Adolescents and Young Adults (AYAs) ages 15-39 years with cancer have received little attention in the health field, resulting in a lack of progress. The purposes of this study were to use the Tennessee Cancer Registry for all new cancer cases from 2004-2008 to determine the main types of cancer that affect AYAs in Tennessee and understand if there were any cancer types that warranted additional investigation. A total of 8,097 cancer cases were diagnosed in AYAs in Tennessee from 2004-2008. The main types were breast, melanomas, thyroid, lymphomas, and testicular, accounting for over 50% (N=4,269) of cancers in the sample. The incidence of melanoma and thyroid cancer was higher in Tennessee compared to the United States, deserving further examination. In Tennessee, females were significantly more likely to be diagnosed with melanomas (AIR 14.01, 95% CI 12.96-15.06) and thyroid cancers (AIR 13.39, CI 12.37-14.42) compared to males (AIR 8.08, CI 7.28-8.88 and AIR 3.50, CI 2.98-4.03. Regression models were used to further analyze melanoma and thyroid cancers, specifically looking at predictors of late stage diagnosis and treatment types, respectively. Individuals with government insurance were eight times (OR 8.41, CI 3.04-23.27) more likely to be diagnosed with late stage melanoma when compared with private or other types of insurance. Individuals diagnosed with regional or distant stage thyroid cancer compared to localized stage were three times (OR 3.01, CI 1.84-4.94) more likely to have a total thyroidectomy. These data suggest the need for additional cancer prevention and control efforts geared towards AYAs.

No description available.

This study investigated the association of race, age, and census tract area poverty level on breast cancer stage at diagnosis. The study was limited to women residing in Missouri, aged 18 years and older, diagnosed with breast cancer, and whose cases were reported to the Cancer Registry between 2003 and 2008. The risk, relative risk, and increased risk of late-stage at diagnosis by race, age, and census tract area poverty level were computed. We found that the odds of late-stage breast cancer among African-American women were higher when compared with their white counterpart (OR 1.433; 95% CI, 1.316, 1.560). In addition, the odds of advanced stage disease for women residing in high-poverty areas were greater than those living in low-poverty areas (OR 1.319; 95% CI 1.08; 1.201). To close the widening cancer disparities gap in Missouri, there is the need for effective and programmatic strategies to enable interventions to reach areas and populations most vulnerable to advanced stage breast cancer diagnosis.

No description available.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Objetivos Descrever as caracterÃsticas clÃnicas e assistenciais de crianÃas com sibilÃncia/asma admitidas no Programa da AtenÃÃo Integral à SaÃde da CrianÃa com Asma (PROAICA) na rede de saÃde de Fortaleza MÃtodo Estudo transversal de natureza exploratÃria realizado com dados obtidos dos prontuÃrios utilizados na admissÃo de crianÃas com sibilÃncia/asma no Programa de AtenÃÃo Integral à SaÃde da CrianÃa com Asma (PROAIC Foi analisada uma amostra de 930 crianÃas entre 2 meses e 16 anos atendidas no perÃodo de Junho de 2004 a Setembro de 2005 em nove postos de saÃde e dois hospitais de Fortaleza A principal variÃvel estudada foi o tempo que as crianÃas com sibilÃncia/asma permaneceram sem assistÃncia programada atà o momento da admissÃo ao Programa Resultados O tempo mÃdio que as crianÃas ficaram sem assistÃncia programada foi de 49 meses (DP=38,1) 90,2% das crianÃas apresentaram os primeiros sintomas de sibilÃncia/asma antes dos trÃs anos de idade (mÃdia= 16 meses) No Ãltimo ano antes da admissÃo ao Programa a proporÃÃo de crianÃas que foram ao pronto-socorro foi de 91,4% enquanto que 42,3% tiveram mÃltiplas internaÃÃes 79% das crianÃas tinham classificaÃÃo de asma leve intermitente ou persistente quadro que pouco freqÃentemente justificam hospitalizaÃÃes 98,1% vinham em uso de medicaÃÃo de alÃvio por via oral e somente 4,3% usavam corticoide inalatÃrio ConclusÃes CrianÃas apresentando sibilÃncia/asma por um tempo muito prolongado sem uma assistÃncia programada na rede de saÃde de Fortaleza foi o achado principal deste estudo A maioria das crianÃas apresentou a primeira crise com idade inferior a trÃs anos e no entanto permaneceram um longo tempo sem assistÃncia programada o que contribuiu para que tivessem atendimentos repetidos nas emergÃncias com vÃrias hospitalizaÃÃes Este cenÃrio demonstra a necessidade de uma adequada atenÃÃo integral à saÃde da crianÃa com asma / Asthma is the most ordinary chronic disease in childhood, and it is characterized by presenting recurrent episodes of wheezing and, most of time, by the need of planned and continued care in order to control it. AIMS To describe clinical and aiding features of children with wheeze/asthma who are users of health services in Fortaleza. METHOD Transversal study, proceeded with data obtained from patient records employed in the admittance of asthmatic children within Integral Care to Children`s Healt Program (Programa de AtenÃÃo Integral à SaÃde da CrianÃa â PROAICA). Were selected 930 children from 2 months to 16 years-old who have been seen from June of 2004 to September of 2005, in nine primary health care facilities (PHCFs) and two hospitals. The primary variable studied was how long the wheezing child stayed without planned assistance until the moment of her admission in the Program. RESULTS The mean time children stayed unassisted was 49 months. (DP=38,1). 90,2% of children presented first symptoms of wheeze before the age of three years (mean= 16 months). In the last year, before admittance in the Program, the proportion of children who went to the ER was 91,4%, and 42,3% were multiply hospitalized. 98,1% arrived in use of relieving medication with oral administration and only 4,3% were using inhaled corticosteroid. CONCLUSIONS Children with wheeze/asthma for a very long time without planned assistance by health services web was the primary found in this study. Most of children presented the first crisis with age under 3 years and, nevertheless, they stayed for a long without planned assistance, which contributed to their recurring in-hospital assessments within the ERs with several hospitalizations. Such setting shows the need for an appropriate integral care to the health of asthmatic child

