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OBJECTIVE: To better understand cancer clinical trials (CCT) information-seeking, a necessary precursor to patient and provider engagement with CCT. METHODS: Data from the National Cancer Institute's Cancer Information Service (CIS) were used to examine CCT information-seeking patterns over a 5-year period. Descriptive and logistic regression analyses were conducted to examine characteristics of CIS inquiries and their associations with having a CCT discussion. RESULTS: Between September 2018 - August 2023, 117,016 CIS inquiries originated from cancer survivors, caregivers, health professionals, and the general public; 27.5 % of these inquiries included a CCT discussion (n = 32,160). Among CCT discussions, 35.5 % originated from survivors, 53.5 % from caregivers, 6.1 % from the public, and 4.9 % from health professionals. Inquiries in Spanish had lower odds of a CCT discussion (OR=.26, [.25-.28]), whereas inquiries emanating from the CIS instant messaging (OR=2.29, [2.22-2.37]) and email (OR=1.24, [1.18-1.30]) platforms were associated with higher odds of discussing CCT compared to the telephone. Individuals who were male, younger, insured, and had higher income and education had significantly higher odds of a CCT discussion while those who were non-Hispanic Black and living in rural locales had significantly lower odds. CONCLUSIONS: Disparities in CCT information-seeking may contribute to downstream CCT participation. PRACTICE IMPLICATIONS: Quality, language-concordant health information is needed to enable equitable awareness of - and ultimately engagement in - CCT.
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Ensayos Clínicos como Asunto , Conducta en la Búsqueda de Información , National Cancer Institute (U.S.) , Neoplasias , Humanos , Estados Unidos , Masculino , Neoplasias/terapia , Femenino , Persona de Mediana Edad , Servicios de Información/estadística & datos numéricos , Adulto , Disparidades en Atención de Salud , AncianoRESUMEN
BACKGROUND: Androgen deprivation therapy (ADT) in prostate cancer (PCa) has been associated with development of insulin resistance. However, the predominant site of insulin resistance remains unclear. METHODS: The ADT & Metabolism Study was a single-center, 24-week, prospective observational study that enrolled ADT-naive men without diabetes who were starting ADT for at least 24 weeks (ADT group, n = 42). The control group comprised men without diabetes with prior history of PCa who were in remission after prostatectomy (non-ADT group, n = 23). Prevalent diabetes mellitus was excluded in both groups using all three laboratory criteria defined in the American Diabetes Association guidelines. All participants were eugonadal at enrollment. The primary outcome was to elucidate the predominant site of insulin resistance (liver or skeletal muscle). Secondary outcomes included assessments of body composition, and hepatic and intramyocellular fat. Outcomes were assessed at baseline, 12, and 24 weeks. RESULTS: At 24 weeks, there was no change in hepatic (1.2; 95% confidence interval [CI], -2.10 to 4.43; p = .47) or skeletal muscle (-3.2; 95% CI, -7.07 to 0.66; p = .10) insulin resistance in the ADT group. No increase in hepatic or intramyocellular fat deposition or worsening of glucose was seen. These changes were mirrored by those observed in the non-ADT group. Men undergoing ADT gained 3.7 kg of fat mass. CONCLUSIONS: In men with PCa and no diabetes, 24 weeks of ADT did not change insulin resistance despite adverse body composition changes. These findings should be reassuring for treating physicians and for patients who are being considered for short-term ADT.
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Peer mentorship, referring to interactions among colleagues at similar career stages for the purpose of bidirectional career development, is a powerful tool to promote personal and professional growth. While dyadic mentoring has traditionally been the norm in academia, the needs of junior faculty may span multiple domains that a single senior mentor may not be able to address. 1,2 A vibrant community garden of peer mentors can help to harvest ideas, encourage mutual collaboration, increase personal satisfaction, and promote career advancement.
