Demographic differences in systemic inflammatory response syndrome score after trauma.

BACKGROUND: Demographic differences in health outcomes have been reported for chronic diseases, but few data exist on these differences in trauma (defined as acute, life-threatening injuries). OBJECTIVE: To investigate the relationship between the systemic inflammatory response syndrome score after trauma and race/ethnicity and socioeconomic status. METHODS: A retrospective chart review of 600 patients from a level I trauma center (1997-2007) was conducted. Inclusion criteria were age 18 to 44 years, Injury Severity Score 15 or greater, and admission to an intensive care unit. Exclusion criteria were use of transfusions, spinal cord injuries, comorbid conditions affecting the inflammatory response, use of nonsteroidal anti-inflammatory medications, and missing data (final sample, 246 charts/patients). Systemic inflammatory response syndrome was measured by using the systemic inflammatory response syndrome score. Race was self-reported. Socioeconomic status was defined by insurance and employment. Descriptive statistics, Wilcoxon rank sum, Kruskal-Wallis, and χ(2) tests were used for analysis. RESULTS: Compared with whites, African Americans (n = 94) had fewer occurrences of the syndrome (P = .04) and a 14% lower white blood cell count on admission to the intensive care unit (mean, 15,200/µL; 95% CI, 14,400/µL to 16,000/µL vs mean 17,700/µL; 95% CI, 16,700/µL to 18,700/µL; P < .001). CONCLUSIONS: Demographic differences exist in the systemic inflammatory response syndrome score after trauma. Additional studies in larger populations of patients are needed as well as basic science and translational research to determine potential mechanisms that may explain the differences.

Systemic inflammatory response syndrome score and race as predictors of length of stay in the intensive care unit.

BACKGROUND: Identifying predictors of length of stay in the intensive care unit can help critical care clinicians prioritize care in patients with acute, life-threatening injuries. OBJECTIVE: To determine if systemic inflammatory response syndrome scores are predictive of length of stay in the intensive care unit in patients with acute, life-threatening injuries. METHODS: Retrospective chart reviews were completed on patients with acute, life-threatening injuries admitted to the intensive care unit at a level I trauma center in the southeastern United States. All 246 eligible charts from the trauma registry database from 1998 to 2007 were included. Systemic inflammatory response syndrome scores measured on admission were correlated with length of stay in the intensive care unit. Data on race, sex, age, smoking status, and injury severity score also were collected. Univariate and multivariate regression modeling was used to analyze data. RESULTS: Severe systemic inflammatory response syndrome scores on admission to the intensive care unit were predictive of length of stay in the unit (F=15.83; P<.001), as was white race (F=9.7; P=.002), and injury severity score (F=20.23; P<.001). CONCLUSIONS: Systemic inflammatory response syndrome scores can be measured quickly and easily at the bedside. Data support use of the score to predict length of stay in the intensive care unit.

A decision aid for teaching limitations of prostate cancer screening.

There is minimal research regarding men's knowledge of the limitations of prostate cancer screening. This study measured knowledge of prostate cancer screening based on exposure to one of two decision aids that were related to prostate cancer screening (enhanced versus usual care). The sample consisted primarily of low income (54%) African-American men (81%) (n=230). The enhanced decision aid was compared against the usual care decision aid that was developed by the American Cancer Society. The enhanced decision aid was associated with higher post-test knowledge scores, but statistically significant differences were observed only in the men who reported having had a previous DRE (p = 0.013) in the multivariable analyses. All the men were screened, regardless of which decision aid they received. This study highlights the impact of previous screening on education of the limitations of prostate screening, and challenges the assumption that increased knowledge of the limitations of prostate cancer screening will lead to decreased screening.

Impact of pretest on posttest knowledge scores with a Solomon Four research design.

There is a paucity of research on the effects of pretest measurement with prostate cancer screening. What effect does a pretest measurement have on posttest outcomes? This research reports knowledge of prostate cancer screening among men randomized to an Enhanced decision aid versus an Usual Care decision aid. Using a Solomon Four research design, there were a total of 198 men in 4 groups. Most of the sample was African American (78%), with a mean age of 52 years. The greatest posttest knowledge occurred with the Enhanced decision aid in contrast to the Usual Care. The Enhanced/Usual Care groups that had both a pretest and posttest and had received a previous digital rectal examination had the highest means (P = .015), with means of 9.1 and 7.0, respectively. Among men who had a previous digital rectal examination, the greatest increase in score occurred among men randomized to the Enhanced decision aid in contrast to the Usual Care decision aid, 2.9 versus 0.4 (P = .008). The outcome varied based on the status of (1) random group assignment of the Solomon Four design and (2) status of previous digital rectal examination. Implications for nurses include consideration 1 of a pretest to increase posttest knowledge scores.

