This study evaluated the five-year observed survival rates of American Indians/Alaskan Native, African American, and white cancer patients among various demographic characteristics in Oklahoma focusing on lung and bronchus, colon and rectum, female breast, and prostate for the cancer patients diagnosed between 1997 and 2008.
The five-year observed survival rates were calculated for overall cancer and specific cancer sites, using Kaplan-Meier method with data from the Oklahoma Central Cancer Registry.
Overall, 51.5% patients diagnosed with cancer survived for five years. For specific sites we found: 79.2% for female breast cancer survived; 77.5% for prostate cancer; 12.9% for lung and bronchus cancer; and 49.9% for colorectal cancer.
The five-year observed survival rates in Oklahoma were consistent with national trends. Overall, cancer survival seems to be improving over time, but there remains disparity with the AA and AI/AN populations in contrast to whites in Oklahoma.
In 2000, Congress passed the Breast and Cervical Cancer Prevention and Treatment Act (BCCPTA) to provide coverage through Medicaid to women who screened positive for breast and cervical cancer. We aimed to determine if late-stage breast cancer prevalence decreased among Oklahoma women after passage of BCCPTA. Data were obtained from the Oklahoma Central Cancer Registry during 2000–2011. We estimated prevalence proportion ratios (PPR) using modified Poisson regression between the proportion of women with late-stage breast cancer and timing of diagnosis related to BCCPTA. Among uninsured women, the probability of being diagnosed with late-stage cancer after enactment of the BCCPTA was 0.80 (95% CI: 0.67, 0.96) times the probability before enactment. This was significant among uninsured women living in metro counties (PPR: 0.74, 95% CI: 0.61, 0.90) but not in non-metro counties (PPR: 1.05, 95% CI: 0.71, 1.56). These findings may be similar to other rural states with large uninsured populations.
Cancer is the second-leading cause of death in the United States (US) and Oklahoma ranks near the top with the highest rates of mortality from cancer. The top four major sites of cancer were prostate, female breast, lung and bronchus, and colon and rectum.
Joinpoint software was used to examine the incidence and mortality for the four cancers over time from 1999-2012 for both the US and Oklahoma.
Incidence and mortality rates declined from 1999-2012 for the four cancer sites. The average annual, age-adjusted incidence rate was higher in the US than Oklahoma for prostate cancer, but higher in Oklahoma for female breast, lung and bronchus, and colon and rectum cancer sites.
Over the course of 14 years from 1999-2012, the age-adjusted incidence and mortality rates of prostate cancer, female breast cancer, lung and bronchus cancer, and colon and rectum cancer decreased over time nationally and in Oklahoma.
Oral cavity cancer (OC) has steadily decreased in the United States (US) since 1973 whereas oropharyngeal cancer (OP) has increased. We analyzed OC and OP cases from the Oklahoma Central Cancer Registry and Surveillance, Epidemiology, and End Results program comparing those diagnosed from 1997–1999 to those diagnosed from 2010–2012. We compared the incidence of OC and OP cases between Oklahoma and the US and by demographic factors. We observed an increase in OP cases, but no change in OC cases in both the US and in Oklahoma, and observed some differences between Oklahoma and the US by race, gender, and age group. A possible explanation for the increasing incidence of OP cancers may be the increasing prevalence of HPV. This study highlighted the differences in temporal trends of OC and OP cancers and the importance of changing risk factors for these cancers.
Testicular cancer is a rare cause of morbidity and mortality in the US. Marked disparities in the development of this cancer exist, with testicular cancer being more common in Caucasian men and men of higher socioeconomic status. The incidence of testicular cancer is increasing worldwide, and the reasons for this have not been well documented. It has been proposed that this increase may be due to highly prevalent environmental factors, or from exposure to polychlorinated biphenyls, polyvinyl chloride, cigarette smoking, and tetrahydrocannabinol (THC). For our analysis, data were obtained from the Oklahoma Central Cancer Registry and the Surveillance, Epidemiology and End Results program. Age-adjusted incidence rates and five-year relative survival were calculated for Oklahoma and for the US. Overall, incidence was lower in Oklahoma than the US, but no differences were observed between the US and Oklahoma regarding survival by year of diagnosis, race, age, and stage.
This study assessed the period prevalence (2000-2008) and mortality rates of melanoma, in Oklahoma, among different racial/ethnic strata.
