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The over 400,000 cardiac surgeries performed in the United States each year hold a risk for the postoperative complication of arrhythmias. Currently, bedside monitoring of surface electrocardiogram leads is used to interpret arrhythmias despite the evidence that atrial electrograms (AEGs) offer superior rhythm discrimination. This hesitancy to use the AEG may be due to a lack of training for practitioners in interpreting AEGs; therefore, our goal was to create an algorithm for the diagnosis of tachyarrhythmia using an AEG that can be utilized by any health care practitioner. Our algorithm classifies the most prevalent type of tachyarrhythmias following cardiac surgery. To allow rhythm identification, we categorized them based on their atrial to ventricular signal ratio, which is uniquely apparent on AEGs. Other considerations were given to rhythm regularity, consistency, P-wave axis, and rate. The algorithm includes the most common postoperative arrhythmias differentiated based on a unique branch-point approach, which walks through the steps in arrhythmia discrimination. Both rendered and collected AEGs are included as references for further understanding and interpretation of tachyarrhythmias. The utility of AEGs for rhythm discrimination post-cardiac surgery is established and recent technology can provide real-time and continuous monitoring; however, practitioner training may be inadequate. To bridge this divide, we created an algorithm so that existing atrial wires can be better used for an enhanced rhythm interpretation via AEGs.

Purpose: The purpose of this study was to examine knowledge, attitudes, barriers, and facilitators for human papillomavirus (HPV) vaccination among Latina mothers of HPV vaccine-eligible children in low-income urban areas, as well as useful strategies to improve HPV vaccination. Methods: The study included 132 Latina mothers of HPV vaccine-eligible children, interviewed in 14 focus groups. Using semi-structured discussions, mothers were asked about their knowledge about HPV infection and vaccine, views toward HPV vaccination, barriers for HPV vaccine initiation as well as completion, and opinions on strategies to improve HPV vaccination. Results: Only 55% of mothers reported having ever heard of the HPV vaccine, 27% of mothers indicated initiating the HPV vaccine, and 14% indicated completing the multi-dose series. Mothers generally lacked knowledge about HPV infection and vaccination, with varying degrees by Latino descent. Health care provider (HCP) recommendation was the strongest barrier/facilitator for HPV vaccination. Useful strategies to improve HPV vaccine initiation and completion that the mothers suggested included strong recommendation from HCPs and addressing side effects and safety concerns. Other useful strategies included community and school-based approaches and the use of text messaging and smartphone technology to educate mothers and send vaccine reminders. Conclusion: The findings provide insight for the development of interventions targeting low-income Latina mothers and the need to improve HCP communication on HPV vaccination.

Social stratification theory predicts that racial minorities and women should have poorer mental health outcomes than Whites and men because they have less social power and fewer resources. Empirical investigations, however, reveal that race and gender differences are far more complex than theory would predict. Women are more distressed than men but distress levels are similar for Blacks and Whites. Women experience internalizing disorders such as major depression and men experience externalizing disorder such as substance abuse, but the overall prevalence of mental disorders does not vary by gender. Even more puzzling is that the overall prevalence diagnosable mental disorder is lower among Blacks than among Whites. We draw on upon intersectionality and stress perspectives to review the complex gender and race patterns observed in the epidemiology of mental health and conclude with a discussion of future research.

Introduction: Maximizing education about living donor kidney transplant (LDKT) during the in-person evaluation at the transplant center may increase the numbers of kidney patients pursuing LDKT. Research Questions and Design: To test the effectiveness of a 1-time LDKT educational intervention, we performed a cluster-randomized trial among 499 patients who presented for evaluation of kidney transplant. We compared usual care education (n = 250) versus intensive LDKT education (n = 249), which was implemented only on the evaluation day and consisted of viewing a 25-minute video of information and stories about LDKT and discussion of LDKT possibilities with an educator. Our primary outcome was knowledge of LDKT, 1 week after the transplant evaluation. Results: One week after evaluation, patients who received intensive education had higher knowledge than patients who received usual care (12.7 vs. 11.7; P = .0008), but there were no differences in postevaluation readiness for LDKT. Among patients who had not previously identified a potential living donor, receiving intensive education was associated with increased willingness to take steps toward LDKT. Discussion: In conclusion, expansion of LDKT education within the evaluation day may be helpful, but interventions that are implemented at multiple times and for greater duration may be necessary to ensure larger and long-term behavioral changes in pursuit of LDKT.

