published_or_final_version / Community Medicine / Master / Master of Public Health

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COLORECTAL CANCER SCREENING: A NON-INVASIVE APPROACH Amy Frazier May, 2004 58 Pages Directed by: Dr. Donna Blackburn, Dr. Patricia Bailey, and Dr. Thomas Nicholson Department of Nursing Western Kentucky University Colorectal cancer (CRC) is the third most common malignant neoplasm worldwide and is expected to affect six percent of Americans within their lifetime (National Cancer Institute, 2003). Clinicians worldwide struggle with selecting the most accurate, cost-effective CRC screening tool. Could a noninvasive screening tool be the answer or part of the answer to the dilemmas surrounding CRC screening? The purpose of this correlational, replication study was to determine whether symptoms such as rectal bleeding, change in bowel habit, and weight loss are associated with symptomatic colorectal cancer using a sample of individuals scheduled for a routine colonoscopy. This study can be considered a pilot study since it has never been replicated in the United States (U.S). Data obtained from 47 Bowel Symptom Assessment Questionnaires (BSAQs) given to patients undergoing routine colonoscopy at Greenview Regional Hospital in Bowling Green, Kentucky were analyzed to address the research objectives of the study. None of the patients had colorectal cancer, but 15 of the 47 patients had polyps. None of the symptoms showed a significant correlation with polyps according to chi-square analysis. T-tests of the means of the polyp group versus the no polyp group showed no difference between the population means for each of the examined variables. Selva scores generated from the BSAQ did not show a 8 significant relationship with the presence or absence of polyps. Additional findings, limitations, and implications for future research are discussed.

Background: The Gail Model is a statistical and risk assessment tool for women with given age and risk factors to estimate their probability that will develop invasive breast cancer. An accurate assessment of individual risk for developing breast cancer would be useful for health care providers to facilitate their risk communication with women at average risk and to make decision on taking chemoprevention for high-risk women in clinical practice. Currently, there are several validation studies of the Gail Model in western populations, however, model validity on Chinese people has not yet to be studied. Objective: To conduct a systematic review on the studies that validated the performance accuracy of the Gail model for predicting risk of developing breast cancer at population level and individual level. Methods and results: The literature search on the PubMed database and additional articles retrieved by hand searching reference lists. After applying the inclusion and exclusion criteria, a total of 11 studies met the criteria and finally include in the systematic review. Quality of review studies was assessed follow the STROBE checklist. The PRSMA guidelines were used to produce this review. Conclusions: The Gail model was validated in general American white women with annual screening. However, there is insufficient evidence to approve that the Gail model can be applied to Chinese women in China widely. / published_or_final_version / Public Health / Master / Master of Public Health

Family physician (FP) knowledge regarding breast cancer risk assessment and prevention strategies such as chemoprevention are important in ensuring that women at high risk for breast cancer are identified and receive proper preventive care. There are many factors which can moderately increase a woman’s risk of developing breast cancer, such as short-term hormone replacement therapy use and being nulliparous over the age of 30 years. Some factors increase a woman’s risk to such an extent that she is deemed “high risk” for breast cancer development, including having a family history of breast cancer or having a personal history of atypical benign breast disease. We conducted a cross-sectional survey of a stratified random sample of 2500 family physicians selected from across Canada to examine breast cancer risk assessment knowledge and practices, chemoprevention knowledge and prescribing practices, attitudes towards breast cancer chemoprevention, and barriers towards its utilization in Canadian FPs. We found that while the majority of physicians identified a woman with a family history of breast cancer (97%) as being high risk, a large proportion of physicians (40%) underestimated the risk associated with having a personal history of atypical benign breast disease. Physicians also tended to overestimate the risk associated with hormone replacement therapy use (70%) and the risk associated with nulliparity over the age of 30 years (50%). We also found that less than 15% of our sample had knowledge about chemoprevention and less than 7% had ever prescribed breast cancer chemoprevention (i.e. tamoxoifen or raloxifene) for primary prevention. Possible predictors of both knowledge of risk assessment and chemoprevention and prescription of chemoprevention were examined. Using multiple logistic regression, we found that several variables significantly predicted physician knowledge of these risk factors and prescription practices including patient load, medical experience and sex. The results of this study indicate that family physicians may need to become more aware about breast cancer prevention methods and risk factors for breast cancer, and in particular those that place a woman at high risk for breast cancer development. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2009-09-19 13:11:22.899

