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Sexual and Gender Minority Issues Across NCCN Guidelines: Results From a National Survey

Hudson, Janella; Schabath, Matthew B; Sanchez, Julian; Sutton, Steven; Simmons, Vani N; Vadaparampil, Susan T; Kanetsky, Peter A; Quinn, Gwendolyn P
Background: The lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ) population is at higher risk for multiple types of cancers compared with the heterosexual population. Expert NCCN panels lead the nation in establishing clinical practice guidelines addressing cancer prevention, early detection, and treatment of cancer sites and populations. Given the emergence of new data identifying cancer disparities in the LGBTQ population, this study examined the inclusion of medical and/or psychosocial criteria unique to LGBTQ within NCCN Guidelines. Methods: Data were collected for 32 of the 50 NCCN Guidelines. Results: NCCN panel members reported that neither sexual orientation (84%) nor gender identity (94%) were relevant to the focus of their guidelines; 77% responded that their panels currently do not address LGBTQ issues, with no plans to address them in the future. Conclusions: Greater consideration should be given to the needs of LGBTQ patients across the cancer care continuum. Given that research concerning LGBTQ and cancer is in its infancy, additional empirical and evidence-based data are needed to bolster further integration of LGBTQ-specific criteria into clinical care guidelines.
PMCID:5705047
PMID: 29118229
ISSN: 1540-1413
CID: 2903322

Birth weight, early life weight gain and age at menarche: a systematic review of longitudinal studies

Juul, F; Chang, V W; Brar, P; Parekh, N
BACKGROUND AND OBJECTIVE/OBJECTIVE:Adiposity in pre- and postnatal life may influence menarcheal age. Existing evidence is primarily cross-sectional, failing to address temporality, for which the role of adiposity in early life remains unclear. The current study sought to systematically review longitudinal studies evaluating the associations between birth weight and infant/childhood weight status/weight gain in relation to menarcheal age. METHODS:PubMed, EMBASE, Web of Science, Global Health (Ovid) and CINAHL were systematically searched. Selected studies were limited to English-language articles presenting multi-variable analyses. Seventeen studies reporting risk estimates for birth weight (n = 3), infant/childhood weight gain/weight status (n = 4) or both (n = 10), in relation to menarcheal age were included. RESULTS:Lower vs. higher birth weight was associated with earlier menarche in nine studies and later menarche in one study, while three studies reported a null association. Greater BMI or weight gain over time and greater childhood weight were significantly associated with earlier menarche in nine of nine and six of seven studies, respectively. CONCLUSIONS:Studies suggested that lower birth weight and higher body weight and weight gain in infancy and childhood may increase the risk of early menarche. The pre- and postnatal period may thus be an opportune time for weight control interventions to prevent early menarche, and its subsequent consequences.
PMID: 28872224
ISSN: 1467-789x
CID: 2909212

High-resolution Temporal Representations of Alcohol and Tobacco Behaviors from Social Media Data

Huang, Tom; Elghafari, Anas; Relia, Kunal; Chunara, Rumi
Understanding tobacco- and alcohol-related behavioral patterns is critical for uncovering risk factors and potentially designing targeted social computing intervention systems. Given that we make choices multiple times per day, hourly and daily patterns are critical for better understanding behaviors. Here, we combine natural language processing, machine learning and time series analyses to assess Twitter activity specifically related to alcohol and tobacco consumption and their sub-daily, daily and weekly cycles. Twitter self-reports of alcohol and tobacco use are compared to other data streams available at similar temporal resolution. We assess if discussion of drinking by inferred underage versus legal age people or discussion of use of different types of tobacco products can be differentiated using these temporal patterns. We find that time and frequency domain representations of behaviors on social media can provide meaningful and unique insights, and we discuss the types of behaviors for which the approach may be most useful.
PMCID:5734092
PMID: 29264592
ISSN: 2573-0142
CID: 2893632

