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1.  Determination of Plasma Concentration Reference Ranges for Risperidone and Paliperidone 
Schizophrenia is a common disease managed by a range of interventions, with the primary treatment being antipsychotic medications (APS). Inadequate response, lack of adherence, and/or adverse events often prevent optimal therapeutic effects or therapeutic efficiency. Monitoring APS plasma concentrations can be used together with a full clinical evaluation to help improve patient care or offer better treatment options for the patient. To enable interpretation of individual risperidone and paliperidone plasma concentrations, we developed “reference ranges,” which consider the expected variability in plasma concentrations between subjects across the population, rather than representing a “therapeutic range” that relates to efficacy and/or safety outcomes. The reference ranges were derived from population pharmacokinetic models, which varied based upon administration route, dose, and time after dose. Good agreement between the proposed reference ranges and external data was obtained through graphical and numerical evaluations, indicating they could be reliably used in clinical practice.
doi:10.1002/psp4.12217
PMCID: PMC5613178  PMID: 28614899
2.  Optimizing Antipsychotic Patient Management Using Population Pharmacokinetic Models and Point‐of‐Care Testing 
Schizophrenia is a common disease, characterized by progressive functional decline exacerbated by psychotic relapses that often result from a lack of full adherence to antipsychotic (APS) medication. Although atypical APS medications do not have clear therapeutic windows, as generally required for therapeutic drug monitoring (TDM), measuring APS plasma levels in the context of a population expected range at the point‐of‐care (POC) may provide valuable clinical insights for differentiating lack of efficacy from a lack of adherence to medication.
doi:10.1002/psp4.12212
PMCID: PMC5613188  PMID: 28575540
3.  Probing ultra-fast processes with high dynamic range at 4th-generation light sources: Arrival time and intensity binning at unprecedented repetition rates 
Structural Dynamics  2017;4(2):024301.
Understanding dynamics on ultrafast timescales enables unique and new insights into important processes in the materials and life sciences. In this respect, the fundamental pump-probe approach based on ultra-short photon pulses aims at the creation of stroboscopic movies. Performing such experiments at one of the many recently established accelerator-based 4th-generation light sources such as free-electron lasers or superradiant THz sources allows an enormous widening of the accessible parameter space for the excitation and/or probing light pulses. Compared to table-top devices, critical issues of this type of experiment are fluctuations of the timing between the accelerator and external laser systems and intensity instabilities of the accelerator-based photon sources. Existing solutions have so far been only demonstrated at low repetition rates and/or achieved a limited dynamic range in comparison to table-top experiments, while the 4th generation of accelerator-based light sources is based on superconducting radio-frequency technology, which enables operation at MHz or even GHz repetition rates. In this article, we present the successful demonstration of ultra-fast accelerator-laser pump-probe experiments performed at an unprecedentedly high repetition rate in the few-hundred-kHz regime and with a currently achievable optimal time resolution of 13 fs (rms). Our scheme, based on the pulse-resolved detection of multiple beam parameters relevant for the experiment, allows us to achieve an excellent sensitivity in real-world ultra-fast experiments, as demonstrated for the example of THz-field-driven coherent spin precession.
doi:10.1063/1.4978042
PMCID: PMC5346102  PMID: 28382317
4.  Preoperative neutrophil:lymphocyte and platelet:lymphocyte ratios predict endometrial cancer survival 
British Journal of Cancer  2015;113(2):311-320.
Background:
Variations in systemic inflammatory response biomarker levels have been associated with adverse clinical outcome in various malignancies. This study determined the prognostic significance of preoperative neutrophil:lymphocyte (NLR), platelet:lymphocyte (PLR) and monocyte:lymphocyte (MLR) ratios in endometrial cancer.
Methods:
Clinicopathological and 5-year follow-up data were obtained for a retrospective series of surgically treated endometrial cancer patients (n=605). Prognostic significance was determined for overall (OS) and cancer-specific survival (CSS) using Cox proportional hazards models and Kaplan–Meier analysis. Receiver–operator characteristic and log-rank functions were used to optimise cut-offs. NLR, PLR and MLR associations with clinicopathological variables were determined using non-parametric tests.