Body mass index and intake of selected foods in African American men.

BACKGROUND: There are minimal data on the relationship between dietary consumption of fats, vegetables, and fruits and body mass index (BMI) in African American men. OBJECTIVE: This study tested the relationships between selected dietary consumption and BMI. DESIGN: The sample was a community-based cohort of 204 African American Southern men who attended a free prostate cancer educational and screening program. The screening was part of an all-day African American celebration that included a health fair. Diet was assessed with a Brief Dietary Scale for Selected Food Intake and Preparation. RESULTS: Most of the men were overweight (34%) or obese (47%). The majority of men ate their chicken (90%) and fish (96%) fried. Few men ate vegetables at supper (29.4%) or lunch (15.8%). Three fatty food items were significantly associated with BMI: leaving the chicken skin on chicken (p=.03); intake of low-fat or skim milk (p=.02); and cooking vegetables with butter (p=.03). CONCLUSION: African American men need culturally appropriate dietary interventions to reduce obesity.

Perceptions of older adults regarding evacuation in the event of a natural disaster.

OBJECTIVES: To investigate the evacuation needs and beliefs of older adults in 2 counties in Georgia; to identify health risk factors; and to provide public health and emergency management officials with planning information. DESIGN: A descriptive survey using The Older Adult Disaster Evacuation Assessment. SAMPLE: 139 lower socioeconomic participants at congregate meal sites. RESULTS: Hurricane Katrina significantly influenced decisions to evacuate in disasters. Over 70% said they would definitely evacuate in the future and nearly 16% would probably evacuate, yet over 13% reported "maybe" or "no." Multiple logistic regressions suggest that those who do not trust their TV and county officials' information would have only 1/4 the odds of definitely evacuating. Those who say they would not follow their county officials' advice have only 1/3 the odds of definitely evacuating. Primary health problems were decreased mobility (40.1%), hypertension (70.5%), and arthritis (53.2%). Forty-six percent would need transportation; approximately 40% lived alone; and about 40% had fair or poor health. CONCLUSIONS: Trust and belief in county officials and the media were the best predictors of willingness to evacuate. Participants in this study would need assistance with transportation, preparation, and support for serious health problems in order to evacuate. Further study is needed with a larger, more representative sample.

Racial difference in circulating sex hormone-binding globulin levels in prepubertal boys.

Racial differences in disease risk (eg, osteoporosis, metabolic cardiovascular syndrome, and prostate cancer) may arise partly on a hormonal basis. While reports of racial differences in gonadal steroid hormone levels in middle-aged men have produced conflicting results, there is evidence that high sex hormone-binding globulin (SHBG) and estradiol levels are more common among young adult African American men than white men. To determine whether this difference relates to pituitary-testicular functioning or to other factors, we conducted a cross-sectional study of 47 healthy prepubertal African American and white boys aged 5 to 9 years at the time of their annual school physical examination. Height, weight, blood pressure, waist and hip circumference, and Tanner staging were determined, and a fasting blood sample was obtained. The African Americans studied were slightly older than the whites (mean +/- SD, 82.4 +/- 15.0 vs 70.5 +/- 10.3 months, P = .003). African Americans were also slightly taller and heavier and had a lower waist-to-hip ratio, but these differences could be explained by the difference in age. Mean SHBG levels were 25% higher (P = .15) in African Americans than in whites (197 +/- 104 vs 157 +/- 79 nmol/L), and when adjusted for age, values were 46 nmol/L higher among African Americans. The fifth quintile for SHBG (values > 245 nmol/L) included 1 (4.2%) of 24 whites and 8 (35%) of 23 African Americans studied (P = .003). There was no significant correlation between age, body mass index, waist circumference, or fasting insulin and SHBG. Total testosterone, the free androgen index, and dehydroepiandrosterone increased with age in both groups, but after adjusting for age, no racial differences were found. Estradiol, estrone, and inhibin B levels, as well as systolic and diastolic blood pressures, were also comparable in both groups. We conclude that high levels of SHBG are more common among African American than in white boys and hypothesize that this difference and its effect on the ratio between bound and free steroid hormones may contribute to racial differences in disease risk in adult men.