Human papillomavirus (HPV) vaccination continues to lag behind other adolescent vaccines, especially in areas with pervasive disparities in HPV-related cancers. The purpose of this study was to examine HPV vaccine completion and dosing intervals among low-income adolescents in urban areas. The study included electronic health record data on HPV vaccination for 872 adolescents who received at least one dose of the HPV vaccine. Only 28.4 % completed the 3-dose series. For the whole sample, HPV vaccine completion was higher for non-English speakers and among adolescents seen at Newark-South and East Orange sites. Completion was higher among non-English speaking female and Hispanic adolescents, females seen in Newark-South and East Orange sites, and insured Black adolescents. Completion was also dramatically lower among non-English speaking Black adolescents seen at Newark-North, Irvington, and Orange sites (12.5 %) compared to other Black adolescents (22.0–44.4 %). The mean dosing intervals were 5.5 months (SD = 4.6) between dose 1 and 2 and 10 months (SD = 6.1) between dose 1 and 3. Longer durations between vaccine doses were found among uninsured adolescents and those seen at Newark-North, Irvington, and Orange sites. Non-English speakers had longer duration between dose 1 and 3. Further, durations between dose 1 and 3 were dramatically longer among insured adolescents seen at Newark-North, Irvington, and Orange locations for the whole sample (M = 11.70; SD = 7.12) and among Hispanic adolescents (M = 13.45; SD = 8.54). Understanding how the study predictors facilitate or impede HPV vaccination is critical to reducing disparities in cervical and other HPV-related cancer, especially among Black, Hispanic, and low-income populations.

This is a descriptive study of cervical cancer screening knowledge, attitudes, beliefs, and practices among ethnically diverse black women. We conducted 6 focus groups with Haitian, African, English-speaking Caribbean, and African American women recruited from a federally qualified health center. Overall, there was limited knowledge and confusion across ethnic groups about cervical cancer and its risk factors, the Pap test, and the human papilloma virus (HPV) and its association with cervical cancer. At the same time, there were distinct differences between ethnic groups in knowledge, practices, and cultural beliefs about cervical cancer. African women knew the least among all the groups, while African American participants had the greatest knowledge of HPV. However, their knowledge was still limited. Patient-doctor relationship was the single most important facilitator for cervical cancer screening. Barriers to cervical cancer screening included cost, busy work schedule, fear of the unknown, lack of insurance or being unemployed, and fear of disclosing immigration status. Interventions with ethnically diverse black women would benefit from recognizing cultural barriers and misconceptions that vary by ethnic group. Culturally based strategies suggested by the focus groups include the use of existing social networks, the use of indigenous community-based health workers, and the inclusion of women of all ages in cervical cancer education because of the roles they have in extended families.

Few studies have examined the role of neighborhood socioeconomic condition in shaping breast cancer disparities in defined local areas. We tested associations between three measures of neighborhood socioeconomic condition (poverty, median income, and a composite neighborhood score) on breast cancer staging in two urban counties of the state of New Jersey. Data for these counties were obtained from the New Jersey Surveillance, Epidemiology, and End Results tumor registry and were selected because of their large racial/ethnic and socioeconomic diversity and pilot prevention efforts taking place in these areas. Our study population included Black, Latina, and White women (N = 4,589) diagnosed with breast cancer from 1999 to 2004. Each cancer case was geocoded and linked to socioeconomic data obtained from the 2000 U.S. census. Census tracts served as proxies for neighborhoods. Logistic regression models accounting for clustering of individuals within neighborhoods were fitted with Generalized Estimating Equations. Women living in neighborhoods with lower versus higher neighborhood scores were significantly more likely to have advanced-stage disease (odds ratio, 1.6; confidence intervals, 1.1-2.3), after adjusting for age at diagnosis and race/ethnicity. In analyses stratified by race/ethnicity, results remained significant for all neighborhood measures for White and Black women, but not for Latinas. Moreover, neighborhood poverty showed a weaker socioeconomic gradient in breast cancer staging among White women. Our study findings support the use of a multidimensional neighborhood index to better capture differences in cancer staging risk across racial/ethnic groups and provides evidence that population-based cancer data could be used to identify local needs specific to local populations. (Cancer Epidemiol Biomarkers Prev 2009;18(11):3024–9)