Results:
Applying cut-offs of ⩾2.4 (NLR), ⩾240 (PLR) and ⩾0.19 (MLR), NLR and PLR (but not MLR) had independent prognostic significance. Combining NLR and PLR scores stratified patients into low (NLR-low and PLR-low), intermediate (NLR-high or PLR-high) and high risk (NLR-high and PLR-high) groups: multivariable hazard ratio (HR) 2.51; P<0.001 (OS); HR 2.26; P<0.01 (CSS) for high vs low risk patients. Increased NLR and PLR were most strongly associated with advanced stage (P<0.001), whereas increased MLR was strongly associated with older age (P<0.001).
Conclusion:
Both NLR and PLR are independent prognostic indicators for endometrial cancer, which can be combined to provide additional patient stratification.
doi:10.1038/bjc.2015.200
PMCID: PMC4506386  PMID: 26079303
endometrial cancer; neutrophil:lymphocyte ratio; platelet:lymphocyte ratio; monocyte:lymphocyte ratio; lymphocyte:monocyte ratio; survival
5.  The Importance of Disclosure: Lesbian, Gay, Bisexual, Transgender/Transsexual, Queer/Questioning, Intersex (LGBTQI) Individuals and the Cancer Continuum 
Cancer  2014;121(8):1160-1163.
Precis
The Lesbian, Gay, Bisexual, Transgender/Transsexual, Queer/Questioning, Intersex (LGBTQI) population experiences cancer health disparities due to lack of disclosure and knowledge about increased cancer risk. Oncology health care providers and institutions should create environments that encourage disclosure of sexual orientation and identity.
doi:10.1002/cncr.29203
PMCID: PMC4505934  PMID: 25521303
LGBT; health; cancer; oncology
6.  High-Field High-Repetition-Rate Sources for the Coherent THz Control of Matter 
Scientific Reports  2016;6:22256.
Ultrashort flashes of THz light with low photon energies of a few meV, but strong electric or magnetic field transients have recently been employed to prepare various fascinating nonequilibrium states in matter. Here we present a new class of sources based on superradiant enhancement of radiation from relativistic electron bunches in a compact electron accelerator that we believe will revolutionize experiments in this field. Our prototype source generates high-field THz pulses at unprecedented quasi-continuous-wave repetition rates up to the MHz regime. We demonstrate parameters that exceed state-of-the-art laser-based sources by more than 2 orders of magnitude. The peak fields and the repetition rates are highly scalable and once fully operational this type of sources will routinely provide 1 MV/cm electric fields and 0.3 T magnetic fields at repetition rates of few 100 kHz. We benchmark the unique properties by performing a resonant coherent THz control experiment with few 10 fs resolution.
doi:10.1038/srep22256
PMCID: PMC4770290  PMID: 26924651
7.  UK Lung Cancer RCT Pilot Screening Trial: baseline findings from the screening arm provide evidence for the potential implementation of lung cancer screening 
Thorax  2015;71(2):161-170.
Background
Lung cancer screening using low-dose CT (LDCT) was shown to reduce lung cancer mortality by 20% in the National Lung Screening Trial.
Methods
The pilot UK Lung Cancer Screening (UKLS) is a randomised controlled trial of LDCT screening for lung cancer versus usual care. A population-based questionnaire was used to identify high-risk individuals. CT screen-detected nodules were managed by a pre-specified protocol. Cost effectiveness was modelled with reference to the National Lung Cancer Screening Trial mortality reduction.
