Delaware journal of public health最新文献

Early brain development research is important to public health professionals for understanding early development and strengthening systemic supports for young children's healthy brain growth. This overview describes basic processes of early brain development, including prenatal development and the "fetal programming" of brain and behavior, neural proliferation and the essential influence of experience in the creation of neural networks, the maturational timing of different brain systems and their behavioral consequences, the myelination of neural pathways and its influence on children's action and thinking, and the capacity of the brain to create new neural connections throughout life, which contributes to its continuing adaptability to new experiences. The implications of this research for public health and for strengthening support for early brain development are considered throughout this discussion.

Purpose: The purpose of this study was to 1) describe oncology caregivers' pre-treatment preparation experiences, 2) elicit their feedback about approaches to improve the pre-treatment preparation experience, and 3) explore the potential use of visual aids into the pre-treatment education experience that will inform future clinician-led VR experiences.

Methods: Using a qualitative descriptive design and convenience sampling technique, adult oncology caregivers were recruited to complete anonymous demographic and qualitative surveys posted on social media sites (i.e. American Cancer Society, Facebook, and LinkedIn) and a university supported community research registry (i.e. Pitt + Me). Demographic data were calculated using descriptive analyses (frequency and percentage) and qualitative data were analyzed using an inductive coding approach.

Results: Participants (N=18) were mostly female (n=13, 72%), white (n=14, 78%), married (n=14, 78%), and had a college degree or higher (n=16, 89%). They categorically ranged in age from 26 years to above 65 years, with the majority (n=11, 61%) between 36-55 years of age. Caregivers described the cancer information as overwhelming and in need of additional side effect information and emotional support. To meet their unmet needs, participants suggested providing additional resources, different approaches to learning, better explanation of processes and procedures, diverse emotional support, and more interactions with the oncology team.

Conclusion: Clinician created VR experiences designed for and informed by oncology caregivers do not exist yet. VR could provide an alternative pediogogical approach to complement standard oncology treatment preparation. These study findings begin the exploration into innovative preparation approaches that could meet oncology caregivers' unmet emotional and educational needs during a stressful period.

Key highlights: There is a dearth of clinicians creating and testing VR experiences for patients, let alone caregivers. Oncology caregivers are the unseen 'backbone' supporting their loved one and providing an innovative modality to support them could improve outcomes. VR has the potential improve outcomes for caregivers, which may improve outcomes for patients.

Vaccines play an import role in cancer prevention as well as a growing role in cancer therapeutics. This article explores current knowledge regarding the role of vaccines (HPV and HBV vaccines) in protecting against preventable risk factors for select cancers as well as anti-cancer vaccines currently being used in practice. Current data suggests that routine childhood vaccination against HPV and HBV is an effective strategy for not only protecting against life-altering infectious diseases but also protecting against adult-onset cancers. Furthermore, while current vaccination practices and anti-cancer therapeutics have come a long way in recent decades, examination of CDC data also identifies areas for growth and improvement.

Lung cancer remains the number one cancer related mortality in the United States . While it is the third most diagnosed cancer, it is often found at an advanced stage. Survival rates for stage I lung cancer are above 70% while survival rates for stage IV lung cancer are less than 10% at five years. Methods to detect lung cancer at an earlier stage when it can be more effectively treated have been investigated for many years. These included regular chest x-rays (CXRs) and sputum samples. Unfortunately, these testing modalities did not show any benefit. This changed in 2011 when data from the National Lung Screening Trial were published. This landmark trial showed conclusively that a low-radiation dose chest computed tomography scan (LDCT) performed annually in patients with a heavy smoking history reduced lung cancer related mortality by 20%. These results have led to a nationwide effort to increase lung cancer screening. While the number of eligible patients that are being screened on a national level remains modest, significant efforts are being made at the state and local levels to increase awareness and to improve screening. These efforts have also targeted underserved areas and are focused on reducing disparities in access.

