This paper is a test of several hypothesized predictors of frequency of breast self-examination among low-income Mexican American women. Current research points to several factors as important predictors of preventive care. Among these are self-efficacy – one’s perceived capacity to perform a given action – and social support from significant others. For Mexican Americans, environmental barriers to health care are important factors. While findings are inconclusive regarding the role of language proficiency as a predictor of preventive care, the model includes this as a hypothesized predictor of frequency of breast self-examination. The findings show a strong relationship between self-efficacy and frequency of breast self-examination. Barriers to health care have a weaker direct effect upon breast self-examination. The effects of English-language proficiency are indirect and mediated by self-efficacy.

No description available.

archives@tulane.edu / Transpapillary drug delivery is a novel drug administration technique that integrates the non-invasive, passive aspect of transdermal drug delivery with the targeted approach of intraductal drug delivery by capitalizing on the mammary ducts to serve as an entry point, conduit and reservoir. Although these channels have been identified as a primary transport route, their contribution to overall tissue penetration has not been quantified. By combining two fluorescence techniques, we were able to quantitatively assess the various transport routes of small molecules and drug delivery vehicles following in vitro diffusion. Analysis of fluorescent images of porcine nipple cross-sections following diffusion of model hydrophilic and lipophilic fluorescent dyes indicated that both molecules penetrated the nipple via the stratum corneum and mammary ducts, however the lipophilic molecule targeted the ducts more so than the hydrophilic molecule. Encapsulating either dye within a liposome enhanced the ductal-associated fluorescence and reduced (hydrophilic dye) or did not affect (lipophilic dye) the stratum corneum-associated fluorescence. This suggests the capability of liposomes to selectively target and improve diffusion within the ductal channels. Encapsulation of the lipophilic dye within an oil-in-water nanoemulsion, however, either substantially increased penetration via both routes or only moderately improved transductal penetration, depending on the specific formulation. The in vivo distribution and efficacy of transpapillary diffusion was evaluated by first establishing an intraductal estrogen receptor positive breast cancer model. Results from in vivo imaging elucidated two growth rates, either slow or fast, which were discernable 14 days post-injection. A pilot therapeutic efficacy study using 4-hydroxytamoxifen was then performed; however due to a small sample size, the results were inconclusive. In vivo transpapillary diffusion of a small, lipophilic molecule was confirmed, as illustrated following application of a fluorescent dye. We conclude that transpapillary drug delivery is a viable in vitro administration technique for which the penetration routes can be tailored with drug carriers on a formulation-dependent basis. Furthermore, the feasibility of intraductally establishing estrogen receptor positive lesions and tracking their growth using in vivo imaging was validated. However, the use of this model to assess in vivo efficacy of transpapillary diffusion merits further evaluation. / 1 / Samantha Kurtz

Malignant tumor (cancer) had become the leading cause among the top ten leading causes of death in Taiwan since 1982. The department of health in Taiwan start to pay attention on cancer prevention until 21th century, and published ¡§The Law of Cancer Control and Prevention¡¨ at 2003, it purpose is to communicate cancer prevention information and activities from each medical centers to the public effectively, it essence is alike the concept of healthcare marketing. This research will review the monthly pamphlet published by the medical centers in southern Taiwan, to know how they construct their communication model, and distinguish if they had promote their merit prevention cancer or health services by the monthly pamphlets. With the integration of ¡§National Cancer Control and Prevention Five Year Plan¡¨ extended from the law of cancer control and prevention, this research shows that different medical centers pay attention on different hierarchy of prevention and cancer type, also different communication model and service have been promoted. But article on the monthly pamphlet are not requisite responsibility to the medical doctors in different medical centers. Although, research on the readers of the pamphlet were worthy, through the understanding of readers, the effectiveness of healthcare marketing through monthly pamphlet can be distinguish.

