cavity was 18.1% (95% confidence interval, 13.4%- 22.8%). Conclusions: Currently, few authors advocate elective treatment of the neck in patients with high-risk SCC of the nasal cavity. The results of this systematic review and... more
cavity was 18.1% (95% confidence interval, 13.4%- 22.8%). Conclusions: Currently, few authors advocate elective treatment of the neck in patients with high-risk SCC of the nasal cavity. The results of this systematic review and meta-analysis demonstrate that the RR of this entity may be higher than previously suspected. Because many stud- ies included other histopathologies or analyzed recur- rence data
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Breast cancer death rates in the U.S. have decreased in recent decades, however areas such as Appalachia with fewer cancer care resources may not have experienced comparable mortality declines. This study examines trends in breast cancer... more
Breast cancer death rates in the U.S. have decreased in recent decades, however areas such as Appalachia with fewer cancer care resources may not have experienced comparable mortality declines. This study examines trends in breast cancer mortality rate disparities in Appalachian states and the continental U.S. using data from SEER mortality files 1969-2007 and the Area Resource File. Overall breast
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Background: The incidence of colon cancer in Pennsylvania is higher than the US. County-level analysis and mapping of cancer clusters may help prioritize cancer control. Purpose: 1) Determine whether geographic clustering of colon cancer... more
Background: The incidence of colon cancer in Pennsylvania is higher than the US. County-level analysis and mapping of cancer clusters may help prioritize cancer control. Purpose: 1) Determine whether geographic clustering of colon cancer incidence occurs and whether cluster patterns differ by stage and site (left- versus right-sided); and 2) Identify county-level characteristics associated with incidence. Methods: Cases diagnosed between 1994-2002 were identified through the Pennsylvania Cancer Registry. Principal components analysis was used to create a county-level SES index based on the 2000 Census. County-level colon cancer screening and obesity prevalence were derived from the Behavioral Risk Factor Surveillance System. SaTScan was used to determine geographic clustering by county. Poisson regression estimated incidence rate ratios (IRR) and 95% confidence intervals (CI) according to the county-distribution of age, sex, race, SES index, obesity, screening, and rural residence a...
The incidence of cervical cancer in Appalachia exceeds the national rate; rural Appalachian women are at especially high risk. We assessed the attitudes and practices related to human papillomavirus vaccination among providers in primary... more
The incidence of cervical cancer in Appalachia exceeds the national rate; rural Appalachian women are at especially high risk. We assessed the attitudes and practices related to human papillomavirus vaccination among providers in primary care practices in a contiguous 5-county area of Appalachian Pennsylvania. In December 2006 and May 2007, all family medicine, pediatric, and gynecology practices (n = 65) in the study area were surveyed by 2 faxed survey instruments. Of the 65 practices, 55 completed the first survey instrument. Of these 55, 44 offered the vaccine to their patients. Forty of the 44 practices offered it to girls and women aged 9 to 26 years, and 11 were willing to accept referrals from other practices for vaccination. The average reported charge for each of the 3 required injections was $150. Of the 55 practices that responded to the first survey instrument, 49 responded to the second survey instrument, 46 of which recommended the vaccine to their patients. The preva...
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... Eugene J. Lengerich, Brenda C. Kluhsman, Marcyann M. Bencivenga, Samuel M. Lesko, Oralia Garcia-Dominic, Betsy B. Aumiller, and Marcia Anderson ... Oralia Garcia-Dominic, is a postdoctoral fellow in the public health sciences in the... more
... Eugene J. Lengerich, Brenda C. Kluhsman, Marcyann M. Bencivenga, Samuel M. Lesko, Oralia Garcia-Dominic, Betsy B. Aumiller, and Marcia Anderson ... Oralia Garcia-Dominic, is a postdoctoral fellow in the public health sciences in the Penn State College of Medicine. ...