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Tutoría , Mentores , Grupo Paritario , Humanos , Mentores/psicología , Tutoría/métodos , Movilidad Laboral , Docentes Médicos/psicología , FemeninoRESUMEN
INTRODUCTION: For academic promotion, clinical faculty are expected to excel in clinical care, teaching, and scholarship. Ensuring adequate protected time and resources to engage in scholarly work in the face of competing clinical responsibilities is critical. The authors examined academic leaders' perspectives across affiliate hospitals of a large medical school regarding the definition of clinical full-time effort and academic time, best practices to enable academic success, and barriers to faculty advancement. METHODS: Open-ended, semistructured, individual interviews were conducted with a purposive sample of clinical department and division heads. Interview data were examined to illuminate the range and commonalities in practices and to identify successful approaches. RESULTS: Interviews were conducted with 17 academic leaders across 6 affiliate hospitals. There was considerable variability in clinical full-time effort definition. "Academic time," more accurately characterized as "nonclinical time," was typically 1 day a week for nonshift specialties and mostly used for administrative work or completing clinical documentation. Certain departments were more explicit in designating and protecting time for academic pursuits; some had invested resources in intensive programs for academic advancement with built-in expectations for accountability. The impact of documentation burden was considerable in certain departments. DISCUSSION AND CONCLUSION: Marked variability exists in time allocations for clinical and academic work, as well as in resources for academic success. This supports the potential value of establishing standards for defining and protecting academic time, motivating clinical faculty to engage in academic work, and building accountability expectations. Sharing best practices and setting standards may enhance academic advancement. Strategies to reduce documentation burden may enhance wellness.
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Éxito Académico , Medicina , Humanos , Docentes , Responsabilidad Social , Encuestas y Cuestionarios , Docentes MédicosRESUMEN
Purpose: Given increased cannabis use for medical and nonmedical purposes alike, there is growing public interest related to the potential risks and benefits of cannabis use, particularly related to cancer. The purpose of this descriptive study was to analyze cannabis inquiries to the National Cancer Institute's Cancer Information Service (CIS). Materials and Methods: From September 2018 to June 2023, 190,070 noncannabis and 425 cannabis inquiries were documented by the CIS. Cannabis inquiries were delineated into two categories: nonmedical cannabis (NMC, n=240) or medical cannabis (MC, n=185). Chi-square tests were performed to determine differences between noncannabis and cannabis inquiries and descriptive analyses were used to identify patterns within cannabis-specific inquiries. Results: Statistically significant differences between noncannabis and cannabis inquiries were observed. In addition, there were variations in MC and NMC inquiries. For example, 73% of MC inquiries originated from cancer survivors and caregivers, whereas almost half of NMC inquiries (48%) were from individuals identifying as tobacco users. MC and NMC inquiries also differed by CIS access channel (e.g., instant chat, telephone), language used (English vs. Spanish), discussions of cancer continuum phases and cancer sites, and referrals provided to individuals for additional information and resources. Conclusion: Cannabis-related information needs of the public-as documented by the CIS-varied by several factors. Health information sources such as the CIS can help address cannabis-related questions and concerns, while noting differences in who is inquiring, how, and why.
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BACKGROUND: Responding to calls for additional research that identifies effective distress screening (DS) processes, including referral practices subsequent to screening and receipt of recommended care, we engaged in qualitative research as part of a larger (mixed methods) study of distress screening. This qualitative inquiry of oncology professionals across different facilities in the United States examined routine DS implementation, facilitators and challenges staff encounter with DS processes, and staff members' perceived value of DS. PARTICIPANTS AND METHODS: We conducted key informant interviews and focus groups with staff in 4 Commission on Cancer (CoC)-accredited oncology facilities (a total of 18 participants) to understand implementation of routine DS within oncology care. We used a rigorous data analysis design, including inductive and deductive approaches. RESULTS: Respondents believe DS enhances patient care and described ways to improve DS processes, including administering DS at multiple points throughout oncology care, using patient-administrated DS methods, and enhancing electronic health records infrastructure to better collect, record, and retrieve DS data. Respondents also identified the need for additional psychosocial staff at their facilities to provide timely psychosocial care. CONCLUSIONS: Results reinforce the value of DS in cancer care, including the importance of follow-up to screening with psychosocial oncology providers. Understanding and resolving the barriers and facilitators to implementing DS are important to ensure appropriate psychosocial care for people with cancer. Insights from oncology staff may be used to enhance the quality of DS and subsequent psychosocial care, which is an essential component of oncology care.