Background: Although some classic risk factors of NPC such as salted fish, tobacco and vegetable consumption were established a few decades ago, no convincing evidence that the decreasing trend in NPC incidence and mortality rates seen in most parts of the world could be explained by the changes of these consumption. As different histological types and age groups may have distinct risk factor profile in NPC development, it is important to look at incidence and mortality trends across different jurisdictions before any further individual studies are carried out worldwide. Objectives: With the focus on both high and low risk areas, this study aimed to 1) examine the descriptive epidemiology of NPC, including the secular trends of age-standardised incidence rate (ASIR), age-standardised mortality rate (ASMR) and age-specific incidence and mortality rate by sex; 2) perform an ecologic analysis between ASIR, ASMR and classical exposures. This included a multi-jurisdiction comparison between ASIR, ASMR and salted fish, cigarette and vegetable consumption per capita and 3) investigate the secular trend of ASIR and ASMR by sex, age and histologic subtype. Methods: NPC ASMR was obtained from the WHO cancer mortality database and ASIR, age-subtype specific incidence and mortality rates were provided by various cancer registries. All age and subtype specific rates were plotted in every 5 calendar years. Per capita consumption of salted fish, tobacco and vegetables in 8 regions (Hong Kong, China, Finland, Japan, Portugal, Singapore, United Kingdom and United States) were obtained from the Food and Agriculture Organization of the United Nation (FAO) and from different corresponding governmental departments. Pearson correlation coefficients and multivariate regression analysis were performed to examine both crude and adjusted associations. Results: There were markedly decreasing trends of NPC ASIR and ASMR in most of the high risk areas over the past three decades, while only some declines in incidence and mortality rates was observed in low risk areas. No association was found between salted fish, vegetable consumption and ASMR or ASIR in any region, except in Hong Kong where lag year cigarette consumption in males was correlated with ASIR (Pearson r for 10 lag year = 0.680; 15 lag year = 0.739 and 20 lag year = 0.747, all p<0.05). Multivariate regression analysis did not show association with any of the consumption in Japan, Portugal, the US and the UK. An earlier age of onset around 45-50 was observed with non-keratinizing carcinoma as the dominant subtype in high risk areas, while in low risk area the peak age was not seen until after 60 years old with most of the cases being keratinizing NPC. Conclusions: There were distinct differences in risk profile between NPC age-standardised and age-subtype specific rates between high and low risk areas. With the general secular trends of NPC incidence and mortality rates by age and tumour type being revealed in this study, further exploration in other jurisdictions with different potential risk or protective factor is warranted. / published_or_final_version / Public Health / Master / Master of Philosophy

Background. Cervical cancer is a common female cancer in Hong Kong. Cervical screening has been used in detecting cervical lesions for several decades. Given that human papillomavirus (HPV) infection is the etiological cause of cervical cancer, highly efficacious HPV vaccines are recently developed for preventing against HPV infection. Hong Kong has a well-developed healthcare system but relatively high cervical cancer incidence compared to other developed countries partly due to its suboptimal cervical screening program. This highlights the significance to evaluate the potential of implementing organized HPV vaccination programs for further reducing cervical cancer burden on top of cervical screening in Hong Kong. Methods. Cross-sectional, population-based surveys were conducted to assess the acceptability of female adolescent HPV vaccination among girls from secondary schools in 2008 and among mothers of adolescent daughters in 2008 and 2012. Mathematical model with transmission dynamic and stochastic individual-based components was constructed to model the natural history of HPV infection and cervical cancer and thus to project the public health and economic impacts of organized female adolescent HPV vaccination programs in a societal perspective. The model used Markov Chain Monte Carlo algorithm to estimate natural history parameters of HPV infection and probabilistic sensitivity analysis to consider the uncertainty of costs and health utilities in the economic evaluation of organized HPV vaccination. Results. Reported vaccine uptake among11–18 year-old girls increased from 2.4% among schoolgirls in 2008 to 9.1% among daughters of interviewed mothers in 2012. Among interviewed mothers, 27.5% and 37.6% of them were willing to have their daughters vaccinated at market price in 2008 and 2012, respectively. The mathematical model projected that HPV prevalence decreased soon after mass HPV vaccination and vaccine-induced cervical cancer reduction became obvious after vaccination programs have been launched for 30 years. If HPV vaccinesprovided30-year protection, the median incremental cost-effectiveness ratio (ICER) of routine HPV vaccination programs for 12 year-old girls at 25–75% vaccination coverage was US$26,367–32,527 per quality-adjusted life-year (QALY). The median ICER was above US$48,000/QALY if adding 2-year catch-up program for13–18 year-old girls and above US$58,000/QALY if vaccines protect against HPV infection for only 15 years. Conclusions. This study presented the first evaluation of organized HPV vaccination programs in Hong Kong. If vaccine protection lasted for 30 years or longer, organized routine HPV vaccination for 12 year-old girls would potentially be a cost-effective add-on in substantially reducing cervical cancers and HPV-related diseases on top of cervical screening in Hong Kong at an ICER threshold of US$33,218/QALY. However, the current estimated vaccine uptake was unexpectedly low and vaccine acceptability was only moderate. The findings indicated the importance to devise efficient strategies in achieving high and universal coverage for maximizing the population-level benefits of HPV vaccination. Policymakers should consider integrating the organized HPV vaccination programs with existing infrastructures to promote higher acceptability, to translate willingness to vaccinate to actual uptake, to assess population effectiveness, and to monitor safety issue and potential replacement effect of non-vaccine targeted HPV types following mass vaccination. / published_or_final_version / Public Health / Doctoral / Doctor of Philosophy

