FACTORS INFLUENCING THE PATTERNS OF PHYSICIAN VISITS TO NURSING HOME RESIDENTS

This study was designed to identify some of the factors related to patterns of physician visits to nursing home residents. The relationship of ten resident and organizational characteristics to patterns of physician visits was investigated through secondary analysis of data abstracted from the 1973-74 National Nursing Home Survey of the National Center for Health Statistics. The study sample was composed of 11,135 of the 19,013 nursing home residents who participated in the survey.^ The analytic results revealed that all ten variables had a statistically significant relationship to patterns of physician visits, mainly due to the large sample size. The degrees of association between the variables, measured by the Cramer's V statistic, ranged from moderate to very weak.^ Certification status of the nursing home under Medicare and/or Medicaid was shown to be most strongly related to patterns of physician visits, followed by primary source of payment for nursing home care, and residence prior to nursing home admission. Several variables thought to be related to patterns of physician visits were found to have a very weak relationship: age of the resident, marital status, length of stay, primary diagnosis, number of chronic conditions, activities of daily living status, and levels of care.^ In order to get a more precise picture of the relative influence of certification status and primary source of payment when the other variables were statistically controlled, these two variables were combined into a single variable. The results revealed that the combined effects of certification status and primary source of payment were sustained, regardless of differences in the residents' personal, utilization, and health status characteristics, and the levels of care that they received. The results also indicated that the five groups created by combining the two variables differed in patterns of physician visits. For example, private pay residents in intermediate care facilities (ICF's) and non-certified facilities were more likely to receive unscheduled visits than private pay residents in skilled nursing homes (SNH's), residents in SNH's supported by Medicare or Medicaid, and residents in ICF's supported by Medicaid. ^

Cross-sectional study examining the role of acculturation in self-reported hypertension among Mexican Americans in Harris County, Texas

The objective of this secondary analysis was to examine the role of acculturation and self-reported hypertension in a Mexican-American cohort from Harris County, Texas. Specifically, we examined the acculturation measures of language-based Bidimensional Acculturation Scale (BAS), nativity, and length of United States (U.S) residency. Of 6,229 participants aged 40 and older, 38.0% self-reported hypertension at baseline. ^ Multiple logistic regression was used to estimate the prevalence odds ratios (pOR) for the association of each acculturation measure and hypertension while controlling for confounding. When adjusted for age, gender, body mass index, number of comorbidities, and family history of hypertension, U.S.-born participants were 1.37 times more likely to report having hypertension compared to Mexico-born participants (95% CI: 1.21, 1.55). Similarly, immigrants residing in the U.S. for more than 20 years had an adjusted pOR of 1.40 (95% CI: 1.16, 1.70) as compared to immigrants living in the U.S. for less than 10 years. ^ In conclusion, individuals who were born in the U.S. or emigrated to the U.S. over 20 years ago were more likely to report having hypertension compared to individuals born in Mexico or compared to those who emigrated more recently to the U.S. This study will contribute to the literature in demonstrating the need for more initiatives in prevention of cardiovascular disease, specifically hypertension, in the acculturating Mexican American population.^

Prevalence of symptoms of neurotoxicity and potential occupational pesticide and solvent exposures among high school students in Starr County, Texas: A pilot study

