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PubMed2007

Treatment for children with severe aplastic anemia and sickle cell disease in low income countries in Latin America: a report on the recent meetings of the Monza International School of Pediatric Hematology/Oncology (MISPHO): Part III.

Treatment of hematologic disorders in low-income countries (LIC) is difficult. This report summarizes treatment of sickle cell disease and aplastic anemia by pediatric hematologists from 15 LIC who participate in the Monza International School of Pediatric Hematology/Oncology (MISPHO). Patients with severe sickle cell disease were treated with low dose hydroxyurea, which safely reduced vaso-occlusive crises. Patients with severe aplastic anemia fared poorly due to lack of availability and high cost of anti-thymocyte globulin and cyclosporine and lack of access to stem cell transplantation. Appropriate therapy was most likely to occur in MISPHO centers with an active twinning program with a center in a high-income country.

Anemia, Aplastic↗
PubMed2007

Protocol-based treatment for children with cancer in low income countries in Latin America: a report on the recent meetings of the Monza International School of Pediatric Hematology/Oncology (MISPHO)--part II.

Pediatric cancer programs in low-income countries (LIC) can improve outcomes. However, treatment must be tailored to the patient's living conditions and the availability of supportive care. In some cases, a more intense regimen will decrease survival since the increase in death from toxicity may exceed any decrease in relapse. Attempts to practice evidence-based pediatric oncology are thwarted by the lack of evidence derived from local experience in LIC to determine optimal therapy. This report summarizes treatment regimens used by pediatric oncologists from 15 countries of the Caribbean, Central and South America who participate in the Monza International School of Pediatric Hematology/Oncology (MISPHO). Patients with hepatoblastoma, Wilms tumor, and histiocytosis treated on unmodified published protocols had outcomes comparable to those in high-income countries (HIC). Those with rhabdomyosarcoma, osteosarcoma, Hodgkin lymphoma, and acute myeloid leukemia treated with unmodified regimens had event-free survival estimates 10%-20% lower than those reported in HIC due to higher rates of toxic death, abandonment of therapy, and relapse. Treatment of retinoblastoma is complicated by advanced stages and extraocular disease at diagnosis; improved outcomes depend on education of pediatricians and the public to recognize early signs of this disease. Use of unmodified protocols for Burkitt lymphoma and acute lymphoblastic leukemia have been associated with unacceptable toxicity in LIC, so MISPHO centers have modified published regimens by giving lower doses of methotrexate and reducing use of anthracyclines. Despite the use of all-trans-retinoic acid during induction for acute promyelocytic leukemia, the incidence of fatal hemorrhage remains unacceptably high.

Adolescent↗
PubMed2007

Improving outcomes for children with cancer in low-income countries in Latin America: a report on the recent meetings of the Monza International School of Pediatric Hematology/Oncology (MISPHO)-Part I.

The difference in survival for children diagnosed with cancer between high- and low-income countries (LIC) continues to widen as curative therapies are developed in the former but not implemented in the latter. In 1996, the Monza International School of Pediatric Hematology/Oncology (MISPHO) was founded in an attempt to narrow this survival gap. During its sixth and seventh meetings, members recognized the problem of lack of affordability of essential drugs to treat childhood cancer in many LIC, and initiated an advocacy program. In 1998, MISPHO spawned a collaboration of Central American pediatric oncology centers: the Asociación de Hemato-Oncología Pediátrica Centroamericana (AHOPCA). AHOPCA members reported preliminary findings from several of the 10 cooperative protocols that are currently in progress. In 2003, a second regional collaborative group was formed that includes seven centers in South America. Twinning programs between MISPHO centers and centers in high-income countries (HIC) have proven invaluable to harness the resources of these centers to improve pediatric oncology care in LIC. MISPHO educational efforts include oncology nursing, supportive care, cancer-specific updates, epidemiology, and clinical research methods. Educational efforts are facilitated by educational content and online conferencing via www.cure4kids.org. Identifying preventable causes of abandonment of therapy and documenting the nutritional status of patients treated at MISPHO centers are areas of active research.