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Neoplasias , Estrés Psicológico , Humanos , Estados Unidos , Estrés Psicológico/psicología , Oncología Médica , Neoplasias/psicología , Psicooncología , Derivación y Consulta , Tamizaje Masivo/métodosRESUMEN
Background: Pertussis, also known as whooping cough, is an endemic vaccine-preventable disease that affects the respiratory tract and is caused by the bacterium Bordetella pertussis. Between 1999 and 2004, the adolescent booster dose of pertussis was introduced across Canada. This report describes the epidemiology of pertussis in Canada from 2005 to 2019, the period after adolescent acellular vaccination was recommended. Methods: We analyzed pertussis incidence by year, age groups, sex and geographic region using national surveillance data from the Canadian Notifiable Disease Surveillance System. Hospitalization data from the Discharge Abstract Database was used to investigate pertussis hospitalizations by sex and age. Deaths from pertussis were explored using Statistics Canada's vital statistics data. Vaccination coverage data was gathered from the 2019 Childhood National Immunization Coverage Survey and 2018-2019 Seasonal Influenza Vaccination Coverage Survey. Results: Between 2005 and 2019, there were a total of 33,481 pertussis cases with the average annual incidence rate of 6.4 cases per 100,000 population. The highest average age-specific incidence rate was among infants under one year of age (n=68.7 cases per 100,000 population). There were a total of 1,593 pertussis hospitalizations; nearly 80% of these hospitalizations were infants under one year of age. Hospitalization rates were 8.2 times higher in infants three months or younger compared to infants four to 11 months of age. There were 17 deaths; all among infants under one year of age. Conclusion: The highest morbidity and fatality of pertussis were among infants under one year of age. It is important to take measures to reduce transmission to infants who are too young to be vaccinated. Increasing vaccine coverage in children and pregnant women are important to reduce the burden of disease.
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OBJECTIVES: This report aims to use tetanus hospitalization data to describe the epidemiology in Canada from 1995 to 2019 and to assess progress on national reduction targets, including validating that Canada has eliminated maternal and neonatal tetanus (MNT). METHODS: Tetanus hospitalizations and fatalities occurring between 1995 and 2019 were retrieved from the Canadian Institute for Health Information (CIHI) and Statistics Canada. Cases coded with ICD-10 codes A33, A34, or A35 as the primary diagnosis (or ICD-9 equivalents) were included. The Canadian national case definition was used for generic tetanus and definitions from the World Health Organization were referenced for MNT. R version 4.0.2 was used for analyses. RESULTS: From 1995 to 2019, 155 non-MNT, 6 neonatal, and 0 maternal tetanus cases were retrieved from CIHI. However, all 6 neonatal cases were excluded after validating with provincial/territorial public health officials. In the same time period, there were 91 national notifications of tetanus. Cases were distributed relatively equally across the country, with the exception of the territories, where zero cases were reported. Adults 75 and over had significantly higher incidence rates compared to younger age groups (p<0.001). Ten deaths were reported during the timeframe. CONCLUSION: Tetanus incidence remains low and hospitalization data reveal that Canada has met its reduction target of maintaining 5 cases or fewer annually in recent years. For MNT, Canada has successfully met the elimination target of zero cases. Continued vaccination efforts must be practiced for all age groups, including those aged 75 years and older, to sustain targets moving forward.
RéSUMé: OBJECTIFS: Ce rapport vise à utiliser les données sur les hospitalisations dues au tétanos pour décrire l'épidémiologie au Canada de 1995 à 2019 et pour évaluer les progrès réalisés par rapport aux objectifs nationaux de réduction, notamment pour confirmer que le Canada a éliminé le tétanos maternel et néonatal (TMN). MéTHODES: Les données sur les hospitalisations et les décès attribuables au tétanos survenus entre 1995 et 2019 proviennent de l'Institut canadien d'information sur la santé (ICIS) et de Statistique Canada. Les cas pour lesquels les codes sont CIM-10 A33, A34 ou A35 comme diagnostic primaire (ou leurs équivalents CIM-9) sont inclus. La définition de cas nationale canadienne a été utilisée pour le tétanos générique et les définitions de l'Organisation mondiale de la santé ont servi de référence pour le TMN. La version 4.0.2 de R a été utilisée pour les analyses. RéSULTATS: De 1995 à 2019, il y a eu 155 cas de tétanos autres que TMN, 6 cas de tétanos néonatal et 0 cas de tétanos maternel selon l'ICIS. Cependant, les 6 cas de tétanos néonatal ont été exclus après validation auprès des responsables de la santé publique provinciaux/territoriaux. Durant la même période, il y a eu 91 notifications nationales de cas de tétanos. Ces cas étaient répartis de manière relativement égale à travers du pays, à l'exception des territoires, où aucun cas n'a été signalé. Les adultes de 75 ans et plus présentaient des taux d'incidence significativement plus élevés que les groupes d'âge plus jeune (p<0,001). Dix décès ont été rapportés pendant cette période. CONCLUSION: L'incidence du tétanos reste faible et les données sur les hospitalisations révèlent que le Canada a atteint son objectif de réduction de 5 cas ou moins par an au cours des dernières années. En ce qui concerne le TMN, le Canada a réussi à atteindre l'objectif d'élimination des cas. Il faut poursuivre les efforts de vaccination pour tous les groupes, y compris les personnes âgées de 75 ans et plus, afin de maintenir les objectifs à l'avenir.
