Anabella Castillo

A randomized controlled trial using patient navigation to increase colonoscopy screening among low-income minorities.

Organizational barriers play a key role in colorectal cancer (CRC) screening disparities in low-income minorities. This is a prospective, randomized trial to determine whether a patient navigator (PN) can help overcome the organizational barriers low-income minorities face in trying to obtain screening colonoscopy. Patients of average risk for CRC were referred by their primary care physician for screening colonoscopy. After the PN received the referral, patients were randomly assigned to either receive navigation (PN+) to screening colonoscopy or not receive navigation (PN-). We hypothesized that a PN would increase patient compliance with screening colonoscopy. A total of 21 patients were enrolled in the pilot study (PN+ = 13, PN- = 8); 54% of navigated patients completed screening colonoscopy versus 13% of nonnavigated patients (p = 0.058). Eighty-six percent of navigated patients had an excellent or very good colon prep; however, there was no difference in prep quality between groups ( p = 0.10). One-hundred percent of navigated patients were very satisfied with navigation services. A PN improves compliance with screening colonoscopy in low-income minorities. Larger studies are needed to evaluate what features of navigation are most effective in facilitating completion of screening colonoscopy.

A Program to Enhance Completion of Screening Colonoscopy Among Urban Minorities

BACKGROUND & AIMS Although colonoscopy is becoming the preferred screening test for colorectal cancer, screening rates, particularly among minorities, are low. Little is known about the uptake of screening colonoscopy or the factors that predict colonoscopy completion among minorities. This study investigated the use of patient navigation within an open-access referral system and its effects on colonoscopy completion rates among urban minorities. METHODS This was a cohort study that took place at a teaching hospital in New York. Participants were mostly African Americans and Hispanics directly referred for screening colonoscopy by primary care clinics from November 2003 to May 2006. Once referred, a bilingual Hispanic female patient navigator facilitated the colonoscopy completion. Completion rates, demographic factors associated with completing colonoscopy, endoscopic findings, and patient satisfaction were analyzed. RESULTS Of 1169 referrals, 688 patients qualified for and 532 underwent navigation. Two thirds (66%) of navigated patients completed screening colonoscopies, 16% had adenomas, and only 5% had inadequate bowel preps. Women were 1.31 times more likely to complete the colonoscopy than men (P = .014). Hispanics were 1.67 times more likely to complete the colonoscopy than African Americans (P = .013). Hispanic women were 1.50 times more likely to complete the colonoscopy than Hispanic men (P = .009). Patient satisfaction was 98% overall, with 66% reporting that they definitely or probably would not have completed their colonoscopy without navigation. CONCLUSIONS By using a patient navigator, the majority of urban minorities successfully completed their colonoscopies, clinically significant pathology was detected, and patient satisfaction was enhanced. This approach may help increase adherence with screening colonoscopy efforts in other clinical settings.

Understanding the Barriers and Facilitators of Colorectal Cancer Screening Among Low Income Immigrant Hispanics

Colorectal cancer (CRC) screening rates are low among Hispanics; thus understanding screening barriers and facilitators is essential. A survey, based on blended health promotion theories, was conducted with low income, mostly immigrant, Hispanics at community based organizations and health clinics in New York City. Correlates of undergoing colonoscopy screening were examined. Four hundred men (28%) and women were interviewed. Older age, longer US residence, having a regular health care provider and provider recommendation predicted colonoscopy receipt (P values <0.01). Greater fear and worry concerning colonoscopy and fewer perceived screening benefits were associated with reduced screening likelihood (P values <0.05). In a multivariate model, colonoscopy receipt was negatively associated with Medicaid and positively associated with English preference, physician recommendation for and encouragement of screening and less fear. Interventions that educate physicians and patients regarding colonoscopy screening guidelines, increase physicians’ screening referrals, and reduce patients’ fear are needed.

Breast and Cervical Cancer Screening Among Latinas Attending Culturally Specific Educational Programs

