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Laws mandating that women be informed of mammographic breast density (MBD) with their mammogram results may increase anxiety. We report on changes in self-reported levels of anxiety, worry about developing breast cancer (BC), as well as perceived risk of BC resulting from three MBD notification methods: usual care (mailed notification letter), enhanced care (usual care with MBD educational brochure), or interpersonal care (enhanced care with promotora education), among a Latina population. A randomized controlled clinical trial of three MBD notifications was performed among Latina women aged 40 to 74 years receiving screening mammography at a federally qualified health center (FQHC). Measures of anxiety, BC worry and perceived lifetime BC risk were assessed using a questionnaire. Anxiety was measured using the State-Trait Anxiety Inventory scale (STAI-S). The question: \"How frequently do you worry about getting breast cancer someday\" assessed BC worry. perceived lifetime risk of BC was rated between 0% (no chance) to 100% (definitely will get). Additional surveys were completed at two weeks to six months (T1) and one year (T2) after the intervention. 1332 Latina women were randomized between October 2016 and October 2019. At T0, 51.8% had moderate or severe anxiety. BC worry was reported to be sometimes/ often/ almost all the time among 41.3% of participants. 25.4% reported a perceived lifetime risk of developing BC of > 10%, compared with 6.6% with Gail model estimated lifetime risk score of > 10%. There was no significant difference in the proportion of patients who maintained low or had decrease in their levels of anxiety, BC worry or perceived risk from T0 to either T1 or T2 surveys between intervention groups. This Latina cohort had high levels of anxiety and BC worry which persisted regardless of intervention received. Future work is needed to improve our understanding of factors that could lower anxiety and BC worry and improve BC risk perception in this population.

Introduction Breast cancer remains a leading cause of death among Latinas. Although breast cancer risk assessment models exist and show promise in reducing mortality, few studies have elicited women's interest in and perceptions around breast cancer risk assessment, particularly among underserved populations, like Latinas, who are susceptible to disparities in breast cancer outcomes. These disparities stem from factors such as limited access to healthcare services, lower rates of screening utilization, language barriers, and socioeconomic challenges, all of which compound their risk and hinder effective engagement with risk assessment tools. This qualitative study aims to explore Latinas' perspectives regarding breast cancer risk assessment and implications on future behaviors. Methods Twenty‐three under‐ or uninsured Latinas aged 45–65 with no personal history of breast cancer took part in either a focus group (n = 3, 15 participants) or individual interviews (8 participants). Guided by health behavior theories (Theory of Planned Behavior and Health Belief Model), data were transcribed, translated, and analyzed using a deductive‐inductive approach to thematic content analysis, resulting in four themes. Results Latinas expressed high interest in knowing their breast cancer risk and reported that the benefits of knowing one's risk outweighed the harms. Latinas also stated that they would continue screening as recommended if found to be at low risk, but that they would speak with their provider or increase screening frequency if found to be at increased risk. Moreover, Latinas described the pivotal role of providers and social networks in influencing interest and perceptions around breast cancer risk assessment and preventive behaviors. Conclusion Underserved Latinas viewed breast cancer risk assessment positively and underscored the need for multilevel, culturally tailored strategies to improve breast cancer risk assessment. This study yielded four distinct themes: (1) Interest and Awareness of Personal Breast Cancer Risk, (2) Benefits and Barriers of Knowing Personal Breast Cancer Risk, (3) Screening Implications of Knowing Personal Breast Cancer Risk, and (4) Provider Influence on Breast Cancer Risk Assessment and Behaviors. Potential strategies include efforts to improve provider engagement and communication and leveraging social networks to increase awareness and encourage preventive behaviors. Trial Registration NCI‐2023‐00465

Background Laws mandating that women be informed of mammographic breast density (MBD) with their mammogram results may increase anxiety. We report on changes in self-reported levels of anxiety, worry about developing breast cancer (BC), as well as perceived risk of BC resulting from three MBD notification methods: usual care (mailed notification letter), enhanced care (usual care with MBD educational brochure), or interpersonal care (enhanced care with promotora education), among a Latina population. Methods A randomized controlled clinical trial of three MBD notifications was performed among Latina women aged 40 to 74 years receiving screening mammography at a federally qualified health center (FQHC). Measures of anxiety, BC worry and perceived lifetime BC risk were assessed using a questionnaire. Anxiety was measured using the State-Trait Anxiety Inventory scale (STAI-S). The question: “How frequently do you worry about getting breast cancer someday” assessed BC worry. perceived lifetime risk of BC was rated between 0% (no chance) to 100% (definitely will get). Additional surveys were completed at two weeks to six months (T1) and one year (T2) after the intervention. Results 1332 Latina women were randomized between October 2016 and October 2019. At T0, 51.8% had moderate or severe anxiety. BC worry was reported to be sometimes/ often/ almost all the time among 41.3% of participants. 25.4% reported a perceived lifetime risk of developing BC of > 10%, compared with 6.6% with Gail model estimated lifetime risk score of > 10%. There was no significant difference in the proportion of patients who maintained low or had decrease in their levels of anxiety, BC worry or perceived risk from T0 to either T1 or T2 surveys between intervention groups. Conclusion This Latina cohort had high levels of anxiety and BC worry which persisted regardless of intervention received. Future work is needed to improve our understanding of factors that could lower anxiety and BC worry and improve BC risk perception in this population. Clinical trial registration ClinicalTrials.gov, NCT02910986. Registered on 22/09/2016.