Adolescent↗
PubMed1996

Causal Attributions and Reading Achievement: Individual Differences in Low-Income Families

In this study the development of causal attributions about reading within low-income families was examined. Specifically, relations between children's reading achievement and their causal attributions were investigated as well as relations between the children's attributions about themselves and their parents' attributions about them. A total 513 students from Grades 3, 6, and 9, and one parent of each student, all from low-income families, participated. Students and parents independently rated the importance of seven causal variables (effort, intellectual ability, liking for reading, the teacher, help at home, difficulty of reading material, and luck) for the students' good and poor reading outcomes. The major findings were that (a) at each grade, students' attributions were reliably related to their reading achievement on the Gates-MacGinitie reading comprehension test, with attributions to ability, liking for reading, and help at home especially critical; (b) at each grade, parent attributions were reliably associated with student attributions; and (c) as students' grade in school increased, they focused more on themselves and less on others as causal determinants of their reading performance. The implications of these findings for research and education are discussed.

Journal Article↗
PubMedDate not supplied

Evaluation of two strategies for heart health promotion by direct mail in a low-income urban community.

BACKGROUND: The objective of this study was to evaluate the reach of mass mailings of heart health education print materials in a low-income, urban community. Materials included a monthly newsletter and a self-help behavior change kit, both distributed to all 12,789 households in the study community. METHODS: Recall, use, and self-reported impact of the materials were measured in a cross-sectional survey of a random sample of 345 adults conducted 2 weeks after distribution of the kit and 18 months after delivery of the first newsletter. RESULTS: Over one-third of the subjects (38.6%) recalled the newsletter and 27.9% had read one or more newsletters; 21.7% recalled the kit and 10.8% had read it. Few subjects had read both materials. Female gender and older age were independent correlates of having seen and read the newsletters. Older age, being widowed/separated/divorced, and infrequent physical activity were correlates of having seen and read the kit. CONCLUSIONS: Although the newsletter and kit formats might appeal to different segments of the population, mass mailings of heart health education print materials in a low-income urban community can reach large numbers of individuals. The cost effectiveness of repeated mailings of short, simple newsletters might be higher than a single mailing of a more complex behavior change kit.

Adolescent↗
PubMedDate not supplied

Cancer information service-initiated outcalls to promote screening mammography among low-income and minority women: design and feasibility testing.

BACKGROUND: The telephone information service of the Cancer Information Service (CIS) historically is most effective in eliciting calls from higher income, white women. This article describes the design and feasibility of a project that tested the use of telephone outcalls to extend the reach of the telephone information service to underserved women. METHODS: Neighborhoods throughout Colorado were identified using a geodemographic database (INFORUM) that allowed selection of census block groups according to demographic characteristics. Households were assigned randomly to: (1) a control group; (2) an outcall-only group, which received "cold" telephone outcalls promoting screening mammography; and (3) an advance card plus outcall group, which received a card introducing the program prior to the outcall. RESULTS: The use of INFORUM to target low-income, less educated, and black women was largely successful. While quality of intervention delivery was high, the protocol was labor intensive, requiring an average of 40 min to identify and counsel each eligible woman. The advance card did not increase acceptance of the outcalls. CONCLUSIONS: This approach successfully extended the CIS's audience; however, its labor intensity may limit its applicability. Strategies for increasing the efficiency of outcall efforts are suggested.

Aged↗
PubMedDate not supplied

Effectiveness of a telephone outcall intervention to promote screening mammography among low-income women.