Numerous harmful occupational exposures affect working teens in the United States. Teens working in agriculture and other heavy-labor industries may be at risk for occupational exposures to pesticides and solvents. The neurotoxicity of pesticides and solvents at high doses is well-known; however, the long term effects of these substances at low doses on occupationally exposed adolescents have not been well-studied. To address this research gap, a secondary analysis of cross-sectional data was completed in order to estimate the prevalence of self-reported symptoms of neurotoxicity among a cohort of high school students from Starr County, Texas, a rural area along the Texas-Mexico border. Multivariable linear regression was used to estimate the association between work status (i.e., no work, farm work, and non-farm work) and symptoms of neurotoxicity, while controlling for age, gender, Spanish speaking preference, inhalant use, tobacco use, and alcohol use. The sample included 1,208 students. Of these, the majority (85.84%) did not report having worked during the prior nine months compared to 4.80% who did only farm work, 6.21% who did only non-farm work, and 3.15% who did both types of work. On average, students reported 3.26 symptoms with a range from 0-16. The most commonly endorsed items across work status were those related to memory impairment. Adolescents employed in non-farm work jobs reported more neurotoxicity symptoms than those who reported that they did not work (Mean 4.31; SD 3.97). In the adjusted multivariable regression model, adolescents reporting non-farm work status reported an average of 0.77 more neurotoxicity symptoms on the Q16 than those who did not work (P = 0.031). The confounding variables included in the final model were all found to be factors significantly associated with report of neurotoxicity symptoms. Future research should examine the relationship between these variables and self-report of symptoms of neurotoxicity.^

Spit & lies: Does social desirability predict smoking cessation success?

This study examines the role of socially desirable responding (SDR) on smoking cessation program success. SDR is the tendency for individuals to give responses that put themselves in what they perceive to be a socially desirable light. ^ This research is a secondary analysis of data from Project Cognition, a study designed to examine the associations between performance on cognitive assessments and subsequent relapse to smoking. Adult smokers (N=183) were recruited from the greater Houston area to participate in the smoking cessation study. In this portion of the research, participants' smoking status was assessed on their quit day (QD), one week after QD, and four weeks after QD. Primary outcome measures were self-reported relapse, true cessation determined by biological measure, discrepancies between self-reported smoking status and biological assessments of smoking, and dropping out. ^ Primary predictor measures were the Balanced Inventory of Desirable Responding (BIDR) and self-reported motivation to quit smoking. The BIDR is a 40-item questionnaire that assesses Self-deceptive Enhancement (SDE; the tendency to give self-reports that are honest but positively biased) and Impression Management (IM; deliberate self-presentation to an audience). Scores were used to create a dichotomous BIDR total score group variable, a dichotomous SDE group variable, and a dichotomous IM group variable. Participants at one standard deviation above the mean were in the "high" group, and scores below one standard deviation were in the "normal" group. In addition, age, race, and gender were analyzed as covariates. ^ The overall findings of this study suggest that in the general population BIDR informs participants' self-reports and the IM and SDR subscales inform participants' behavior. BIDR predicted self-reported relapse in the general population and trended toward indicating that a participant will claim smoking cessation success when biological measures indicate otherwise. SDE interacted with motivation to predict biologically verified cessation success. There was no main effect for BIDR, IM, or SDE predicting drop out; however, IM interacted with age to predict participants' likelihood of drop out. Used in conjunction, the BIDR, IM subscale, and SDR subscale can be used to more accurately tailor smoking cessation programs to the needs of individual participants.^

Infant breastfeeding patterns by sex: Do males feed more?

Background: Most studies have looked at breastfeeding practices from the point of view of the maternal behavior only, however in counseling women who choose to breastfeed it is important to be aware of general infant feeding patterns in order to adequately provide information about what to expect. Available literature on the differences in infant breastfeeding behavior by sex is minimal and therefore requires further investigation. Objectives: This study determined if at the age of 2 months there were differences in the amount of breast milk consumed, duration of breastfeeding, and infant satiety by infant sex. It also assessed whether infant sex is an independent predictor of initiation of breastfeeding. Methods: This is a secondary analysis of data obtained from the Infant Feeding Practices Survey II (IFPS II) which was a longitudinal study carried out from May 2005 through June 2007 by the Food and Drug Administration and the Centers for Disease Control and Prevention. The questionnaires asked about demography, prenatal care, mode of delivery, birth weight, infant sex, and breastfeeding patterns. A total of 3,033 and 2,552 mothers completed the neonatal and post-neonatal questionnaires respectively. ^ Results: There was no significant difference in the initiation of breastfeeding by infant sex. About 85% of the male infants initiated breastfeeding compared with 84% of female infants. The odds ratio of ever initiating breastfeeding by male infants was 0.93 but the difference was not significant with a p-value of 0.49. None of the other infant feeding patterns differed by infant gender. ^ Conclusion: This study found no evidence that male infants feed more or that their mothers are more likely to initiate breastfeeding. Each baby is an individual and therefore will have a unique feeding pattern. Based on these findings, the major determining factors for breastfeeding continue to be maternal factors therefore more effort should be invested in promoting breastfeeding among mothers of all ethnic groups and social classes.^