Expanding Parental Permission in Pediatric Treatment: A Hasty Generalization

Nahata, Leena; Quinn, Gwendolyn P
PMID: 29111930
ISSN: 1536-0075
CID: 2903332

ACR Appropriateness Criteria(R) Ovarian Cancer Screening

Pandharipande, Pari V; Lowry, Kathryn P; Reinhold, Caroline; Atri, Mostafa; Benson, Carol B; Bhosale, Priyadarshani R; Green, Edward D; Kang, Stella K; Lakhman, Yulia; Maturen, Katherine E; Nicola, Refky; Salazar, Gloria M; Shipp, Thomas D; Simpson, Lynn; Sussman, Betsy L; Uyeda, Jennifer; Wall, Darci J; Whitcomb, Bradford; Zelop, Carolyn M; Glanc, Phyllis
There has been much interest in the identification of a successful ovarian cancer screening test, in particular, one that can detect ovarian cancer at an early stage and improve survival. We reviewed the currently available data from randomized and observational trials that examine the role of imaging for ovarian cancer screening in average-risk and high-risk women. We found insufficient evidence to recommend ovarian cancer screening, when considering the imaging modality (pelvic ultrasound) and population (average-risk postmenopausal women) for which there is the greatest available published evidence; randomized controlled trials have not demonstrated a mortality benefit in this setting. Screening high-risk women using pelvic ultrasound may be appropriate in some clinical situations; however, related data are limited because large, randomized trials have not been performed in this setting. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
PMID: 29101987
ISSN: 1558-349x
CID: 2772182

Longitudinal pathways from unconventional personal attributes in the late 20s to cannabis use prior to sexual intercourse in the late 30s

Lee, Jung Yeon; Brook, Judith S; Pahl, Kerstin; Brook, David W
A quarter of people living with human immunodeficiency virus (HIV) infection in the United States are women. Furthermore, African American and Hispanic/Latina women continue to be disproportionately affected by HIV, compared with women of other races/ethnicities. Cannabis use prior to intercourse may be associated with increased risky sexual behaviors which are highly related to HIV. The ultimate goal of this research is to better understand the relationships between unconventional personal attributes (e.g., risk-taking behaviors) in the late 20s, substance use (e.g., alcohol) in the mid 30s, and cannabis use prior to intercourse in the late 30s using a community sample; such an understanding may inform interventions. This study employing data from the Harlem Longitudinal Development Study includes 343 female participants (50% African Americans, 50% Puerto Ricans). Structural equation modeling indicated that unconventional personal attributes in the late 20s were associated with substance use in the mid 30s (beta=0.32, p<0.001), which in turn, was associated with cannabis use prior to sexual intercourse in the late 30s (beta=0.64, p<0.001). Unconventional personal attributes in the late 20s were also directly related to cannabis use prior to sexual intercourse in the late 30s (beta=0.39, p<0.01). The findings of this study suggest that interventions focused on decreasing unconventional personal attributes as well as substance use may reduce sexual risk behaviors among urban African American and Puerto Rican women. Also, the implications of this study for health care providers and researchers working in HIV prevention are that these precursors may be useful as patient screening tools.
PMCID:5595245
PMID: 28648991
ISSN: 1873-6327
CID: 2614532

Lung Function and Incident Kidney Disease: The Atherosclerosis Risk in Communities (ARIC) Study