A continuing challenge in weight loss treatment is attaining maintenance of weight loss. The goal of this study was to develop a counseling method that would assist African American breast cancer survivors with weight loss maintenance. In this pilot study, 31 obese breast cancer survivors were recruited. Individualized, dietitian-led counseling by telephone and free Weight Watchers coupons were provided to all participants for 18 months. At the 6-month time point, women were randomized to receive spirituality counseling or not in addition to the standard program. The spirituality counseling was delivered via telephone using an 8-step framework. Subjects were asked to utilize daily meditation or prayer, daily readings, and the recording of thoughts in a journal. Mean weight loss from baseline to 6 months was a modest 2.0% of baseline weight. From 6 to 18 months, there was no further weight change in the spirituality arm and a gain of 0.7% in the dietitian-only arm. Despite little effect on weight loss, it did appear that spirituality counseling positively affected spiritual well-being (FACIT-Sp) scores and dietary quality. The spirituality counseling framework therefore may be further refined and useful for other health promotion studies with African American populations.

Objectives. We examined the prevalence and correlates of human papillomavirus (HPV) vaccine initiation among adolescents in low-income, urban areas. Methods. The study consisted of electronic health record data on HPV vaccination for 3180 adolescents (aged 10–20 years) at a multisite community health center in 2011. Results. Only 27% initiated the HPV vaccine. The adjusted odds ratio (AOR) of HPV vaccination was lower among older adolescents (AOR = 0.552; 95% confidence interval [CI] = 0.424, 0.718) and those seen by nonpediatric health care providers (HCPs; AOR = 0.311; 95% CI = 0.222, 0.435), and higher among non-English speakers (AOR = 1.409; 95% CI = 1.134, 1.751) and those seen at 2 site locations (AOR = 1.890; 95% CI = 1.547, 2.311). Insurance status was significant only among female and Hispanic adolescents. Language was not a predictor among Hispanic adolescents. Across all analyses, the interaction of age and HCP specialty was associated with HPV vaccination. Dramatically lower HPV vaccination rates were found among older adolescents seen by nonpediatric HCPs (3%–5%) than among other adolescents (23%–45%). Conclusions. Improving HPV vaccination initiation in low-income urban areas is critical to reducing disparities in cervical and other HPV-related cancer, especially among Black, Hispanic, and low-income populations.

Purpose The practice patterns of medical oncologists at a large National Cancer Institute Comprehensive Cancer Center in Detroit, MI were evaluated to better understand factors associated with accrual to breast cancer clinical trials. Patients and Methods From 1996 to 1997, physicians completed surveys on 319 of 344 newly evaluated female breast cancer patients. The 19-item survey included clinical data, whether patients were offered clinical trial (CT) participation and enrollment, and when applicable, reasons why they were not. Multivariate analyses using logistic regression were performed to evaluate predictors of an offer and enrollment. Results The patients were 57% white, 32% black, and 11% other/unknown race. One hundred six (33%) were offered participation and 36 (34%) were enrolled. In multivariate analysis, CTs were less likely offered to older women (mean age, 52 years for those offered v 57 years for those not offered; P = .0005) and black women (21% of blacks offered v 42% of whites; P = .0009). Women with stage 1 disease, poor performance status, and those who were previously diagnosed were also less likely to be offered trials. None of these factors were significant predictors of enrollment. Women were not offered trials because of ineligibility (57%), lack of available trials (41%), and noncompliance (2%). Reasons for failed enrollment included patient refusal (88%) and failed eligibility (12%). Conclusion It is important for cooperative groups to design studies that will accommodate a broader spectrum of patients. Further work is needed to assess ways to improve communication about breast cancer CT participation to all eligible women.