The role of cardiorespiratory fitness and weight status on 24-hr ambulatory blood pressure among adolescents

BACKGROUND: This observational research study investigated the association of cardiorespiratory fitness and weight status with repeated measures of 24-hr ambulatory blood pressure (24-hr ABP). Little is known about these associations and few data exist examining the interaction between cardiorespiratory fitness and weight status and the contributions of each on 24-hr ABP in youth. ^ METHODS: This research study used secondary analysis data from the "Adolescent Blood Pressure and Anger: Ethnic Differences" study. This current study sample included 374 African-American, Anglo-American, and Mexican-American adolescents 11-16 years of age. Mixed-effects models were used for testing the relationship between weight status and cardiorespiratory fitness and repeated measures of ambulatory blood pressure over 24 hours (24-hr ABP). Weight status was categorized into "normal weight" (BMI<85th percentile), "overweight" (85th≤BMI<95th), and "obese" (BMI≥95th). Cardiorespiratory fitness, determined by heart rate recovery (HRR), was defined as the difference between heart rate at peak exercise and heart rate at two minutes post-exercise, as measured by a height-adjusted step test and stratified into two groups: low and high fitness, using a median split. Ambulatory blood pressure (ABP) was monitored for a 24-hr period on a school day using the Spacelabs ambulatory monitor (Model 90207). Blood pressure and heart rate were recorded at 30 minute intervals throughout the day of recording and at 60 minute intervals during sleep. ^ RESULTS: No significant associations were found between weight status and mean 24-hr systolic blood pressure (SBP) or mean arterial pressure (MAP). A significant and inverse association between weight status and mean 24-hr diastolic blood pressure (DBP) was revealed. Cardiorespiratory fitness was significantly and inversely associated with mean 24-hr ABP. High fitness adolescents had significantly lower mean 24-hr SPB, DBP, and MAP measurements than low fitness adolescents. Compared to low fitness adolescents, high fitness adolescents had 1.90 mmHg, 1.16 mmHg, and 1.68 mmHg lower mean 24-hr SBP, DBP, and MAP, respectively. Additionally, high fitness appeared to afford protection from higher mean 24-hr SBP and MAP, irrespective of weight status. Among normal weight adolescents, low fitness resulted in higher mean 24-hr SBP and MAP, compared to their fit counterparts. Among adolescents categorized as high fitness, increasing weight status did not appear to result in higher mean 24-hr SBP or MAP. Cardiorespiratory fitness, rather than weight status, appeared to be a more dominant predictor of mean 24-hr SBP and MAP. ^ CONCLUSIONS: To our knowledge, this research is the first study to investigate the independent and combined contributions of cardiorespiratory fitness and weight status on 24-hr ABP, all objectively measured. The results of this study may potentially guide and inform future research. It appears that early cardiovascular disease (CVD) prevention should focus on improving cardiorespiratory fitness levels among all adolescents, particularly those adolescents least fit, regardless of their weight status, while obesity prevention efforts continue.^