Sumida, Keiichi; Kwak, Lucia; Grams, Morgan E; Yamagata, Kunihiro; Punjabi, Naresh M; Kovesdy, Csaba P; Coresh, Josef; Matsushita, Kunihiro
BACKGROUND:Reduced lung function is associated with clinical outcomes such as cardiovascular disease. However, little is known about its association with incident end-stage renal disease (ESRD) and chronic kidney disease (CKD). STUDY DESIGN/METHODS:Prospective cohort study. SETTING & PARTICIPANTS/METHODS:14,946 participants aged 45 to 64 years at baseline (1987-1989) in the Atherosclerosis Risk in Communities (ARIC) Study (45.0% men and 25.2% black), with follow-up through 2012. PREDICTORS/METHODS:/FVC) at baseline determined with spirometry. OUTCOMES/RESULTS:, or CKD-related hospitalizations/deaths) as the secondary outcome. RESULTS:/FVC 70%-<75%; 44.3% of participants) at 1.21 (95% CI, 0.94-1.55). Similar associations were seen with incident CKD. LIMITATIONS/CONCLUSIONS:Limited number of participants with moderate/severe lung dysfunction and spirometry only at baseline. CONCLUSIONS:Reduced lung function, particularly lower percent-predicted FVC, is independently associated with CKD progression. Our findings suggest a potential pathophysiologic contribution of reduced lung function to the development of CKD and a need for monitoring kidney function in persons with reduced lung function.
PMCID:5651181
PMID: 28754455
ISSN: 1523-6838
CID: 5100792

Nursing Education to Reduce Use of Tobacco and Alternative Tobacco Products: Change Is Imperative

VanDevanter, Nancy; Katigbak, Carina; Naegle, Madeline; Zhou, Sherry; Sherman, Scott; Weitzman, Michael
BACKGROUND: Tobacco use continues to be the leading cause of preventable death worldwide. OBJECTIVE: To assess perceived tobacco educational preparation of undergraduate and graduate nurses in a large urban university. DESIGN: A cross-sectional web-based survey of all nursing students in an urban college of nursing was conducted to assess perceived tobacco educational content, skills, and self-efficacy for cessation counseling with patients who smoke cigarettes and use alternative tobacco products (e.g., hookah and e-cigarettes). RESULTS: Participants reported the most education about health effects of tobacco use (67%), and less than 6% reported education about alternative tobacco products. While the majority of nurses agreed that advising patients to quit is a priority, less than 40% reported receiving sufficient training in cessation counseling. CONCLUSIONS: There continues to be a compelling need articulated by leaders in tobacco policy and research over the past decade for a more vigorous response by nurses to the tobacco epidemic.
PMID: 28778128
ISSN: 1532-5725
CID: 2656042

Educational intervention in prostate cancer [Editorial]

Loeb, Stacy
PMID: 29105995
ISSN: 1464-410x
CID: 2945982

The "residential" effect fallacy in neighborhood and health studies: formal definition, empirical identification, and correction

Chaix, Basile; Duncan, Dustin; Vallee, Julie; Vernez-Moudon, Anne; Benmarhnia, Tarik; Kestens, Yan
BACKGROUND: Because of confounding from the urban/rural and socioeconomic organizations of territories and resulting correlation between residential and nonresidential exposures, classically estimated residential neighborhood-outcome associations capture nonresidential environment effects, overestimating residential intervention effects. Our study diagnosed and corrected this "residential" effect fallacy bias applicable to a large fraction of neighborhood and health studies. METHODS: Our empirical application investigated the effect that hypothetical interventions raising the residential number of services would have on the probability that a trip is walked. Using global positioning systems (GPS) tracking and mobility surveys over 7 days (227 participants, 7440 trips), we employed a multilevel linear probability model to estimate the trip-level association between residential number of services and walking to derive a naive intervention effect estimate; and a corrected model accounting for numbers of services at the residence, trip origin, and trip destination to determine a corrected intervention effect estimate (true effect conditional on assumptions). RESULTS: There was a strong correlation in service densities between the residential neighborhood and nonresidential places. From the naive model, hypothetical interventions raising the residential number of services to 200, 500, and 1000 were associated with an increase by 0.020, 0.055, and 0.109 of the probability of walking in the intervention groups. Corrected estimates were of 0.007, 0.019, and 0.039. Thus, naive estimates were overestimated by multiplicative factors of 3.0, 2.9, and 2.8. CONCLUSIONS: Commonly estimated residential intervention-outcome associations substantially overestimate true effects. Our somewhat paradoxical conclusion is that, to estimate residential effects, investigators critically need information on nonresidential places visited.
PMID: 28767516
ISSN: 1531-5487
CID: 2655792