BACKGROUND: This study evaluated the impact of a telephone outcall intervention (based on the Transtheoretical Model) on screening mammography behavior among lower income, older women. METHODS: A geodemographic database, INFORUM, was used to identify low-income and minority neighborhoods throughout the state of Colorado. Residences were assigned randomly to three study groups: (1) control, (2) outcall only, and (3) advance "invitation" + outcall. Information Specialists of the Cancer Information Service implemented the protocol. Mammography adherence was assessed in telephone interviews conducted 6 months and 2 years after the initial call. RESULTS: Neither intervention had a significant effect on the main outcome, receipt of mammography in the 6-month follow-up period. At 6 months, intentions to have a mammogram were significantly stronger in the intervention groups compared with the control group, particularly among those who were precontemplators at baseline. The 2-year follow-up indicated a small increase in mammography adherence attributable to the advance invitation + outcall, but this effect was restricted to those adherent at baseline. Mammography behavior during the 6-month follow-up period was predicted strongly by decisional balance, intentions, receipt of a physical and clinical breast exam, and previous mammography behavior. CONCLUSIONS: The intervention promoted minimal movement in the stages of change for mammography. Outcall interventions may have promise for encouraging repeat mammography behavior, but more intensive interventions are likely to be necessary to promote behavior change among nonadherent women.

Aged↗
PubMed2000

Free nicotine patches plus proactive telephone peer support to help low-income women stop smoking.

BACKGROUND: This study tested the impact of free nicotine patches plus proactive telephone peer support to help low-income women stop smoking. METHODS: A total of 214 Medicaid-eligible women smokers of childbearing age were randomized to receive free nicotine patches through the mail or free nicotine patches through the mail plus the provision of proactive support by telephone from a woman ex-smoker for up to 3 months. Assessments were conducted by telephone at baseline, 10 days, and 3 and 6 months after enrollment. RESULTS: At the 3-month follow-up, significantly more women in the patch plus proactive telephone support condition were abstinent (42%) compared to the patch only condition (28%) (P = 0.03). Similarly, more women in the experimental condition were abstinent at both the 10-day and 3-month assessments (32 v 19%, P = 0.02). However, differences were not found at the 6-month follow-up, suggesting that the addition of proactive telephone peer support enhanced short-term, but not long-term cessation. CONCLUSIONS: This is the first study to demonstrate a beneficial effect for the addition of proactive telephone support as an adjunct to free nicotine replacement in a low-income population.

Administration, Cutaneous↗
PubMed1992

Repair of ultraviolet light damage in Saccharomyces cerevisiae as studied with double- and single-stranded incoming DNAs.

Purified double- and single-stranded DNAs of the autonomously replicating vector M13RK9-T were irradiated with ultraviolet light (UV) in vitro and introduced into competent whole cells of Saccharomyces cerevisiae. Incoming double-stranded DNA was more sensitive to UV in excision repair-deficient rad2-1 cells than in proficient repair RAD+ cells, while single-stranded DNA exhibited high sensitivity in both host cells. The results indicate that in yeast there is no effective rescue of UV-incoming single-stranded DNA by excision repair or other constitutive dark repair processes.

DNA Damage↗
PubMed1990

Determinants of breast self-examination among women of lower income and lower education.

This study investigated breast self-examination (BSE) frequency and quality and determinants of BSE practice in two samples of women: (a) women of childbearing age who were of lower income and lower education and (b) women of childbearing age who were of higher income and higher education. Mothers recruited from a pediatric practice completed a questionnaire addressing BSE frequency and quality and factors derived from the Health Belief Model that might influence performance. Results indicated that there were no differences in mean BSE frequency or quality between the two samples. Regression analyses revealed that the perceived barriers index, consisting of forgetting, exclusive reliance on medical personnel for breast exams, and low confidence in ability to perform BSE, was the single best predictor of BSE frequency, accounting for 67% of the variance in each sample of women. When quality of BSE was examined, knowledge of BSE was the best predictor.

Adult↗
PubMed1988

Effects of a televised smoking cessation intervention among low-income and minority smokers.

In November 1985, a television smoking cessation program was broadcast for 20 days on the noon and 9 p.m. news. Smokers in West Garfield Park, an inner-city impoverished area of Chicago, were randomly assigned either to a comprehensive intervention or to a no-intervention control condition. Although 100,000 self-help manuals had been distributed throughout Chicago, none of the controls in this low-income area had obtained a manual. The intervention consisted of providing the smokers a self-help manual, the televised broadcast, weekly support meetings, and supportive phone calls. At a 4-month follow-up, 20% of treatment participants were abstinent compared to 9% of controls. The results indicated that intensive supplementary opportunities enhanced participation by low-income smokers in a media smoking cessation program.

