Jodi E. Siever

All Our Babies Cohort Study: recruitment of a cohort to predict women at risk of preterm birth through the examination of gene expression profiles and the environment

BackgroundPreterm birth is the leading cause of perinatal morbidity and mortality. Risk factors for preterm birth include a personal or familial history of preterm delivery, ethnicity and low socioeconomic status yet the ability to predict preterm delivery before the onset of preterm labour evades clinical practice. Evidence suggests that genetics may play a role in the multi-factorial pathophysiology of preterm birth. The All Our Babies Study is an on-going community based longitudinal cohort study that was designed to establish a cohort of women to investigate how a womens genetics and environment contribute to the pathophysiology of preterm birth. Specifically this study will examine the predictive potential of maternal leukocytes for predicting preterm birth in non-labouring women through the examination of gene expression profiles and gene-environment interactions.Methods/DesignCollaborations have been established between clinical lab services, the provincial health service provider and researchers to create an interdisciplinary study design for the All Our Babies Study. A birth cohort of 2000 women has been established to address this research question. Women provide informed consent for blood sample collection, linkage to medical records and complete questionnaires related to prenatal health, service utilization, social support, emotional and physical health, demographics, and breast and infant feeding. Maternal blood samples are collected in PAXgene™ RNA tubes between 18-22 and 28-32 weeks gestation for transcriptomic analyses.DiscussionThe All Our Babies Study is an example of how investment in clinical-academic-community partnerships can improve research efficiency and accelerate the recruitment and data collection phases of a study. Establishing these partnerships during the study design phase and maintaining these relationships through the duration of the study provides the unique opportunity to investigate the multi-causal factors of preterm birth. The overall All Our Babies Study results can potentially lead to healthier pregnancies, mothers, infants and children.

A Randomized Trial of External Beam Radiotherapy Versus Cryoablation in Patients With Localized Prostate Cancer: Quality of Life Outcomes

A recent randomized trial to compare external beam radiation therapy (EBRT) to cryoablation for localized disease showed cryoablation to be noninferior to external beam EBRT in disease progression and overall and disease‐specific survival. We report on the quality of life (QOL) outcomes for this trial.

A qualitative study of the experience of CenteringPregnancy group prenatal care for physicians

BackgroundThis study sought to understand the central meaning of the experience of group prenatal care for physicians who were involved in providing CenteringPregnancy through a maternity clinic in Calgary, Canada.MethodThe study followed the phenomenological qualitative tradition. Three physicians involved in group prenatal care participated in a one-on-one interview between November and December 2009. Two physicians participated in verification sessions. Interviews followed an open ended general guide and were audio recorded and transcribed. The purpose of the analysis was to identify meaning themes and the core meaning experienced by the physicians.ResultsSix themes emerged: (1) having a greater exchange of information, (2) getting to knowing, (3) seeing women get to know and support each other, (4) sharing ownership of care, (5) having more time, and (6) experiencing enjoyment and satisfaction in providing care. These themes contributed to the core meaning for physicians of “providing richer care.”ConclusionsPhysicians perceived providing better care and a better professional experience through CenteringPregnancy compared to their experience of individual prenatal care. Thus, CenteringPregnancy could improve work place satisfaction, increase retention of providers in maternity care, and improve health care for women.

Maternal well-being and its association to risk of developmental problems in children at school entry

BackgroundChildren at highest risk of developmental problems benefit from early identification and intervention. Investigating factors affecting child development at the time of transition to school may reveal opportunities to tailor early intervention programs for the greatest effectiveness, social benefit and economic gain. The primary objective of this study was to identify child and maternal factors associated with children who screened at risk of developmental problems at school entry.MethodsAn existing cohort of 791 mothers who had been followed since early pregnancy was mailed a questionnaire when the children were aged four to six years. The questionnaire included a screening tool for developmental problems, an assessment of the childs social competence, health care utilization and referrals, and maternal factors, including physical health, mental health, social support, parenting morale and sense of competence, and parenting support/resources.ResultsOf the 491 mothers (62%) who responded, 15% had children who were screened at high risk of developmental problems. Based on a logistic regression model, independent predictors of screening at high risk for developmental problems at age 5 were male gender (OR: 2.3; 95% CI: 1.3, 4.1), maternal history of abuse at pregnancy (OR: 2.4; 95% CI: 1.3, 4.4), and poor parenting morale when the child was 3 years old (OR: 3.9; 95% CI: 2.1, 7.3). A child with all of these risk factors had a 35% predicted probability of screening at high risk of developmental problems, which was reduced to 13% if maternal factors were favourable.ConclusionsRisk factors for developmental problems at school entry are related to maternal well being and history of abuse, which can be identified in the prenatal period or when children are preschool age.

