Racial/Ethnic Differences in Multiple Self-Care Behaviors in Adults with Diabetes

OBJECTIVE: To assess racial/ethnic differences in multiple diabetes self-care behaviors. DESIGN: Cross-sectional study. PARTICIPANTS: 21,459 participants with diabetes in the 2003 Behavioral Risk Factor Surveillance survey. MEASUREMENTS: The study assessed self-care behaviors including physical activity, fruits/vegetables consumption, glucose testing, and foot examination, as well as a composite of the 4 self-care behaviors across racial/ethnic groups. Multiple logistic regression was used to assess the independent association between race/ethnicity, the composite variable, and each self-care behavior controlling for covariates. STATA was used for statistical analysis. RESULTS: Overall, 6% engaged in all 4 self-care behaviors, with a range of 5% in non-insulin users to 8% in insulin users. Blacks were less likely to exercise (OR 0.63, 95% CI 0.51, 0.79), while Hispanics and “others” were not significantly different from whites. Hispanics (OR 0.64, 95% CI 0.49, 0.82) and others (OR 0.69, 95% CI 0.49, 0.96) were less likely to do home glucose testing, while blacks were not significantly different from whites. Blacks (OR 1.42, 95% CI 1.12, 1.80) were more likely to do home foot examinations, while Hispanics and others were not significantly different from whites. Blacks (OR 0.56, 95% CI 0.36, 0.87) were less likely to engage in all 4 behaviors, while Hispanics and others were not significantly different from whites. There were no significant racial/ethnic differences in fruit and vegetable consumption. CONCLUSIONS: Few patients engage in multiple self-care behaviors at recommended levels, and there are significant racial/ethnic differences in physical activity, dietary, and foot care behaviors among adults with diabetes

The mechanisms by which polyamines accelerate tumor spread

Increased polyamine concentrations in the blood and urine of cancer patients reflect the enhanced levels of polyamine synthesis in cancer tissues arising from increased activity of enzymes responsible for polyamine synthesis. In addition to their de novo polyamine synthesis, cells can take up polyamines from extracellular sources, such as cancer tissues, food, and intestinal microbiota. Because polyamines are indispensable for cell growth, increased polyamine availability enhances cell growth. However, the malignant potential of cancer is determined by its capability to invade to surrounding tissues and metastasize to distant organs. The mechanisms by which increased polyamine levels enhance the malignant potential of cancer cells and decrease anti-tumor immunity are reviewed. Cancer cells with a greater capability to synthesize polyamines are associated with increased production of proteinases, such as serine proteinase, matrix metalloproteinases, cathepsins, and plasminogen activator, which can degrade surrounding tissues. Although cancer tissues produce vascular growth factors, their deregulated growth induces hypoxia, which in turn enhances polyamine uptake by cancer cells to further augment cell migration and suppress CD44 expression. Increased polyamine uptake by immune cells also results in reduced cytokine production needed for anti-tumor activities and decreases expression of adhesion molecules involved in anti-tumor immunity, such as CD11a and CD56. Immune cells in an environment with increased polyamine levels lose anti-tumor immune functions, such as lymphokine activated killer activities. Recent investigations revealed that increased polyamine availability enhances the capability of cancer cells to invade and metastasize to new tissues while diminishing immune cells' anti-tumor immune functions

The Aerosphere as a Network Connector of Organisms and Their Diseases

Aeroecological processes, especially powered flight of animals, can rapidly connect biological communities across the globe. This can have profound consequences for evolutionary diversification, energy and nutrient transfers, and the spread of infectious diseases. The latter is of particular consequence for human populations, since migratory birds are known to host diseases which have a history of transmission into domestic poultry or even jumping to human hosts. In this chapter, we present a scenario under which a highly pathogenic avian influenza (HPAI) strain enters North America from East Asia via postmolting waterfowl migration. We use an agent-based model (ABM) to simulate the movement and disease transmission among 106 generalized waterfowl agents originating from ten molting locations in eastern Siberia, with the HPAI seeded in only ~102 agents at one of these locations. Our ABM tracked the disease dynamics across a very large grid of sites as well as individual agents, allowing us to examine the spatiotemporal patterns of change in virulence of the HPAI infection as well as waterfowl host susceptibility to the disease. We concurrently simulated a 12-station disease monitoring network in the northwest USA and Canada in order to assess the potential efficacy of these sites to detect and confirm the arrival of HPAI. Our findings indicated that HPAI spread was initially facilitated but eventually subdued by the migration of host agents. Yet, during the 90-day simulation, selective pressures appeared to have distilled the HPAI strain to its most virulent form (i.e., through natural selection), which was counterbalanced by the host susceptibility being conversely reduced (i.e., through genetic predisposition and acquired immunity). The monitoring network demonstrated wide variation in the utility of sites; some were clearly better at providing early warnings of HPAI arrival, while sites further from the disease origin exposed the selective dynamics which slowed the spread of the disease albeit with the result of passing highly virulent strains into southern wintering locales (where human impacts are more likely). Though the ABM presented had generalized waterfowl migration and HPAI disease dynamics, this exercise demonstrates the power of such simulations to examine the extremely large and complex processes which comprise aeroecology. We offer insights into how such models could be further parameterized to represent HPAI transmission risks as well as how ABMs could be applied to other aeroecological questions pertaining to individual-based connectivity

Health Care Access and Utilization among Women Who Have Sex with Women: Sexual Behavior and Identity

Past research has shown that women who either have sex with women or who identify as lesbian access less preventive health care than other women. However, previous studies have generally relied on convenience samples and have not examined the multiple associations of sexual identity, behavior and health care access/utilization. Unlike other studies, we used a multi-lingual population-based survey in New York City to examine the use of Pap tests and mammograms, as well as health care coverage and the use of primary care providers, among women who have sex with women and by sexual identity status. We found that women who had sex with women (WSW) were less likely to have had a Pap test in the past 3 years (66 vs. 80%, p<0.0001) or a mammogram in the past 2 years (53 vs. 73%, p=0.0009) than other women. After adjusting for health insurance coverage and other factors, WSW were ten times [adjusted odds ratio (AOR), 9.8, 95% confidence interval (CI), 4.2, 22.9] and four times (AOR, 4.0, 95% CI 1.3, 12.0) more likely than non-WSW to not have received a timely Pap test or mammogram, respectively. Women whose behavior and identity were concordant were more likely to access Pap tests and mammograms than those whose behavior and identity were discordant. For example, WSW who identified as lesbians were more likely to have received timely Pap tests (97 vs. 48%, p<0.0001) and mammograms (86 vs. 42%, p=0.0007) than those who identified as heterosexual. Given the current screening recommendations for Pap tests and mammograms, provider counseling and public health messages should be inclusive of women who have sex with women, including those who have sex with women but identify as heterosexual