Identifying an association between socio-demographic factors and breast cancer screening adherence in a federally qualified health centre sample in the United States. A retrospective, cross-sectional study.

Federally Qualified Health Centres (FQHC) are community-based centres in the United States, intended to fill a gap in care for underserved populations, including Medicaid patients and the homeless. Because of the Affordable Care Act, passed into law in 2010, there was a 29% increase in Medicaid enrolees nationally. One service offered at FQHCs is breast cancer screening. Breast cancer screening has been shown to have the lowest adherence levels among low-income women and homeless women. As they serve patients with socio-economic barriers, FQHCs are a vital resource in ensuring access to such screening. This study aimed to identity an association between socio-demographic factors and breast cancer screening adherence in FQHC patients that included the homeless. This exploratory, cross-sectional, retrospective study looked at encounter level data from a FQHC in a major metropolitan (Chicago, IL) area from January 1st, 2017 through December 31st, 2018. Data were collected in January of 2019. This was a convenience sample. Association was tested through bivariate chi-square tests and multivariate logistic regression analysis, investigating the association between socio-demographic characteristics and compliance (Yes/No) for breast cancer screening. Results showed age (55-59; 65-69) and homeless status (doubling-up, transitional) showed a positive association with breast cancer screening, while insurance status (self-pay) had a negative association. Age, homeless status and insurance type were significantly associated with adherence. Demographic characteristics in the homeless population can be used to identify nonadherence.

The Effect of Place of Service on Diabetic Screening Adherence in the Homeless Population.

This study examined the association between place of service and adherence to select diabetes screening measures in a homeless population. At a Midwestern metropolitan federally qualified health center (FQHC), 508 participants with diabetes and also experiencing homelessness were studied throughout calendar year 2018. Diabetes measures included controlled blood pressure, diabetic foot exam and hemoglobin A1C screening. Patients were seen at one of three locations: FQHC only, shelter only and both shelter and FQHC. After controlling for primary insurance, insurance status, homeless status, age group, ethnicity, primary language, race, sex and poverty level, a stepwise binary logistic regression demonstrated significant model improvement in A1c screening (p ≤ 0.001) and controlled blood pressure (p = 0.009) when place of service was added as a predictor. Specifically, results showed significant negative associations in screening adherence for shelter as compared to FQHC for both controlled blood pressure (OR = 0.40; 95% CI = 0.20-0.79; p = 0.009) and A1c screening (OR = 0.06; 95% CI = 0.03-0.16; p ≤ 0.001). Our results support the hypothesis that FQHC care results in higher rates of adherence than shelter only or FQHC and shelter combined care. The study addresses the gap in literature surrounding place of service and patient adherence. Recommendations for future research are included.

The Relationship between Gene Network Structure and Expression Variation among Individuals and Species.

Variation among individuals is a prerequisite of evolution by natural selection. As such, identifying the origins of variation is a fundamental goal of biology. We investigated the link between gene interactions and variation in gene expression among individuals and species using the mammalian limb as a model system. We first built interaction networks for key genes regulating early (outgrowth; E9.5-11) and late (expansion and elongation; E11-13) limb development in mouse. This resulted in an Early (ESN) and Late (LSN) Stage Network. Computational perturbations of these networks suggest that the ESN is more robust. We then quantified levels of the same key genes among mouse individuals and found that they vary less at earlier limb stages and that variation in gene expression is heritable. Finally, we quantified variation in gene expression levels among four mammals with divergent limbs (bat, opossum, mouse and pig) and found that levels vary less among species at earlier limb stages. We also found that variation in gene expression levels among individuals and species are correlated for earlier and later limb development. In conclusion, results are consistent with the robustness of the ESN buffering among-individual variation in gene expression levels early in mammalian limb development, and constraining the evolution of early limb development among mammalian species.