Social equity in Human Papillomavirus vaccination: a natural experiment in Calgary Canada.

BackgroundThe Alberta Immunization Program offers a vaccine against the Human Papillomavirus (HPV) free of charge to all girls in Grades 5 and 9. The vaccine is provided in two different service delivery models depending upon the acceptance of the program by the local school board. Vaccinations may be provided “in-school” or in “community” through appointments at Public Health Clinics. The purpose of this study was to determine whether there was a difference in vaccine uptake in Calgary between the two service delivery models, “in-school” and “community”, and to examine if socioeconomic status (SES) was a contributing factor.MethodsIndividual data from the Calgary Zone Public Health vaccination database for all grade 5 and 9 girls in Calgary for school years 2008–2011 were analyzed using descriptive statistics. These data included vaccination records for 35,592 girls. Logistic regression was used to examine the effect of delivery system and SES status on being vaccinated, controlling for school type.ResultsHPV vaccination completion rates were 75% (95% confidence interval = 74.7%, 75.8%) for girls with an “in-school” compared to 36% (95% confidence interval = 35.3%, 37.2%) for girls in schools with a “community” service delivery model. A girl’s neighbourhood SES was related to the likelihood of being HPV vaccinated depending on the service delivery model available to her. For girls attending a Public school with an “in-school” delivery model, the proportion completing vaccination increased as SES decreased (high SES = 79%; medium SES = 79%; low SES = 83%; p-value<0.001). For girls attending Calgary Catholic School District schools with the “community” delivery model there was a decrease in immunization rates from high and mid to low SES (high SES = 41%; medium SES = 42%; low SES = 34%; p-value<0.001). These results show that those with lower SES were differentially disadvantaged by not having access to an “in-school” vaccination delivery model.ConclusionService delivery models make a difference in HPV vaccination completion rates and create inequities for health protection and disease prevention based on socioeconomic status.

Connecting Children to Recreational Activities: Results of a Cluster Randomized Trial

Purpose. Identify if outreach support increases school-aged childrens participation in recreational activities. Design. Cluster randomized trial. Setting. Sixteen schools in economically vulnerable neighborhoods were randomized to either an intervention or control group. Subjects. Children in grades 3 to 5 and their families were invited to participate. Intervention. Children in intervention schools were assigned a “connector” (outreach worker) to facilitate participation in recreation activities. Measures. The Childrens Assessment of Participation and Enjoyment (CAPE) was the primary measure at baseline, middle, and end of 1 year. Demographics, body mass index, child physical and psychosocial health, coordination, and self-esteem were measured. Analysis. A generalized linear model was used to test differences between intervention and control groups. Results. Three hundred and sixty children enrolled, and 306 (85 %) completed the study. A greater proportion of children in the intervention group compared with the control group increased participation in physical activity (21 % vs. 10%, p = .02). Children who increased their activity were more likely to have higher levels of contact with the connectors (31 % vs. 8%, p = .001). Study limitations included (I) 29% of eligible families participated, (2) first use of the CAPE instrument as a longitudinal measure, and (3) connectors were not blinded to group assignment. Conclusion. Children living in vulnerable neighborhoods benefit from outreach workers to connect them with physical activity programs.

An examination of the effectiveness of Handwriting Without Tears® instruction Examen de l’efficacité du programme Handwriting Without Tears®