PurposeThe Sangre Por Salud (SPS) Biobank was established to facilitate biomedical research opportunities for the Latino community by creating an easily accessible prospective cohort for scientists interested in studying health conditions and health disparities in this population.ParticipantsIndividuals self-identifying as Latino, aged 18–85 years, were prospectively recruited from the primary care Internal Medicine clinic at Mountain Park Health Center in Phoenix, Arizona. After obtaining informed consent, detailed medical history questionnaires were captured, and blood samples were obtained for common laboratory tests. Participants authorised the research team to access their electronic health records for research purposes. In addition, participants had serum, plasma and DNA samples isolated and stored at the Mayo Clinic Arizona Biorepository Laboratory for long-term storage and future access. As part of the study, participants consented and agreed to be contacted for potential participation in future research studies.Findings to date3756 participants provided informed consent, of whom 3733 completed all study questionnaires, an oral glucose tolerance test and had blood collected and stored. The SPS cohort is predominantly composed of females (72%), with a median age at time of consent of 42 years. All participants self-identified as Hispanic/Latino, 45% were married, 53% were employed for wages and 60% had less than a high school degree. Around 25% of participants met diagnostic criteria for overweight (BMI 25–29 kg/m2), and 49% met for obesity (BMI≥30 kg/m2). At time of recruitment, hypertension, hyperlipidaemia and depression affected 22%, 20% and 13% of the cohort, respectively.Future plansWe plan to regularly update the participants’ electronic health records and self-reported health data to longitudinal research. Additionally, we plan to obtain a more comprehensive genomic analysis on the entire cohort, ensuring greater research interest and investigation into the underlying genetic factors that contribute to disease susceptibility in this cohort.

Abstract Context Metformin is the first-line drug for treating diabetes but has a high failure rate. Objective To identify demographic and clinical factors available in the electronic health record (EHR) that predict metformin failure. Methods A cohort of patients with at least 1 abnormal diabetes screening test that initiated metformin was identified at 3 sites (Arizona, Mississippi, and Minnesota). We identified 22 047 metformin initiators (48% female, mean age of 57 ± 14 years) including 2141 African Americans, 440 Asians, 962 Other/Multiracial, 1539 Hispanics, and 16 764 non-Hispanic White people. We defined metformin failure as either the lack of a target glycated hemoglobin (HbA1c) (<7%) within 18 months of index or the start of dual therapy. We used tree-based extreme gradient boosting (XGBoost) models to assess overall risk prediction performance and relative contribution of individual factors when using EHR data for risk of metformin failure. Results In this large diverse population, we observed a high rate of metformin failure (43%). The XGBoost model that included baseline HbA1c, age, sex, and race/ethnicity corresponded to high discrimination performance (C-index of 0.731; 95% CI 0.722, 0.740) for risk of metformin failure. Baseline HbA1c corresponded to the largest feature performance with higher levels associated with metformin failure. The addition of other clinical factors improved model performance (0.745; 95% CI 0.737, 0.754, P < .0001). Conclusion Baseline HbA1c was the strongest predictor of metformin failure and additional factors substantially improved performance suggesting that routinely available clinical data could be used to identify patients at high risk of metformin failure who might benefit from closer monitoring and earlier treatment intensification.

To maximize the potential benefits of genomic medicine for all, it is crucial to research and support the delivery of genomic medicine in under-researched healthcare settings. This project investigated experiences of healthcare providers caring for low-resourced patients in a Federally Qualified Health Center in Phoenix, Arizona (FQHC) using a mixed-methods, cross-sectional case study. Interviews were conducted with 14 healthcare providers working in a FQHC, involved with delivering genomic testing (specifically, polygenic risk scores [PRS] and monogenic testing) to patients enrolled in the electronic Medical Records and Genomics (eMERGE) network, specifically the eMERGE IV study. Providers expressed a general confidence in genomic testing in practice. Quantitatively, most providers expressed confidence in communicating genomic test results to patients. However, qualitative findings emphasize time constraints, insufficient training, lack of human resources, and concerns for follow-up care and financial barriers, which are pronounced in FQHC settings. The potential of genomic testing to improve patient outcomes is strong, but system-level support for providers is necessary to strive towards sustainable and equitable implementation of genomic medicine, particularly in FQHC and other under-resourced primary care settings.