The role of youth sports in public health

Study 1: Schools provide a range of opportunities for youth to be active, however, over the past decade, these opportunities have been declining. Sports teams are a promising venue to promote physical activity yet limited research has examined the gender an ethnic differences in sport participation. The purpose of this study is to examine trends in sport participation from 1991-2009 among US high school students. Secondly, we examined the association between gender and ethnicity with sports over time. This serial cross-sectional study used surveillance data from the Youth Risk Behavior Survey, a probability based sample weighted to represent gender and race/ethnic subpopulations of US high school students. The findings of this paper reveal persistent gender and ethnic disparities for sports participation among US youth. Since sports teams may provide a substantial source of physical activity, greater efforts should be undertaken to increase the participation of girls, especially minorities, in sports teams. ^ Study 2: Sports team participation is congruent with teaching and supporting healthy eating, yet limited research has examined the association between sports participation and dietary behaviors. This study aims to determine the association between youth sports participation and dietary behaviors among elementary-aged children. Significant dose-response associations were observed between number of sports teams and consumption of most fruits and vegetables. The likelihood of eating fruit for boys increased with the number of sports teams (1 team: OR=1.89; 3 teams: OR=3.44, p<0.001) and the likelihood of consuming green vegetables for girls was higher with the number of sports teams (1 team: OR=1.50; 3 teams: OR=2.39; p<0.001). For boys, the odds of consuming fruit-flavored drinks was higher ( p=0.019) and the odds of drinking soda was lower (p=0.018) with participation in increasing number of sports teams whereas for girls, sports participation was positively associated with diet soda consumption (p=0.006). ^ Study 3: Parents and peers have been shown to have a strong influence over the physical activity, dietary, and sedentary behaviors of youth. Youth sports teams have the potential to offer physical activity, displace sedentary behaviors, and promote a healthy diet. The purpose of this study is to assess how peer and parental support for physical activity and healthy eating, coupled with sport participation, is associated obesity related risk factors including diet and sedentary behaviors. A secondary analysis of data from the School Physical Activity and Nutrition study, a state-representative survey, was conducted. Eighth (n=3,931) and 11th (n=2,785) grade students were categorized into four groups based upon the level of peer and parental support derived from a three item scale and their participation in sports (sports/high support, sports/low support, no sports/high support, no sports/low support). Linear models were conducted to determine the difference in means between these groups for the following outcome variables: previous day fruit and vegetable intake, scores for an unhealthy and healthy food index, and hours spent watching television, playing video games, and working on a computer. Eighth graders had significantly greater levels of parental support for healthy eating and physical activity compared to 11th grade. Both 8 th and 11th graders in the sport/high support for healthy eating from peers and parents scored significantly higher on the healthy food index than other groups. Eighth and 11th graders in the sport/high support for physical activity from peers participated in fewer hours of sedentary behaviors than any other group (p ≤ 0.032). Although it is thought that sport participation may offer opportunities to support a healthy diet and displace sedentary time by offering providing physical activity, our study found that parental and peer support for activity and healthy eating may further attenuate this association. Parents and peer support should be an important target when developing strategies to improve healthy diets and reduce sedentary time among youth, especially in the context of youth sports. (Abstract shortened by UMI.)^

Associations between teacher support and students' fruit and vegetable consumption in low-income elementary schools in central Texas

Background. Similar to parent support in the home environment, teacher support at school may positively influence children's fruit and vegetable (FV) consumption. This study assessed the relationship between teacher support for FV consumption and the FV intake of 4th and 5th grade students in low-income elementary schools in central Texas. Methods. A secondary analysis was performed on baseline data collected from 496 parent-child dyads during the Marathon Kids study carried out by the Michael & Susan Dell Center for Healthy Living at the University of Texas School of Public Health. A hierarchical linear regression analysis adjusting for key demographic variables, parent support, and home FV availability was conducted. In addition, separate linear regression models stratified by quartiles of home FV availability were conducted to assess the relationship between teacher support and FV intake by level of home FV availability. Results. Teacher support was not significantly related to students' FV intake (p = .44). However, the interaction of teacher support and home FV availability was positively associated with students' FV consumption (p < .05). For students in the lowest quartile of home FV availability, teacher support accounted for approximately 6% of the FV intake variance (p = .02). For higher levels of FV availability, teacher support and FV intake were not related. Conclusions. For lower income elementary school-aged children with low FV availability at home, greater teacher support may lead to modest increases in FV consumption.^