Thesis (M.S.H.P.) PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / BACKGROUND: Effective colorectal cancer prevention programs should ensure that patients with adenomas receive timely surveillance colonoscopy consistent with guidelines. The aim of our study was to identify patient-, provider-, and system-level predictors of adherence with surveillance colonoscopy in an ethnically diverse safety-net population. METHODS: We performed a retrospective analysis of average-risk patients age 50-75 with adenomas diagnosed at screening colonoscopy at Boston Medical Center and its affiliated community health centers from 1/1/2005 to 12/31/2007. The primary outcome was on-time follow-up defined as attendance at surveillance colonoscopy within 5.5 years of the screening colonoscopy. We compared frequencies of on-time follow-up and performed multivariable analysis, including ethnicity/language and any variable with P value <0.20 in unadjusted analysis. RESULTS: We identified 891 patients, of which 38% were English-speaking Non-Hispanic blacks, 24% Non-Hispanic white, and 10% Spanish-speaking Hispanics. Overall, 38.2% attended on-time surveillance colonoscopy. In unadjusted analyses, having ≥3 PCP visits in year 3-5 after baseline colonoscopy (OR 3.6 [2.6-5.1]), having “adenoma” on the electronic medical record problem list (OR 2.2 [1.6-2.9]), age (OR 0.98 [0.96-1.0]), and Charlson Index ≥1 (OR 1.3 [1.0-1.8]) were positively associated with adherence. In multivariate analysis, having “adenoma” on the problem list remained significant (adjusted OR (aOR) 1.8 [1.3-2.5]). Significant interactions were observed for ethnicity/language and PCP visits (P=0.008). CONCLUSION: A substantial proportion of adenoma-bearing patients fail to attend surveillance colonoscopy even in a safety net setting. Adding “adenomas” to the EMR problem list improved attendance, suggesting that system-level interventions may increase adherence to surveillance colonoscopy. / 2031-01-01

The research evaluated an intervention strategy designed to prevent skin cancer in young adolescents. The intervention used parents as change agents to effectively communicate the risks of skin cancer and encourage their children to avoid high-risk sun-related behaviors while increasing positive sun-safe behaviors. Three hundred and forty parents in two regions of the United States were educated about the dangers of risky sun behaviors and how to convey information about skin cancer prevention to their children. Parents were then encouraged to talk with their children about these issues over a 1-month period prior to the onset of summer. Following this time period, children whose parents received and implemented the intervention materials were compared with a control sample of 129 children. These two groups were matched on age, gender, and school on number of sunburns and sunburn severity, attitudes and beliefs, and sunbathing behavior. Children in the treatment condition differed significantly from controls in the predicted directions on all outcome variables. The findings are discussed in terms of reducing skin cancer risk behaviors of children via parent-based intervention approaches.