Results
247 354 individuals aged 50–75 years were approached; 30.7% expressed an interest, 8729 (11.5%) were eligible and 4055 were randomised, 2028 into the CT arm (1994 underwent a CT). Forty-two participants (2.1%) had confirmed lung cancer, 34 (1.7%) at baseline and 8 (0.4%) at the 12-month scan. 28/42 (66.7%) had stage I disease, 36/42 (85.7%) had stage I or II disease. 35/42 (83.3%) had surgical resection. 536 subjects had nodules greater than 50 mm3 or 5 mm diameter and 41/536 were found to have lung cancer. One further cancer was detected by follow-up of nodules between 15 and 50 mm3 at 12 months. The baseline estimate for the incremental cost-effectiveness ratio of once-only CT screening, under the UKLS protocol, was £8466 per quality adjusted life year gained (CI £5542 to £12 569).
Conclusions
The UKLS pilot trial demonstrated that it is possible to detect lung cancer at an early stage and deliver potentially curative treatment in over 80% of cases. Health economic analysis suggests that the intervention would be cost effective—this needs to be confirmed using data on observed lung cancer mortality reduction.
Trial registration
ISRCTN 78513845.
doi:10.1136/thoraxjnl-2015-207140
PMCID: PMC4752629  PMID: 26645413
Lung Cancer; Imaging/CT MRI etc
8.  Setting Occupational Exposure Limits for Chemical Allergens—Understanding the Challenges 
Chemical allergens represent a significant health burden in the workplace. Exposures to such chemicals can cause the onset of a diverse group of adverse health effects triggered by immune-mediated responses. Common responses associated with workplace exposures to low molecular weight (LMW) chemical allergens range from allergic contact dermatitis to life-threatening cases of asthma. Establishing occupational exposure limits (OELs) for chemical allergens presents numerous difficulties for occupational hygiene professionals. Few OELs have been developed for LMW allergens because of the unique biological mechanisms that govern the immune-mediated responses. The purpose of this article is to explore the primary challenges confronting the establishment of OELs for LMW allergens. Specific topics include: (1) understanding the biology of LMW chemical allergies as it applies to setting OELs; (2) selecting the appropriate immune-mediated response (i.e., sensitization versus elicitation); (3) characterizing the dose (concentration)-response relationship of immune-mediated responses; (4) determining the impact of temporal exposure patterns (i.e., cumulative versus acute exposures); and (5) understanding the role of individual susceptibility and exposure route. Additional information is presented on the importance of using alternative exposure recommendations and risk management practices, including medical surveillance, to aid in protecting workers from exposures to LMW allergens when OELs cannot be established.
doi:10.1080/15459624.2015.1072277
PMCID: PMC4685595  PMID: 26583909
allergens; asthma; chemicals; exposure; occupational; sensitization
9.  Setting Occupational Exposure Limits for Chemical Allergens—Understanding the Challenges 
Chemical allergens represent a significant health burden in the workplace. Exposures to such chemicals can cause the onset of a diverse group of adverse health effects triggered by immune-mediated responses. Common responses associated with workplace exposures to low molecular weight (LMW) chemical allergens range from allergic contact dermatitis to life-threatening cases of asthma. Establishing occupational exposure limits (OELs) for chemical allergens presents numerous difficulties for occupational hygiene professionals. Few OELs have been developed for LMW allergens because of the unique biological mechanisms that govern the immune-mediated responses. The purpose of this article is to explore the primary challenges confronting the establishment of OELs for LMW allergens. Specific topics include: (1) understanding the biology of LMW chemical allergies as it applies to setting OELs; (2) selecting the appropriate immune-mediated response (i.e., sensitization versus elicitation); (3) characterizing the dose (concentration)-response relationship of immune-mediated responses; (4) determining the impact of temporal exposure patterns (i.e., cumulative versus acute exposures); and (5) understanding the role of individual susceptibility and exposure route. Additional information is presented on the importance of using alternative exposure recommendations and risk management practices, including medical surveillance, to aid in protecting workers from exposures to LMW allergens when OELs cannot be established.
doi:10.1080/15459624.2015.1072277
PMCID: PMC4685595  PMID: 26583909
allergens; asthma; chemicals; exposure; occupational; sensitization
10.  Domestic exposure to fungal allergenic particles determined by halogen immunoassay using subject's serum versus particles carrying three non-fungal allergens determined by allergen-specific HIA 
Indoor air  2014;24(4):438-445.