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Background: Colorectal (CRC) cancer is the third most commonly occurring cancer in the U.S. and the third leading cause of cancer-related death. Early detection through periodic screening is recommended for average-risk adults 50-74 years... more
Background: Colorectal (CRC) cancer is the third most commonly occurring cancer in the U.S. and the third leading cause of cancer-related death. Early detection through periodic screening is recommended for average-risk adults 50-74 years of age because it has been shown to reduce CRC mortality. However, uptake of CRC screening by patients in rural and medically underserved Appalachia is not universal, even among patients in a primary care clinic. The objective of our study was to determine the feasibility of using academic detailing to increase CRC screening in rural primary care practices. Methods: We developed and implemented clinic-based academic detailing with feedback in four primary care practices, three of which used electronic medical records, in rural Pennsylvania. Academic detailing included education, small media, and practice aids. We measured the uptake of CRC screening before and after detailing by reviewing randomly selected medical charts. We used Key-informant inte...
This paper describes the design and implementation of three web-based geovisualization and geocollaboration applications developed for the domain of public health. Each was implemented using Web 2.0 architecture. First, the Pennsylvania... more
This paper describes the design and implementation of three web-based geovisualization and geocollaboration applications developed for the domain of public health. Each was implemented using Web 2.0 architecture. First, the Pennsylvania Cancer Atlas is a web-based geovisualization tool for the exploration of county- level cancer incidence rates using multiple interactive and live-linked statistical representations. Second, the Health GeoJunction is a web-based geovisualization and geocollaboration tool for geographic, temporal, and attribute filtering of articles from the PubMed medical research database. Finally, the Geo-Explication Web Portal is a web- based geocollaboration tool for the annotation and dissemination of geovisualization tools, training materials, and analysis artifacts collected from the application of geovisualization tools and techniques.
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Background: HIV+ women are at high risk for HPV-associated cancers, but HPV infections at non-cervical anatomical sites have not been well studied in HIV+ women. Objectives: To assess the prevalence of oral, vaginal, and anal HPV... more
Background: HIV+ women are at high risk for HPV-associated cancers, but HPV infections at non-cervical anatomical sites have not been well studied in HIV+ women. Objectives: To assess the prevalence of oral, vaginal, and anal HPV infection; and to understand factors associated with HPV infections in HIV+ women. Methods: HIV+ women were recruited from 5 HIV/AIDS outpatient clinics. The participants answered a behavioral survey questionnaire, provided oral, vaginal, and anal swabs that were collected by a clinical nurse, and provided 10ml of blood. The swabs were tested for the presence of 37 types of HPV DNA using a PCR-based assay and the sera were tested for antibody responses to 12 HPV types using virus-like particles (VLPs) antigens by ELISA. HIV/AIDS-related clinical information was obtained from the medical records. Results: Among 81 HIV+ women enrolled in this study, the majority were older than 40 years and had been infected with HIV for more than 10 years. Whites accounted f...
Overall, individuals from vulnerable populations groups who are less integrated because of their ethnicity/race, citizenship, or economic status are more likely to be diagnosed with advanced stages of cancer, suffer from larger tumors,... more
Overall, individuals from vulnerable populations groups who are less integrated because of their ethnicity/race, citizenship, or economic status are more likely to be diagnosed with advanced stages of cancer, suffer from larger tumors, and experience higher rates of cancer mortality. Individual behaviors have been shown to modify these risks. For example, lower rates of cancer screening and higher rates of obesity, sedentary lifestyle and smoking are described as independent risk factors for multiple cancers. To understand the link between behavior and cancer risk among vulnerable groups, specifically immigrants, this study links data from the Medical Expenditure Panel Survey (years 2000-2008) to the National Health Interview Survey to examine patterns and identify predictors of modifiable behaviors for cancer prevention among U.S. adults aged 18 years and older (N=190,965). This work provides a foundation for translation into future community-engaged interventions for cancer preven...
