Sociocultural Disparities Research Articles

Predictors of retention in a cervical cancer survivorship study.

6132 Background: Women with cervical cancer experience numerous quality of life (QOL) disruptions. A completed pilot study indicated that QOL and key biomarkers could be improved with psychosocial telephone counseling (PTC). A confirmatory trial has recently completed accrual.The purpose of this study is to identify predictors of retention in this large biobehavioral trial, and examine retention differences between the pilot and confirmatory trial. Methods: Women with stage I – III cervical cancer diagnosed 9 – 30 months earlier were randomized to either PTC or usual care. PROs and biological specimens were collected prior to randomization (N=204), and 3 (T2) and 9 months post baseline. Sociodemographic, clinical and QOL variables were evaluated from baseline to T2 to identify predictors of study retention. Multiple measures, including the PROMIS Depression and Anxiety scales were entered into a multivariate stepwise logistic regression model to predict study retention. Results: In the multivariate model, being randomized to counseling (OR=4.4, 95% CI: 1.5-12.6), having clinically significant depression, defined as >1 SD above the 50th percentile (OR=4.2, 95% CI:1.7-10.5) and being single (OR=3.4, 95% CI: 1.3-9.2) were the most significant predictors of drop-out in the study overall. Among those in the counseling arm, depression is the strongest predictor of dropout, with a five times higher dropout rate (OR=5.2, 95% CI:1.9-15.6) than those with low to moderate levels of depression, or no depression. However, retention rates improved substantially overall from the pilot study (72%) to the confirmatory study (84%), in both study arms, and retention increased among Latinas from 60% in the pilot study to 83% in the current study, and from 52% to 81% among those with less than a high school education. Conclusions: Results from this analysis of predictors of retention indicate that enhanced attention to sociocultural disparities can improve study retention. Attending to baseline clinical depression may be a further consideration.

Editors’ Introduction: New Approaches to Irish Migration

Editors’ Introduction: New Approaches to Irish Migration Piaras Mac Éinrí (bio) and Tina O’Toole (bio) The field of historical and contemporary migration to and from Ireland is a discordant one of multiple enquiries, meanings, discourses, and processes. This discordancy is also found in debates about the fluid and inchoate process of “migrancy” itself—the ontological state or condition of migrant mobility, constituting an ambivalent, “in-between” area of identity and enquiry. In the first place, migration to and from Ireland is marked by a series of historical, spatial, political, and sociocultural disparities. Ireland has long been an emigration nation, with a focus since the Act of Union in 1800 (after several centuries of links with Britain, but also with France, Spain, and other parts of continental Europe) on English-speaking destinations (Québec and Argentina are notable exceptions) and on the various and scattered parts of the British Empire. During that time, by contrast, the numbers migrating in the other direction remained extremely modest. There were already small numbers of black immigrants (usually servants) in eighteenth-century Ireland. The late nineteenth and twentieth centuries saw modest numbers of Jewish, Italian, Chinese, Indian, and other immigrants. Their combined numbers never challenged the formation of a dominant identity, or rather, of two competing, partly confessional and partly ethnic, identities within Ireland. The combined presence of the English, Scots, and Welsh also constituted at all times and for obvious reasons the most significant foreign migrant community in Ireland. Yet they were rarely considered “immigrants,” possibly because their largely hegemonic presence or an assumption of a shared identity of Britishness/Irishness, albeit based upon an unequal relationship, [End Page 5] was taken in some way as self-evident and therefore rendered them invisible. More recent discourses concerning immigration placed a disproportionate emphasis on distinctions of skin color. Today, British people living in Ireland still constitute the largest ethnic minority in the country, but they are never referred to as such. In Britain itself, and for similar reasons, the twentieth-century Irish were not always recognized as a separate ethnic community, at least until Hickman and Walter’s pioneering work challenged the conventional wisdom concerning “race” and immigration.1 The same fundamental asymmetry in migratory flows, reflecting a dominant paradigm of movement from less-developed to more-developed Europe, can be observed in other peripheral European regions. In the twentieth century the Finns went to Sweden and southern Europeans from the former Yugoslavia, Greece, Italy, Turkey, Spain, and Portugal went to various parts of northern Europe. The Irish, no exception to this general rule, continued to migrate to Britain irrespective of the changed political relationship between the two countries. Irish emigrants had also gone to destinations, notably the United States but also Canada, Australia, and New Zealand, in which they themselves played a central, constitutive role in the dynamics of evolving, ethnically mixed societies. In this sense, for example, it is possible to argue that the Great Famine in Ireland and its accompanying outpouring of desperate people was a formative event, not just in Irish history, but also in the transformation of urban America. Ultimately, the Irish achieved radical transitions in terms of their own social advancement and positioning. In so doing, they became insider players in a complex process of emergent societies delineated, for better or for worse, by ethnicity, class, and gender. In the case of migration to the United States in particular, while Irish migrants were part of a broader movement of transatlantic European emigration, they had certain advantages (even while constructed as an often despised “alien other” in terms of religion, education, and class) in language and political and organizational experience, which, over time, gave them a prominent role in American [End Page 6] political life. In a society where the individual’s opportunities were often defined by ethnic identity and by its accompanying advantages or disadvantages, the Irish were ultimately accepted. To acknowledge this is not to reject the problematic elements of that inheritance. In particular, the Irish “became white,” to use Ignatiev’s phrase, and went on to play a less than glorious role, with honorable exceptions, in the construction of American racial politics. In the period...