Studies that estimate indoor aeroallergen exposure typically measure a pre-selected limited range of allergens. In this study, inhalable aeroallergen particles were quantified using the halogen immunoassay (HIA) to determine the contribution of fungal and non-fungal aeroallergens to total allergen exposure. Bioaerosols from 39 homes of fungal-allergic subjects were sampled using inhalable fraction samplers and immunostained by HIA using resident subject's immunoglobulin E (IgE) to detect allergen-laden particles. Fungal aerosols as well as particles carrying mite, cat, and cockroach allergens were identified and enumerated by HIA. Reservoir dust-mite (Der p 1), cat (Fel d 1), and cockroach (Bla g 1) allergen concentrations were quantified by ELISA. Fungal particles that bound subject's IgE in the HIA were 1.7 (bedroom)- and 1.4 (living room)-fold more concentrated than Der p 1, Fel d 1, and Bla g 1 allergen particles combined. Predominant fungal conidia that bound IgE were derived from common environmental genera including Cladosporium and other fungi that produce amerospores. Airborne mite, cat, and cockroach allergen particle counts were not associated with reservoir concentrations determined by ELISA. This study demonstrates that inhalable fungal aerosols are the predominant aeroallergen sources in Sydney homes and should be considered in future exposure assessments.
doi:10.1111/ina.12087
PMCID: PMC4678322  PMID: 24354925
Aeroallergens; Bioaerosols; Allergen exposure; Airborne fungi; Fungal allergens
11.  Cancer and Lesbian, Gay, Bisexual, Transgender/Transsexual, and Queer/Questioning Populations (LGBTQ) 
This article provides an overview of the current literature on seven cancer sites that may disproportionately affect lesbian, gay, bisexual, transgender/transsexual, and queer/questioning (LGBTQ) populations. For each cancer site we present and discuss the descriptive statistics, primary prevention, secondary prevention and preclinical disease, tertiary prevention and late stage disease, and clinical implications. Finally, an overview of psychosocial factors related to cancer survivorship is offered as well as strategies for improving access to care.
doi:10.3322/caac.21288
PMCID: PMC4609168  PMID: 26186412
LGBT; sexual minorities; cancer; health behavior; survivorship; health disparities
12.  Optical nanoscopy of transient states in condensed matter 
Scientific Reports  2015;5:12582.
Recently, the fundamental and nanoscale understanding of complex phenomena in materials research and the life sciences, witnessed considerable progress. However, elucidating the underlying mechanisms, governed by entangled degrees of freedom such as lattice, spin, orbit, and charge for solids or conformation, electric potentials, and ligands for proteins, has remained challenging. Techniques that allow for distinguishing between different contributions to these processes are hence urgently required. In this paper we demonstrate the application of scattering-type scanning near-field optical microscopy (s-SNOM) as a novel type of nano-probe for tracking transient states of matter. We introduce a sideband-demodulation technique that allows for probing exclusively the stimuli-induced change of near-field optical properties. We exemplify this development by inspecting the decay of an electron-hole plasma generated in SiGe thin films through near-infrared laser pulses. Our approach can universally be applied to optically track ultrafast/-slow processes over the whole spectral range from UV to THz frequencies.
doi:10.1038/srep12582
PMCID: PMC4648477  PMID: 26215769
13.  Understanding the Psychosocial Issues of African American Couples Surviving Prostate Cancer 
African Americans are disproportionately affected by prostate cancer, yet less is known about the most salient psychosocial dimensions of quality of life. The purpose of this study was to explore the perceptions of African American prostate cancer survivors and their spouses of psychosocial issues related to quality of life. Twelve African American couples were recruited from a National Cancer Institute Comprehensive Cancer Center registry and a state-based non-profit organization to participate in individual interviews. The study was theoretically based on Ferrell's Quality of Life Conceptual Model. Common themes emerged regarding the psychosocial needs of African American couples. These themes were categorized into behavioral, social, psychological, and spiritual domains. Divergent perspectives were identified between male prostate cancer survivors and their female spouses. This study delineated unmet needs and areas for future in-depth investigations into psychosocial issues. The differing perspectives between patients and their spouses highlight the need for couple-centered interventions.