Purpose Using a health services utilization conceptual framework, the purpose of this analysis was to examine race differences in factors predictive of the behavioral intention of older persons to participate in a clinical treatment trial should they have a diagnosis of cancer. In addition, the analysis sought to determine if older African Americans were less likely than Whites to express willingness to participate, given knowledge of the Tuskegee syphilis study and greater fatalistic cancer beliefs. Design and methods Data were drawn from a community-based telephone survey of 216 African Americans and 222 Whites, 50 years of age and older. Results Findings show that willingness to participate was significantly higher among males, persons of younger age, higher incomes, and with nonfatalistic cancer beliefs. Race differences were only apparent for the two significant interactions of race with age and high income. Neither knowledge of the Tuskegee study nor fatalistic cancer beliefs were more important for African Americans than for Whites. Implications Study findings suggest that recruitment strategies need to be tailored to racial differences in factors affecting willingness to participate, particularly those related to age and income level.

The influence of religion on mental well-being has been the subject of controversy for a long while. Yet little is known about this relationship among black Americans. Using a probability-based sample of 451 urban black Americans, this study examines gender differences in religiosity and explores the ramifications for mental health. Findings indicate that females are more religious than males as evidenced by their greater participation in organizational forms of religious practice such as meetings and other gatherings. However, for both males and females, religiosity varied significantly by age and by marital and parental status. On the other hand, there were no differences in religiosity according to levels of education, income, and employment status for either males or females. With regard to mental health, greater religiosity was associated with fewer depressive symptoms for both males and females. Further, in the event of stressful circumstances, the influence of religion on mental well-being for females was direct, while religious involvement appeared to have an indirect or stress- buffering effect for males.

Background: The best treatment option for end-stage renal disease is usually a transplant, preferably a live donor kidney transplant (LDKT). The most effective ways to educate kidney transplant candidates about the risks, benefits, and process of LDKT remain unknown. Methods/design. We report the protocol of the Enhancing Living Donor Kidney Transplant Education (ELITE) Study, a cluster randomized trial of an educational intervention to be implemented during initial transplant evaluation at a large, suburban U.S. transplant center. Five hundred potential transplant candidates are cluster randomized (by date of visit) to receive either: (1) standard-of-care ("usual") transplant education, or (2) intensive education that is based upon the Explore Transplant series of educational materials. Intensive transplant education includes viewing an educational video about LDKT, receiving print education, and meeting with a transplant educator. The primary outcome consists of knowledge of the benefits, risks, and process of LDKT, assessed one week after the transplant evaluation. As a secondary outcome, knowledge and understanding of LDKT are assessed 3 months after the evaluation. Additional secondary outcomes, assessed one week and 3 months after the evaluation, include readiness, self-efficacy, and decisional balance regarding transplant and LDKT, with differences assessed by race. Although the unit of randomization is the date of the transplant evaluation visit, the unit of analysis will be the individual potential transplant candidate. Discussion. The ELITE Study will help to determine how education in a transplant center can best be designed to help Black and non-Black patients learn about the option of LDKT. Trial registration. Clinicaltrials.gov number NCT01261910. © 2013 Weng et al.; licensee BioMed Central Ltd.

This article focuses on emerging issues associated with HIV/AIDS in aging minoritypopulations. Based on a review of the literature as well as available national surveillance data, this article discusses current knowledge about HIV/AIDS in agingminority populations, particularly as they relate to sociodemographic, cultural, andhealth status factors. The authors not only examine the circumstances of older personsinfected by HIV/AIDS but also those affected by HIV/AIDS as a result of additionalof caregiving responsibilities. Recommendations for future research are provided.

