Christine Brennan

How does health literacy affect quality of life among men with newly diagnosed clinically localized prostate cancer? Findings from the North Carolina-Louisiana Prostate Cancer Project (PCaP).

Health literacy deficits affect half of the US overall patient population, especially the elderly, and are linked to poor health outcomes among noncancer patients. Yet little is known about how health literacy affects cancer populations. The authors examined the relation between health‐related quality of life (HRQOL) and health literacy among men with prostate cancer.

Patient-health care provider communication among patients with newly diagnosed prostate cancer: findings from a population-based survey.

OBJECTIVE To examine the multidimensional concept of patient-health care provider (HCP) communication, its effects on patient satisfaction with oncology care services, and related racial differences. METHODS The current analysis draws from a population-based survey sample of 1011 African American and 1034 Caucasian American men with newly diagnosed prostate cancer. The variables of satisfaction with health care services, interpersonal treatment, contextual knowledge of the patient, and prostate cancer communication were analyzed using multiple-group structural equation modeling. RESULTS Regardless of race, patient-HCP communication was related positively to interpersonal treatment by the HCP, HCPs contextual knowledge of the patient, and prostate cancer communication. More positive patient-HCP communication was related to more satisfaction with health care services. Racial differences were significant in the relationships between patient-HCP communication and prostate cancer communication. CONCLUSION Content and interpersonal relationships are important aspects of patient-HCP communication and affect patient satisfaction with oncologic care for prostate cancer. PRACTICE IMPLICATIONS HCPs need to integrate the transfer of information with emotional support and interpersonal connection when they communicate with men with newly diagnosed prostate cancer.

Treatment of Hepatitis C Virus in the Coinfected Patient

Since hepatitis C virus (HCV) was first identified in 1989, the impact of HCV infection on the HIV-infected population has been steadily increasing. It is now known that HCV affects the course and treatment of HIV disease in coinfected individuals (those infected with both HCV and HIV). Although there are significant data regarding the treatment of HCV in non-coinfected individuals, there are numerous questions that still remain regarding how to monitor and treat HCV infection in the coinfected population. This article reviews the available data regarding treatment of HCV in the coinfected population as well as how these individuals should be monitored, before and during HCV therapy, as well as how to address the numerous side effects associated with HCV treatment. To meet the demands of the coinfected population. HIV nurses must be willing to expand their knowledge to support, educate, assess, and advocate for coinfected individuals.

Unit Nonresponse in a Population-Based Study of Prostate Cancer.

Low unit response rates can increase bias and compromise study validity. Response rates have continued to fall over the past decade despite all efforts to increase participation. Many factors have been linked to reduced response, yet relatively few studies have employed multivariate approaches to identify characteristics that differentiate respondents from nonrespondents since it is hard to collect information on the latter. We aimed to assess factors contributing to enrollment of prostate cancer (PCa) patients. We combined data from the North Carolina-Louisiana (LA) PCa Project’s LA cohort, with additional sources such as US census tract and LA tumor registry data. We included specific analyses focusing on blacks, a group often identified as hard to enroll in health-related research. The ability to study the effect of Hurricane Katrina, which occurred amidst enrollment, as a potential determinant of nonresponse makes our study unique. Older age (≥ 70) for blacks (OR 0.65) and study phase with respect to Hurricane Katrina for both races (OR 0.59 for blacks, OR 0.48 for whites) were significant predictors of participation with lower odds. Neighborhood poverty for whites (OR 1.53) also was a significant predictor of participation, but with higher odds. Among blacks, residence in Orleans parish was associated with lower odds of participation (OR 0.33) before Katrina. The opposite occurred in whites, with lower odds (OR 0.43) after Katrina. Our results overall underscore the importance of tailoring enrollment approaches to specific target population characteristics to confront the challenges posed by nonresponse. Our results also show that recruitment-related factors may change when outside forces bring major alterations to a populations environment and demographics.

Estimates of Risk for Chlamydia/Gonorrhea Associated with Disciplinary Alternative School Placement in United States Public High Schools

Background: In United States public schools, students in disciplinary alternative schools report engaging in risky sexual behaviors significantly more frequently than students in regular schools. We sought to determine whether the risk of chlamydia or gonorrhea infection in disciplinary alternative schools is significantly higher relative to the risk of infection in regular schools. Methods: A matched case-control study was retrospectively designed using data obtained from New Orleans public high school students tested for chlamydia and gonorrhea in a school-based screening between the years 2001 and 2003. Cases were 63 African American students tested at a disciplinary alternative school during the school years 2001-2002 (n = 36) and 2002-2003 (n = 27). Each case was matched to 4 controls by date of birth, sex and race among respectively 3029 and 2216 students contemporaneously tested in regular schools. Mantel-Haenszel procedures for matched-pair analysis were used to estimate odds ratios, confidence intervals (CI) and significance tests. Results: The odds ratio for chlamydia/gonorrhea infection associated with placement in disciplinary alternative school was 2.09 overall (95% CI 1.01, 4.30; p 0.40) among females and 3.25 (95% CI 1.18, 8.92; p < 0.025) among males. Conclusions: Behaviorally troubled adolescents in disciplinary alternative school placement are the highest risk group for sexually transmitted infection ever identified in United States public high schools. These students and the disciplinary alternative schools where they are placed would benefit most from screening. They should be considered first for inclusion in any school-wide chlamydia and gonorrhea screening initiative.

Modelling attrition and nonparticipation in a longitudinal study of prostate cancer

BackgroundAttrition occurs when a participant fails to respond to one or more study waves. The accumulation of attrition over several waves can lower the sample size and power and create a final sample that could differ in characteristics than those who drop out. The main reason to conduct a longitudinal study is to analyze repeated measures; research subjects who drop out cannot be replaced easily. Our group recently investigated factors affecting nonparticipation (refusal) in the first wave of a population-based study of prostate cancer. In this study we assess factors affecting attrition in the second wave of the same study. We compare factors affecting nonparticipation in the second wave to the ones affecting nonparticipation in the first wave.MethodsInformation available on participants in the first wave was used to model attrition. Different sources of attrition were investigated separately. The overall and race-stratified factors affecting attrition were assessed. Kaplan-Meier survival curve estimates were calculated to assess the impact of follow-up time on participation.ResultsHigh cancer aggressiveness was the main predictor of attrition due to death or frailty. Higher Charlson Comorbidity Index increased the odds of attrition due to death or frailty only in African Americans (AAs). Young age at diagnosis for AAs and low income for European Americans (EAs) were predictors for attrition due to lost to follow-up. High cancer aggressiveness for AAs, low income for EAs, and lower patient provider communication scores for EAs were predictors for attrition due to refusal. These predictors of nonparticipation were not the same as those in wave 1. For short follow-up time, the participation probability of EAs was higher than that of AAs.ConclusionsPredictors of attrition can vary depending on the attrition source. Examining overall attrition (combining all sources of attrition under one category) instead of distinguishing among its different sources should be avoided. The factors affecting attrition in one wave can be different in a later wave and should be studied separately.