doi:10.1007/s13187-012-0360-1
PMCID: PMC4497555  PMID: 22544536
Prostate cancer; Survivorship; Psychosocial factors; African Americans; Quality of life; Qualitative methods
14.  Assessing Needs and Assets for Building a Regional Network Infrastructure to Reduce Cancer Related Health Disparities 
Significant cancer health disparities exist in the United States and Puerto Rico. While numerous initiatives have been implemented to reduce cancer disparities, regional coordination of these efforts between institutions is often limited. To address cancer health disparities nationwide, a series of regional transdisciplinary networks through the Geographic Management Program (GMaP) and the Minority Biospecimen/Biobanking Geographic Management Program (BMaP) were established in six regions across the country. This paper describes the development of the Region 3 GMaP/BMaP network composed of over 100 investigators from nine institutions in five Southeastern states and Puerto Rico to develop a state-of-the-art network for cancer health disparities research and training.
We describe a series of partnership activities that led to the formation of the infrastructure for this network, recount the participatory processes utilized to develop and implement a needs and assets assessment and implementation plan, and describe our approach to data collection. Completion, by all nine institutions, of the needs and assets assessment resulted in several beneficial outcomes for Region 3 GMaP/BMaP. This network entails ongoing commitment from the institutions and institutional leaders, continuous participatory and engagement activities, and effective coordination and communication centered on team science goals.
doi:10.1016/j.evalprogplan.2013.12.003
PMCID: PMC4360072  PMID: 24486917
cancer health disparities; needs assessment; evaluation; implementation plan; multi-institutional; biospecimen; biobank; team science
15.  Home Blood Pressure Monitoring, Secure Electronic Messaging and Medication Intensification for Improving Hypertension Control 
Applied Clinical Informatics  2014;5(1):232-248.
Summary
Objective
We evaluated the role of home monitoring, communication with pharmacists, medication intensification, medication adherence and lifestyle factors in contributing to the effectiveness of an intervention to improve blood pressure control in patients with uncontrolled essential hypertension.
Methods
We performed a mediation analysis of a published randomized trial based on the Chronic Care Model delivered over a secure patient website from June 2005 to December 2007. Study arms analyzed included usual care with a home blood pressure monitor and usual care with home blood pressure monitor and web-based pharmacist care. Mediator measures included secure messaging and telephone encounters; home blood pressure monitoring; medications intensification and adherence and lifestyle factors. Overall fidelity to the Chronic Care Model was assessed with the Patient Assessment of Chronic Care (PACIC) instrument. The primary outcome was percent of participants with blood pressure (BP) <140/90 mm Hg.
Results
At 12 months follow-up, patients in the web-based pharmacist care group were more likely to have BP <140/90 mm Hg (55%) compared to patients in the group with home blood pressure monitors only (37%) (p = 0.001). Home blood pressure monitoring accounted for 30.3% of the intervention effect, secure electronic messaging accounted for 96%, and medication intensification for 29.3%. Medication adherence and self-report of fruit and vegetable intake and weight change were not different between the two study groups. The PACIC score accounted for 22.0 % of the main intervention effect.
Conclusions
The effect of web-based pharmacist care on improved blood pressure control was explained in part through a combination of home blood pressure monitoring, secure messaging, and antihypertensive medication intensification.
doi:10.4338/ACI-2013-10-RA-0079
PMCID: PMC3974258  PMID: 24734136
Personal health records; patient-provider communication; telemedicine and telehealth; remote monitoring; internet portal; patient self-care; home care and e-health
16.  Hoxb8 regulates expression of microRNAs to control cell death and differentiation 
Cell Death and Differentiation  2013;20(10):1370-1380.