Background. Latinas in the United States have higher morbidity and mortality rates for breast and cervical cancers (compared with non-Latina Whites), often due to lower screening rates. A community-based participatory research (CBPR) approach could help to improve screening rates by creating a culturally customized educational program for Latino men and women addressing low knowledge, gender roles, and spirituality. Objectives. This study was designed to assess the effectiveness of a culturally customized program (Esperanza y Vida [Hope and Life]) in increasing breast and cervical cancer screening among Latinas, and to examine how screening rates related to changes in cancer knowledge, differences in ethnic origins, and geographic location. Methods. Participants were recruited to attend either a breast and cervical (intervention) or diabetes (control) education program, within a randomized plan. Sixty-nine programs (44 intervention; 25 control) were conducted in Arkansas (AR; n = 39) and New York City (NYC; n = 30) with a total of 847 Latino men and women. Telephone follow-up data were collected on 49% of the women who consented to being contacted 2 months postintervention. Results. At the 2-month follow-up call, screening rates were significantly higher for the intervention versus the control group for clinical breast examination (CBE; 48% vs. 31%; adjusted odds ratio [aOR], 2.2; 95% confidence interval [CI], 1.1–4.2), breast self-examination (45% vs. 27%; aOR, 2.3; 95% CI, 1.1–5.0), and Pap testing (51% vs. 30%; aOR, 3.9; 95% CI, 1.1–14.1), but not for mammography (67% vs. 58%; aOR, 0.7; 95% CI, 0.1–3.6). The aORs accounted for the significant effects of study site (AR vs. NYC) and marital status. Conclusions.Esperanza y Vida has the potential to reduce health disparities in breast and cervical cancer morbidity and mortality rates through increasing cancer screening and thereby increasing early detection.

The features of mucosa-associated microbiota in primary sclerosing cholangitis

Little is known about the role of the microbiome in primary sclerosing cholangitis.

Esperanza y Vida: A Culturally and Linguistically Customized Breast and Cervical Education Program for Diverse Latinas at Three Different United States Sites

Breast cancer is the most common cause of cancer and the leading cause of cancer death among Latinas in the United States. In addition, Latinas experience a disproportionate burden of cervical cancer incidence, morbidity, and mortality compared with non-Hispanic White women. Lower use of breast and cervical cancer screening services may contribute to these disparities. To address the underutilization of breast and cervical cancer screening among diverse subgroups of Latinas, a peer-led education program called Esperanza y Vida (“Hope and Life”) was developed and administered at 3 sites (2 in New York and 1 in Arkansas). Immigrant Latina women and their partners were educated about the importance of breast and cervical cancer screening, with the goals of increasing their knowledge about these cancers and their screening behavior. An analysis of the interventions findings at baseline among female participants demonstrated significant sociodemographic, interpersonal, cultural, health care system, and program variability in 3 distinct geographic regions in the United States. These data indicate the need for and feasibility of customizing cancer outreach and educational programs for diverse Latina subgroups living in various U.S. regions, with implications for informing the expansion and replication of the program in other regions of the country.

Gut microbiota density influences host physiology and is shaped by host and microbial factors

To identify factors that regulate gut microbiota density and the impact of varied microbiota density on health, we assayed this fundamental ecosystem property in fecal samples across mammals, human disease, and therapeutic interventions. Physiologic features of the host (carrying capacity) and the fitness of the gut microbiota shape microbiota density. Therapeutic manipulation of microbiota density in mice altered host metabolic and immune homeostasis. In humans, gut microbiota density was reduced in Crohn’s disease, ulcerative colitis, and ileal pouch-anal anastomosis. The gut microbiota in recurrent Clostridium difficile infection had lower density and reduced fitness that were restored by fecal microbiota transplantation. Understanding the interplay between microbiota and disease in terms of microbiota density, host carrying capacity, and microbiota fitness provide new insights into microbiome structure and microbiome targeted therapeutics.

Mo1757 Evidence for a Role of Superantigens in the Pathogenesis of Ulcerative Colitis-Associated Primary Sclerosing Cholangitis

G A A b st ra ct s 0.002) and downregulation of Mmp-2 (FC=3.3, p=0.020), Mmp-9 (FC=3.1, p=0.030), Cldn1 (FC=3, p=0.040) compared to control mice. After chronic DSS administration, Xpnpep2 (FC=4.2, p=0.020) was upregulated in TIMP-1 KO mice compared to control mice. Young TIMP-1 KO mice (10-12 weeks) versus older animals (19-21 weeks) showed significantly increased expression of Reg3g (FC=16, p=0.030), Reg3b (FC=12.6, p=0.040) and Ido1 (FC= 3.5, p=0.008), whereas the expression levels of Mir200b (FC=2.2, p=0.009), Ctse (FC=1.3, p=0.030) and Wnt2b (FC=1.1, p=0.002) were decreased. Conclusion: TIMP-1 deficiency leads to upregulation of anti-bacterial and innate immunity genes, resulting in an attenuated development of acute colitis. In a chronic setting of inflammation, TIMP-1 KO mice have less remodeling and fibrosis. Unraveling the role of TIMP-1 in extracellular matrix remodeling will be necessary to understand the biology of intestinal wound healing and fibrosis in IBD.