Intake of selected nutritional supplements by African-American men.

OBJECTIVES: To measure the self-reported intake of vitamins, selenium, vitamin E, and saw palmetto supplements in African-American men. METHODS: A correlational study was conducted of 198 African-American men, aged 40 to 70 years old, who attended a community-based free prostate cancer educational and screening program. The rates of supplement use were compared among demographic groups. RESULTS: Just more than one half of the men (51%) took one or more of the supplements. Almost one half (46%) took multivitamin supplements. About 34% took vitamin E supplements, 6% took selenium supplements, and 7% took saw palmetto. Higher income men were more likely to take nutritional supplements. No statistically significant associations were found between supplement use and age, education, or marital status. Almost all use of selenium, vitamin E, and saw palmetto was among men who were already taking a multivitamin supplement. CONCLUSIONS: The implications from the results of this study include the need to conduct an assessment of supplement intake as part of the health history.

Developmental gene expression profiling of mammalian, fetal orofacial tissue.

BACKGROUND: The embryonic orofacial region is an excellent developmental paradigm that has revealed the centrality of numerous genes encoding proteins with diverse and important biological functions in embryonic growth and morphogenesis. DNA microarray technology presents an efficient means of acquiring novel and valuable information regarding the expression, regulation, and function of a panoply of genes involved in mammalian orofacial development. METHODS: To identify differentially expressed genes during mammalian orofacial ontogenesis, the transcript profiles of GD-12, GD-13, and GD-14 murine orofacial tissue were compared utilizing GeneChip arrays from Affymetrix. Changes in gene expression were verified by TaqMan quantitative real-time PCR. Cluster analysis of the microarray data was done with the GeneCluster 2.0 Data Mining Tool and the GeneSpring software. RESULTS: Expression of >50% of the approximately 12,000 genes and expressed sequence tags examined in this study was detected in GD-12, GD-13, and GD-14 murine orofacial tissues and the expression of several hundred genes was up- and downregulated in the developing orofacial tissue from GD-12 to GD-13, as well as from GD-13 to GD-14. Such differential gene expression represents changes in the expression of genes encoding growth factors and signaling molecules; transcription factors; and proteins involved in epithelial-mesenchymal interactions, extracellular matrix synthesis, cell adhesion, proliferation, differentiation, and apoptosis. Following cluster analysis of the microarray data, eight distinct patterns of gene expression during murine orofacial ontogenesis were selected for graphic presentation of gene expression patterns. CONCLUSIONS: This gene expression profiling study identifies a number of potentially unique developmental participants and serves as a valuable aid in deciphering the complex molecular mechanisms crucial for mammalian orofacial development.

Knowledge of the limitations associated with prostate cancer screening among low-income men.

This correlational pilot study measured limitations of prostate cancer screening, using a revised Knowledge of Prostate Cancer Questionnaire. Knowledge in 81 low-income men is reported. The Knowledge About Prostate Cancer Screening Questionnaire consists of 12 questions, with scores ranging from 0 to 12. Concepts measured include limitations, symptoms, risk factors, and screening age guidelines. The Total Knowledge Score had a mean of 6.60, with a standard deviation of 3.00, indicating that knowledge was low. Half of the men knew that "some treatments for prostate cancer can make it harder for men to control their urine." More than half of the men knew that, "some treatments for prostate cancer can cause problems with a man's ability to have sex." Married men, low-income men, and Caucasian men had significantly lower Total Knowledge Scores than unmarried, higher income, and African American men. Implications for practice and research are discussed.

Self-reported reasons men decide not to participate in free prostate cancer screening.

PURPOSE: To determine the reasons why men fail to participate in a free prostate cancer screening. DESIGN: Survey and secondary analyses using correlational design. SETTING: Community sites in the Southeastern United States. SAMPLE: The sample (N = 241) ranged in age from 40-68 years. Mean age was 50 years (SD = 7.4). Most of the men were African American (79%) and married (70%). Almost half of the subjects (44%) earned between $9,601 and $25,020 per year. METHOD: Telephone survey of men who did not participate in initial prostate cancer screening after educational program. MAIN RESEARCH VARIABLES: Demographics, self-reported reasons men decided not to participate in a free screening following a prostate cancer educational program, and predictors for subsequent participation in screening. FINDINGS: The main self-reported reason for not participating in a free prostate cancer screening opportunity was time problems. A significant relationship between income and physician problems existed among the men who did not participate. Twenty-one percent of the 241 men participated in a second opportunity for free prostate cancer screening. Men who cited "lost packet" as their reason for not participating in the first free screening were more than twice as likely to go for the second opportunity for free screening when offered another packet or voucher for a free screening with their physician of choice. CONCLUSIONS: "Time problems" was the most frequent self-reported reason men gave for failure to participate. Providing a follow-up phone call and vouchers a second time for reimbursement of the cost associated with a screening increased participation. Men often need assistance with locating physicians and nurse practitioners who will file for financial reimbursement. Appointment reminders are critical. IMPLICATIONS FOR NURSING: The findings of this study of the significant relationship between income and "physician problems" for not participating has implications for healthcare providers. Future programs could provide telephone follow-up with men and remail vouchers, as needed. In addition, men could be encouraged to designate one place in their households for health-related papers (for safekeeping).

