characteristics and symptoms were assessed by FACIT-F, ESAS; serum cytokines [IL-1β and receptor antagonist (IL-1RA), IL-6, IL-6R, TNF-α and sTNF-R1 and R2, IL-8, IL-10, IL-17] levels measured by Luminex. Data were analyzed using principal component analysis (PCA) [reporting cumulative variance (variance) for the first four components] to determine their association with fatigue and response to treatment. Results: Females were 54%. Mean (SD) was as follows for age, 61(14); baseline FACIT (F) scores, 21.4(8.6); ESAS Fatigue item, 6.5(1.9); and FACIT-F change, 6.4(9.7); ESAS (fatigue) change, -2 (2.41). Baseline median in pg/mL for IL-6, TNF-α, IL-1β were 31.9; 18.9; 0.55, respectively. Change in IL-6 negatively correlated with change in FACIT-F scores (p=0.02). Baseline CRF (FACIT-F score) was associated with IL-6, IL-6R and IL-17, Variance = 78% whereas IL-10, IL-1RA, TNF-α and IL-1β were associated with improvement of CRF, Variance=74%. Conversely, IL-6 and IL-8 were associated with no improvement or worsening of CRF, Variance= 93%. Conclusions: Change in IL-6 negatively correlated with change in FACIT-F scores. IL-6, IL-6R and IL-17 are associated with CRF while IL-6 and IL-8 were associated with no improvement of CRF. Further studies are warranted confirm our findings.

Response to chemotherapy, recurrence and survival in advanced-stage ovarian, fallopian tube and primary peritoneal cancer patients with non-Ashkenazi Jewish BRCA mutations, compared to those without

Objectives. Previous studies have shown a survival advantage in ovarian cancer patients with Ashkenazi-Jewish (AJ) BRCA founder mutations, compared to sporadic ovarian cancer patients. The purpose of this study was to determine if this association exists in ovarian cancer patients with non-Ashkenazi Jewish BRCA mutations. In addition, we sought to account for possible "survival bias" by minimizing any lead time that may exist between diagnosis and genetic testing. ^ Methods. Patients with stage III/IV ovarian, fallopian tube, or primary peritoneal cancer and a non-Ashkenazi Jewish BRCA1 or 2 mutation, seen for genetic testing January 1996-July 2007, were identified from genetics and institutional databases. Medical records were reviewed for clinical factors, including response to initial chemotherapy. Patients with sporadic (non-hereditary) ovarian, fallopian tube, or primary peritoneal cancer, without family history of breast or ovarian cancer, were compared to similar cases, matched by age, stage, year of diagnosis, and vital status at time interval to BRCA testing. When possible, 2 sporadic patients were matched to each BRCA patient. An additional group of unmatched, sporadic ovarian, fallopian tube and primary peritoneal cancer patients was included for a separate analysis. Progression-free (PFS) & overall survival (OS) were calculated by the Kaplan-Meier method. Multivariate Cox proportional hazards models were calculated for variables of interest. Matched pairs were treated as clusters. Stratified log rank test was used to calculate survival data for matched pairs using paired event times. Fisher's exact test, chi-square, and univariate logistic regression were also used for analysis. ^ Results. Forty five advanced-stage ovarian, fallopian tube and primary peritoneal cancer patients with non-Ashkenazi Jewish (non-AJ) BRCA mutations, 86 sporadic-matched and 414 sporadic-unmatched patients were analyzed. Compared to the sporadic-matched and sporadic-unmatched ovarian cancer patients, non-AJ BRCA mutation carriers had longer PFS (17.9 & 13.8 mos. vs. 32.0 mos., HR 1.76 [95% CI 1.13–2.75] & 2.61 [95% CI 1.70–4.00]). In relation to the sporadic- unmatched patients, non-AJ BRCA patients had greater odds of complete response to initial chemotherapy (OR 2.25 [95% CI 1.17–5.41]) and improved OS (37.6 mos. vs. 101.4 mos., HR 2.64 [95% CI 1.49–4.67]). ^ Conclusions. This study demonstrates a significant survival advantage in advanced-stage ovarian cancer patients with non-AJ BRCA mutations, confirming the previous studies in the Jewish population. Our efforts to account for "survival bias," by matching, will continue with collaborative studies. ^

Pediatric obesity: Managed care collaborating with providers to improve diagnosis and treatment