We analyzed incident cases of melanoma from 2000-2008 from the Oklahoma Central Cancer Registry and determined disease duration using Kaplan-Meier survival analysis to calculate period prevalence of melanoma in Oklahoma. Using a series of Chi-Square tests, we compared period prevalence and mortality rates among the racial groups and compared mortality between Oklahoma and the US.
White non-Hispanics in Oklahoma have the highest period prevalence (p<0.0001) among the racial strata. American Indian or Alaska Native (AI/AN) individuals have the second highest period prevalence in Oklahoma (p<0.0001). Furthermore, white non-Hispanics (p<0.0001) and AI/AN individuals (p=0.0003) in Oklahoma had higher mortality rates compared to the US.
There are disparities in the prevalence and mortality of melanoma among the AI/AN population in Oklahoma, and prevention and education programs should focus on this population.
While cancer is relatively rare in children under 20, it is the leading cause of disease-related death among children aged 5 to 14 years. We aimed to describe the incidence and survival of childhood cancer in Oklahoma from 1997-2012. We calculated age-adjusted incidence rates and five-year observed survival by cancer type using Oklahoma Central Cancer Registry and Surveillance, Epidemiology, and End Results program data among children diagnosed with cancer under the age of 20 from 1997-2012. The average annual age-adjusted incidence rate of childhood cancer was 168.9 per million for the US and 171.7 per million for Oklahoma. Overall, Oklahoma had lower survival from childhood cancer compared to the US (77.0% v. 80.6%). In recent years, research has been conducted on the epidemiology of childhood cancer. Little research has been done, however, on the incidence or survival of childhood cancer at state levels and none focused exclusively on Oklahoma.
Pancreatic cancer is among the most deadly cancers. Risk factors associated with the disease include age, race, sex, smoking status, and diabetes status.
We conducted a prospective analysis of risk factors and length of survival among pancreatic cancer patients living in Oklahoma between 1997 and 2012 (n=6,291). Kaplan-Meier survival curves were created followed by the log-rank test to compare difference in the survival time. Cox proportional hazard regression models were used to examine the strength of association through the estimated hazard ratios.
The median survival time of the cohort was three months. Significant risk factors for reduced survival times included age, stage at diagnosis, and year of diagnosis.
Results are in agreement with previous research findings. There have been small but noteworthy improvements in survival times for pancreatic cancer patients in Oklahoma. Length of survival during the study period was significantly associated with known risk factors such as age and stage of diagnosis.
Recent studies have shown an apparent increase in thyroid cancer in the United States. Whether is due to an actual increase or increased screening is disputed. We analyzed thyroid cancer incidence and mortality across age and racial groups in Oklahoma (using data from the Oklahoma Central Cancer Registry) against Surveillance, Epidemiology, and End Results (SEER) program national data – using SEER*Stat software for mortality. In the US and Oklahoma, females had a higher AAIR compared to males, but it was lower in Oklahoma than in the US (Females: US 15.5 per 100,000, OK 10.9 per 100,000; Males: US 5.4 per 100,000, OK 3.8 per 100,000). Overall, five-year relative survival was lower, yet still high, for Oklahoma than in the US (92.1% v. 97.1%). Survival by stage was lower in Oklahoma compared to the United States for localized (97.8% v. 99.8%), regional (92.0% v. 97.0%), and distant (36.6% v. 55.3%) stage cancers.
Estimates of venous thromboembolism (VTE) incidence in the United States are limited by lack of a national surveillance system. We implemented a population-based surveillance system in Oklahoma County, OK, for April 1, 2012 to March 31, 2014, to estimate the incidences of first-time and recurrent VTE events, VTE-related mortality, and the proportion of case patients with provoked versus unprovoked VTE. The Commissioner of Health made VTE a reportable condition and delegated surveillance-related responsibilities to the University of Oklahoma, College of Public Health. The surveillance system included active and passive methods. Active surveillance involved reviewing imaging studies (such as chest computed tomography and compression ultrasounds) from all inpatient and outpatient facilities. Interrater agreement between surveillance officers collecting data was assessed using κ. Passive surveillance used International Classification of Disease, Ninth Revision (ICD-9) codes from hospital discharge data to identify cases. The sensitivity and specificity of various ICD-9–based case definitions will be assessed by comparison with cases identified through active surveillance. As of February 1, 2015, we screened 54,494 (99.5%) of the imaging studies and identified 2,725 case patients, of which 91.6% were from inpatient facilities, and 8.4% were from outpatient facilities. Agreement between surveillance officers was high (κ ≥0.61 for 93.2% of variables). Agreement for the diagnosis of pulmonary embolism and diagnosis of deep vein thrombosis was κ = 0.92 (95% CI 0.74-1.00) and κ = 0.89 (95% CI 0.71-1.00), respectively. This surveillance system will provide data on the accuracy of ICD-9–based case definitions for surveillance of VTE events and help the Centers for Disease Control and Prevention develop a national VTE surveillance system.