Under the Patient Protection and Affordable Care Act (PPACA), all foreign-born who are lawfully present in the United States will be eligible for healthcare coverage beginning January 1, 2014. Currently, pathways to citizenship include... more
Under the Patient Protection and Affordable Care Act (PPACA), all foreign-born who are lawfully present in the United States will be eligible for healthcare coverage beginning January 1, 2014. Currently, pathways to citizenship include naturalization after 5 years of legal permanent residency, which has also been identified as a threshold for deteriorating health among immigrants. The objective of this study is to examine the association between citizenship, duration in the U.S., and cancer screening over time. We analyzed 11 years (2000-2010) of consolidated data from the Medical Expenditure Panel Survey linked with the National Health Interview Survey. Multivariate analyses were conducted, revealing that over time, compared to foreign-born citizens living in the U.S. for 5 years or more, foreign-born non-citizens living in the U.S. less than 5 years had lower odds of receiving a mammogram (N=70,585) or clinical breast exam (N=70,394) in the past 2 years {OR(95% CI) = .52(.41-.66);...
We introduce an approach to visual analysis of multivariate data that integrates several methods from information visualization, exploratory data analysis (EDA), and geovisualization. The approach leverages the component-based... more
We introduce an approach to visual analysis of multivariate data that integrates several methods from information visualization, exploratory data analysis (EDA), and geovisualization. The approach leverages the component-based architecture implemented in GeoVISTA Studio to construct a flexible, multiview, tightly (but generically) coordinated, EDA toolkit. This toolkit builds upon traditional ideas behind both small multiples and scatterplot matrices in three fundamental ways. First, we develop a general, MultiForm, Bivariate Matrix and a complementary MultiForm, Bivariate Small Multiple plot in which different bivariate representation forms can be used in combination. We demonstrate the flexibility of this approach with matrices and small multiples that depict multivariate data through combinations of: scatterplots, bivariate maps, and space-filling displays. Second, we apply a measure of conditional entropy to (a) identify variables from a high-dimensional data set that are likely...
Research Interests: Data Mining, Information Visualization, Data Analysis, Pattern Recognition, Statistical Analysis, and 13 moreMultivariate Data Analysis, Visual Analysis, Cancer Diagnosis, Design Methodology, High Dimensional Data, Risk factors, Exploratory Data Analysis, Information Analysis, Multivariate Data, Interactive Monitoring System, Spatial Database, Risk Factors, and Feature Evaluation and Selection
Research Interests: Zoology()
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Research Interests: Genetics, Nursing, Human Genetics, Medical Genetics, Strategic Planning, and 19 moreForecasting, Policy Development, Public Health, Health Services Research, Health Policy, Maternal and Child Health, Humans, Needs Assessment, Genetic Testing, Public Health Administration, Chronic Disease, United States, Disease Prevention, Data Collection, Public Administration and Policy, Public health systems and services research, State government, Genetic Predisposition, and Preventive Health Services(Forecasting, Policy Development, Public Health, Health Services Research, Health Policy, Maternal and Child Health, Humans, Needs Assessment, Genetic Testing, Public Health Administration, Chronic Disease, United States, Disease Prevention, Data Collection, Public Administration and Policy, Public health systems and services research, State government, Genetic Predisposition, and Preventive Health Services)
(Forecasting, Policy Development, Public Health, Health Services Research, Health Policy, Maternal and Child Health, Humans, Needs Assessment, Genetic Testing, Public Health Administration, Chronic Disease, United States, Disease Prevention, Data Collection, Public Administration and Policy, Public health systems and services research, State government, Genetic Predisposition, and Preventive Health Services)
Colorectal cancer (CRC) is the third leading cause of cancer death for men and women in the United States. CRC screening can save lives by detecting precancerous polyps that are then removed or by detecting cancer early when treatment is... more
Colorectal cancer (CRC) is the third leading cause of cancer death for men and women in the United States. CRC screening can save lives by detecting precancerous polyps that are then removed or by detecting cancer early when treatment is most effective. CRC screening participation in Montana is low. To increase screening participation among Montanans with health insurance, the Montana Cancer Control Programs (MCCP) partnered with a small association health organization (AHO). This partnership implemented a postcard campaign to increase CRC screening participation among the AHO's enrollees. Postcards were sent to 1,011 people insured through the AHO; 504 people were mailed 1 postcard and 507 people were mailed 2 postcards. Evaluation of the campaign assessed recall of the campaign among people who received 1 postcard versus people who received 2 postcards. Women were 60% more likely to recall receiving the postcards than were men. People who received 2 postcards were 2.3 times as likely to recall receiving them as were people who received 1 postcard. The MCCP considers this collaborative project with an AHO a promising approach to implementing evidence-based colorectal cancer screening interventions. The MCCP plans to partner with additional AHOs in Montana to evaluate CRC screening participation among their enrollees.