Class of 2009 Abstract / OBJECTIVES: Skin cancer is particularly prevalent in Arizona, with incidence rates ranking number two worldwide. Pharmacists are useful advocates for educating patients about the risks of skin cancer and methods of prevention. This study was conducted to assess pharmacists’ knowledge of skin cancer and their demographics and to evaluate how these factors impact skin cancer prevention patient counseling. METHODS: Participants were recruited using a listserv from pharmacists that were members of the Arizona Pharmacy Alliance or preceptors of the University of Arizona College of Pharmacy. Subjects completed an online questionnaire consisting of knowledge- based questions, questions about patient counseling preferences and subject demographics. RESULTS: The average score by pharmacists on the Skin Cancer and Sun Exposure Knowledge Indicator was 5.8 + 1.9. Pharmacists living in Arizona for longer times were more likely to know the minimum recommended SPF of sunscreen for adults to use when outdoors (p=0.003) and the factors associated with malignant melanoma prognosis/survival (p=0.004), but were less likely to know the definition of ABCD acronym (p=0.027). Having a family or friend diagnosed with any form of skin cancer or precancerous skin condition led to more pharmacists knowing the risk factors for developing melanoma (p=0.046) and knowing how often to apply water resistant sunscreen (p=0.035). CONCLUSIONS: The length of pharmacy practice in Arizona and having a family member or close friend affected by skin cancer significantly impacted a pharmacists’ knowledge of skin cancer.

Vitamin A and its chemical analogues (retinoids) are known to play a role in the maintenance and differentiation of epithelial tissue. Retinoids have been shown to inhibit carcinogenesis in a number of tissues in experimental animals and to inhibit the growth of various untransformed and cancer cell lines in vitro. This study investigated the effect of retinyl acetate supplemented at concentrations of 1 μM, 5 μM, 10 μM and 100 μM to in vitro cultured untransformed LLCMK cells, and transformed BL-6 melanoma and human hepatoma cell lines. A small but non-significant effect of vitamin A addition on the growth of the untransformed cells was observed, while substantial inhibition of proliferation of the two tumour cell lines was found. At the cytotoxic level of 100 μM supplemented vitamin A, all three cell lines showed marked inhibition of growth. This led to an electron microscopy study to examine the ultrastructural effect of the vitamin A addition. At the low non-toxic levels of vitamin A addition (1 - 10 μM), no ultrastructural changes were observed in the untransformed cells. However, at a level of 5 μM and 10 μM vitamin A addition in the tumour cells, an increase in the size of suspected lipid droplets was observed. At the cytotoxic level of 100 μM supplemented vitamin A, large lipid droplets were very apparent, as was much cellular degeneration. This effect was more marked in the tumour cells than in the untransformed cells. The lipid nature of the droplets was confirmed by using the lipid stain, Sudan IV. In order to investigate the effect of added vitamin A at the cell surface level, an ELISA system was used to quantify the level of the cell surface glycoprotein, fibronectin, in the culture media. Vitamin A plays an important role in the production of mature fibronectin by participating in the glycosylation of the molecule. This study showed no major effect of added vitamin A on the release of fibronectin into the culture media. This did not, however, exclude the possibility that the vitamin A was involved in the production and enhanced binding of fibronectin to the cell surface, and was possibly also exerting an effect on the availability of fibronectin receptors. Further studies would, however, be required to substantiate such effects of vitamin A supplementation. No single mechanism of action of vitamin A on tumour cell growth inhibition was identified, but the possibility that at least two mechanisms exist, was suggested

Submitted in fulfillment of the requirements of the Degree of Master of Technology: Chemistry, Durban University of Technology. 2014. / Peptide folding is a very complicated and dynamic process taking place in all living systems. The understanding of a bioactive conformation of the peptides is very important to understand their biological functions and underlying mechanism of action. However, the high flexible nature of peptides makes this process difficult as they can adopt thousands of conformations within the fraction of a second. The usage of experimental techniques in the characterization process is also limited due to several associated complications including synthesis, isolation and crystallization of peptides. The present computational methodologies, on the other hand, are solid enough to provide detailed complementary information about the intrinsic conformational features of peptides by mimicking their physiological conditions. In the present work, molecular dynamics (MD) computational method was used to explore the configurational space of three Aurein peptides, namely Aurein 2.3, Aurein 2.4 and Aurein 2.5. These peptides are secreted by the amphibian skin when they are exposed to external stimuli. These peptides have been reported to possess anti-cancer and anti-bacterial activity with minimum resistance compared to the available drugs. However, despite their medicinal significance, the precise three dimensional structures of Aurein 2.4 and Aurein 2.5 are not as yet known. First, a validation study was performed on Aurein 2.3 to check the efficiency of the computational protocol. The results obtained revealed the presence of -helicity in all residues of the Aurein 2.3, in accordance with its experimental structure. A similar protocol was further used to explore the conformational profiles of the remaining two peptides (Aurein 2.4 and Aurein 2.5) under implicit and explicit solvent conditions. The results obtained revealed that both these peptides exhibit -helical character in all residues although in varying percentages. The -helical region in the case of Aurein 2.4 was localized predominantly in the central residues extending towards its N-terminal residues, whereas it was flanked by N-terminal and the central residues in Aurein 2.5. However, -helicity was completely absent in the explicit solvents, and the peptides preferred to stay either in -turns or extended forms. Hence, the present work provides comprehensive information about the conformational preferences of Aurein peptides which could lead to a better understanding of their native conformations for future investigations and point the way towards developing their new agonists.