To determine macronutrients and micronutrients in foods served to and consumed by children at child-care centres in Oklahoma, USA and compare them with Dietary Reference Intakes (DRI).
Observed lunch nutrients compared with one-third of the age-based DRI (for 1–3 years-olds and 4–8-year-olds).
Oklahoma child-care centres (n 25), USA.
Children aged 3–5 years (n 415).
Regarding macronutrients, children were served 1782 (sd 686) kJ (426 (sd 164) kcal), 22·0 (sd 9·0) g protein, 51·5 (sd 20·4) g carbohydrate and 30·7 (sd 8·7) % total fat; they consumed 1305 (sd 669) kJ (312 (sd 160 kcal), 16·0 (sd 9·1) g protein, 37·6 (sd 18·5) g carbohydrate and 28·9 (sd 10·6) % total fat. For both age-based DRI: served energy (22–33 % of children), protein and carbohydrate exceeded; consumed energy (7–13% of children) and protein exceeded, while carbohydrate was inadequate. Regarding micronutrients, for both age-based DRI: served Mg (65·9 (sd 24·7) mg), Zn (3·8 (sd 11·8) mg), vitamin A (249·9 (sd 228·3) µg) and folate (71·9 (sd 40·1) µg) exceeded; vitamin E (1·4 (sd 2·1) mg) was inadequate; served Fe (2·8 (sd 1·8) mg) exceeded only in 1–3-year-olds. Consumed folate (48·3 (sd 38·4) µg) met; Ca (259·4 (sd 146·2) mg) and Zn (2·3 (sd 3·0) mg) exceeded for 1–3-year-olds, but were inadequate for 4–8-year-olds. For both age-based DRI: consumed Fe (1·9 (sd 1·2) mg) and vitamin E (1·0 (sd 1·7) mg) were inadequate; Mg (47·2 (sd 21·8) mg) and vitamin A (155·0 (sd 126·5) µg) exceeded.
Lunch at child-care centres was twice the age-based DRI for consumed protein, while energy and carbohydrate were inadequate. Areas of improvement for micronutrients pertain to Fe and vitamin E for all children; Ca, Zn, vitamin E and folate for older pre-schoolers. Adequate nutrients are essential for development and the study reveals where public health nutrition experts, policy makers and care providers should focus to improve the nutrient density of foods.
Child-care centre; Dietary Reference Intake (DRI); Lunch; Pre-school
Despite progress to reduce the burden of tobacco, disparities in tobacco-related morbidity and mortality remain. This research examines trends in lung cancer incidence rates by race and by gender within race during 2001–2010 in Oklahoma.
Incident cases of lung cancer were obtained from the Oklahoma State Department of Health public use database. Cases were linked to the Indian Health Service database to reduce misclassification of American Indian race. Annual percent change (APC) was estimated by race and by gender within race to describe rates over time. Rates were considered to increase or decrease if the p-value for trend was <0.05.
Average lung cancer incidence rates were highest among American Indians (105.52 per 100,000) and lowest among whites (78.64 per 100,000). Lung cancer incidence rates declined among the overall white (APC:−2.17%; p=0.001) and African American (APC:−2.95%; p=0.003) populations, as well as white (APC:−3.02%; p<.001) and African American males (APC:−3.39%; p=0.007). Rates increased among American Indian females (APC: 2.20%; p=0.03).
Analysis of lung cancer incidence data reveals an inequality in tobacco-related morbidity among American Indians, especially American Indian females. This research suggests a need for more evidence-based tobacco control interventions within the American Indian population.
lung cancer; disparities; race; gender; tobacco; cigarette smoking; epidemiology
American Indians in Oklahoma have higher rates of tobacco use (29.2%) than any other racial group in the state. The Oklahoma Tobacco Helpline provides free cessation services to all Oklahomans and implements strategies specifically aimed at increasing the utilization and effectiveness of cessation services for American Indians.
To explore Helpline utilization patterns as well as outcomes, such as participant satisfaction and success in quitting, for American Indians. The utilization patterns and outcomes for American Indians were compared to that of the white population from July 1, 2010, to June 30, 2013, to determine whether the Helpline is equally effective among American Indians compared to whites.
