Incidence of Etiology-specific Hepatocellular Carcinoma: Diverging Trends and Significant Heterogeneity by Race and Ethnicity.

BACKGROUND & AIMS: The main causes of hepatocellular carcinoma (HCC) include chronic hepatitis C and B viral infections (HCV, HBV), nonalcoholic fatty liver disease (NAFLD), and alcohol-related disease (ALD). Etiology-specific HCC incidence rates and temporal trends on a population-basis are needed to improve HCC control and prevention. METHODS: All 14,420 HCC cases from the Florida statewide cancer registry were individually linked to data from the hospital discharge agency and the viral hepatitis department to determine the predominant etiology of each case diagnosed during 2010 to 2018. Age-adjusted incidence rates (AAIRs) were used to assess the intersection between etiology and detailed race-ethnicity. Etiology-specific temporal trends based on diagnosis year were assessed using Joinpoint regression. RESULTS: HCV remains the leading cause of HCC among men, but since 2017 NAFLD-HCC is the leading cause among women. HCV-HCC AAIRs are particularly high among U.S.-born minority men, including Puerto Rican (10.9 per 100,000), African American (8.0 per 100,000), and U.S.-born Mexican American men (7.6 per 100,000). NAFLD is more common among all Hispanics and Filipinos and HBV-HCC among Asian and Haitian black men. HCV-HCC surpasses HBV-HCC in Asian women. ALD-HCC is high among specific Hispanic male groups. Population-based HCV-HCC rates experienced a rapid decline since 2015 (-9.6% annually), whereas ALD-HCC (+6.0%) and NAFLD-HCC (+4.3%) are rising (P < .05). CONCLUSIONS: New direct acting anti-viral drugs have impacted rates of HCV-HCC, offsetting important increases in both ALD- and NAFLD-HCC. Hispanics may be a group of concern because of higher rates for ALD- and NAFLD-HCC. HCC etiology varies remarkably and may warrant specific interventions by detailed race-ethnicity.

Effects of Peer Sexual Health Education on College Campuses: A Systematic Review.

Objective. College peer health education groups have grown in popularity to provide information about health and wellness topics. The purpose of this systematic review was to evaluate the effectiveness of peer education groups on reducing sexual health risks and increasing sexual health knowledge on a college campus. Method. The Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines were followed in searching, extracting, appraising, and synthesizing the evidence. A quality assessment was also conducted. The review was conducted in April 2017. Results. The initial search yielded 2,503 records. After critical appraisal, eight articles remained. Peer education was beneficial for increasing knowledge of sexual health topics and creating some behavior change such as increased condom use and HIV testing. Additionally, interventions developed specifically for women were effective. Conclusions. Peer education is an effective way to disseminate sexual health information and can be a reliable resource for college students.

Cross-Sectional Examination of Patient and Therapist Factors Affecting Participation in Physical Therapy in Acute Care Hospital Settings.

Background: Research has demonstrated benefits of early and continued physical therapy for patients in acute care hospitals. Despite known benefits, scheduled sessions do not always result in treatment. Reported percentages for nontreatment are 15% to 25%. Understanding when and why nontreatment occurs is fundamental to future interventions to reduce it and provide patients with needed services. Objective: The study objective was to describe nontreatment and the extent to which attributes of the patient, physical therapist, and environment affect its occurrence at a suburban community hospital. Design: This was a cross-sectional study. Methods: Medical records for 1,252 patients who were scheduled for 6,246 physical therapy sessions were reviewed. Therapist demographics were collected via a questionnaire. Results: Therapist sexes were equally represented, and most therapists were nonwhite and worked full time at the hospital. The nontreatment percentage for individual therapists ranged from 5.4% to 23.2%. This percentage was 1.3% for the first scheduled session but nearly 20% for the remaining sessions. In more than 30% of nontreatment events, the specific therapist attempting treatment was not identified. Patients were much less likely to experience nontreatment if they were scheduled for therapy on a Tuesday or if they were in the hospital for a musculoskeletal condition. Sunday had a particularly high percentage of nontreatment. Limitations: The participants were recruited from a single hospital. The specific therapist associated with nontreatment events was not always known. Conclusions: Hospital and rehabilitation department policies and culture for weekend therapy staffing should be evaluated in light of the high percentage of nontreatment on Sunday. The impact of patient diagnosis on nontreatment must be evaluated further and may reflect hospital culture. Future research efforts should be designed to obtain data on the assigned therapist for all instances of nontreatment.