Abstract B73: The Chicago Colorectal Cancer Consortium (CCCC), a step forward in understanding colorectal cancer in African Americans

Abstract Background: Colorectal cancer (CRC) is the third leading cause of cancer-related death in both sexes in the United States. While the overall CRC incidence rates have declined over the past 10 years, the disparity between African Americans (AAs) and non-Hispanic whites has increased and the incidence in AAs remains higher than in other populations. Very few studies have specifically addressed CRC in AAs, and important studies on CRC almost never include significant numbers of AAs to draw any firm conclusions. Objective: To establish a large, robust and well-characterized database and bio-repository collection of CRC from AA patients and controls strengthening a collaborative working group, the Chicago Colorectal Cancer Consortium (CCCC), which spans 5 of the main hospitals of the Chicago area. We collect clinical, demographic and dietary data; and a biological repository of specimens consisting of tumor and non-tumor genomic DNA, RNA, plasma, serum, and paraffin-embedded samples. Specific Aims: The primary goal of the project is to study how genetic and environmental factors and their interaction result in the development of CRC. We will also study prognosis determinants in the AA population. Results: Recruitment and data collection: So far we have recruited 56 AA and 17 white-non Hispanic adenocarcinoma colorectal patients. We have also recruited 84 AAs and 32 white patients with adenomatous polyps, and 44 AAs and 30 white controls (individuals without polyps or previous history of polyps). From all individuals we have collected demographic/socioeconomic data, clinical data, family history of cancer, medication and toxic substance history, and dietary data using the Block Brief 2000 Food Frequency Questionnaire. Preliminary analyses: To identify potential variables that could influence the cancer disparity between AAs and whites, we performed a preliminary analysis of all these data using a Fisher exact test. A systematic molecular analysis of BRAF and KRAS mutations, microsatellite instability and presence of CpG island methylation phenotype in all CRC tumors is being performed. We are also analyzing protein expression of the mismatch repair genes through immunohistochemistry. We will test for an association between these molecular features and clinical variables. Moreover, 1 year follow-up data is already available and being collected on 23 cases. Therefore, we will soon be able to start investigating the relationship of those molecular features with survival and specific chemotherapy response. Summary: The preliminary analysis has highlighted some significant differences between AA and white CRC patients. In comparison with white patients, a higher proportion of AA patients are less than 50 years at diagnosis, take NSAIDS, and fulfill Bethesda criteria, which is a set of criteria to select out patients to be pre-screened for mismatch repair deficiency and eventually for genetic testing to rule out Lynch syndrome. It has also highlighted that CRC patients have a lower level of education than cancer-free individuals in both ethnicities. This type of sociocultural disparities could potentially be associated with different life styles. In fact, AA CRC cases consumed more carbohydrates than controls reflecting this potential life style difference. Cancer Relevance: Understanding the key molecular features and environmental factors that impact CRC development in the AA population is of paramount importance given the scarce information available. Understanding the role genetic factors will be crucial to help risk stratify patients, recommend screening modalities, and recommend preventive measures. When this information is combined with environmental factors, such as dietary habits, we will be able to offer a comprehensive personalized medicine approach for AA CRC patients. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B73.

Ethical and legislative perspectives on liver transplantation in the People's Republic of China

Ethical and legislative perspectives on liver transplantation in the People's Republic of China

Chest pain: Communication of symptoms and history in a London emergency department

Objective To describe patient–provider interactions for patients in an emergency department with possible acute coronary syndrome (ACS) and to generate hypotheses about how communication might contribute to sociocultural disparities in cardiac care. Methods Qualitative analysis of observational data. Seventy-four consecutive patients presenting between 8 a.m. and 10 p.m. over a 4-month period. Results Participants were aged 40–85 years; 58% were male; 67% were white, 18% Afro-Caribbean, and 15% South East Asian. Observations revealed significant obstacles to communication for the majority of patients. The three most prominent impediments to effective communication were: the use of leading questions to define chest pain, patient–provider conflict as a result of, and contributor to, poor communication, and frank miscommunication due to language barriers and translational difficulties. Conclusion This study documents aspects of the communication process that compromise the quality of the medical history obtained in emergency department patients with suspected ACS. Accurate diagnosis relies on an interaction that weaves both the patient's and the physician's perspective into a shared understanding of events that comprise a patient's history. When diagnostic short cuts are taken to overcome educational, cultural, or language barriers in the medical interview, they may contribute to health care disparities. Practice implications Physicians should take a more attentive and careful approach to patient interviewing than was observed here and should be aware of the ways in which they shape the interview through their questions and focus. Good communication skills can be effectively taught at all levels of training and practice.

The Aripae o's Landscape: Local Control Within Global Reality

The Aripae o are maroon descendants living in the Lower Caura region of Bol var state, Venezuela. A product of an earlier process of globalization that gave rise to the Atlantic slave trade, present-day Aripae o continue to resist any outside influence, intervention, or penetration that could spur sociocultural relations of inequality and (in)difference. Although they are consciously aware of the sociocultural disparities inherent in the modern world capitalist system, this does not imply that they are necessarily against the globalizing tendencies of modernity. Rather, their desire is to have direct participation and control over the resources that they consider important for their cultural production, representation, and reproduction. Through the utilization of the concept of "landscape" as an integrated and yet polysemic cultural repertoire, the aim of this article is to demonstrate that the Aripae o's commitment to their traditional way of life still incorporates their appreciation of modernity and globalization.