Helpline utilization data from July 1, 2010, to June 30, 2013, were analyzed in the fall of 2013 to identify patterns and compare differences between American Indian and white Helpline registrants. Four- and 7-month follow-up survey data were used to compare outcomes related to satisfaction with services and quit rates.
During the 3-year study period, 10.6% of registrants who enrolled in an intervention were American Indian (11,075) and 71.2% were white (74,493). At the 7-month follow-up survey, 31.7% of American Indians reported having used no tobacco in the past 30 days compared to 36.5% of whites, but the differences were not statistically significant between racial groups.
The Oklahoma Tobacco Helpline is equally effective for American Indian and white tobacco users who register for Helpline services.
Despite well-established clinical guidelines for breast cancer treatment, Standard of Care (SOC) is not universal in the U.S. The purpose of this study was to describe the extent to which patients receive guideline-based, stage-specific treatments for localized female breast cancer in Oklahoma. Data were obtained from the Oklahoma Central Cancer Registry for the period 2003–2006. We included localized, invasive female breast cancers and analyzed both treatment and demographic factors. We used the National Comprehensive Cancer Network (NCCN) treatment guidelines to determine SOC. Among women who received breast conserving surgery (BCS), we used logistic regression to evaluate factors related to SOC. In Oklahoma, 92 percent of the 4,177 localized breast cancer patients were treated with recognized SOC. In women aged ≥65 years with BCS, those ≥75 years had a lower adjusted odds of meeting SOC than did those without insurance, with comorbid conditions, or whose comorbid status was unknown. Among women aged <65 years, those with Medicare/Medicaid, Medicare only, or without insurance, along with comorbid conditions, had a lower adjusted odds of meeting SOC. Overall, 92 percent of women met SOC. Factors such as age, insurance type, and comorbid conditions were associated with meeting SOC.
breast cancer; localized; Oklahoma; standard of care
Background: Determine the relationship between obesogenic characteristics of childcare and child adiposity in tribally-affiliated centers in Oklahoma. Methods: The two-day Environment and Policy Assessment and Observation (EPAO) included a total environment (TE), nutrition (N), and physical activity (PA) score and took place in 11 centers across Oklahoma. Eighty-two preschool children (3-5 years) participated. Child height and weight were measured and overweight status (≥ 85th percentile for age and sex) was determined. Regression models, fit using Generalized Estimating Equations methodology to account for clustering by center were used and adjusted for center characteristics. Results: Participants were 3.8 (0.8) years old, 55% male, 67% American Indian (AI) and 38% overweight. A healthier TE and PA was associated with a reduced odds of overweight, which remained significant after adjusting for some center characteristics, but not all. A healthier TE, N, and PA was associated with lower BMI percentile, which remained significant after some center-level adjustments, but not all. Lower sedentary opportunity and sedentary time were no longer associated with reduced odds of overweight following adjustment. Lower opportunity for high sugar and high fat foods and minutes of active play were associated with reduced odds of overweight in some adjusted models. Conclusions: Collectively unadjusted and adjusted models demonstrate that some aspects of a healthier childcare center environment are associated with reduced odds of overweight and lower BMI percentile in preschool children attending tribally-affiliated childcare in Oklahoma. Future research should examine the association of childcare and health behaviors and further explore the role of potential confounders.
•Childcare characteristics are associated with child weight status.•Childcare characteristics are associated with child body mass index percentile.•Elements of physical activity and nutrition environments can influence child health.
Obesity; Day care; Preschool; Young children; American Indian
We describe reach, partnerships, products, benefits, and lessons learned of the 25 Community Network Programs (CNPs) that applied community-based participatory research (CBPR) to reduce cancer health disparities.
Quantitative and qualitative data were abstracted from CNP final reports. Qualitative data were grouped by theme.
Together, the 25 CNPs worked with more than 2,000 academic, clinical, community, government, faith-based, and other partners. They completed 211 needs assessments, leveraged funds for 328 research and service projects, trained 719 new investigators, educated almost 55,000 community members, and published 991 articles. Qualitative data illustrated how use of CBPR improved research methods and participation; improved knowledge, interventions, and outcomes; and built community capacity. Lessons learned related to the need for time to nurture partnerships and the need to attend to community demand for sustained improvements in cancer services.
Findings demonstrate the value of government-supported, community–academic, CBPR partnerships in cancer prevention and control research.
This study describes overall and site specific cancer incidence among AI/ANs compared to whites in Oklahoma and differences in cancer staging.