The purpose of the study was to examine HPV vaccine knowledge and acceptability among ethnically diverse Black women. Forty-four women were interviewed in 6 focus groups (2 African American, 2 English-speaking Caribbean, 1 Haitian, and 1 African). Thematic content analysis was used to generate common concepts and themes and to compare findings across groups. There was varied but limited knowledge and confusion across ethnic groups about the HPV infection and vaccine. African and Haitian women had the least knowledge. Overall, women were generally receptive toward the HPV vaccine for girls but unclear about the need to vaccinate boys. Concerns about the HPV vaccine were mainly related to side effects/safety and vaccinating children at a young age. Healthcare provider’s recommendation of the vaccination was important for decision making. Educational interventions with Black women about HPV vaccination should recognize cultural beliefs that vary by ethnic group.

Context Kidney transplant is usually the best treatment option for patients with end-stage renal disease; however, transplant rates remain low in the United States. More research is needed about patients' educational needs to ensure that patients are making informed decisions about their treatment options. Objective To examine patients' perceptions of the delivery and format of a kidney transplant education program in a clinical setting, specifically to (1) identify useful aspects of the transplant education process, (2) discuss aspects of the program delivery that need improvement, and (3) provide recommendations to enhance the education delivery and format surrounding kidney transplant. Design A descriptive study using focus group meetings with patients at different stages of the transplantation process (in evaluation, listed, and transplant recipients). Data were analyzed by using thematic content analysis. Results Use of printed materials and handouts, group education format, and patient advocate component as well as bringing a companion were all effective aspects of the education program. Concerns about the education program stemmed from its complexity, technicality, and length. Participants recommended that patients be sent a formal invitation letter, with a detailed agenda and a video on kidney transplant, and that patients be encouraged to bring a companion to the education program. Responses specific to the stage of the transplant process are presented. Conclusion Concentrated attention to the delivery and content of the transplant education programs may significantly assist with patients' outcomes throughout the transplant process.

This chapter distinguishes stressors, stress, and distress in the interest of bringing the use of these terms more into line with the way they are used in the stress literature and to reduce the problems of inconsistent usage prevalent in the discussion of stress in everyday life. It discusses two original stress models- biological and engineering. The chapter distinguishes varieties of stress, from life events to chronic to traumas to nonevents to daily hassles, at the individual level. It demonstrates that these distinctions are empirically supported by findings that different sources of stress have distinct impacts on mental health outcomes. The chapter discusses the issue of misconceptions about stress to argue that stress, although a general concept is a concept with theoretical and operational borders. It reviews trends in stress research, which reveal an upward trajectory in the study of all of the kinds of stress.

Objectives: This qualitative study examined underserved black males' perspectives about prostate and colorectal cancer screening. Methods: Black male residents of Newark, NJ, ≥ 18 years of age, were recruited to participate in focus groups. Two groups were conducted with a total of 24 participants. Transcripts were analyzed using an immersion/crystallization approach. Results: Three major themes were identified, while men reflected on their experiences with prostate and colorectal cancer screening: 1) motivation for seeking screening; 2) fear associated with screenings; and 3) healthcare system barriers (e.g., patient-doctor relationships, insurance and mistrust of healthcare professionals). Participants also gave recommendations on how to increase preventive screening. Discussion: Fear and past experiences with healthcare serve as motivators and demotivators of preventive screening behavior. Interventions that address motivation and fear are recommended to increase preventive screening among this population.

Because social support has been shown to have value in decreasing morbidity and possibility in increasing length of survival in cancer patients, the objectives of the study are: 1) to utilize a network of oncology services, churches, and community organizations to recruit African American women diagnosed with breast cancer for project participation; 2) to implement the spiritual-based intervention; 3) to assess the efficacy of the intervention to positively impact treatment-related outcomes; and 4) to refine the intervention for broader dissemination. The intervention involved an experimental/control group design approach. The experimental support group (intervention group) received the Spiritual-based support intervention. There were two control groups: control group A included participants in a traditional support group model and control group B included individuals who received the standard care consisting of no additional structured support. Data were gathered through a pre-test at baseline (T1), a post test at the conclusion of the 7 month intervention (T2), and at a three-month follow-up at the end of the support group sessions (T3). Findings suggest a positive influence of the spiritual support group on mental well-being, with the impact diminishing over time.