Happy trails: the effect of a media campaign on urban trail use in southern Nevada.

BACKGROUND: Many Americans do not meet recommendations for physical activity (PA). Communities are building trail networks to encourage PA, but the relationship between trails and PA is not well understood. METHODS: We monitored usage of urban trails (N = 10) in Las Vegas, NV, before and after a promotional marketing campaign (October 2011 and April 2012). The media campaign featured print, online, and radio ads, as well as billboards and signage on gas pumps. Data were collected with infrared monitors that were placed on the trails for periods of 7 days. We compared preintervention and postintervention usage rates. RESULTS: Mean usage increased (P < .001) from 3.91 to 5.95 users per hour (52.17%) after the promotional campaign. We observed significant increases at 7 individual trails, significant declines at 2 trails, and no change at 1 trail. CONCLUSION: Promotional campaigns may be an effective way to increase trail usage and encourage PA.

A population-based survey of lumbar surgery beliefs in the United States.

INTRODUCTION: Studies have shown that lumbar surgery (LS) outcomes may be influenced by perception. However, the perceptions of the general population regarding LS are not known. Therefore, the purpose of this study was to investigate the general population's perceptions regarding LS. SUBJECTS: This study included 262 participants (mean age: 46.1 years; 125 males and 137 females) from the Las Vegas (NV) metropolitan area. METHODS: A questionnaire was developed by an expert panel and was assessed for face and content validity. After revision and establishment of test-retest reliability, participants were surveyed at 12 randomly selected grocery stores in Las Vegas. The questionnaire assessed demographics, personal and family medical history, and 11 items pertaining to perceptions of LS. RESULTS: The participants had a somewhat uncertain expectation about the potential success of LS; however, approximately two-thirds believed that LS is unsuccessful to the point that they would not be able to return to their previous level of activity after LS. Of the questions dealing with success of LS, the neutral response had the greatest frequency suggesting a lack of knowledge or uncertainty about LS. More than half of the respondents were fearful of LS and anticipated a protracted recovery accompanied by undesired side effects. Three quarters of the respondents agreed that they would try all other means of treatment before opting for LS, yet 39% said that they would undergo LS if they had severe lower back pain (LBP). CONCLUSIONS: The general population has an uncertain view of LS outcomes and anticipates postoperative side effects and a protracted recovery; these views may explain why a majority of participants expressed fear of LS and why most would only opt for LS as a last resort. This uncertainty and anticipation of poor outcomes may be a strong contributor to preoperative fear and anxiety, which could deleteriously influence postoperative outcomes.

The effect of a trail use intervention on urban trail use in Southern Nevada.

OBJECTIVE: Communities are building or improving trail networks for biking and walking to encourage physical activity, but the relationship between trail environments and physical activity is not well understood. We examined the effect of a trail use intervention in Southern Nevada. METHODS: We monitored the usage of urban trails (n=10) in Southern Nevada before, during, and after an intervention which included a marketing campaign promoting trail use and the addition of way-finding and incremental distance signage to selected trails (October 2011-October 2012). Data were collected with infrared monitors placed on the trails for three periods of 7days. We compared pre-, mid-, and post-intervention usage rates on the 6 trails where signage was added to usage rates on the 4 control trails. RESULTS: The groups of trails experienced different patterns of increases and decreases over the 1-year study period. Mean users per hour increased 31% for the study trails and 35% for the control trails (p<0.001), but the total increase did not vary between the groups. CONCLUSION: Trail use increased about 33% during the 1-year study period for the intervention. Adding wayfinding and incremental distance signage appeared to support the increase in usage which followed the marketing campaign.

Environmental and social determinants of youth physical activity intensity levels at neighborhood parks in Las Vegas, NV.

