Improving rates of cervical cancer screening and Pap smear follow-up for low-income women with limited health literacy.

Adult literacy is an independent and important predictor of health behavior. In 1993, the National Adult Literacy Survey conducted by the U.S. Department of Education demonstrated that one-third of the U.S. population over age 16 (44 million adults) is functionally illiterate. Several studies link low health literacy to self-reported poor health status, poor health behavior, and inadequate knowledge about disease. Epidemiologic studies of cancer prevention have not detected strong racial and ethnic disparities in disease detection and progression, resulting in an emphasis on behavioral and intervention-based research. Low literacy presents a wide-reaching barrier to disease prevention that, unlike race/ethnicity, is potentially modifiable. Here, we explore the relationship between health literacy and health behaviors related to cervical cancer prevention in an effort to address concerns about low rates of screening and follow-up in vulnerable populations. Our goal is to improve our understanding of the health impact of low literacy among urban women and to inspire interventions that will promote disease prevention behaviors in this population, particularly with regard to cervical cancer.

PPARgamma: observations in the hematopoietic system.

Human Peroxisome Proliferator-Activated Receptor gamma (PPARgamma) was originally cloned from a human bone marrow library. What role does this ligand activated transcription factor play in hematopoiesis and the immune system? We note that: a) PPARgamma has potential to interact/interfere or synergize with retinoid biology, b) fatty acids and a prostaglandin have been identified as ligands, and c) lymphocytes, monocytes and neutrophils use fatty acids as a major source of energy production, d) PPARgamma has been shown to oppose TNFalpha and down regulate cytokine production in monocytes. Therefore, we undertook a review of the literature and an expression survey of PPARgamma in a number of major organs and cells involved in the hematopoietic system, for the purpose of building a database towards understanding the role and function of PPARgamma gene regulation in the developing blood and immune systems. PPARgamma is expressed before mesodermal induction in tissue in and around Speymann's organizer in the xenopus blastocyst, in erythroid precursors of blood islands and in the circulation of the day 10.0 murine embryo, in human 19 week fetal liver, in some but not all murine and human bone marrow erythroid, myeloid, and monocytoid progenitors, bone marrow stromal cells and adipocytes, osteoblasts, endothelial cells, some T, and B lymphocytes, monocytes, macrophages, and other monocytic derivatives. It can be found in the cells of Peyer's patches, lymphoid follicles, spleen, and thymus. It is not clear if it is ever or transiently expressed in megakaryocytes, mast cells, or neutrophils. Based on the above data and a review of the literature, PPARgamma seems to play a role during the elicitation of immune responses. We propose PPARgamma may be involved in changes in energy states required during activation and development of many cell types involved, and has additional immunologically relevant effects in erythroid, myeloid, monocytic, T and B lymphocytic, stromal, and endothelial cell function.