Association between length of stay in the U.S. and diabetes risk factors among Chinese Americans in Houston, Texas in 2004-2005

Studies have suggested that acculturation is related to diabetes prevalence and risk factors among immigrant groups in the United States (U.S.), however scant data are available to investigate this relationship among Asian Americans and Asian American subgroups. The objective of this cross-sectional study was to examine the association between length of stay in the U.S. and type 2 diabetes prevalence and its risk factors among Chinese Americans in Houston, Texas. Data were obtained from the 2004-2005 Asian-American Health Needs Assessment in Houston, Texas (N=409 Chinese Americans) for secondary analysis in this study. Diabetes prevalence and risk factors (overweight/obesity and access to medical care) were based on self-report. Descriptive statistics summarized demographic characteristics, diabetes prevalence, and reasons for not seeing a doctor. Logistic regression, using an incremental modeling approach, was used to measure the association between length of stay and diabetes prevalence and related risk factors, while adjusting for the potential confounding factors of age, gender, education level, and income level. Although the prevalence of type 2 diabetes was highest among those living in the U.S. for more than 20 years, there was no significant association between length of stay in the U.S. and diabetes prevalence among these Chinese Americans after adjustment for confounding factors. No association was found between length of stay in the U.S. and overweight/obese status among this population either, after adjusting for confounding factors, too. On the other hand, a longer length of stay was significantly associated with increased health insurance coverage in both unadjusted and adjusted models. The findings of this study suggest that length of stay in the U.S. alone may not be an indicator for diabetes risk among Chinese Americans. Future research should consider alternative models to measure acculturation (e.g., models that reflect acculturation as a multi-dimensional, not uni-dimensional process), which may more accurately depict its effect on diabetes prevalence and related risk factors.^

Data Accuracy in Medical Record Abstraction

Clinical Research Data Quality Literature Review and Pooled Analysis We present a literature review and secondary analysis of data accuracy in clinical research and related secondary data uses. A total of 93 papers meeting our inclusion criteria were categorized according to the data processing methods. Quantitative data accuracy information was abstracted from the articles and pooled. Our analysis demonstrates that the accuracy associated with data processing methods varies widely, with error rates ranging from 2 errors per 10,000 files to 5019 errors per 10,000 fields. Medical record abstraction was associated with the highest error rates (70–5019 errors per 10,000 fields). Data entered and processed at healthcare facilities had comparable error rates to data processed at central data processing centers. Error rates for data processed with single entry in the presence of on-screen checks were comparable to double entered data. While data processing and cleaning methods may explain a significant amount of the variability in data accuracy, additional factors not resolvable here likely exist. Defining Data Quality for Clinical Research: A Concept Analysis Despite notable previous attempts by experts to define data quality, the concept remains ambiguous and subject to the vagaries of natural language. This current lack of clarity continues to hamper research related to data quality issues. We present a formal concept analysis of data quality, which builds on and synthesizes previously published work. We further posit that discipline-level specificity may be required to achieve the desired definitional clarity. To this end, we combine work from the clinical research domain with findings from the general data quality literature to produce a discipline-specific definition and operationalization for data quality in clinical research. While the results are helpful to clinical research, the methodology of concept analysis may be useful in other fields to clarify data quality attributes and to achieve operational definitions. Medical Record Abstractor’s Perceptions of Factors Impacting the Accuracy of Abstracted Data Medical record abstraction (MRA) is known to be a significant source of data errors in secondary data uses. Factors impacting the accuracy of abstracted data are not reported consistently in the literature. Two Delphi processes were conducted with experienced medical record abstractors to assess abstractor’s perceptions about the factors. The Delphi process identified 9 factors that were not found in the literature, and differed with the literature by 5 factors in the top 25%. The Delphi results refuted seven factors reported in the literature as impacting the quality of abstracted data. The results provide insight into and indicate content validity of a significant number of the factors reported in the literature. Further, the results indicate general consistency between the perceptions of clinical research medical record abstractors and registry and quality improvement abstractors. Distributed Cognition Artifacts on Clinical Research Data Collection Forms Medical record abstraction, a primary mode of data collection in secondary data use, is associated with high error rates. Distributed cognition in medical record abstraction has not been studied as a possible explanation for abstraction errors. We employed the theory of distributed representation and representational analysis to systematically evaluate cognitive demands in medical record abstraction and the extent of external cognitive support employed in a sample of clinical research data collection forms. We show that the cognitive load required for abstraction in 61% of the sampled data elements was high, exceedingly so in 9%. Further, the data collection forms did not support external cognition for the most complex data elements. High working memory demands are a possible explanation for the association of data errors with data elements requiring abstractor interpretation, comparison, mapping or calculation. The representational analysis used here can be used to identify data elements with high cognitive demands.