Parks can play an important role in youth activity. This study used observational data to evaluate the relationship of environmental and social determinants to youth physical activity intensity levels in Las Vegas neighborhood parks. System for observing play and leisure activity in youth was used to code activity levels as sedentary, walking, or vigorous in five low-income and five high-income parks. Environmental determinants included amenities, incivilities, size, high-speed streets, sidewalk condition, and temperature. Social determinants included percent minority and Hispanic, gender, and income. A multinomial logistic regression model was performed. We observed 1,421 youth, 59% male, 41% female; 21% were sedentary, 38% walking, and 41% vigorous. Males were more likely to be observed walking (OR 1.42) and vigorous (OR 2.21) when compared to sedentary. High-speed streets (OR 0.76), sidewalks condition (OR 0.34), and low-income neighborhoods (OR 0.07) was associated with decreased odds of vigorous activity; incivilities (OR 1.34) and amenities (OR 1.27) were associated with greater odds of being vigorous. Environmental and social determinants are associated with physical activity intensity levels at parks. Stakeholders should ensure quality parks, as they relate to physical activity levels in youth. Understanding environmental and social determinants that influence physical activity at parks is critical to utilizing their full potential in an effort to combat childhood obesity.

Health disparities experienced by people with disabilities in the United States: a Behavioral Risk Factor Surveillance System study.

The Americans with Disabilities Act became law in 1990; since then research has shown that people with disabilities continue to experience barriers to health care. The purpose of this study was to compare utilization of preventive services, chronic disease rates, and engagement in health risk behaviors of participants with differing severities of disabilities to those without disabilities. This study was a secondary analysis of 2010 data collected in the Behavioral Risk Factor Surveillance System national survey in the United States. Rao Chi square test and logistic regression were employed. Participants with disabilities had significantly higher adjusted odds ratios for all chronic diseases, for physical inactivity, obesity and smoking. They were significantly more likely to participate in some preventive services (flu/pneumonia vaccination, HIV test) and significantly less likely to participate in other preventive services (mammogram, Pap test). Our findings suggest that people with disabilities are less able to fully participate in all preventive services offered.

Adolescent gender and ethnicity differences in physical activity perceptions and behavior.

OBJECTIVES: To examine gender and ethnicity differences in adolescents' physical activity (PA) behavior and perceptions. METHODS: Surveys designed to measure PA behavior and perception were completed by 175 adolescents. Gender and ethnicity differences in PA behavior were examined using chi-square tests. A two-way between groups MANOVA was used to examine perception. RESULTS: No significant differences were found between gender groups for PA. Caucasian students were more likely to be active and to perceive that PA makes their health better. Hispanics were more likely to perceive that PA requires more time than Caucasians. CONCLUSIONS: Findings suggest greater consideration be given to the ethnic orientation of PA behavior antecedents when promoting PA to adolescents.

The effects of signage and the physical environment on stair usage.

BACKGROUND: Physical activity (PA) is a health behavior that most Americans do not participate in at recommended levels. METHODS: We sought to increase PA by use of motivational signs in selected buildings. Because physical environments are known to influence PA, the relationship of building characteristics and stair usage was also assessed. One pre- and two post-intervention observations were conducted. RESULTS: The proportion of those using the stairs increased from baseline to the second data collection, (chi2 = 39.31, p < 0.01) and baseline to a final data collection (chi2 = 10.1, p < 0.01). Built environment factors, including steps to the next higher floor and the number of floors in the building were consistent predictors of stair use. With signs positioned, the visibility of the stairs while standing in front of elevators became a significant predictor of stair usage. CONCLUSIONS: Motivational signs and characteristics of built environments are associated with increased stair usage.

Physical activity opportunity in K-12 public school settings: Nevada.

OBJECTIVES: We examined the status of physical activity opportunity in Nevada K-12 public schools. The focus was on determining both prevalence and nature of existing programs as well as school administrators-perceived barriers to offering physical activity programs. METHODS: A 15 item questionnaire was used to assess prevalence and nature of programs as well as perceived barriers. RESULTS: Nevada school-age children do not have regular access to physical education. Excluding physical education, more than 30% of schools do not provide physical activity programming. Most existing programs are competitive sport related. In addition, as students matriculate through school, fewer program options and opportunities to participate throughout the school day are available. Lack of funds was the most frequently reported perceived barrier to offering physical activity programs. CONCLUSIONS: Opportunities to be physically active over the course of the school day are limited and as a result, hinder important national objectives for health-related outcomes.