While Black and White women are diagnosed with breast cancer (BC) at similar rates, Black women die from BC at a 40% higher rate. This disparity is even more pronounced for younger Black women, who die from BC at nearly twice the rate as younger White women. Black-White differences in BC mortality are largely attributable to health care and tumor biology factors. Black women face greater barriers to accessing BC screening and are twice as likely to be diagnosed with the aggressive triple-negative breast cancer (TNBC) subtype. Delaware leads the US for the incidence of late-stage BC diagnosed among younger women and TNBC. This commentary begins with a discussion of precision public health, an emerging framework that builds on and complements recent advances in precision medicine. Next, a new precision public health initiative designed to reduce BC disparities in Delaware by targeting local hotspots with prevention interventions is presented. Finally, next steps are considered for implementation, evaluation, and new research activities.

Objective: To describe the Delaware Cancer Registry (DCR)'s participation in the National Cancer Institute (NCI)/North American Association of Central Cancer Registries (NAACCR) Zone Design Project to create sub-county geographic areas ("zones") for use in cancer reporting and geospatial analysis.

Methods: DCR and other stakeholders reviewed up to ten unique zone configurations for each of Delaware's three counties. The zone configurations were created using AZTool and were set to optimize three objectives: create zones that have a minimum and target population of 50,000; are homogenous based on the variables of percent minority, percent below poverty, and percent urban; and are as compact as possible. The DCR sent a survey to stakeholders to provide input on their preferred zone configuration for each county. Following the final selection of zones, the DCR utilized the geographies for calculating overall and late-stage breast cancer incidence statistics and created choropleth maps to visualize the rates by quintiles.

Results: The final selections resulted in a total of 15 zones for Delaware, with three in Kent County, nine in New Castle County, and three in Sussex County. The zones ranged in population size from 54,013 to 67,693 people. Zones with higher late-stage breast cancer incidence rates included those near the areas of Wilmington, Middletown, and between Milford and Georgetown. Comparing results of overall breast cancer incidence rates by zone with late-stage rates by zone, there were areas that had lower relative overall breast cancer incidence rates but were relatively higher for late-stage rates by zones or vice versa.

Conclusions: Aggregating census tracts into zones allows for reporting reliable cancer rates at sub-county levels, which is instrumental in conveying meaningful information about regional cancer trends to stakeholders and the public. Delaware will be able to utilize zone-level cancer information to provide targeted interventions and outreach initiatives.

Introduction: American College of Surgeons Commission on Cancer (CoC) quality measures are used to monitor and evaluate metrics among their CoC-accredited programs, which include seven of Delaware's hospitals. The Delaware Department of Health and Social Services, Division of Public Health (DPH) also utilizes these metrics to monitor and evaluate Delaware's overall performance on these standards of care as it relates to the health care provided to cancer patients.

Methods: Delaware Cancer Registry (DCR) cases diagnosed in 2018 and 2019 were selected and were analyzed separately to calculate results for each selected measure by year: HT, nBX, LNoSurg, and RECRTCT.

Results: Results of the analysis showed that three out of the four CoC quality measures evaluated met the CoC standard of care for both 2018 and 2019 data. The three measures that met the CoC standards for 2018 were HT (90.4%), nBX (87.6%), and LNoSurg (93.3%). The RECRTCT measure did not meet the CoC standard for 2018 data with 71.4%. All four measures evaluated met the CoC standards for 2019 (HT - 91.6%; nBX - 85.2%; LNoSurg - 92.7%; RECRTCT - 92.3%).

Discussion: A majority of cases assessed met the CoC quality measure standards, meeting standards of cancer care and treatment. More discovery work needs to be done to assess the RECRTCT metric to explore reasons why cases did not meet the CoC quality measure standards. There was notable improvement seen for the HT measure over time, where cases had not met the CoC standard in previous years.

Public health implications: When CoC quality measures are met, medical providers can ensure patients receive effective and targeted cancer care. This practice ultimately saves resources, reduces cancer burden, impacts survival, and improves public health outcomes.