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Tétanos , Adulto , Recién Nacido , Humanos , Tétanos/epidemiología , Canadá/epidemiología , Hospitalización , Familia , VacunaciónRESUMEN
PURPOSE: Medical educators are expected to produce educational scholarship, which can lead to career advancement and promotion. Institutions have developed author development programs, which vary in duration, instructional approach, and effectiveness. However, no summation of the evidence exists for academic medicine leaders to use as guidance for building similar programs. This scoping review characterizes faculty development programs that support educational scholarship and author development in academic medicine. METHOD: The authors searched PubMed, Scopus, Google Scholar, and ProQuest (Healthcare Administration Database and Social Science Premium Collection) for articles published from inception to June 14, 2021. Articles that described formal instruction on scholarly writing for publishing were included. Data were analyzed by program participation, structure, content delivery, and outcomes. RESULTS: Of 923 articles identified, 20 met inclusion criteria. The included studies covered 18 unique programs of which 1 was sponsored jointly by a university and professional society, 5 by professional societies, 5 by university or medical school organizations, and 7 by medical departments. Nine programs relied at least in part on volunteers. Instructional approaches included didactics (7 programs) and mentoring (5 programs) but mostly featured group-based work (11 programs). Expectations for participants ranged from participation to manuscript submission. The main funding sources were grants (8 programs) and internal funds (7 programs) from the sponsoring institution. Only 4 programs reported participation fees. The impact of these programs included scholarly work products, other measures of career advancement, and participant perceptions. CONCLUSIONS: Author development programs require resource investment and a culture that values educational scholarship. Workshops, 1-on-1 mentoring, and peer writing groups are cornerstones of the experiential learning approach needed to build scholarship skills and can pay dividends in supporting the academic mission in medicine. These findings may benefit leaders in academic medicine who want to develop evidence-based programs in author development.
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Docentes Médicos , Becas , Humanos , Curriculum , Facultades de Medicina , Aprendizaje Basado en ProblemasRESUMEN
BACKGROUND: Most men diagnosed with prostate cancer today have organ-confined disease and low risk of disease recurrence after radical prostatectomy. Testosterone deficiency in prostate cancer survivors contributes to impaired health-related quality of life but testosterone treatment is viewed as a contraindication in this population. OBJECTIVES: We describe the design of the first randomized trial to determine the safety and efficacy of testosterone treatment in men who have undergone prostatectomy for non-aggressive prostate cancer and have symptomatic testosterone deficiency. METHODS: Surviving Prostate cancer while Improving quality of life through Rehabilitation with Testosterone Trial is a randomized, placebo-controlled, double-blind, parallel group trial in 142 men, ≥ 40 years, who have undergone radical prostatectomy for organ-confined prostate cancer, Gleason score ≤ 7 (3+4), Stage pT2, N0, M0 lesions and have symptomatic testosterone deficiency and undetectable prostate specific antigen for > 2 years after surgery. Eligible participants are randomized to weekly intramuscular injections of 100-mg testosterone cypionate or placebo for 12 weeks and followed for another 12 weeks. Primary endpoint is change from baseline in sexual activity. Secondary outcomes include change in sexual desire, erectile function, energy, lean and fat mass, physical and cognitive performance. Safety is assessed by monitoring prostate-specific antigen, lower urinary tract symptoms, hemoglobin, and adverse events. RESULTS: The trial is being conducted at two trial sites in Boston, MA and Baltimore, MD. As of July 30, 2022, 42 participants have been randomized. No prostate-specific antigen or clinical recurrence has been noted to-date. DISCUSSION: Recruitment was slowed by coronavirus disease 2019-related closures, slow subsequent ramp-up of research activities, and patient concerns about safety of testosterone treatment. Despite these challenges, participant retention has been high. CONCLUSION: The Surviving Prostate cancer while Improving quality of life through Rehabilitation with Testosterone Trial, a placebo-controlled, randomized trial, will determine whether testosterone replacement therapy is safe and efficacious in correcting symptoms of testosterone deficiency in prostate cancer survivors, and potentially inform clinical practice.