Age-adjusted incidence rates obtained from the Oklahoma Central Cancer Registry are presented for all cancer sites combined and for the most common cancer sites among AI/ANs with comparisons to whites. Percentages of late stage cancers for breast, colorectal, and melanoma cancers are also presented.
AI/ANs had a significantly higher overall cancer incidence rate compared to whites (629.8/100,000 vs. 503.3/100,000), with a rate ratio of 1.25 (95% CI: 1.22, 1.28). There was a significant disparity in the percentage of late stage melanoma cancers between 2005 and 2009, with 14.0% late stage melanoma for whites and 20.0% for AI/ANs (p-value: 0.03).
Overall, there were cancer disparities between AI/ANs and whites in Oklahoma. Incidence rates were higher among AI/ANs for all cancers and many site specific cancers.
Indians; North American; Neoplasms; Registries; Health Policy; Health Status Disparities
venous thromboembolism; pulmonary embolism; deep vein thrombosis; incidence; recurrence
To examine how the National Cancer Institute-funded Community Network Program (CNP) operationalized principles of community-based participatory research (CBPR).
Based on our review of the literature and extant CBPR measurement tools, scientists from nine of 25 CNPs developed a 27-item questionnaire to self-assess CNP operationalization of nine CBPR principles.
Of 25 CNPs, 22 (88%) completed the questionnaire. Most scored well on CBPR principles to recognize community as a unit of identity, build on community strengths, facilitate co-learning, embrace iterative processes in developing community capacity, and achieve a balance between data generation and intervention. CNPs varied in extent to which they employed CBPR principles of addressing determinants of health, sharing power among partners, engaging community in research dissemination, and striving for sustainability.
Although tool development in this field is in its infancy, findings suggest that fidelity to CBPR processes can be assessed in a variety of settings.
Cancer disparities; community health; empowerment; health status disparities; indigenous populations; minority health; partnerships; training
Worsened renal function (WRF) during heart failure (HF) hospitalization is associated with in-hospital mortality, but there are limited data regarding its relationship to long-term outcomes after discharge. The influence of WRF resolution is also unknown. This retrospective study analyzed patients who received care from a large health system and had a primary hospital discharge diagnosis of HF between 1/2000 and 6/2008. Renal function was estimated from creatinine levels during hospitalization. The first available value was considered baseline. WRF was defined a creatinine increase of ≥0.3mg/dl on any subsequent hospital day compared to baseline. Persistent WRF was defined as having WRF at discharge. Proportional hazards regression, adjusting for baseline renal function and potential confounding factors, was used to assess time to re-hospitalization or death. Among 2465 patients who survived to discharge, 887 (36%) developed WRF. Median follow up was 2.1 years. In adjusted models, WRF was associated with higher rates of post-discharge death or re-hospitalization (HR 1.12, 95%CI 1.02 – 1.22). Among those with WRF, 528 (60%) had persistent WRF while 359 (40%) recovered. Persistent WRF was significantly associated with higher post-discharge event rates (HR 1.14, 95%CI 1.02 – 1.27), whereas transient WRF showed only a non-significant trend towards risk (HR 1.09 95%CI 0.96-1.24). In conclusion, among patients surviving hospitalization for HF, WRF was associated with increased long-term mortality and re-hospitalization, particularly if renal function did not recover by the time of discharge.
heart failure; cardiorenal syndrome; mortality; morbidity
Inhaled corticosteroids (ICS) are considered first-line treatment for persistent asthma; yet, there is significant variability in treatment response. Dual specificity phosphatase-1 (DUSP1) appears to mediate the anti-inflammatory action of corticosteroids.
To determine whether variants in the DUSP1 gene are associated with clinical response to ICS treatment.
Study participants with asthma were drawn from the following multi-ethnic cohorts: the Genetics of Asthma in Latino Americans (GALA) study, the Study of African Americans, Asthma, Genes & Environments (SAGE), and the Study of Asthma Phenotypes and Pharmacogenomic Interactions by Race-ethnicity (SAPPHIRE). We screened GALA participants for genetic variants that modified the relationship between ICS use and bronchodilator response. We then replicated our findings in SAGE and SAPPHIRE participants. In a group of SAPPHIRE participants treated with ICS for 6 weeks, we examined whether a DUSP1 polymorphism was associated with changes in forced expiratory volume at one second (FEV1) and self-reported asthma control.