Background Understanding factors that shape breast cancer risk perceptions is essential for implementing risk-based approaches to breast cancer detection and prevention. This study aimed to assess multilevel factors, including prior screening behavior, shaping underserved, Hispanic women’s perceived risk for breast cancer. Methods Secondary analysis of survey data from Hispanic women ( N  = 1325, 92% Spanish speaking, 64% < 50) enrolled in a large randomized controlled trial. Analyses were performed in two cohorts to account for the role of age on screening guideline recommendations (< 50 and 50 +). For each cohort, we examined differences in three common measures of perceived risk of breast cancer (percent lifetime, ordinal lifetime, comparative) by participant factors with chi-square or Kruskal–Wallis tests, as appropriate. Multivariate analyses examined the association between mammography history with percent perceived lifetime risk (outcome > 10 vs ≤ 10%). Results Overall, 75% reported a lifetime risk between 0 and 10%, 96% rated their ordinal risk as “not high,” and 50% rated their comparative risk as “much lower.” Women < 50 with a family history of breast cancer reported significantly higher levels of perceived risk across all three measures. Among women 50 + , those reporting lower levels of perceived risk were significantly more likely to be Spanish speaking. No significant association was observed between mammography history and percent lifetime risk of breast cancer. Conclusion Factors shaping breast cancer risk perceptions differ by age. Prior screening may play less of role in constructing risk perceptions. Research is needed to develop culturally and linguistically appropriate strategies to improve implementation of risk-based screening.

This mixed methods research study explores the factors that prevent students with learning disabilities from requesting and using reasonable accommodations in a community college. Eleven students with a learning disability attending a community college were interviewed about factors that may have affected whether they requested and used reasonable accommodations. The same eleven students along with other 49 students responded to a survey based on a 4-point Likert-scale addressing the same factors. The ANOVA analysis was not significant however; two variables were significant predictors of whether students regularly requested reasonable accommodations. Seven themes emerged from the qualitative data: poor self-concept, negative faculty attitudes, self-advocacy, satisfaction with reasonable accommodations, and dissatisfaction with reasonable accommodations, disability-related barriers, and Disabled Student Programs & Services (good experiences vs. bad experiences).

Medication non-adherence remains a significant challenge in healthcare, impacting treatment outcomes and the overall effectiveness of medical interventions. This article introduces a novel approach to understanding and predicting medication non-adherence by integrating patient beliefs, efficacy expectations, and perceived costs. Existing theoretical models often fall short in quantifying the impact of barrier removal on medication adherence and struggle to address cases where patients consciously choose not to follow prescribed medication regimens. In response to these limitations, this study presents an empirical framework that seeks to provide a quantifiable model for both individual and population-level prediction of non-adherence under different scenarios. We present an empirical framework that includes a health production function, specifically applied to antihypertensive medications nonadherence. Data collection involved a pilot study that utilized a double-bound contingent-belief (DBCB) questionnaire. Through this questionnaire, participants could express how efficacy and side effects were affected by controlled levels of non-adherence, allowing for the estimation of sensitivity in health outcomes and costs. Parameters derived from the DBCB questionnaire revealed that on average, patients with hypertension anticipated that treatment efficacy was less sensitive to non-adherence than side effects. Our derived health production function suggests that patients may strategically manage adherence to minimize side effects, without compromising efficacy. Patients' inclination to manage medication intake is closely linked to the relative importance they assign to treatment efficacy and side effects. Model outcomes indicate that patients opt for full adherence when efficacy outweighs side effects. Our findings also indicated an association between income and patient expectations regarding the health of antihypertensive medications. Our framework represents a pioneering effort to quantitatively link non-adherence to patient preferences. Preliminary results from our pilot study of patients with hypertension suggest that the framework offers a viable alternative for evaluating the potential impact of interventions on treatment adherence.

Chemotherapeutic agents used for most common cancers are frequently associated with neurotoxicity, which often include debilitating side effects such as seizures. Docetaxel, one of the most widely and effectively used chemotherapeutic drugs, is associated with an array of symptoms referred to as Docetaxel-Induced Peripheral Neuropathies (DIPNs), including motor neuropathy, tingling, muscle weakness, and numbness. In this study, we use the electroconvulsive assay to model DIPN-related muscle weakness in C. elegans, via shock induction . We show that acutely or chronically exposing nematodes to docetaxel increases time to recovery from shock-induced seizure-like behaviors. Additionally, we find that sildenafil citrate, a PDE-5 inhibitor, and a novel bicyclic bridge compound, Resveramorph-3 (RVM-3), are both effective at rescuing the animals from prolonged seizure-like movement duration following acute and chronic exposure to docetaxel. The results demonstrate that sildenafil citrate and RVM-3 are potential candidates for mitigating the neurological deficits resulting from DIPNs.