Increased susceptibility to retinoid-induced teratogenesis in TGF-beta2 knockout mice.

Transforming growth factor-beta (TGF-beta) and retinoic acid (RA) have been implicated in normal and abnormal embryonic development. The aim of this study was to investigate the effect of TGF-beta2 gene deletion on susceptibility to RA-induced teratogenesis in a mouse model. TGF-beta2 heterozygous or wild-type mice were mated and the dams dosed with a teratogenic dose of RA, or with control vehicle. The incidence of RA-induced cleft palate (CP) was 48% in wild-type embryos from wild-type dams, increasing to 71% in TGF-beta2 heterozygous littermates. Wild-type and TGF-beta2 heterozygous embryos from heterozygous dams exhibited a CP incidence of 74 and 77% respectively, following treatment with RA. Ninety-one percent of littermates nullizygous for TGF-beta2 were dead when examined; the remainder exhibited a CP. We conclude that the genotype of the dam and embryo with respect to TGF-beta2 affects the incidence of RA-induced teratogenesis.

Association of prostate cancer with rapid N-acetyltransferase 1 (NAT1*10) in combination with slow N-acetyltransferase 2 acetylator genotypes in a pilot case-control study.

N-acetyltransferase-1 (NAT1) and N-acetyltransferase-2 (NAT2) are important in the metabolism of aromatic and heterocyclic amine carcinogens that induce prostate tumors in the rat. We investigated the association of genetic polymorphisms in NAT1 and NAT2, alone and in combination, with human prostate cancer. Incident prostate cancer cases and controls in a hospital-based case-control study were frequency-matched for age, race, and referral pattern. The frequency of slow acetylator NAT1 genotypes (NAT1*14, *15, *17) was 5.8% in controls but absent in cases. In contrast, in comparison with all other NAT1 genotypes the putative rapid acetylator NAT1 genotype (NAT1*10) was significantly higher in prostate cancer cases than controls (OR, 2.17; 95% CI, 1.08-4.33; P = 0.03). Combinations of NAT1*10 with NAT2 slow acetylator genotypes (OR, 5.08; 95% CI, 1.56-16.5; P = 0.008) or with NAT2 very slow (homozygous NAT2*5) acetylator genotypes (OR, 7.50; 95% CI, 1.55-15.4; P = 0.016) further increased prostate cancer risk. The results of this small pilot study suggest increased susceptibility to prostate cancer for subjects with combinations of NAT1*10 and slow (particularly very slow) NAT2 acetylator genotypes. This finding should be investigated further in larger cohorts and in other ethnic populations.

Effects of a long-term psychosocial nursing intervention on adolescents exposed to catastrophic stress.

This research tested the effects of a long-term psychosocial nursing intervention designed to decrease mental distress in adolescents following a catastrophic event. Advanced Practice Psychiatric Nurses conducted the Catastrophic Stress Intervention (CSI) in two South Carolina high schools for three years following Hurricane Hugo. The CSI consisted of nine protocols designed to decrease adolescents' mental distress by increasing their understanding of stress and by enhancing their self-efficacy and social support. Adolescents (N = 1030) were randomized to intervention or control groups and completed one baseline and five postintervention measures of mental distress, self-efficacy, and social support. The hypothesis was that intervention adolescents would have less mental distress than control adolescents. The research also addressed the particular time points at which differences between intervention and control adolescents might be shown. Repeated measures multivariate analysis of variance, with exposure to the hurricane, self-efficacy, and social support as control variables, showed that intervention adolescents reported less mental distress than control adolescents at 12, 18, and 24 months but that this difference dissipated by 30 and 36 months. Implications for the CSI and timing of interventions with adolescents after a catastrophic event are discussed.