The association of area socioeconomic status and cancer screening: A systematic review and multilevel study

Background. The gap between actual and ideal rates of routine cancer screening in the U.S., particularly for colorectal cancer screening (CRCS) (1;2), is responsible for an unnecessary burden of morbidity and mortality, particularly for disadvantaged groups. Knowledge about the effects of individual and area influences is being advanced by a growing body of research that has examined the association of area socioeconomic status (SES) and cancer screening after controlling for individual SES. The findings from this emerging and heterogeneous research in the cancer screening literature have been mixed. Moreover, multilevel studies in this area have not yet adequately explored the possibility of differential associations by population subgroup, despite some evidence suggesting gender-specific effects. ^ Objectives and methods. This dissertation reports on a systematic review of studies on the association of area SES and cancer screening and a multilevel study of the association between area SES and CRCS. The specific aims of the systematic review are to: (1) describe the study designs, constructs, methods, and measures; (2) describe the association of area SES and cancer screening; and (3) identify neglected areas of research. ^ The empiric study linked a pooled sample of respondents aged ≥50 years without a personal history of colorectal cancer from the 2003 and 2005 California Health Interview Surveys with a comprehensive set of census-tract level area SES measures from the 2000 U.S. Census. Two-level random intercept models were used to test 2 hypotheses: (1) area SES will be associated with adherence to two modalities of CRCS after controlling for individual SES; and (2) gender will moderate the relationship between area socioeconomic status and adherence to both modalities of CRCS. ^ Results. The systematic review identified 19 eligible studies that demonstrated variability in study designs, methods, constructs, and measures. The majority of tested associations were either not statistically significant or significant and in the positive direction, indicating that as area SES increased, the odds of CRCS increased. The multilevel study demonstrated that while multiple aspects of area SES were associated with CRCS after controlling for individual SES, associations differed by screening modality and in the case of endoscopy, they also differed by gender. ^ Conclusions. Conceptual and methodologic heterogeneity and weaknesses in the literature to date limit definitive conclusions about the underlying relationships between area SES and cancer screening. The multilevel study provided partial support for both hypotheses. Future research should continue to explore the role of gender as a moderating influence with the aim of identifying the mechanisms linking area SES and cancer prevention behaviors. ^

Evaluation of racial and ethnic disparities of glycemic control in the Health and Retirement Study. 2003 Diabetes Survey

Objective. To examine and evaluate racial and ethnic disparities in glycemic control among HRS respondents with diabetes aged 55-94 years. ^ Methods. The HRS Diabetes 2003 database provides data on blood-drawn glycemic control and self-reported demographics, socioeconomic status, clinical, health access and self-care characteristics. 1,141 non-Hispanic White, non-Hispanic Black, and Hispanic respondents were included in multiple logistic regression of glycemic control. ^ Results. The rate of poor control was significantly higher among Blacks (61.5%, 105/171) and Hispanics (65.3% 72/110) than among Whites (45.0% 387/860) (p < 0.01). After controlling for influential covariates and interactions, Blacks and Hispanics had a three-fold increased risk for poor control compared to Whites when duration was five years or less. ^ Conclusions. Clinical and self-perception variables, like duration, medication, and self-rated poor diabetes control affected glycemic control independent of race and ethnicity, but there remains unexplained racial and ethnic disparities for newly-diagnosed individuals. This is the first study to find an interaction between duration and race and ethnicity on glycemic control. Future research should incorporate cultural beliefs and attitudes about diabetes control that may explain the racial and ethnic disparity. ^

Seroprevalence of toxoplasmosis and current thinking regarding screening in pregnancy: A review of the literature and case study discussion