Adult↗
PubMed1996

The fragmentation of incoming Semliki Forest virus nucleocapsids in mosquito (Aedes albopictus) cells might be coupled to virion uncoating.

The fate of Semliki Forest virus (SFV) nucleocapsid, especially the capsid protein (C-protein), was investigated during the early stages of a productive infection in mosquito Aedes albopictus cells. Infection of the cells resulted in a time dependent accumulation of a C-protein derived fragment. This fragmentation of incoming viral nucleocapsid was prevented by NH4Cl, an agent generally used to elevate the pH in acidic intracellular compartments, suggesting that a low intravesicular pH is required for this process. Density gradient analysis of the postnuclear cell lysate demonstrated that the fragmentation was associated with a cellular compartment showing a density of 1.14 +/- 0.02 g/ml. This cellular compartment was devoid from a lysosomal marker enzyme and represented the timely preceding cellular fraction through which SFV passed before encountering a lysosomal fraction. Furthermore, the intracellular distribution of the viral, 3H-uridine-labeled RNA suggested that the same fraction might represent a key cellular compartment in which the separation of the viral RNA from the viral structural proteins is primed. In conclusion, these data lead to the suggestion that the fragmentation of incoming SFV nucleocapsids in Aedes albopictus cells might be the part of the mechanism leading to the release of viral RNA into the cytosol during early stages of productive infection.

Aedes↗
PubMed1994

Locus of control and self-esteem in depressed, low-income African-American women.

Depressed, schizophrenic, and well low-income, African-American women were studied in an effort to extend previous hypotheses of the association between depression and the two personality constructs of low self-esteem and externality to this population. Subjects were 113 low income African-American women including 26 who had been diagnosed as depressed, 54 diagnosed as schizophrenic, and 33 well women. Locus of control was measured with the Adult Nowicki-Strickland Internal-External Control Scale (Nowicki & Duke, 1974). Self-esteem was measured with the Rosenberg Self-Esteem Scale (Rosenberg, 1965). Contrary to predictions, a diagnosis of schizophrenia, but not depression, was associated with more external locus of control. For self-esteem, severity of disturbance, rather than diagnosis, seemed to be of primary importance. Also, lower self-esteem scores were correlated significantly with higher levels of externality for both depressed and schizophrenic women but not for well controls. The present study indicates that self-esteem and locus of control are related to depression differently in low socio-economic status (SES) African-American women than in previously studied middle SES depressed whites. The findings emphasize the need for more normative studies to clarify the complex relations among SES, race, emotional disturbance, self-esteem, and locus of control.

Adult↗
PubMed1998

An ecological model for school-based mental health services for urban low-income aggressive children.

An ecological model for school-based mental health services that targets urban low-income aggressive children--a highly vulnerable and underserved population--is presented. The goals of the model are to increase children's and teachers' involvement in the delivery of services and to increase the integration of these services into existing school resources and activities. The model proposes that mental health service providers work in collaboration with teachers to deliver services that (1) can be managed by existing school resources and personnel, (2) are related to empirically based factors associated with reduced aggression and increased social functioning, and (3) are group administered to increase the number of children served and to reduce stigmatization associated with mental health services. The model is individualized and flexible by acknowledging that contexts for aggression differ across classrooms and children and by providing services specific to those contexts. Two studies are presented illustrating the application of this model to decrease aggression and increase academic engagement in low-income urban public schools.

Achievement↗
PubMed2006

Radiofrequency catheter ablation of supraventricular tachycardia in children and adolescents : feasibility and cost-effectiveness in a low-income country.