Skin cancer is the most commonly diagnosed cancer in the United States; it is estimated that the number of Americans who have had a skin cancer in the last three decades is higher than the number for all other cancers combined. Fortunately, there are known prevention methods, effective treatments available for early-stage cases, and behavioral practices that can reduce the risk of secondary and recurrent cancer. However, in spite of these, skin cancer incidence continues to increase and mortality still exists, making skin cancer prevention of the utmost importance. Outlined in this dissertation are factors identify as associated with the development, diagnosis, and prognosis of skin cancer that could be targeted during primary, secondary, and tertiary skin cancer control and prevention interventions in Arizona. Utilizing the 2013 Arizona Behavior Risk Factor Surveillance System survey, aim one of this dissertation investigates factors associated with UVR exposure (as measured by sun protection use and sunburn history) that could be targeted during primary prevention efforts in order to reduce the disease burden. The results of this research are that approximately 20% of Arizona adults are protecting their skin with sunscreen or protective clothing every time they go outdoors and 28% of Arizona adults experienced one or more sunburns in the past 12 months. Compared with males, females were more likely to report that they protect their skin. Other factors associated with use of sun protection were higher education, higher income, good general health, and living in a more urban area. A recent history of sunburns was associated with being non-Hispanic white and a history of indoor tanning. Given that melanoma diagnosed in the earlier progression of the disease is associated with improved prognosis and significantly higher survival rates, secondary prevention interventions are essential to skin cancer control efforts. The second aim of this dissertation was to gain a better understanding of patient and community factors associated with late-stage melanoma diagnosis in Arizona. Based on Arizona Cancer Registry and community-level data, among melanoma patients there is evidence for significant associations between late-stage of diagnosis and being male (OR 1.22 [95%CI1.09-1.37]), non-white (OR 3.15 [95%CI 2.01-4.95]), and Hispanic (OR 2.13 [95%CI 1.61-2.81]). Additionally, access to care was found to influence stage of diagnosis. Residence in a rural area, compared to an urban area, was associated with late-stage melanoma diagnosis. Similarly, zip codes with a dermatologist density of less than 6 dermatologists per 100,000 persons, when compared to zip codes with greater than 12 dermatologists per 100,000 persons, were associated with late-stage melanoma diagnosis. A travel distance to the reporting hospital or clinic of over 40 miles, as compared to travel distance of 20 miles or less, was also associated with melanoma cases being diagnosed at a late-stage. Even after the progression of the disease, skin cancer survivors' prognosis and quality of life can be improved by following healthy lifestyle recommendations. The final aim of this study was to examine at what levels skin cancer survivors are meeting the recommended healthy lifestyle behaviors. Skin cancer survivors' behaviors were similar, with the exception of increased sun protection use, to behaviors among survivors of other non-skin forms of cancer. However, skin cancer survivors were more likely to practice healthy lifestyle behaviors than individuals without a reported history of cancer. Although skin cancer survivor did report better behaviors than non-cancer controls, there was still a considerable amount of survivors not practicing the recommended behaviors. Over 25% of skin cancer survivors only protected their skin during the summer or not at all. Additionally, low levels of other healthy lifestyle behaviors were noted among skin cancer survivors: slightly over half of skin cancer survivors met the physical activity recommendations, approximately half reported receiving their annual influenza vaccination, and less than 20% consumed 5 fruit or vegetable servings daily. This research suggests that there are opportunities for improved clinical and public health interventions targeted at increasing sun protection use, preventing sunburns, reducing disparities associated with late-stage melanoma, and improving healthy lifestyle behaviors among skin cancer survivors.

published_or_final_version / Nursing Studies / Master / Master of Nursing