According to the Centers for Disease Control and Prevention (CDC) prevalence data for 2007, diabetes is a chronic and progressive disease that affects nearly 24 million people in the U.S.1 It is projected that by the year 2030, more than 30 million people will have diabetes.2 From 90% to 95% of diagnosed cases are type-2 diabetes, which is characterized by insulin resistance and an altered secretion of pancreatic beta cells, leading to hyperglycemia.1 Diabetes is associated with various microvascular and macrovascular complications that often lead to death. In 2006, diabetes was listed as the seventh leading cause of death in the U.S. The World Health Organization (WHO) predicts that diabetes-related deaths will double between 2005 and 2030 worldwide.1,2
The United Kingdom Prospective Diabetes Study (UKPDS) established the importance of reducing glucose levels to decrease the risk of complications associated with type-2 diabetes.3 Since the publication of that report, more recent studies, such as Action to Control Cardiovascular Risk in Diabetes Trial (ACCORD) and the Veterans Affairs Diabetes Trial (VADT), have re-emphasized the importance of glycemic control and its association with vascular complications.4,5
Although numerous pharmacological agents are available for the management of the disease, type-2 diabetes is controlled in fewer than 50% of patients in the U.S.6 These statistics are alarming; more effort is needed to achieve the recommended American Diabetes Association (ADA) and American Association of Clinical Endocrinologists (AACE) glycosylated hemoglobin (HbA1c) goals of below 7% and 6.5%, respectively.7,8 Research in pharmacological management, in addition to lifestyle modifications, has flourished as a consequence of the complications associated with diabetes.
The incretin mimetic class of medications was introduced to the market in 2005 in the form of exenatide (Byetta, Amylin/Lilly), a twice-daily subcutaneous (SQ) injection.9 Incretins—glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP)—cause an increase in the amount of insulin released from pancreatic beta cells after meals.10 The incretin effect is defined as a significantly greater insulin stimulatory response after an oral glucose load, compared with an intravenous (IV) glucose infusion when plasma glucose concentrations are equivalent.11 GLP-1 levels are reduced in patients with type-2 diabetes, compared to individuals with normal glucose tolerance.11,12
Thus, product development has focused primarily on GLP-1 for type-2 diabetes. The incretin mimetic liraglutide (Victoza, Novo Nordisk) was approved in the U.S. in January 2010 as an adjunctive therapy to diet and exercise in adults with type-2 diabetes.13 Liraglutide is also approved in Europe and Japan.14
During patient care rounds with the medical team, pharmacy students have made positive contributions for the benefit of the patient. However, very little has been documented regarding the impact these future healthcare professionals are making while on clinical rotations. The objective of this study was to assess the impact that clinical interventions made by 6th year pharmacy students had on overall patient outcome. Using a special program for a personal digital assistant (PDA), the students daily recorded the pharmacotherapeutic interventions they made. The interventions ranged from dosage adjustments to providing drug information. Data was collected over a 12-week period from various hospitals and clinics in the Jacksonville, Florida area. In total, there were 89 pharmaceutical interventions performed and recorded by the students. Fifty interventions involved drug modification and fifty-four interventions were in regards to drug information and consulting. Of the drug information and consulting interventions, 15 were drug modification. This study shows the impact pharmacy students make in identifying, recommending, and documenting clinical pharmacotherapeutic interventions. Similar to pharmacists, pharmacy students can also have a positive contribution towards patient care.
Introduction: The only racial/ethnic group that has not met the Healthy People 2010 goal for the nation relating to prostate cancer (CaP) is African American Men (AAM). With the differences in CaP morbidity and mortality experienced by AAM compared to other racial groups, there is significant CaP health disparity for AAM. Given that behavioral choices is arguably the most influential determinant of population health, accounting for about 40%, it is important to target individual behavior in the effort to eliminate health disparity. Thus, our study objective was to develop and validate an Integrative Personal Model of Prostate Cancer Disparity (PIPCaD) model for AAM. We identified factors that directly influence AAM9s CaP prevention and detection activities, with the goal to develop effective interventions that will address this disparity. Materials and Methods: After generating the items for the PIPCaD survey through focus group interviews, the PIPCaD survey was pre-tested among 100 AAM to ensure that the items were culturally sensitive, relevant and reliable. Subsequently, AAM between the age of 40 and 70 were recruited at ethnic barber shops, churches and CaP forums to participate in a cross-sectional survey study to: (a) Assess the behavior of AAM relative to CaP prevention and detection; and (b) Test the predictive validity of the proposed PIPCaD model. The usual descriptive statistics and multiple regression analyses were employed for the study analyses. Results: Four hundred and twenty-four (424) AAM were recruited for the study, comprising mostly AAM between 40 and 49 years, college educated, married, with full-time employment, and earning between $40,000 and $59,999. Based on mean statistics and frequency analyses, most of the men have moderately good eating behavior, consistently seek information about CaP, have moderate exercise schedule and hardly consume supplements to prevent CaP. About 24% received only DRE or PSA within the past year and 31% had both tests. The following variables were significantly associated with a composite index of CaP prevention and detection behavior, explaining 45% of the variance: CaP knowledge, perceived behavioral control, cues to action, CaP fatalism, temporal orientation and full-time employment. We also found that: (i) perceived behavioral control determined eating behavior; (ii) employment, cues to action and acculturation determined supplement consumption; (iii) education, religiosity and perceived behavioral control determined physical activity; (iv) perceived behavioral control, cues to action, acculturation and knowledge determined seeking CaP information; and (v) household income, perceived susceptibility, and cues to action determined CaP screening. Conclusion: Undoubtedly, the health behavior of AAM contributes to CaP health disparity. Our study is the first one to confirm the cognitive-behavioral factors and cultural beliefs and values that affect AAM9s CaP prevention behavior. This study is of significant importance in the African American community given the powerful impact of cultural and health beliefs on health promotion and disease prevention. Based on the modifiable factors found to impact behavior in this study, appropriate effective, culturally sensitive and relevant interventions can be developed to promote CaP prevention and early detection among AAM.