Application of the general linear model to assess the effect of missing data on bone marrow mononuclear cell therapy with infusion timing and follow-up MRI

With most clinical trials, missing data presents a statistical problem in evaluating a treatment's efficacy. There are many methods commonly used to assess missing data; however, these methods leave room for bias to enter the study. This thesis was a secondary analysis on data taken from TIME, a phase 2 randomized clinical trial conducted to evaluate the safety and effect of the administration timing of bone marrow mononuclear cells (BMMNC) for subjects with acute myocardial infarction (AMI).^ We evaluated the effect of missing data by comparing the variance inflation factor (VIF) of the effect of therapy between all subjects and only subjects with complete data. Through the general linear model, an unbiased solution was made for the VIF of the treatment's efficacy using the weighted least squares method to incorporate missing data. Two groups were identified from the TIME data: 1) all subjects and 2) subjects with complete data (baseline and follow-up measurements). After the general solution was found for the VIF, it was migrated Excel 2010 to evaluate data from TIME. The resulting numerical value from the two groups was compared to assess the effect of missing data.^ The VIF values from the TIME study were considerably less in the group with missing data. By design, we varied the correlation factor in order to evaluate the VIFs of both groups. As the correlation factor increased, the VIF values increased at a faster rate in the group with only complete data. Furthermore, while varying the correlation factor, the number of subjects with missing data was also varied to see how missing data affects the VIF. When subjects with only baseline data was increased, we saw a significant rate increase in VIF values in the group with only complete data while the group with missing data saw a steady and consistent increase in the VIF. The same was seen when we varied the group with follow-up only data. This essentially showed that the VIFs steadily increased when missing data is not ignored. When missing data is ignored as with our comparison group, the VIF values sharply increase as correlation increases.^

Circadian rhythm profiles in porcine ICU subjects

Purpose: To explore the natural trajectory of circadian rhythms of sedation requirement, core body temperature (CBT), pulmonary mechanics (PM), and gas exchange (GE) in mechanically ventilated swine, as these variables affect the duration of mechanical ventilation. ^ Design: A secondary analysis to describe and compare circadian rhythms of study variables in swine mechanically ventilated for ≤ 7 days. ^ Setting: Porcine Intensive Care Unit (ICU).^ Sample: Six male swine. ^ Methods: Sedation requirements were recorded hourly and the CBT, PM and GE variables were sampled every 1 s – 1 min for ≤ 7 days. The data sets for each pig with > 5 days ICU length of stay were divided into one section representing the first 3 days and one section representing subsequent days. The Lomb periodogram was used to estimate the circadian time period for each variable, and cosinor analysis with the estimated time period to obtain amplitude and mesor. Circadian to ultradian bandpower ratio to assess rhythm quality and stability over time and goodness-of-fit index to describe biological significance of a rhythm were used. Together, these two parameters were used to define rhythm robustness over time. The masking effect of sedation as a potential confounder of the circadian rhythms of CBT, PM, and GE was explored, and circadian rhythm profiles of CBT of pigs in the ICU setting were compared with those of the same pigs in the ambulatory setting. ^ Results: All pigs had significant rhythms in CBT, respiratory rate, and peripheral oxygen saturation across ICU data sets. Healthier pigs had more robust rhythms of study variables over time. Sedation did not appear to mask the circadian rhythms of CBT, PM, and GE. The circadian rhythm of CBT was less robust in the ICU setting than in the ambulatory setting. ^ Conclusions: Individual subject observations provided preliminary evidence that robustness of rhythms varies with subject acuity. Comparison of profiles of circadian rhythms among ICU subjects with similar acuity and disease processes is warranted to determine if the profiles in the present study are reproducible. Identification of consistent patterns may provide insight into subject morbidity and timing of such therapeutic interventions as weaning from mechanical ventilation. ^