Hoxb8 overexpression immortalises haematopoietic progenitor cells in a growth-factor-dependant manner and co-operates with interleukin-3 (IL-3) to cause acute myeloid leukaemia. To further understand how Hoxb8 contributes to myeloid cell immortalisation, we generated IL-3-dependant myeloid cells expressing Hoxb8 under the control of an inducible promoter. Downregulation of Hoxb8, in the presence of IL-3, caused cell-cycle arrest and apoptosis in the majority of cells. Apoptosis was dependant on Bax and Bak and, in part, on Bim, which was repressed by Hoxb8. Deletion of the miR-17∼92 seed sequences in the Bim 3′UTR abolished Hoxb8-dependant regulation of Bim reporter constructs. Expression of all six miRNAs from this cluster were elevated when Hoxb8 was overexpressed. The miR-17∼92 cluster was required for repression of Bim in Hoxb8-immortalised cells and deletion of the miR-17∼92 cluster substantially inhibited Hoxb8, but not Hoxa9, mediated survival and proliferation. Hoxb8 appears to promote miR-17∼92 expression through c-Myc, a known transcriptional regulator of the miR-17∼92 cluster. We have uncovered a previously unrecognised link between Hoxb8 expression and microRNAs that provides a new insight into the oncogenic functions of Hoxb8.
doi:10.1038/cdd.2013.92
PMCID: PMC3770316  PMID: 23872792
Apoptosis; Hoxb8; interleukin-3; microRNA
17.  Akt1 is the principal Akt isoform regulating apoptosis in limiting cytokine concentrations 
Cell Death and Differentiation  2013;20(10):1341-1349.
The activation of the Akt signalling in response to cytokine receptor signalling promotes protein synthesis, cellular growth and proliferation. To determine the role of Akt in interleukin-3 (IL-3) signalling, we generated IL-3-dependent myeloid cell lines from mice lacking Akt1, Akt2 or Akt3. Akt1 deletion resulted in accelerated apoptosis at low concentrations of IL-3. Expression of constitutively active Akt1 was sufficient to delay apoptosis in response to IL-3 withdrawal, but not sufficient to induce proliferation in the absence of IL-3. Akt1 prolonged survival of Bim- or Bad-deficient cells, but not cells lacking Puma, indicating that Akt1-dependent repression of apoptosis was in part dependent on Puma and independent of Bim or Bad. Our data show that a key role of Akt1 during IL-3 signalling is to repress p53-dependent apoptosis pathways, including transcriptional upregulation of Puma. Moreover, our data indicate that regulation of BH3-only proteins by Akt is dispensable for Akt-dependent cell survival.
doi:10.1038/cdd.2013.63
PMCID: PMC3770321  PMID: 23787999
Akt; Bcl-2; interleukin-3; puma
18.  Establishing the Infrastructure to Comprehensively Address Cancer Disparities: A Model for Transdisciplinary Approaches 
Summary
The Center for Equal Health (CEH), a transdisciplinary Center of Excellence, was established to investigate cancer disparities comprehensively and achieve health equity through research, education, training, and community outreach. This paper discusses challenges faced by CEH, strategies employed to foster collaborations, lessons learned, and future considerations for establishing similar initiatives.
doi:10.1353/hpu.2013.0186
PMCID: PMC4163783  PMID: 24185157
Health disparities; cancer; research; education; training
19.  Establishing the Infrastructure to Conduct Comparative Effectiveness Research Toward the Elimination of Disparities: A Community-Based Participatory Research Framework 
Health promotion practice  2013;14(6):893-900.