Background. Handwriting is an important childhood occupation, and implications of poor handwriting may have significant long-term effects. Purpose. The purpose of this study was to determine the effectiveness of Handwriting Without Tears ® (HWT) on Grade 1 students’ handwriting and perception of skills. Methods. A cross-over design was used. Repeated measures, at three points, included the Minnesota Handwriting Assessment (MHA) and performance rating scales. Findings. Eighty-three boys and 66 girls with an average age of 6.2 years participated in the study. Students receiving HWT achieved significantly higher improvements compared to students with teacher-designed instruction in MHA Total Test Score and in MHA components of form, size, space, and alignment (all p < .05). Students had higher average performance ratings when receiving HWT in the first half of the school year. Implications. Instruction using HWT improves students’ perception and skill in handwriting performance. Description. L’écriture est une occupation importante de l’enfance et les conséquences d’une pauvre écriture peuvent avoir des effets à long terme. But. Déterminer si le programme Handwriting Without Tears ® (HWT) est efficace pour améliorer l’écriture des élèves de la première année du primaire, de même que leur perception face à leurs compétences en écriture. Méthodologie. Un schéma d’expériences croisées a été utilisé. Des mesures répétées ont été effectuées, à trois points, à l’aide du Minnesota Handwriting Assessment (MHA) et d’échelles d’évaluation du rendement. Résultats. Quatre-vingt-trois garçons et 66 filles dont l’âge moyen était de 6,2 ans ont participé à l’étude. Des améliorations plus significatives ont été observées chez les élèves ayant suivi le programme HWT que chez les élèves ayant reçu un enseignement conçu par un enseignant, en ce qui a trait au score total obtenu au MHA et aux composantes de la forme, de la taille, de l’espace et de l’alignement du MHA (tous les p < 0,05). Les élèves ayant suivi le programme HWT dans la première moitié de l’année scolaire ont obtenu de meilleurs scores en ce qui a trait au rendement moyen. Conséquences. L’enseignement à l’aide du programme HWT améliore la perception des élèves, de même que leurs compétences en écriture.

Utilization of the 2009 H1N1 Vaccine by Pregnant Women in a Pandemic Year

OBJECTIVE To determine the proportion of pregnant women in a community-based cohort who received the H1N1 vaccine during the 2009-2010 influenza pandemic, and to identify sociodemographic factors that were associated with receiving the vaccine. METHODS Women in Alberta from a cross-sectional community-based cohort who were participating in a study of prenatal care were asked about their receipt of the 2009 H1N1 and seasonal influenza vaccines and whether they had contracted influenza. Univariable and backwards multivariable logistic regression were used to identify the sociodemographic factors associated with receiving the 2009 H1N1 vaccine. RESULTS Approximately 72% of women in this sample (n = 402) received an influenza vaccine in 2009; 29.4% received both H1N1 and seasonal influenza vaccines, 40.8% received only the 2009 H1N1 vaccine, 1.7% received only the seasonal influenza vaccine, and 28.1% did not receive either vaccine. Univariable analysis found that receiving the 2009 H1N1 vaccine was significantly associated with household income, education, current employment status, and contentment about the pregnancy. After multivariable analysis, education and having a planned pregnancy remained as independent predictors of vaccination status. CONCLUSION During the 2009-2010 pandemic influenza season, over 70% of this cohort received influenza vaccinations, a much higher proportion than seen in previous influenza seasons. The majority of women who received the 2009 H1N1 vaccine were likely influenced by the increased media attention given to the 2009-2010 pandemic and the replacement of seasonal vaccine by the 2009 H1N1 vaccine.

Assessment of ERCC1 and XPF Protein Expression Using Quantitative Immunohistochemistry in Nasopharyngeal Carcinoma Patients Undergoing Curative Intent Treatment

PURPOSE We sought to evaluate the prognostic/predictive value of ERCC1 and XPF in patients with nonmetastatic nasopharyngeal carcinoma (NPC) treated with curative intent. METHODS AND MATERIALS ERCC1 and XPF protein expression was evaluated by immunofluorescence combined with automated quantitative analysis (AQUA) using the FL297 and 3F2 antibodies, respectively. ERCC1 and XPF protein expression levels were correlated with clinical outcomes. RESULTS Patient characteristics were as follows: mean age 52 years (range, 18-85 years), 67% male, 72% Karnofsky performance status (KPS) ≥ 90%, World Health Organization (WHO) type 1/2/3 = 12%/28%/60%, stage III/IV 65%. With a median follow-up time of 50 months (range, 2.9 to 120 months), the 5-year overall survival (OS) was 70.8%. Median standardized nuclear AQUA scores were used as cutpoints for ERCC1 (n=138) and XPF (n=130) protein expression. Agreement between dichotomized ERCC1 and XPF scores was high at 79.4% (kappa = 0.587, P<.001). Neither biomarker predicted locoregional recurrence, DFS, or OS after adjustment for age and KPS, irrespective of stratification by stage, WHO type, or treatment. CONCLUSIONS Neither ERCC1 nor XPF, analyzed by quantitative immunohistochemistry using the FL297 and 3F2 antibodies, was prognostic or predictive in this cohort of NPC patients.

ATM, THMS, and RRM1 protein expression in nasopharyngeal carcinomas treated with curative intent

In advanced nasopharyngeal carcinoma (NPC), biomarkers may help predict survival.