Cancer screening behaviors among Asian Americans in Houston, Texas

Background: Cancer is the second-leading cause of death in the United States, and Asian Americans/Pacific Islanders are the only racial/ethnic group for which cancer is the leading cause of death. Regular cancer screenings help to identify precancerous lesions and cancer at an earlier stage, when the cancer is more treatable. Ethnic disparities in participation in cancer screenings are also striking, and evidence indicates that Asian Americans may have lower rates of cancer screening participation than other racial/ethnic groups. The Health of Houston Survey 2010 (HHS 2010) is an address-based survey, administered via telephone, website, and mail, of over 5,000 respondents in Houston and Harris County that provides recent data on the health status and needs of the Houston community. HHS 2010 researchers oversampled for Asians and Vietnamese Americans in order to obtain a sample size large enough to obtain statistical power. This dataset provides a unique opportunity to examine the cancer screening behaviors and predictors of Vietnamese and Chinese Americans living in Houston, Texas.^ Methods: This study was a secondary data analysis of HHS 2010 data. The data were analyzed to compare the breast, cervical, and colorectal cancer screening compliance rates of Vietnamese and Chinese Americans with other racial/ethnic groups in Houston, Texas. Key predictors of participation and barriers to cancer screening were identified.^ Results: The results of this study indicate that in Houston, Vietnamese Americans and Asian Americans as a whole have strikingly lower rates of participation in cancer screenings compared to other ethnic groups. Chinese Americans had the highest rate of noncompliance for mammography of all ethnic groups; Asian Americans and Vietnamese Americans also had high rates of noncompliance. Similarly, Vietnamese and Asian Americans had high rates of noncompliance with colorectal cancer screening recommendations. Importantly, Vietnamese, Chinese, and Asian Americans had by far the worst pap test participation, with noncompliance rates more than double that of all other racial/ethnic groups. In general, the findings indicated several key predictors in cancer screening behaviors, including English language proficiency, years lived in the United States, health insurance, college education, and income; however, the significance and patterns of these variables varied by ethnic group as well as cancer site.^ Conclusions: This secondary analysis highlights the disparities in cancer screening participation among Vietnamese, Chinese, and Asian Americans in Houston, Texas and indicate the need to identify Asian Americans as a high-risk group in need of health promotion attention. Barriers to screening and educational needs appear to be specific to each target ethnic group. Thus, health educators and health professionals in Houston must focus on the specific educational needs of the key ethnic groups that make up the Houston population. Further, more ethnic-specific research is needed to examine the health behaviors and needs of Houston's Asian American subgroups.^

Análisis comparativo sobre trabajo rural en la forestoindustria, las semilleras y la fruticultura (Argentina 2008-2011)

Este artículo analiza transversalmente estudios de caso sobre el trabajo rural en la Argentina entre 2008 y 2011 en unidades de producción de capital concentrado: fruticultura en el Alto Valle de Río Negro, forestación en el NO de Misiones y producción de semillas de maíz transgénico en la Zona Núcleo Cerealera. La metodología aplicada fue la etnografía multisitio. Para el análisis que se presenta en este artículo se aplicó el método comparativo, que permitió establecer continuidad entre los casos sobre la base de tres estrategias empresariales: la reducción de puestos de trabajo clásico distinguiendo producción y servicios; la ambientalización de las relaciones laborales y territorios diferenciados para la producción, y el trabajo y la residencia de los trabajadores