Child overweight and obesity reaches across ethnic, cultural, socioeconomic and regional barriers. It must be assessed, diagnosed and treated to help families make sustainable behavior changes. Treatment recommendations have been made to address pediatric overweight and obesity. They include screening for risk factors, monitoring BMI trends and educating patients and families to make small sustainable changes. Health insurance companies can play a meaningful role in supporting and facilitating provider education and behavior change to diagnose, treat and prevent pediatric overweight and obesity.^ The aims of this thesis were: (1) Describe a disease management program that uses evidence-based practices to create provider behavior change related to pediatric obesity screening, diagnosis and treatment. (2) Identify ways to improve the implementation of the program based on the perceptions of participating clinicians.^ A literature review was completed to evaluate current recommendations for screening and treating pediatric obesity using the Ovid data base. The evidenced-based recommendations were compared against the practices of the Healthy Lifestyles Program (HeLP). The literature confirmed that HeLP is following evidence-based recommendations for assessment, diagnosis and treatment of pediatric obesity.^ A Children’s Mercy Family Health Partners focus group was convened to create a provider survey. The goals of the survey were to assess providers’ perception of the Healthy Lifestyles Program (HeLP). The survey was sent out through email using Survey Monkey. All survey responses were anonymous. The survey was sent to a total of 80 providers who had completed HeLP. Twenty-five percent responded. The survey results were evaluated to make recommendations for HeLP.^ Results of the survey included motivating factors for participation in HeLP. Concern about the increasing prevalence of pediatric obesity was a frequent motivator for participation. Provider barriers to obesity diagnosis were evaluated. Lack of time during clinic visits a frequent barrier to obesity diagnosis. ^ In conclusion several recommendations for the HeLP were made based on survey results. It is recommended that the program evaluate methods and tools for facilitating effective weight management follow up visits. Promotional materials should highlight the increasing prevalence of pediatric obesity when advertising HeLP. These recommendations will be used to refine the current Healthy Lifestyles Program.^

Thrombolytic therapy for acute myocardial infarction: A cohort study to evaluate a selective approach to invasive diagnosis and therapy. The Corpus Christi Heart Project

Coronary perfusion with thrombolytic therapy and selective reperfusion by percutaneous transluminal coronary angioplasty (PTCA) were examined in the Corpus Christi Heart Project, a population-based surveillance program for hospitalized acute myocardial infarction (MI) patients in a biethnic community of Mexican-Americans (MAs) and non-Hispanic whites (NHWs). Results were based on 250 (12.4%) patients who received thromobolytic therapy in a cohort of 2011 acute MI cases. Out of these 107 (42.8%) underwent PTCA with a mean follow-up of 25 months. There were 186 (74.4%) men and 64 (25.6%) women; 148 (59.2%) were NHWs, 86 (34.4%) were MAs. Thrombolysis and PTCA were performed less frequently in women than in men, and less frequently in MAs than in NHWs.^ According to the coronary reperfusion interventions used, patients were divided in two groups, those that received no-PTCA (57.2%) and the other that underwent PTCA (42.8%) after thrombolysis. The case-fatality rate was higher in no-PTCA patients than in the PTCA (7.7% versus 5.6%), as was mortality at one year (16.2% versus 10.5%). Reperfusion was successful in 48.0% in the entire cohort and (51.4% versus 45.6%) in the PTCA and no-PTCA groups. Mortality in the successful reperfusion patients was 5.0% compared to 22.3% in the unsuccessful reperfusion group (p = 0.00016, 95% CI: 1.98-11.6).^ Cardiac catheterization was performed in 86.4% thrombolytic patients. Severe stenosis ($>$75%) obstruction was present most commonly in the left descending artery (52.8%) and in the right coronary artery (52.8%). The occurrence of adverse in-hospital clinical events was higher in the no-PTCA as compared to the PTCA and catheterized patients with the exception of reperfusion arrythmias (p = 0.140; Fisher's exact test p = 0.129).^ Cox regression analysis was used to study the relationship between selected variables and mortality. Apart from successful reperfusion, age group (p = 0.028, 95% CI: 2.1-12.42), site of acute MI index (p = 0.050) and ejection-fraction (p = 0.052) were predictors of long-term survival. The ejection-fraction in the PTCA group was higher than (median 78% versus 53%) in the no-PTCA group. Assessed by logistic regression analysis history of high cholesterol ($>$200mg/dl) and diabetes mellites did have significant prognostic value (p = 0.0233; p = 0.0318) in long-term survival irrespective of treatment status.^ In conclusion, the results of this study support the idea that the use of PTCA as a selective intervention following thrombolysis improves survival of patients with acute MI. The use of PTCA in this setting appears to be safe. However, we can not exclude the possibility that some of these results may have occurred due to the exclusion from PTCA of high risk patients (selection bias). ^