Abstract Background: The Healthy Immigrant Effect (HIE) phenomenon proposes that: (1) when immigrants arrive in the U.S., they are healthier than their locally born counterparts; and that (2) this health advantage dissipates over time. While this phenomenon has been well studied and documented among Asians and Hispanics, few studies have explored the HIE among blacks. Most research studies on prostate cancer (CaP) health disparities have focused on comparing Black men to other ethnic groups within the U.S. A research area that has been overlooked and understudied is the within-group differences among black men. We investigated the ethnic variations among native-born black men, African-born black men, and Caribbean-born black men on: (1) personal history of CaP; (2) discussion of CaP risk reduction and early detection with physician; (3) screening by digital rectal examination (DRE); (4) screening by prostate specific antigen (PSA); (5) CaP knowledge; (6) diet; (7) use of chemoprevention products; and (8) physical activity. Methods: This study was part of the Florida Prostate Cancer Disparity Project referred to as the PIPCaD project. The inclusion criteria were black men (regardless of country of origin) who were 35 years and older. Data collection took place primarily in five Florida counties. Using a previously validated survey, data were collected from over 3,400 black men. A one-way ANOVA analyses were carried out to determine if there were significant differences among the three groups on outcome variables. Results: Of the 3,410 responses received, 3,040 indicated their ethnicity: 2,405 were native-born black men, 315 were African-born black men, and 320 were Caribbean-born black men. We found significant differences on CaP knowledge level (F{2,3016} = 13.43, p<.001), vegetable consumption (F{2,3016} = 13.43, p<.001), use of chemoprevention products (F{2,3016} = 13.43, p < .001). Post hoc tests revealed that native-born men had significantly higher CaP knowledge compared to African-born and Caribbean-born men (p<.05). Chi-square test results comparing the three groups were significant for frequencies of meat consumption (χ2{2} = 45.2845, p <.001), discussion of CaP risk-reduction and early detection with a doctor (χ2{2} = 3.81, p =.022), and insurance status (χ2{2} = 8.5071, p <.014). Relative to diet, significantly more native-born men reported meat products make up the biggest portion of their meal. Over 70% of native-born men reported eating meat at least four to six times a week compared to 64% African-born men and 62% Caribbean-born men. Although African-born men were the least insured of the three groups, more men in this group reported that they discuss CaP risk-reduction and early detection with a physician every chance they get compared to native born and Caribbean-born men. In addition, the frequency of chemoprevention use was highest among African-born men. Discussion: Given the significant number of foreign-born blacks in the U.S., it is important to disaggregate the data of native-born and foreign-born blacks to identify knowledge gaps and develop effective programs and policies to address disparities. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):PR-2.
Since behavioral factors are significant determinants of population health, addressing prostate cancer (CaP)-related health beliefs and cultural beliefs are key weapons to fight this deadly disease. This study investigated the health beliefs and cultural beliefs of black men relative to CaP, and the key socio-demographic correlates of these beliefs. The study design was a cross-sectional survey of 2,864 Florida black men, age 40 to 70, on their perceived susceptibility, perceived severity, attitude, outcomes beliefs, perceived behavioral control, CaP fatalism, religiosity, temporal orientation, and acculturation relative to CaP screening and prevention. The men reported favorable attitude and positive outcome beliefs, but moderate perceived behavioral control, CaP susceptibility and CaP severity. They also had low level of acculturation, did not hold fatalistic beliefs about CaP, had high religious coping skills and had high future time perspective. Several demographic variables were found to be associated with health beliefs and cultural beliefs. Our study provides rich data with regard to the health and cultural beliefs that might serve to inform the development of CaP control initiative for US-born and foreign-born black men.
1.1 Inflammatory breast cancer as a distinct clinicopathologic entity There are several clinically distinct types of breast cancer, which include early stage breast cancer, locally advanced breast cancer (LABC) and metastatic breast cancer. The most rare but lethal form of LABC is inflammatory breast cancer (IBC) (reviewed in 1). This type of breast cancer accounts for an estimated 25% of all breast cancers in the United States and up to 20% of all breast cancers globally (2-4). Although primary IBC is less commonly diagnosed than other types of breast cancer, IBC is responsible for a disproportionate number of breast cancer-related deaths that occur each year world-wide due to its propensity to rapidly metastasize. (2-4). Women diagnosed with IBC have a significantly shorter median survival time (~ 2.9 years) than women with either LABC (~ 6.4 years) or non-LABC breast cancer (>10 years). The clinical diagnosis of IBC is based on the combination of the physical appearance of the affected breast, a careful medical history, physical examination, and pathological findings from a skin biopsy and/or needle or core