Comparação entre prótese plástica e metálica na paliação endoscópica da obstrução maligna da via biliar: revisão sistemática e metanálise baseadas em estudos randomizados

INTRODUÇÃO: A prótese biliar endoscópica é aceita em todo o mundo como a primeira escolha de tratamento paliativo na obstrução biliar maligna. Atualmente ainda persistem dois tipos de materiais utilizados em sua confecção: plástico e metal. Consequentemente, muitas dúvidas surgem quanto a qual deles é o mais benéfico para o paciente. Esta revisão reúne as informações disponíveis da mais alta qualidade sobre estes dois tipos de prótese, fornecendo informações em relação à disfunção, complicação, taxas de reintervenção, custos, sobrevida e tempo de permeabilidade; e pretende ajudar a lidar com a prática clínica nos dias de hoje. OBJETIVO: Analisar, através de metanálise, os benefícios de dois tipos de próteses na obstrução biliar maligna inoperável. MÉTODOS: Uma revisão sistemática de ensaios clínicos randomizados (RCT) foi conduzida, com a última atualização em março de 2015, utilizando EMBASE, CINAHL (EBSCO), Medline, Lilacs / Centro (BVS), Scopus, o CAPES (Brasil), e literatura cinzenta. As informações dos estudos selecionados foram extraídas tendo em vista seis desfechos: primariamente disfunção, taxas de reintervenção e complicações; e, secundariamente, custos, sobrevivência e tempo de permeabilidade. Os dados sobre as características dos participantes do RCT, critérios de inclusão e exclusão e tipos de próteses também foram extraídos. Os vieses foram avaliados principalmente através da escala de Jadad. Esta metanálise foi registrada no banco de dados PROSPERO pelo número CRD42014015078. A análise do risco absoluto dos resultados foi realizada utilizando o software RevMan 5, calculando as diferenças de risco (RD) de variáveis dicotômicas e média das diferenças (MD) de variáveis contínuas. Os dados sobre a RD e MD para cada desfecho primário foram calculados utilizando o teste de Mantel-Haenszel e a inconsistência foi avaliada com o teste Qui-quadrado (Chi2) e o método de Higgins (I2). A análise de sensibilidade foi realizada com a retirada de estudos discrepantes e a utilização do efeito aleatório. O teste t de Student foi utilizado para a comparação das médias aritméticas ponderadas, em relação aos desfechos secundários. RESULTADOS: Inicialmente foram identificados 3660 estudos; 3539 foram excluídos por título ou resumo, enquanto 121 estudos foram totalmente avaliados e foram excluídos, principalmente por não comparar próteses metálicas (SEMS) e próteses plásticas (PS), levando a treze RCT selecionados e 1133 indivíduos metanálise. A média de idade foi de 69,5 anos, e o câncer mais comum foi de via biliar (proximal) e pancreático (distal). O diâmetro de SEMS mais utilizado foi de 10 mm (30 Fr) e o diâmetro de PS mais utilizado foi de 10 Fr. Na metanálise, SEMS tiveram menor disfunção global em comparação com PS (21,6% versus 46,8% p < 0,00001) e menos reintervenções (21,6% versus 56,6% p < 0,00001), sem diferença nas complicações (13,7% versus 15,9% p = 0,16). Na análise secundária, a taxa média de sobrevida foi maior no grupo SEMS (182 contra 150 dias - p < 0,0001), com um período maior de permeabilidade (250 contra 124 dias - p < 0,0001) e um custo semelhante por paciente, embora menor no grupo SEMS (4.193,98 contra 4.728,65 Euros - p < 0,0985). CONCLUSÃO: SEMS estão associados com menor disfunção, menores taxas de reintervenção, melhor sobrevida e maior tempo de permeabilidade. Complicações e custos não apresentaram diferença