In Tampa, Florida, researchers have partnered with community- and faith-based organizations to create the Comparative Effectiveness Research for Eliminating Disparities (CERED) infrastructure. Grounded in community-based participatory research, CERED acts on multiple levels of society to enhance informed decision making (IDM) of prostate cancer screening among Black men. CERED investigators combined both comparative effectiveness research and community-based participatory research to design a trial examining the effectiveness of community health workers and a digitally enhanced patient decision aid to support IDM in community settings as compared with “usual care” for prostate cancer screening. In addition, CERED researchers synthesized evidence through the development of systematic literature reviews analyzing the effectiveness of community health workers in changing knowledge, attitudes and behaviors of African American adults toward cancer prevention and education. An additional systematic review analyzed chemoprevention agents for prostate cancer as an emerging technique. Both of these reviews, and the comparative effectiveness trial supporting the IDM process, add to CERED’s goal of providing evidence to eliminate cancer health disparities.
doi:10.1177/1524839913475451
PMCID: PMC4163786  PMID: 23431128
community health workers; comparative effectiveness research; health disparity; community-based participatory research; prostate cancer
20.  Affecting African American Men’s Prostate Cancer Screening Decision-making through a Mobile Tablet-Mediated Intervention 
African American men experience a 60% higher incidence of prostate cancer and are more than twice as likely to die from it than White men. Evidence is insufficient to conclude that definitively screening for prostate cancer reduces the likelihood of morbidity or death. Patients are encouraged to discuss screening alternatives with health care providers for informed decision-making (IDM). The extent of IDM in clinical or community setting is not known. This study uses data from a community-based, computer-mediated, IDM intervention that targeted 152 African American aged 40 to 70. Pretest-posttest differences in means for prostate cancer knowledge, screening decisional conflict, and screening decisional self-efficacy were examined by two-tailed t-tests. Overall, the intervention significantly improved respondents’ prostate cancer knowledge (p<.0001), significantly improved decisional self-efficacy (p<.0001) and significantly reduced decisional conflict (p<.0001). Specifically, the intervention significantly promoted IDM among men who reported more education, being married, having financial resources, and younger age.
doi:10.1353/hpu.2014.0148
PMCID: PMC4160127  PMID: 25130238
African American; prostate cancer; screening; informed decision-making; computer-mediated intervention; community setting
21.  Unwillingness to participate in colorectal cancer screening: Examining fears, attitudes, and medical mistrust in an ethnically diverse sample of adults 50 years and older 
American journal of health promotion : AJHP  2012;26(5):10.4278/ajhp.110113-QUAN-20.
Purpose
Identify the influence of medical mistrust, fears, attitudes, and sociodemographic characteristics on unwillingness to participate in colorectal cancer (CRC) screening.
Design
Cross-sectional disproportionally allocated, stratified, random-digit dial telephone questionnaire of non-institutionalized households.
Setting
New York City, NY; Baltimore, MD; San Juan, Puerto Rico.
Subjects
Ethnically diverse sample of 454 adults ≥ 50 years of age.
Measures
Health status, cancer screening effectiveness, psychosocial factors (i.e., perceptions of pain, fear, trust), and CRC screening intentions using the Cancer Screening Questionnaire which addresses a range of issues related to willingness of minorities to participate in cancer screening.
Analysis
Multivariate logistic regression was used to model the probability of reporting unwillingness to participate in CRC screening.
Results
Fear of embarrassment during screening (OR = 10.72; 95% CI: 2.15–53.39), fear of getting AIDS (OR = 8.75; 95% CI: 2.48–30.86), fear that exam might be painful (OR=3.43; 95% CI: 1.03–11.35), and older age (OR = 1.10; 95% CI: 1.04 – 1.17) were positively associated with unwillingness to participate in CRC screening. Fear of developing cancer (OR = 0.12; 95% CI: 0.03 – 0.57) and medical mistrust (OR =0.19; 95% CI: 0.06 – 0.60) were negatively associated with unwillingness to screen.
Conclusions
Findings suggest that CRC health initiatives should focus on increasing knowledge; addressing fears, mistrust, normalize CRC screening as a beneficial preventive practice; and increase focus on older adults.