Pediatric motivational interviewing to address obesity and overweight

Not only are obesity and overweight associated with a myriad of medical and psychological concerns in childhood, but these health problems can persist even into adulthood. With the obvious need for better approaches in tackling childhood obesity and overweight and the strong evidence of motivational interviewing's effectiveness in the adult population, it is likely that an updated review will provide a more complete picture of the application of motivational interviewing in the pediatric population. The objective of this review is whether or not motivational interviewing will be instrumental in promoting factors that help in reducing the number of children who are or become overweight or obese. A literature search was completed that identified ten studies that incorporated MI as an intervention. Studies focused on either behavior health changes like increased physical activity, improved nutrition, or reducing parameters of weight like BMI or body composition. Three out of the 10 articles were still in progress and no results were provided. Five studies were able to achieve statistical significance in health benefits to control childhood overweight and obesity. Results revealed the overall feasibility of applying MI in the pediatric overweight and obese population, but the scarce number of studies limits conclusions about its efficacy. Therefore, additional scientific evidence is necessary to fully understand MI's role in affecting behavior changes in this population.^

Returning Texas Senate Bill 530 back to 1100 Congress Avenue: The need for effective surveillance reporting of student fitness levels to Texas house representatives

Every Texas student is required to complete the FITNESSGRAM fitness assessment under legislation outlined in Senate Bill 530. This study described cardiovascular, body mass index (BMI), and overall fitness levels of students (grades 3–12) in the state of Texas during the 2009–2010 school year, and provides examples of how to effectively present results to Texas House Representatives using three unique health communication strategies. Given the Texas legislature mandates FITNESSGRAM collection yet did not require reporting according to their election district, the data were aggregated to 150 Texas House Representative Districts by sex and grade category to facilitate effective fitness data dissemination. Fitness data were also analyzed with results from the Texas Assessment of Knowledge and Skills (TAKS) to provide insight into potential relationships between fitness and academic achievement. ^ The majority of students in Texas need improvement on at least 1 fitness assessment. In general, female students have superior fitness in elementary and middle school but the fitness edge is erased by high school. Female cardiovascular fitness deteriorates faster from elementary to high school compared to male students. Female BMI deteriorates and male BMI improves from elementary to high school. Cardiovascular fitness and overall fitness decreases from elementary to high school for both male and female students. ^ Student fitness was significantly and strongly independently correlated with academic achievement. Further analysis showed that House Representatives with TAKS scores in the top quartile consistently showed superior fitness. Small significant partial correlations remain between fitness and TAKS assessment after controlling for socioeconomic status. In general, correlations were stronger between female BMI and TAKS assessment compared to male students. Cardiovascular fitness was significantly correlated with TAKS assessment for both genders. This paper supports student fitness as a confounder in the relationship between socioeconomic status and academic achievement. Plus, student fitness has a strong correlation with academic that deserves further exploration. ^ Senate Bill 530 fails to organize and implement a health communication strategy that effectively disseminates the health data collected to stakeholders of interest. The lack of a vital health communication strategy results in an incomplete student health surveillance system. This paper outlines three unique strategies tailored to legislators. It is important to disseminate health information using a variety of methods tailored to your targeted audience. The use of interactive mapping technology presented (GIS) uses new technology that has the potential to effectively reach a large audience.^

The Children’s Bureau’s Role in Promoting Parent Engagement and Family Support: A Brief History and Current Efforts

Over the years, federal child welfare policy has supported parent engagement and family support strategies through various Children’s Bureau funded state formula grant programs, research and demonstration discretionary grants, and technical assistance. This article highlights programs funded by two federal laws, Promoting Safe and Stable Families and the Child Abuse Prevention and Treatment Act, and Children’s Bureau’s efforts to test innovations and disseminate knowledge about promising and evidence-based practices regarding parent engagement and family support. The article begins with a brief legislative history and then describes several grant programs that are supported by the legislation. The article concludes with lessons learned and a discussion of the new opportunities for system changes through the Title IV-E Waiver Demonstration projects.