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Characteristics and rates of shooting injuries associated with hunting various game species are unreported. For the 1,345 hunting-related shooting incidents in Pennsylvania from 1987 to 1999, age-adjusted hunter injury rates and... more
Characteristics and rates of shooting injuries associated with hunting various game species are unreported. For the 1,345 hunting-related shooting incidents in Pennsylvania from 1987 to 1999, age-adjusted hunter injury rates and case-fatality ratios were calculated for each of seven species hunted. Differences in the incidents and injuries were tested (p < 0.05). Fall turkey hunters had the highest (7.5 per 100,000 hunters) and grouse hunters the lowest (1.9 per 100,000) injury rate. The case-fatality ratio was highest for deer hunters (10.3%) and lowest for pheasant hunters (1.3%). Poor skill was the leading cause of deer hunting injuries, and poor judgment the leading cause for injuries during the hunting of other species. Coinciding with changes in regulations requiring orange clothing for hunters, the injury rates for fall turkey hunters initially decreased (rate ratio, 4.1), then increased (rate ratio, 0.5). Hunters younger than 20 years had the highest injury rates. The rates and characteristics of hunting-related shooting injuries varied by hunted species. Hunter orange clothing regulations appeared to reduce fall turkey hunting injury rates.
Research Interests: Nursing, Turkey, Causality, Safety, Humans, and 19 moreChild, Needs Assessment, Judgment, Clothing, Accidents, Deer, RECREATION, Birds, Animals, Incidence, Sciuridae, Pennsylvania, Clinical Sciences, Aged, Middle Aged, Adult, Educational Status, Seasons, and Rabbits
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To understand the potential and establish a framework for mentoring as a method to develop professional competencies of state-level applied chronic disease epidemiologists, model mentorship programs were reviewed, specific competencies... more
To understand the potential and establish a framework for mentoring as a method to develop professional competencies of state-level applied chronic disease epidemiologists, model mentorship programs were reviewed, specific competencies were identified, and competencies were then matched to essential public health services. Although few existing mentorship programs in public health were identified, common themes in other professional mentorship programs support the potential of mentoring as an effective means to develop capacity for applied chronic disease epidemiology. Proposed competencies for chronic disease epidemiologists in a mentorship program include planning, analysis, communication, basic public health, informatics and computer knowledge, and cultural diversity. Mentoring may constitute a viable strategy to build chronic disease epidemiology capacity, especially in public health agencies where resource and personnel system constraints limit opportunities to recruit and hire new staff.
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Research Interests: Education, Nutrition, Focus Groups, Family, Diet, and 10 moreHumans, Child, Female, Male, Vegetables, Pennsylvania, Middle Aged, Adult, Food Preferences, and Choice Behavior(Humans, Child, Female, Male, Vegetables, Pennsylvania, Middle Aged, Adult, Food Preferences, and Choice Behavior)
(Humans, Child, Female, Male, Vegetables, Pennsylvania, Middle Aged, Adult, Food Preferences, and Choice Behavior)
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Asthma is the most common chronic illness among U.S. children as well as a leading cause of hospitalization and functional disability. This cross-sectional study uses 2001 hospitalization data for Pennsylvania to examine disparities among... more
Asthma is the most common chronic illness among U.S. children as well as a leading cause of hospitalization and functional disability. This cross-sectional study uses 2001 hospitalization data for Pennsylvania to examine disparities among Black, Hispanic, and White children in asthma symptomatology at the time of admission. Compared with Whites, Black children were over twice as likely to have the most severe asthma symptoms, taking into account age, sex, insurance status, income, and rural/urban residence. Increased likelihood of severe clinical condition at admission was also independently associated with Medicaid coverage, with older age at admission, and with urban residence. The relationship between symptom severity at presentation in the emergency department and access to and utilization of appropriate ambulatory care services for children with asthma warrants further investigation.