strong>Objectives: Women with substance use disorders experience unique challenges to contraceptive obtainment and user-dependent method adherence, contributing to higher than average rates of unintended pregnancy. This study estimated the prevalence of barriers to contraception and their associations with contraceptive use and unwanted pregnancies among women receiving opioid agonist therapy (OAT) in northeast Tennessee. Methods: A cross-sectional survey was piloted among female patients aged 18 to 55 years from 2 OAT clinics. Logistic regression was used to evaluate associations between contraceptive barriers and current contraceptive use and previous unwanted pregnancies among women receiving OAT. Results: Of 91 participants, most experienced previous pregnancies (97.8%), with more than half reporting unwanted pregnancies (52.8%). Although 60% expressed a strong desire to avoid pregnancy, ambivalence toward becoming pregnant was common (30.0%). Most experienced ≥1 barriers to contraceptive use or obtainment (75.8%), the most prevalent being aversion to adverse effects (53.8%), healthcare provider stigmatization (30.7%), scheduled appointment compliance (30.3%), and prohibitive cost (25.0%). Experience of any contraceptive barrier (adjusted odds ratio [AOR] 8.64, 95% confidence interval [CI] 2.03–36.79) and access to a contraceptive provider (AOR 5.01, 95% CI 1.34–18.77) were positively associated with current use of prescribed contraceptives, whereas prohibitive cost was negatively associated (AOR 0.28, 95% CI 0.08–0.94). Conclusions: Although most participants desired to avoid pregnancy, ambivalence or uncertainty of pregnancy intention was common. Most experienced barriers to contraception, which were more strongly associated with previous unwanted pregnancy than current contraceptive use. The provision of long-acting reversible contraceptives and contraceptive education at OAT clinics represents an opportunity to reduce the incidence of neonatal abstinence syndrome.

Introduction. Research on teen childbearing has consistently noted that unfavorable socioeconomic conditions experienced at the community and family levels underpin disparities in teen birth rates. However, rather than examining socioeconomic factors alone, community-level differences in teen births could be measured by examining in tandem, the intersection between sociodemographic deprivation and health professional shortage areas (HPSA). Objectives. To examine the differences in teen birth rates by sociodemographic deprivation and HPSA in rural and urban counties of the United States. Methods. Results. Of the 3,136 counties, 78.7% of rural counties were in the highest category of socio-demographic deprivation compared to about 21.1% of urban counties. 76.0% of rural counties were categorized as having shortages of primary care, dental, and mental health providers, compared to 24.0% of urban counties. Rural counties had an additional 7.4 births per 1,000 females aged 15-19 years (p <0.0001) when compared to urban counties. The highest level of sociodemographic deprivation had a strong positive association with teen birth rates (β = 17.46; SE = 0.53; p < 0.0001). Rural counties with the whole designation of a health professional shortage increased county-level teen births by 7.18 births per 1,000 females aged 15-19 years (p <0.0001), compared to urban counties with no designation. Rural counties with higher levels of sociodemographic deprivation and a designation of health professional shortages in at least one area had significantly higher teen births than their urban counterparts (p <0.0001). Conclusions. Rural communities across different levels of deprivation and HPSA designated categories continue to have disproportionately greater teen birth rates. While these findings reveal the unique characteristics of sociodemographic and HPSA as a useful social determinant of teen birth, rural communities showed inherent vulnerabilities that contribute to poorer teen birth outcomes. Future research should examine the extent to which access to contraceptive services differs among rural and urban communities and the role of rural safety net providers in the provision of these services.

No description available.

backgroundWomen with opioid use disorder (OUD) experience unique barriers to contraception, contributing to higher than average rates of unintended pregnancy. Rates of neonatal abstinence syndrome (NAS), a drug withdrawal syndrome resulting from antenatal drug exposure, are higher in Tennessee than the nation. Few studies have quantified experience of contraceptive barriers or their associations with contraceptive use among women with OUD. objectives This study estimated prevalence of barriers to access/acceptance of contraceptive services and their associations with current contraceptive use and unwanted pregnancy among reproductive-aged women in Northeast Tennessee receiving opioid agonist therapy (OAT). methods A cross-sectional survey was administered to female patients aged 18-55 from two OAT clinics. Logistic regression was used to evaluate associations between contraceptive barriers and current contraceptive use and previous unwanted pregnancies. results Of 91 participants, most were insured (84.4%), experienced at least one barrier (75.8%), and more than half reported unwanted pregnancies (52.8%). Most desired to avoid pregnancy (60.0%) or were ambivalent (30.0%). Common barriers were side effect aversion (53.8%), provider stigmatization (30.7%), appointment compliance (30.23%), and cost (25.0%). Experience of any barrier (AOR=11.6, 2.25-59.8) and access to a contraceptive provider (AOR=9.78, 1.34-71.7) were positively associated with use, while cost was negatively associated (AOR=0.27, 0.07-0.98). Eight barriers were significantly associated with unwanted pregnancies. conclusionWhile most participants desired to avoid pregnancy, contraceptive barriers were common. Barriers were more strongly associated with previous unwanted pregnancy than current contraception. Contraceptive provision at OAT clinics may reduce incidence of unwanted pregnancy and NAS in Northeast Tennessee.

No description available.