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COVID-19 , Supervivientes de Cáncer , Neoplasias de la Próstata , Masculino , Humanos , Calidad de Vida , Neoplasias de la Próstata/tratamiento farmacológico , Neoplasias de la Próstata/cirugía , Neoplasias de la Próstata/patología , Antígeno Prostático Específico , Testosterona/uso terapéutico , Resultado del Tratamiento , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
The benefits of cancer information-seeking may be particularly salient to individuals impacted by childhood cancer, including patients, caregivers, health professionals, and advocates. The purpose of this study was to explore information-seeking patterns for childhood cancer through the National Cancer Institute's Cancer Information Service (CIS), a multi-channel, bilingual resource for cancer information. The study team conducted descriptive analyses on secondary data characterizing 1820 caregivers, health professionals, organizations, and members of the general public who contacted the CIS about childhood cancer between September 2018 and June 2022. Almost 80% of inquiries about childhood cancer were initiated by caregivers, followed by the public, health professionals, and organizations. Although English was the primary language used by individuals to reach the CIS when discussing childhood cancer, there were variations in points of access (i.e., telephone, instant messaging, email, social media) across the four user groups. Most childhood cancer inquiries were about staging and treatment, and the primary cancer sites discussed by CIS users were neurologic or brain, hematologic, and musculoskeletal cancers. Discussion topics included managing and coping with cancer, clinical trials, and treatment side effects. Just over half (54%) of CIS contacts about childhood cancer resulted in a health professional referral. Findings provide direction for the CIS and other public health organizations to deliver, prioritize, and tailor their services to support the information needs of childhood cancer survivors and their families-as well as those who care and advocate for them-who may have a significant need for credible cancer information.
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Conducta en la Búsqueda de Información , Neoplasias , Niño , Estados Unidos , Humanos , National Cancer Institute (U.S.) , Neoplasias/terapia , Servicios de Información , Personal de SaludRESUMEN
An informal needs assessment and lack of a national standardized curriculum suggest that there is tremendous variability in the formal teaching of radiation oncology resident throughout the USA. The goal of this study was to characterize formal radiation oncology resident education, in order to identify knowledge gaps and areas for improvement. We developed a 14-item survey consisting of the following domains: program characteristics, teaching faculty, formal teaching time, instructional approaches for formal teaching, curricular topics, and satisfaction with didactics. All 91 accredited US-based radiation oncology program directors received an invitation to complete the survey anonymously by email. Twenty-four (26% response rate) program directors responded. Programs used a variety of instructional methods; all programs reported using lecture-based teaching and only a minority using simulation (38%) or flipped classroom techniques (17%). Other than PowerPoint, the most common electronic resource utilized was quizzing/polling (67%), webinar (33%), and econtour.org (13%). The lack of a national, standardized, radiation oncology residency didactic curriculum promotes variability and insufficiency in resident training. Themes for improvement were diversity in didactic topics, incorporation of evidence-based teaching practices, increased faculty involvement, and sharing of resources across programs. Development of a national curriculum and increased electronic resource sharing may help address some of these areas of improvement.
