Search

Objectives: Hypertension affects 1 in 3 adults in the United States and disproportionately affects African Americans. Kaiser Permanente demonstrated that a "bundle" of evidence-based interventions significantly increased blood pressure control rates. This paper describes a multiyear process of developing the protocol for a trial of the Kaiser bundle for implementation in under-resourced urban communities experiencing cardiovascular health disparities during the planning phase of this biphasic award (UG3/UH3)., Methods: The protocol was developed by a collaboration of faith-based community members, representatives from community health center practice-based research networks, and academic scientists with expertise in health disparities, implementation science, community-engaged research, social care interventions, and health informatics. Scientists from the National Institutes of Health and the other grantees of the Disparities Elimination through Coordinated Interventions to Prevent and Control Heart and Lung Disease Risk (DECIPHeR) Alliance also contributed to developing our protocol., Results: The protocol is a hybrid type 3 effectiveness-implementation study using a parallel cluster randomized trial to test the impact of practice facilitation on implementation of the Kaiser bundle in community health centers compared with implementation without facilitation. A central strategy to the Kaiser bundle is to coordinate implementation via faith-based and other community organizations for recruitment and navigation of resources for health-related social risks., Conclusions: The proposed research has the potential to improve identification, diagnosis, and control of blood pressure among under-resourced communities by connecting community entities and healthcare organizations in new ways. Faith-based organizations are a trusted voice in African American communities that could be instrumental for eliminating disparities., Competing Interests: Conflict of Interest: S.T.L. discloses that she is founder and co-owner of NowPow LLC, a company acquired in 2021 by Unite Us LLC, where she is currently an advisor and stockholder. She is president of MAPSCorps, a 501c3 nonprofit organization, and serves on other nonprofit boards. Neither the University of Chicago nor the University of Chicago Medicine endorses or promotes any NowPow, Unite Us, or MAPSCorps product or service. S.T.L. holds debt in Glenbervie Health LLC and owns health care-related investments managed by third parties. S.T.L. is a contributor to UpToDate, Inc. The University of Chicago receives royalties from UpToDate, Inc. In addition to the acknowledged funding for the CIRCL study, S.T.L., E.M.A., and E.A.P. are also supported by R01MD012630, R01AG064949, R01DK127961, R01HL150909, and P30CA014599. T.L.W. receives research funding from Gilead Sciences for work related to coronavirus disease (COVID) in immunosuppressed populations. O.A.S. is supported by an Administrative Supplement to Promote a Diverse Research Community from the Office of the Vice President for Research at the University of Utah, awarded to J.D.S. F.S.A. was supported by grants from the National Institutes of Health/National Heart, Lung, and Blood Institute (K23HL155970) and the American Heart Association (AHA number 856917).

Background: Every year, more than 90,000 U.S. women undergo mastectomy. More than 40% have reconstruction. Following reconstruction, most women experience persistent partial or complete numbness of the reconstructed breasts, and many experience pain. Yet, breast reconstruction procedures focus largely on esthetic outcomes with mixed impact on sensory outcomes and little attention to pain. This study examines whether and how breast sensation is important to women., Materials and Methods: Conventional content analysis of extant qualitative data from a clinical registry (29 women with prior breast surgery for cancer, 2008-2022), a volunteer community sample (qualitative interviews with 6 women with and 5 without breast cancer, 2019), and from a Twitter social media survey ( N  = 32, 2022)., Results: Functions of the breast identified by women with and without cancer include breastfeeding, sexual function, and femininity. Five interrelated themes on the importance of breast sensation emerged among women with breast cancer history: sexual function, experience of partnered sex or relationship with one's sexual partner, breast embodiment, effect of breast pain on sexual function, and importance to psychological wellbeing. Women, advocates, and clinicians described a lack of patient-physician communication in this domain that exacerbates the negative impact of breast sensation loss on health and wellbeing., Conclusions: Breast sensation is important to women following mastectomy, yet a gap exists in patient-physician communication about the impact of mastectomy and reconstruction on breast sensory function. Lessons for physicians, scientists, and skeptics are conveyed about why the basic integrity of women's bodies matters for practice and science., Competing Interests: S.T.L. discloses that under the terms of Grant Number 1C1CMS330997-01-00 (S.T.L., PI) from the Department of Health and Human Services, Centers for Medicare and Medicaid Services, she was expected to develop a sustainable business model to continue and support the model that we tested after award funding ended. S.T.L. was the founder and owner of a social impact company, NowPow, LLC, which was acquired by Unite USA, Inc., in 2021. S.T.L. is an unpaid advisor to and holds stock in Unite USA, Inc. Neither the University of Chicago nor UChicago Medicine is endorsing or promoting Unite Us or its business, products, or services. S.T.L. is an editor on Female Sexual Dysfunction for UpToDate and received royalties <$100/year in 2019, 2020 for this work. Subsequent royalties have been paid to the University of Chicago. S.T.L. and her spouse own equity in a health care company unrelated to this study. The University of Chicago has filed patents (pending) for the Bionic Breast Project, a project led by S.T.L. All other authors have no competing interests to disclose. The study findings are the authors' own and do not reflect the view of the National Cancer Institute or the National Institutes of Health., (© Stacy T. Lindau et al., 2023; Published by Mary Ann Liebert, Inc.)