doi:10.4278/ajhp.110113-QUAN-20
PMCID: PMC3807238  PMID: 22548424
Colorectal Cancer; Screening; Fear; Trust; Prevention and Control
22.  Sociodemographic differences in fears and mistrust contributing to unwillingness to participate in cancer screenings 
Effective provider-patient relationships are vital for positive patient health outcomes. This analysis assessed sociodemographic differences in fears and mistrust related to the provider-patient relationship, which may contribute to unwillingness to participate in cancer screenings (CSs). The data are from a stratified, random-digit dial telephone questionnaire of non-institutionalized households in New York, Maryland, and Puerto Rico. Statistically significant results indicate that Hispanics, compared with Whites, were nearly two times more likely to report that fear of being a “guinea pig” and lacking trust in medical people would make them unwilling to participate in CSs. Additionally, those with less education were over two times more likely to indicate a fear of being embarrassed during the screening would make them unwilling to participate in CSs. These results highlight areas where health professionals can improve interactions with their patients and be attentive to their fears and/or mistrusts to promote CSs utilization.
doi:10.1353/hpu.2012.0148
PMCID: PMC3786428  PMID: 23124501
Cancer screening; provider-patient relationship; sociodemographic characteristics
23.  Belief in AIDS Origin Conspiracy Theory and Willingness to Participate in Biomedical Research Studies: Findings in Whites, Blacks, and Hispanics in Seven Cities Across Two Surveys 
HIV clinical trials  2011;12(1):37-47.
Purpose
The purpose of this study was to determine whether a belief in the AIDS origin conspiracy theory is related to likelihood or fear of participation in research studies.
Methods
The Tuskegee Legacy Project Questionnaire was administered via random-digit-dialed telephone interview to black, white, and Hispanic participants in 4 cities in 1999 and 2000 (n = 1,133) and in 3 cities in 2003 (n = 1,162).
Results
In 1999, 27.8% of blacks, 23.6% of Hispanics, and 8% of whites (P ≤ .001) reported that it was “very or somewhat likely” that AIDS is “the result of a government plan to intentionally kill a certain group of people by genocide.” In 2003, 34.1% of blacks, 21.9% of Hispanics, and 8.4% of whites (P ≤ .001) reported the same.
Conclusions
Whereas blacks and Hispanics were more than 3 times more likely than whites to believe in this AIDS origin conspiracy theory, holding this belief was not associated with a decreased likelihood of participation in, or increased fear of participation in, biomedical research.
doi:10.1310/hct1201-37
PMCID: PMC3778447  PMID: 21388939
AIDS; biomedical research; conspiracy theory; health disparities; HIV; research participation
24.  Gender differences in cancer screening beliefs, behaviors, and willingness to participate: Implications for health promotion 
American journal of men's health  2011;6(3):211-217.
Men have higher cancer mortality rates for all sites combined compared to women. Cancer screening (CS) participation is important for the early detection of cancer. This study explores gender differences in CS beliefs, behaviors, and willingness to participate. The data were collected from a stratified, random-digit dial survey of adults living in New York, Maryland, and Puerto Rico. Chi-square tests and logistic regressions were computed to analyze gender associations among CS beliefs, behaviors, and willingness variables. Men and women believed cancer screenings were effective, though a higher percentage of men had never had a past CS. Men were less willing to participate in a CS at the present time and in a skin cancer exam; however, when given descriptions of screening conditions, men indicated more willingness to participate. These gender differences highlight the need for health professionals to examine their efforts in providing enhanced CS promotion and education among men.
doi:10.1177/1557988311425853
PMCID: PMC3776317  PMID: 22071507
Cancer screening; Gender differences; Health promotion
25.  Influence of scary beliefs about the Tuskegee Syphilis Study on willingness to participate in research 
Objectives
To assess whether scary/alarming beliefs about details on the Tuskegee Syphilis Study (TSS) are associated with willingness and/or fear to participate in biomedical research.
Methods
Scary beliefs about TSS were examined for 565 Black and White adults who had heard of the TSS. Multivariate analyses by race were used to measure association.
Results
No association between scary beliefs and willingness or fear to participate in research was found (P>0.05).
Conclusions
These findings provide additional evidence that awareness or detailed knowledge about the TSS does not appear today to be a major factor influencing Blacks’ willingness to participate in research.
PMCID: PMC3776318  PMID: 22924230
Tuskegee Syphilis Study; biomedical research; minority participation

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