The approach to the diagnosis and treatment of congenital toxoplasmosis has been one of flux and debate, fueled by lack of knowledge, lack of consensus, different methods of screening and different national policies for screening in different parts of the world. Countries with higher prevalence of disease such as in Europe and South America have a heightened awareness of the need to screen and treat for this parasitic infection during pregnancy. In contrast, in the United States, it is a condition scarcely discussed and has been largely ignored except in some large centers and by a few researchers. Policies and research strategies for any condition should start with obtaining good data. The aims of this thesis included a review of prevalence studies conducted in the United States, focused on the past 20 years, combined with a description of original research conducted by the author several years ago. The latter was a cross-sectional study performed in Houston, one of the largest American cities with a great ethnic mix. The study analyzed prevalence rates of Toxoplasma gondii IgG antibody in sera of women of reproductive age. Overall seroprevalence was 12.3%. In keeping with other studies, higher prevalence correlated with lower socioeconomic status, Black and Hispanic and Asian ethnicities, and increasing age. A literature search revealed only three prevalence studies performed in the United States over the past 20 years, with another four studies only referred to as personal communications or within a textbook, without further study detail available. The literature review also revealed a lack of consensus on whether or not to screen for toxoplasmosis in pregnancy, and even whether or not treatment in utero is worthwhile.^ Proponents of screening and treatment in pregnancy site studies both in the United States and France, emphasize that treatment reduces disease manifestations in infants. Opponents cite other studies that show only marginal benefits, together with potential side effects of medication regimens and generation of anxiety in parents. What is agreed on so far is the value of educating pregnant women on how to avoid contracting toxoplasmosis, and educating physicians on making the best use of reference laboratories before major treatment decisions are made. Further research to reevaluate the literature critically, review new treatment regimens and examine costs and benefits of screening and treatment of toxoplasmosis in pregnancy, bringing together European and American researchers, is needed.^

Assessment of the effect on statistical power of regression model misspecification by using techniques of mathematical statistics and simulation study

Objectives. This paper seeks to assess the effect on statistical power of regression model misspecification in a variety of situations. ^ Methods and results. The effect of misspecification in regression can be approximated by evaluating the correlation between the correct specification and the misspecification of the outcome variable (Harris 2010).In this paper, three misspecified models (linear, categorical and fractional polynomial) were considered. In the first section, the mathematical method of calculating the correlation between correct and misspecified models with simple mathematical forms was derived and demonstrated. In the second section, data from the National Health and Nutrition Examination Survey (NHANES 2007-2008) were used to examine such correlations. Our study shows that comparing to linear or categorical models, the fractional polynomial models, with the higher correlations, provided a better approximation of the true relationship, which was illustrated by LOESS regression. In the third section, we present the results of simulation studies that demonstrate overall misspecification in regression can produce marked decreases in power with small sample sizes. However, the categorical model had greatest power, ranging from 0.877 to 0.936 depending on sample size and outcome variable used. The power of fractional polynomial model was close to that of linear model, which ranged from 0.69 to 0.83, and appeared to be affected by the increased degrees of freedom of this model.^ Conclusion. Correlations between alternative model specifications can be used to provide a good approximation of the effect on statistical power of misspecification when the sample size is large. When model specifications have known simple mathematical forms, such correlations can be calculated mathematically. Actual public health data from NHANES 2007-2008 were used as examples to demonstrate the situations with unknown or complex correct model specification. Simulation of power for misspecified models confirmed the results based on correlation methods but also illustrated the effect of model degrees of freedom on power.^

An evaluation of Employee Assistance Programs: An overview and case study

Methodologies for the analysis and cross-evaluations of Employee Assistance Programs (EAPs) are necessary to indicate program weaknesses and strengths for both present and future EAP services.^ As EAPs have matured from simplistic industrial alcoholism programs to all problem-encompassing, complex programs, an aggressive group of entrepreneurs has developed. Business and industrial managements need established criteria to select the most suitable professional services for their needs, as well as the best investment value for cost containments.^ Four major EAPs were compared to determine critical areas necessary for cross evaluation. Future standardization of terminology and definitions of services will facilitate both the evaluation of a specific program and its comparison to problems or successes of other EAPs.^ Past evaluation difficulties have been caused by the lack of EAP program accreditations and professional personnel licensure requirements. The Association of Labor Management Administrators and Consultants on Alcoholism (ALMACA) has recently set certification criteria for personnel, which will enhance the professional standards for EAPs. ^

Sedimentological and palynological study of sediment cores from the northern Mekong River Delta

A sedimentological and palynological study of three sediment cores from the northern Mekong River Delta shows the regional sedimentary and environmental development since the mid-Holocene sea level highstand. A sub- to intertidal flat deposit of mid-Holocene age is recorded in the northernmost core. Shoreline deposits in all three cores show descending ages from N to S documenting 1) the early stages of the late Holocene regression and 2) the subsequent delta progradation. The delta plain successions vary from floodplain deposits with swamp-like elements to natural levee sediments. The uppermost sediments in all cores show human disturbance to varying degrees. The most intense alteration is recorded in the northernmost core where the palynological signal together with a charcoal peak indicates the profound change of the environment during the modern land reclamation. The sediments from at least one of the three presented cores do not show a "true" delta facies succession, but rather estuary-like features, as also observed in records from southern Cambodia. This absence is probably due to lack of accommodation space during the initial phase of rapid delta progradation which impeded the development of "true" delta successions as shown in cores from the southern Mekong River Delta.