Because social support has been shown to have value in decreasing morbidity and possibly in increasing length of survival in cancer patients, the objective of the study are: 1) to utilize a network of oncology services, churches, and community organizations to recruit African American women diagnosed with breast cancer for project participation; 2) to implement the spiritual-based intervention; 3) to assess the efficacy of the intervention to positively impact treatment-related outcomes; and 4) to refine the intervention for broader dissemination. The intervention involves and experimental/control group design approach. The experimental support group (Intervention group) will receive the Spiritual-based support intervention. There will be two control groups; control group A will include participants in a traditional support group model and control group B will include individuals who receive the standard care consisting of no additional structured support. An Advisory Committee comprised of breast cancer survivors and local clergy will provide guidance to project implementation. Data will be gathered through a pre-test at baseline (TI), a post test at the conclusion of the 7 months intervention (T2), and at a three month follow up at the end of the support group sessions (T3).

Researchers are giving greater attention to the recruitment and retention of minority women in clinical studies because of their historical underrepresentation, despite their greater morbidity and mortality for many conditions. Using findings from four studies, this article examines documented barriers to the recruitment and retention of minority women to clinical cancer research and discusses effective recruitment strategies. Among the major barriers to recruitment were lack of awareness, lack of transportation, interference with work/family responsibilities, financial costs, negative side effects, and burdensome procedures. Effective recruitment strategies focused on using culturally targeted mass mailings and media presentations based on acquiring an understanding of the minority community. Recommendations are made for further study and implementation.

Despite the large number of available studies, most women with breast cancer do not participate in clinical trials, and this is especially true among lower income and minority women. In this study the authors surveyed the practice patterns of four medical oncologists who comprised the clinical breast service at a large urban university hospital to develop a better understanding of the clinical trials enrollment process for women with breast cancer. Of 136 new female breast cancer patients seen by the four physicians over a 7-month period, there were 47 women (34%) offered participation in a clinical trial, and 16 women (12%) were eventually enrolled. Women who were offered participation were more likely to be younger (p = 0.068) and to have earlier stage disease then were women not offered participation (p = 0.008). Women enrolled into a trial were also more likely to be younger, although this difference was not statistically significant (p = 0.114). Patient race was not associated with the accrual or enrollment process. Over half of the women were not offered participation in clinical trials because of the lack of available studies. Further work evaluating the process of patient enrollment and physician and patient barriers is necessary to develop effective strategies for recruitment into breast cancer clinical trials.

Data from a community-based survey of 252 African American women 18 to 44 years of age were used to examine the relation between cigarette smoking and two measures of religious involvement. Findings indicated that cigarette smoking among African American women of childbearing age is related to their denominational affiliation. Specifically, Pentecostal women had significantly lower odds of being a current smoker and higher odds of quitting smoking than did women who belonged to other religious denominations. No significant association was found, however, between smoking and the degree of religiosity. Older age and lower level of education predicted current smoking, whereas having few daily hassles was associated with quitting smoking.

Few community-based field studies have examined racial differences in the prevalence of phobia disorders. Using data from two sites of a large epidemiologic survey, this study investigates risk factors associated with the one-month prevalence of phobia disorders from 2340 black and 3936 white respondents. Findings indicate that recent prevalence is higher for blacks than whites, with racial differences remaining even when demographic and socioeconomic factors are held constant. Additional significant risk factors for recent phobia pertained to site and being female, being young, and having low education attainment.

Using data from a national probability sample of black and white females, this study focuses on racial differences and similarities in factors affecting levels of global perceived stress. Selected socio-demographic characteristics as well as satisfactions with the major domains of life — such as self, standard of living, health, family life, and leisure — are examined as predictors of global perceived stress. Generally, domain satisfactions are found to be stronger predictors of perceived stress than are socio-demographic characteristics. Moreover, no racial differences between black and white females are found when socio-demographic factors are controlled. However, a significant racial difference is encountered for one domain: satisfaction with leisure appears to be a stronger predictor of perceived stress for black females than it is for white females.