Although there are hereditary risk factors strongly associated with breast cancer, only a small percentage of breast tumors can be attributed to these. Instead, it is believed that 85-90% of breast cancers are primarily of environmental origin. Polycylic aryl hydrocarbons (PAHs) are environmental carcinogens derived from combustion including fossil fuels. PAHs bind to a cellular aryl hydrocarbon receptor (AhR) that mediates downstream events leading to cellular transformation. Previous work in our laboratory used the prototypical PAH 7,12-dimethylbenz[a]anthracene (DMBA) to form tumors in mouse mammary glands that had constitutive AhR activation, increased Wnt signaling, and strong induction of the CK2 subunit CK2α (Currier, Solomon et al. 2005). Wnt, an important developmental pathway, is implicated in several cancers (Dominguez, Sonenshein et al. 2009). CK2 is a highly promiscuous, constitutively active serine/threonine kinase that is over-expressed in every cancer that has been examined for its presence (Meggio and Pinna 2003). Data from the DMBA-induced mouse tumors demonstrated that these factors may be involved in carcinogen-induced breast cancer, but their role in tumor development is uncertain. The hypothesis underlying this project was that CK2 and the Wnt pathway would be involved in early changes in mouse mammary and liver tissues in animals exposed to DMBA. We used qPCR, Western blotting, and immunohistochemistry to look at changes in Wnt pathway components and known Wnt-dependent genes, and CK2 subunits in mammary and liver tissues one and two weeks after DMBA exposure. Liver tissue was analyzed along with mammary gland tissue because the liver is the site of DMBA metabolism. Our results showed no change in liver or mammary gland morphology at these time points. There was induction of the AhR gene targets cyp1a1 and cyp1b1 in liver tissue but not in mammary gland. Liver also had evidence of Wnt pathway activation. Mammary glands did not have a strong AhR response but did show Wnt induction at two weeks post-exposure, suggesting that DMBA was affecting the liver before the mammary glands. CK2α had an unexpected early decrease in protein expression at one week in liver, which at two weeks resolved to the same levels as control tissue. In mammary glands, CK2α expression levels were the same as control at one week and decreased at two weeks, again suggesting a slower response than liver. Interestingly, CK2β was markedly overexpressed in mammary glands at the two week time-point. These results suggest there is a role for both Wnt and CK2 in early DMBA-generated tissue changes. It is still unclear if these pathways are separately affected by DMBA or if one initiates the other. Further experimentation, possibly in cell culture using inhibitors and siRNA, are called for to better understand these findings.