Biochemical, geochemical and sedimentological study of ODP Leg 112 samples

Organic-rich diatomaceous muds from Ocean Drilling Program Leg 112 (offshore Peru) are the subject of a comprehensive organic diagenetic study covering the burial interval, <1 to >100 m. The organic matter has been classified in terms of its elemental, biochemical, and geochemical compositions. About 60% of the organic carbon in sediments from <1 m can be attributed to hydrolyzable, biochemical constituents, while at 22 m this figure decreased to 20%. Pyrolysis-gas chromatography and gas chromatography-mass spectrometry chromatograms of these same sediments contain mainly hydrocarbons and nitrogenous compounds, with low amounts of other heteroatomic compounds, even though the total organic matter is rich in oxygen (about 35 atoms per 100 carbon atoms) and sulfur (1 to 5 atoms per 100 C atoms). Overall, the organic matter in these sediments, even at these shallow depths and young ages, has many of the geochemical features of far more deeply buried sediments, providing further strong evidence for the claim that "kerogen-formation" is a very early diagenetic process.

Geochemical and optical study of organic matter in some Pleistocene and Pliocene sediments at DSDP Leg 64 Holes

Pleisto-Pliocene hemipelagic and diatomaceous mud was recovered from Deep Sea Drilling Project (DSDP) Sites 474 through 481 in the Gulf of California. The organic matter is mostly marine and mainly derived from diatomaceous protoplasm. We found some continental organic matter in sediments near the bottom basalts or near dolerites (Holes 474A and 478). The organic matter in most of the samples is in an early stage of evolution.

Microstructural and mechanical study of AL2O3/Er3Al5O12 eutectic rods grown by the laser floating zone method

Eutectic rods of Al2O3–Er3Al5O12 were grown by directional solidification using the laser-heated floating zone method at rates in the range 25–1500 mm/h. Their microstructure and mechanical properties (hardness, toughness and strength) were investigated as a function of the growth rate. A homogeneous and interpenetrated microstructure was found in most cases, and interphase spacing decreased with growth rate following the Hunt–Jackson law. Hardness increased slightly as the interphase spacing decreased while toughness was low and independent of the microstructure. The rods presented very high bending strength as a result of the homogeneous microstructure, and their strength increased rapidly as the interphase spacing decreased, reaching a maximum of 2.7 GPa for the rods grown at 750 mm/h. The bending strength remained constant up to 1300 K and decreased above this temperature. The relationship between the microstructure and the mechanical properties was established from the analysis of the microstructure and of the fracture mechanisms

Clean Coal Technologies Scenario and Evaluation of Present CO2 Dwindling Initiatives to Approach Zero Emission Power Stations By Coal Combustion. Deployment Situation and Evaluation Study

In the present uncertain global context of reaching an equal social stability and steady thriving economy, power demand expected to grow and global electricity generation could nearly double from 2005 to 2030. Fossil fuels will remain a significant contribution on this energy mix up to 2050, with an expected part of around 70% of global and ca. 60% of European electricity generation. Coal will remain a key player. Hence, a direct effect on the considered CO2 emissions business-as-usual scenario is expected, forecasting three times the present CO2 concentration values up to 1,200ppm by the end of this century. Kyoto protocol was the first approach to take global responsibility onto CO2 emissions monitoring and cap targets by 2012 with reference to 1990. Some of principal CO2emitters did not ratify the reduction targets. Although USA and China spur are taking its own actions and parallel reduction measures. More efficient combustion processes comprising less fuel consuming, a significant contribution from the electricity generation sector to a CO2 dwindling concentration levels, might not be sufficient. Carbon Capture and Storage (CCS) technologies have started to gain more importance from the beginning of the decade, with research and funds coming out to drive its come in useful. After first researching projects and initial scale testing, three principal capture processes came out available today with first figures showing up to 90% CO2 removal by its standard applications in coal fired power stations. Regarding last part of CO2 reduction chain, two options could be considered worthy, reusing (EOR & EGR) and storage. The study evaluates the state of the CO2 capture technology development, availability and investment cost of the different technologies, with few operation cost analysis possible at the time. Main findings and the abatement potential for coal applications are presented. DOE, NETL, MIT, European universities and research institutions, key technology enterprises and utilities, and key technology suppliers are the main sources of this study. A vision of the technology deployment is presented.