DUSP1 polymorphisms, rs881152 and rs34507926, localized to different haplotype blocks and appeared to significantly modify the relationship between ICS use and bronchodilator response among GALA participants. This interaction was also seen for rs881152 among SAPPHIRE, but not SAGE participants. Among the group of SAPPHIRE patients prospectively treated with ICS for 6 weeks, rs881152 genotype was significantly associated with changes in self-reported asthma control but not FEV1.
DUSP1 polymorphisms were associated with clinical response to ICS therapy, and therefore, may be useful in the future to identify asthma patients more likely to respond to this controller treatment.
These findings further our understanding of ICS pharmacogenetics and will hopefully result in improved tailoring of this controller therapy among individuals with asthma and in better disease control.
We identified genetic variants in DUSP1 which appeared to mediate the clinical response to inhaled corticosteroid (ICS) medication. These findings may eventually assist in identifying individuals with asthma most likely to respond this controller therapy.
Asthma; inhaled corticosteroids; dual specificity phosphatase-1; DUSP1; corticosteroid responsiveness
Inhaled corticosteroid (ICS) non-adherence is common among patients with asthma; however, interventions to improve adherence have often been complex and not easily applied to large patient populations.
To assess the effect of supplying patient adherence information to primary care providers.
Patients and providers were members of a health system serving southeast Michigan. Providers (88 intervention; 105 control) and patients (1,335 intervention; 1,363 control) were randomized together by practice. Patients were age 5–56 years; had a diagnosis of asthma; and had existing prescriptions for ICS medication. Adherence was estimated using prescription and fill data. Unlike clinicians in the control arm, intervention arm providers could view updated ICS adherence information on their patients via electronic prescription software, and further details on patient ICS use could be viewed by selecting that option. The primary outcome was ICS adherence in last 3-months of the study period.
At study end for the intention-to-treat analysis, ICS adherence was not different among patients in the intervention arm when compared with those in the control arm (21.3% vs. 23.3%, respectively; P=0.553). However, adherence was significantly higher among patients whose clinician elected to view their detailed adherence information (35.7%) when compared with both control arm patients (P=0.026) and intervention arm patients whose provider did not view adherence data (P=0.002).
Overall, providing adherence information to clinicians did not improve ICS use among patients with asthma. However, patient use may improve when clinicians are sufficiently interested in adherence to view the details of this medication use.
Medication adherence; inhaled corticosteroids; asthma; randomized controlled trial
Rationale: Adherence to inhaled corticosteroid (ICS) medication is known to be low overall, but tends to be lower among African-American patients when compared with white patients.
Objectives: To understand the factors that contribute to ICS adherence among African-American and white adults with asthma.
Methods: Eligible individuals had a prior diagnosis of asthma, one or more ICS prescriptions, and were members of a large health maintenance organization in southeast Michigan. Individuals were sent a survey that included questions about internal factors (e.g., patient beliefs, knowledge, and motivation) and external factors (e.g., socioeconomic status, barriers to care, social support, and stressors) potentially related to ICS adherence. Adherence was calculated using electronic prescription and fill data. Stepwise regression was used to identify factors associated with adherence before and after stratifying by race-ethnicity.
Measurements and Main Results: Surveys were returned by 1,006 (56.3%) of 1,787 eligible patients. Adjusting for internal factors, but not external factors, diminished the relationship between race-ethnicity and ICS adherence. Among African-American patients, readiness to take ICS medication was the only internal or external factor significantly associated with ICS adherence; it explained 5.6% of the variance in adherence. Among white patients, perceived ICS necessity, ICS knowledge, doctors being perceived as the source of asthma control, and readiness to take medication were the internal factors associated with ICS adherence; these accounted for 19.8% of the variance in adherence.
Conclusions: Factors associated with ICS adherence appear to differ between African-American and white patients, suggesting that group-specific approaches are needed to improve adherence.
medication adherence; inhaled corticosteroids; asthma; race-ethnicity; patient compliance
A system has been described in which the penetration of Rickettsia tsutsugamushi (Karp strain) into tissue culture cells can be quantitated, and the factors affecting this process studied. The results indicated that rickettsial penetration in vitro depended largely on the viability of the organisms. Certain components of the fluid environment such as the divalent cations and protein were found to be of importance. The temperature dependence of the penetration process was found to vary with the nature of the suspending medium. A number of compounds related to L-glutamic acid enhanced penetration, whereas metabolic inhibitors depressed this process. Aureomycin at concentrations between 50 and 250 µg./ml. inhibited the penetration of rickettsiae while chloramphenicol at similar concentrations was ineffective. The results are discussed in terms of the biological and biochemical properties of this group of agents.