Thesis (MSc)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Phytoestrogens are perceived as a safer alternative to conventional hormone replacement therapy (HRT) for the alleviation of menopausal symptoms as they present a decreased side-effect profile. The Cyclopia subternata (honeybush) methanol extract, SM6Met, displays estrogenic attributes desirable for the development of an phytoestrogenic nutraceutical, namely, estrogen receptor (ER) α antagonism, ERβ agonism, and antagonism of 17β-estradiol (E2)-induced breast cancer cell proliferation. Activity-guided fractionation was employed in an attempt to isolate and identify the compounds inducing the specific estrogenic profile of SM6Met. Fractions were evaluated for estrogenic attributes and major polyphenols present. Initial liquid-liquid fractionation of SM6Met yielded a polar fraction (PF) and a non-polar fraction (NPF), with the estrogenic attributes of interest retained and concentrated in NPF. Subsequent high performance counter-current chromatography (HPCCC) fractionation of NPF yielded three fractions (F1-F3). Interestingly, the fractions revealed separation of the previously demonstrated positive estrogenic attributes of NPF into separate fractions, with F1 and F2 acting as ERα antagonists, only F2 inducing antagonism of E2-induced breast cancer cell proliferation and only F3 retaining ERβ agonist activity. Although ERβ agonism displayed by F3 was robust and significantly higher than that of 10-11 M E2, it also displayed weak ERα agonism. Fractionation also for the first time in the study revealed ERβ antagonism, as induced by F1. In terms of major polyphenols HPCCC fractionation resulted in a divergence with F1 emerging as the dihydrochalcone-rich fraction and F2 as the flavanone and benzophenone-rich fraction, while the xanthones, flavones and phenolic acids were retained in F3. In addition, a preliminary absorption study was conducted using the ex vivo flow-through diffusion assay whereby the permeability of porcine small and large intestine for polyphenols in SM6Met was evaluated. The major compounds present in SM6Met were not able to penetrate the large intestinal mucosa, but small intestinal permeation of all major compounds in SM6Met ensued, with apparent permeability coefficient (Papp) values ranging from 1.91-3.74 x 10-6 cm.s-1, indicative of good intestinal absorption. Open source programs used for theoretical prediction of absorption gave conflicting results, emphasising the need to confirm predictions experimentally. ACD/Labs predicted poor intestinal absorption of SM6Met compounds based on physicochemical profiling, while OSIRIS and ChemAxon anticipated good absorption. In conclusion, activity-guided fractionation results suggest that retention of all the positive estrogenic attributes of the original SM6Met in one fraction is not an attainable goal. This suggests that several of the polyphenols present in SM6Met or NPF, through antagonistic, synergistic, or additive effects, may together be conferring these desired estrogenic traits. Thus production or isolation of a mixture of compounds, i.e. an “intelligent” mixture, should serve as a superior strategy in designing a nutraceutical product tailored to user demand of estrogenic activity. / AFRIKAANSE OPSOMMING: Fitoestrogene word beskou as ‘n veiliger alternatief vir konvensionele hormoon-vervangingsterapie (HVT) vir die verligting van simptome geassosiaeer met menopause aangesien dit ‘n verminderde newe-effek profiel vertoon. Die metanol ekstrak van Cyclopia subternata (heuningbos), SM6Met, vertoon estrogeniese eienskappe wat wenslik is vir die ontwikkeling van ‘n fitoestrogeen nutraseutiese middel, naamlik, estrogeen reseptor (ER) α antagonisme en ERβ agonisme, asook antagonisme van 17β-estradiol (E2) geïnduseerde proliferasie van borskankerselle. Aktiwiteit-begeleide fraksionering (ABF) is gebruik om die verbindings wat die spesifieke estrogeniese profiel aan SM6Met verleen te probeer isoleer en identifiseer. Fraksies is ge-evalueer vir estrogeniese eienskappe, asook vir die hoof polifenole teenwoordig. Aanvankilike vloeistof-vloeistof fraksionering van SM6Met het ‘n polêre fraksie (PF) en ‘n nie-polêre fraksie (NPF) opgelewer met behoud en konsentrering van die wenslike estrogeniese eienskappe in NPF. Daaropeenvolgende hoë werkverrigting teen-vloei chromatografie (HPCCC) van NPF het drie fraksies (F1-F3) opgelewer. Interessant genoeg het hierdie fraksies ‘n verdeling van die wenslike estrogeniese eienskappe van NPF in die individuele fraksies teweeggebring, deurdat F1 en F2 ERα antagonisme getoon het, F2 E2-geïnduseerde proliferasie van borskankerselle antagoniseer het, en net F3 ERβ agonis-aktiwiteit behou het. Alhoewel die ERβ agonis-aktiwiteit van F3 betekenisvol hoër was in vergelyking met die aktiwiteit van 10-11 M E2, het dit ook swak ERα agonisme getoon. Verder het fraksionering, vir die eerste keer in hierdie studie, ERβ antagonisme meegebring soos getoon deur F1. HPCCC het ook ‘n skeiding van die hoof polifenole veroorsaak, waarvolgens F1 as die dihidrogalkoon-ryke fraksie, F2 as die bensofenoon-ryke en flavanoon-ryke fraksie, en F3 as die xantoon-, flavoon- en fenoliese suur-ryke fraksie tevoorskyn gekom het. ‘n Voorlopige absorpsie studie, wat gebruik gemaak het van die ex vivo deurvloei diffusie toetssisteem, is uitgevoer om die deurlaatbaarheid van vark dik- en dunderm vir SM6Met polifenole te evalueer. Die hoof verbindings van SM6Met kon nie die dikderm mukosa penetreer nie, maar die deurlaatbaarheid van die dunderm vir alle SM6Met hoof polifenole is aangetoon, met skynbare deurlaatbaarheidskoëffisiënt (Papp) waardes wat strek vanaf 1.91 tot 3.74 x 10-6 cm.s-1, ooreenstemmend met goeie intestinale absorpsie. Oopbron programme, wat gebruik is vir die teoretiese voorspelling van absorpsie deur gebruik te maak van fisiese-chemiese profilering van verbindings, het teenstellende resultate opgelewer wat daarop dui dat hierdie voorspellings eksperimenteel bevestig moet word. ACD/Labs, wat van die fisiese-chemiese eienskappe van die verbinding gebruik maak, het swak intestinale absorpsie van die polifenole voorspel, terwyl OSIRIS en ChemAxon goeie absorpsie voorspel het. Ten slotte, resultate van aktiwiteit-begeleide fraksionering het getoon dat behoud van al die gewensde estrogeniese eienskappe van SM6Met in een fraksie nie ‘n haalbare doelwit is nie. Hierdie bevinding dui daarop dat verskeie van die polifenole teenwoordig in SM6Met of NPF saam, deur middel van antagonistiese, sinergistiese of additiewe effekte, die wenslike estrogeniese eieskappe verleen. Die ontwikkeling of isolering van ‘n mengsel van verbindings, met ander woorde ‘n ―intelligente‖ mengsel is dus ‘n beter strategie vir die ontwerp van ‘n estrogeniese nutraseutiese produk om die verbruikers-aanvraag van estrogeniese aktiwiteit te voorsien.