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Internado y Residencia , Oncología por Radiación , Humanos , Oncología por Radiación/educación , Educación de Postgrado en Medicina , Curriculum , Encuestas y CuestionariosRESUMEN
PROBLEM: Leading inpatient teams is a foundational clinical responsibility of resident physicians and leadership is a core competency for inpatient physicians, yet few training programs have formal leadership curricula to realize this clinical skill. INTERVENTION: We implemented a 4-module curriculum for PGY1 internal medicine residents. The program focused on the managerial skills necessary for daily clinical leadership, followed by clinical coaching. Interns were first introduced to foundational concepts and then given the opportunity to apply those concepts to real-world practice followed by clinical coaching. CONTEXT: Using direct-observations and a previously published checklist for rounds leadership, this study sought to evaluate the workplace behavior change for novice residents leading inpatient teams for the first time. We conducted a prospective cohort study (March 2016 and August 2018) of internal medicine residents at a large tertiary academic medical center in Boston, MA. Trained faculty raters performed direct observations of clinical rounding experiences using the checklist and compared the findings to historical and internal controls. Questionnaires were distributed pre- and post- curriculum to assess satisfaction and readiness to lead a team. IMPACT: We trained 65 PGY1 residents and raters conducted 140 direct observations - 36 in the intervention group and 104 among historical controls. The unadjusted mean score in rounds leadership skills for the intervention group was 19.0 (SD = 5.1) compared to 16.2 (SD = 6.2) for historical controls. Adjusting for repeated measures, we found significant improvement in mean scores for behaviors linked to the curricular objectives (p = 0.008) but not for general behaviors not covered by the curriculum (p = 0.2). LESSONS LEARNED: A formal curriculum to train residents as leaders led to behavior change in the workplace in domains essential to rounds leadership. We also found that the curriculum was highly regarded in that all interns indicated they would recommend the curriculum to a peer. Moreover, the program may have assuaged some anxiety during the transition to junior year as 90% of interns surveyed felt more ready to start PGY2 year than historical trainings. We learned that while a robust, multi-faceted modular curriculum and clinical coaching successfully resulted in behavior change, the resources required to manage this program are significant and difficult to sustain. Future iterations could include asynchronous material and potentially peer-observation of rounds leadership to reduce the burden on faculty and program curricular time.
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Internado y Residencia , Humanos , Pacientes Internos , Estudios Prospectivos , Curriculum , Educación de Postgrado en Medicina/métodos , Competencia ClínicaRESUMEN
Invasive Haemophilus influenzae type a (iHia) disease was detected in Alaska and Northern Canada in 2002 and 2000, respectively. From 2006 to 2017, 164 iHia cases (Alaska=53, Northern Canada=111) were reported. Rates of iHia disease per 100,000 persons were higher in Northern Canada compared to Alaska and were significantly higher in Indigenous (Alaska 2.8, Northern Canada 9.5) compared to non-Indigenous populations (Alaska 0.1, Northern Canada=0.4). Disease rates were highest in Indigenous children <2 years of age (Alaska 56.2, Northern Canada=144.1) and significantly higher than in non-Indigenous children <2 (Alaska 0.1, Northern Canada 0.4). The most common clinical presentation in children <5 years was meningitis of age and pneumonia in persons ≥5 years old. Most patients were hospitalised (Alaska=87%, Northern Canada=89%) and fatality was similar (Alaska=11%, Northern Canada=10%). MLST testing showed sequence types ST23 and ST576 in Northern Canada and ST576, ST23 and ST56 in Alaska. Alaska and Northern Canada have high rates of iHia disease. A vaccine is needed in these regions to protect young children.
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Haemophilus influenzae , Grupos Raciales , Niño , Humanos , Preescolar , Tipificación de Secuencias Multilocus , Serogrupo , Alaska/epidemiologíaRESUMEN
Adopting a multi-level perspective that considers the many interrelated contexts influencing health could make health communication interventions more effective and equitable. However, despite increasing interest in the use of multi-level approaches, multi-level health communication (MLHC) interventions are infrequently utilized. We therefore sought to conduct a modified Delphi study to better understand how researchers conceptualize MLHC interventions and identify opportunities for advancing MLHC work. Communication and health behavior experts were invited to complete two rounds of surveys about the characteristics, benefits, pitfalls, best practices, barriers, and facilitators of MLHC interventions; the role of technology in facilitating MLHC interventions; and ways to advance MLHC intervention research (46 experts completed the first survey, 44 completed both surveys). Survey data were analyzed using a mixed-methods approach. Panelists reached consensus on two components of the proposed definition of MLHC interventions and also put forward a set of best practices for these interventions. Panelists felt that most health intervention research could benefit from a multi-level approach, and generally agreed that MLHC approaches offered certain advantages over single-level approaches. However, they also expressed concern related to the time, cost, and complexity of MLHC interventions. Although panelists felt that technology could potentially support MLHC interventions, they also recognized the potential for technology to exacerbate disparities. Finally, panelists prioritized a set of methodological advances and practical supports that would be needed to facilitate future MLHC intervention research. The results of this study point to several future directions for the field, including advancing how interactions between levels are assessed, increasing the empirical evidence base demonstrating the advantages of MLHC interventions, and identifying best practices for the use of technology. The findings also suggest that researchers may need additional support to overcome the perceived practical challenges of conducting MLHC interventions.