The objective of this study is to provide results and costs of catheter ablation in children and adolescents in a low-income country. Reports from first-world countries have demonstrated the cost-effectiveness of radiofrequency catheter ablation (RFCA) compared to medical treatment of supraventricular tachycardia (SVT). The study included 28 patients younger than 18 years of age with SVT in a pediatric cardiology unit in Guatemala. All patients underwent RFCA. Clinical outcome and cost-effectiveness of RFCA compared to continued medical treatment were the end points. Twenty-four patients had successful ablation (85.7%). Mean age at RFCA was 11.42 +/- 3.49 years. Three patients underwent a second ablation, increasing the success rate to 96.4%. One remaining patient is awaiting a second procedure. At a mean follow-up of 13.69 +/- 7.16 months, all 27 patients who had a successful ablation remained in sinus rhythm. Mean cost per procedure was 4.9 times higher than that of medical treatment. However, the estimated cost of catheter ablation equal that of medical therapy after 5.1 years and is 3.4 times less after 20 years. Radiofrequency catheter ablation of SVT in children and adolescents is safe and cost-effective compared to medical therapy. Resources must be judiciously allocated, especially in low-income countries, to treat the largest number of pediatric patients.

Adolescent↗
PubMed2005

Relationship of education, occupation, and income with mortality in a representative longitudinal study of South Korea.

To examine relationship of education, occupation, and income with mortality risk, the 1998 National Health and Nutrition Survey data were linked to data on mortality. Education, occupation, and income had independent effects on mortality risk after adjustment for the remaining two socioeconomic position indicators. Educational, occupational, and financial approaches would be equally important to reduce socioeconomic mortality inequalities in South Korea.

Adult↗
PubMed2005

Seasonal variations in mood and behaviour associated with gender, annual income and education: the Hordaland Health Study.

OBJECTIVE: To explore the relationship between demographic factors and seasonal changes in mood and behaviour. METHOD: A health survey was conducted among 40-45 year old inhabitants in Hordaland County, Norway. The Global Seasonality Score, investigating seasonal symptoms, was given to 4299 men and 9983 women. Response rates among those receiving the questionnaire were 79.8% for men (n = 3432) and 81.2% for women (n = 8223). RESULTS: High seasonality was reported by 18.4% of men and 22.2% of women. Female gender, low educational level, high level of affective symptomatology and low household income correlated with high seasonality. Among men, being single was also a determinant factor for high seasonality. Reported seasonality also depended on which month the questionnaire was filled in. CONCLUSIONS: In this study, high seasonality was most prevalent among females, being single, having a low annual income and a low education level. The latter two findings are different from expectations which could be drawn from previous studies suggesting an opposite association.

Adult↗
PubMed2005

Long-term effects of chronic depressive symptoms among low-income childrearing mothers.

OBJECTIVES: Longitudinal studies of maternal depression in the postpartum period have demonstrated that a chronic state of depressive symptoms is not rare. In spite of this, however, the characteristics of chronically depressed mothers have rarely been studied. This study examines the demographic and socioenvironmental characteristics across time of childrearing women with chronic depressive symptoms. METHODS: A cohort of 476 childrearing lower-income mothers was interviewed from the first trimester of pregnancy through the tenth year postpartum. The Center for Epidemiologic Studies-Depression Scale (CES-D; Radloff, L. (1977) Appl Psychol Meas 1:385-401) was used to define depressive symptomatology. Four groups were defined based on the CES-D scores at 18 months, 3, 6 and 10 years: never-depressed (CES-D < 16), depressed only at one phase (CES-D > or = 16), chronically mildly depressed (CES-D > 16 and < or =24 at three or more phases), and chronically severely depressed (CES-D > or = 25 at three or more times). Demographic and socioenvironmental characteristics of the groups were evaluated across time. RESULTS: Chronically depressed women compared to never-depressed women were less likely to be married, had less education, had lower family income, and were more likely to use substances. They reported more frequent arguments with close family members or friends, separation/divorce with partners, financial problems, less social support, and more financial strain. CONCLUSIONS: Women who continue to be depressed across the 10 postpartum years have less optimal outcomes compared to women who are not depressed and those who are only intermittently depressed. Pregnancy and delivery and subsequent pediatric visits are important times to identify women who are depressed.

Chronic Disease↗