Research Interests: Asthma, Adolescent, Chronic illness, Humans, Child, and 19 moreFemale, Male, Infant, Income, Pennsylvania, Health Status, African Americans, Adult, Public health systems and services research, Urban Population, Cross sectional Study, Cross Sectional Studies, Child Health Services, Emergency Department, Ambulatory Care, Cohort Studies, Functional Disability, Insurance Coverage, and Socioeconomic Factors(Female, Male, Infant, Income, Pennsylvania, Health Status, African Americans, Adult, Public health systems and services research, Urban Population, Cross sectional Study, Cross Sectional Studies, Child Health Services, Emergency Department, Ambulatory Care, Cohort Studies, Functional Disability, Insurance Coverage, and Socioeconomic Factors)
(Female, Male, Infant, Income, Pennsylvania, Health Status, African Americans, Adult, Public health systems and services research, Urban Population, Cross sectional Study, Cross Sectional Studies, Child Health Services, Emergency Department, Ambulatory Care, Cohort Studies, Functional Disability, Insurance Coverage, and Socioeconomic Factors)
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In order to promote ongoing quality improvement of not only the Penn State Cancer Genetics Program, but also other cancer risk assessment programs throughout the country, we developed, piloted and conducted a survey to explore patient... more
In order to promote ongoing quality improvement of not only the Penn State Cancer Genetics Program, but also other cancer risk assessment programs throughout the country, we developed, piloted and conducted a survey to explore patient expectations, experiences, and satisfaction with the cancer genetic counseling process. The comprehensive survey was mailed to 340 eligible patients, 156 (45.9%) of whom returned the completed survey within the allotted time. Responses to closed-ended questions were tallied and open-ended questions were content analyzed. Major findings show that: (1) Patients were seeking cancer-related information and support throughout the cancer risk assessment process and were interested in participating in available research studies; (2) The setting in which patients are seen for cancer risk assessment may pose potential emotional ramifications; (3) Misperceptions regarding insurance discrimination and lack of insurance coverage persist; (4) Patients view the genetic counselor as responsible for updating them about new discoveries. Specific recommendations for cancer genetics programs are included.
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To determine the number and protectiveness of local smoking regulations adopted before the implementation of a preemptive statewide smoking control bill. Review of local smoking control regulations from all 100 counties and 85... more
To determine the number and protectiveness of local smoking regulations adopted before the implementation of a preemptive statewide smoking control bill. Review of local smoking control regulations from all 100 counties and 85 municipalities with populations greater than 5000 in North Carolina. Adoption of local smoking control regulations before and during the 3-month delay in enactment of the preemptive bill. Protectiveness of regulations was based on restrictions on smoking and requirements for separate ventilation systems at private work sites: none (smoking unrestricted); minimal (smoking restricted to designated areas); partial (smoking restricted to designated areas served by separate ventilation systems); and complete (smoking prohibited). Because some regulations would be phased in gradually over the next 5 years, we evaluated the requirements that will be in effect by January 1, 2000. Between July 15 and October 15, 1993, the number of local smoking regulations in North Carolina increased from 16 to 105. By the year 2000, 59% of private employees still will not be guaranteed any protection from work site environmental tobacco smoke; 19% will have minimal protection, 22% will have partial protection, and none will have complete protection. The 3-month delay in preemption created an unnatural time frame for communities to organize, debate, and adopt smoking restrictions. Despite the adoption of 89 new regulations, no private employees will be guaranteed complete protection from work site environmental tobacco smoke by the year 2000; new regulations can no longer be adopted. HB 957 has been a setback for public health in North Carolina.