BACKGROUND: Considering the factors that affect health across multiple levels (e.g., individual, family, community, and policy) could make health communication interventions more effective and equitable. The goal of this study was to better understand how researchers characterize multi-level health communication (MLHC) interventions and to identify opportunities for advancing work in this area. METHODS: Communication and health behavior experts were invited to complete two rounds of surveys about MLHC interventions. RESULTS: Panelists reported that most health communication interventions could benefit from a multi-level approach, and generally agreed that MLHC approaches offer certain advantages over single-level approaches. However, they also expressed concern related to the time, cost, and complexity of MLHC interventions. Although panelists felt that technology could potentially support MLHC interventions, they also recognized that the use of technology could have unintended consequences. Using input from the panel of experts recruited for the study, we propose a working definition of MLHC interventions and a set of best practices for conducting these types of interventions. CONCLUSIONS: Results suggest the need to improve methods, conduct additional research demonstrating the advantages of MLHC interventions, and identify how technology can best be used to support these interventions.
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Comunicación en Salud , Comunicación Interdisciplinaria , Humanos , Técnica Delphi , Consenso , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To characterize the circulating androgen levels across the menstrual cycle in healthy women using highly sensitive and accurate methods and report sex differences in the relative levels of dihydrotestosterone (DHT) to testosterone (T) levels. DESIGN: Prospective cohort study. SETTING: Research clinic, academic teaching hospital. PATIENT(S): Twenty-one healthy premenopausal women, aged 19-40 years, with regular menstrual cycles. INTERVENTION(S): Not applicable. MAIN OUTCOME MEASURE(S): Serum total T and DHT levels measured using liquid chromatography-tandem mass spectrometry, free T levels measured using a standardized equilibrium dialysis method coupled with measurement of the T levels in the dialysate using liquid chromatography-tandem mass spectrometry, and comparison of the DHT-to-T ratio between healthy women and age-matched healthy men. RESULT(S): The serum total and free T levels increased across the follicular phase and peaked at midcycle (total T, 43.6 ± 16.2 ng/dL; free T, 15.6 ± 11.9 pg/mL) and gradually declined in the luteal phase. The DHT level did not significantly change across the menstrual cycle. The DHT-to-T ratios were 1:4 and 1:13 in women and men, respectively. CONCLUSION(S): In healthy premenopausal women, the total and free T levels varied significantly across the menstrual cycle, whereas the DHT levels did not change; the peak total and free T levels in the midcycle period were higher than previously reported, underscoring the importance of establishing menstrual phase-specific reference ranges to avoid misdiagnosis of hyperandrogenism. Women have significantly higher DHT levels relative to total T than men; the significance of this sex difference in the DHT-to-T ratio needs further investigation.
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Dihidrotestosterona , Testosterona , Femenino , Humanos , Masculino , Estudios Prospectivos , Cromatografía Liquida/métodos , Ciclo MenstrualRESUMEN
BACKGROUND/AIM: Cholangioblastic variant of intrahepatic cholangiocarcinoma (CVICC) is an exceedingly rare primary biliary tract tumor and typically occurs in young patients with a median age of 24.5-year-old. It can mimic metastatic well-differentiated neuroendocrine tumors in the liver with its similar histologic and immunophenotypic features. CASE REPORT: We hereby report a CVICC in a 68-year-old female patient with distinctive biphasic cytologic features. The patient was diagnosed and treated as a metastatic well differentiated neuroendocrine tumor. The recurrent liver tumor was resected and the tumor cells were strongly positive for Inhibin A and cytokeratin 19 (CK19), focally and weakly positive for synaptophysin and chromogranin, and negative for Insulinoma associated protein 1 (INSM1). Ribonucleic acid (RNA) sequencing showed that the tumor bared a characteristic Nipped-B-like protein (NIPBL)-Nucleus accumbens-associated protein 1 (NACC1) gene fusion. CONCLUSION: To the best of our knowledge, this is the first documented case in an elder patient of this entity with NIPPL-NACC1 gene fusion. Acknowledgment of the biphasic cytology, screening with Inhibin A in suspicious cases, and coupled with a molecular study may facilitate accurate classification of this aggressive tumor and lead to proper clinical management.