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Community Health Centers and Translational Clinical Research: The Fenway Health Experience

Fri, 11/07/2014 - 12:30pm

This is the Symposium's Keynote presentation by Kenneth Mayer, MD, Medical Research Director and Co-Chair of The Fenway Institute, on the history, services, and research initiatives of Fenway Health, which was founded in 1971 in Boston, Massachusetts. The mission of Fenway Health is to enhance the well being of the LGBT (lesbian, gay, bisexual, and transgender) community as well as people in our neighborhoods and beyond through access to the highest quality health care, education, research and advocacy.

YouthConnect Worcester: A Consortium Delivering Positive Outcomes for Health, Education and Family Stability

Fri, 11/07/2014 - 11:00am

YouthConnect Worcester provides high quality, year round, neighborhood-based youth development opportunities for recreation, education and culture to isolated and underserved Worcester youth age 5-24 (focusing on the middle school years) who reside in Worcester’s most at risk neighborhoods. We do this through the establishment of a seamless, inclusive youth-serving consortium, modeled on best practice, utilizing a common system of measures to drive efficient use of resources for impact, and built on a framework that delivers positive outcomes in the areas of health, education, and family stability. Partners include: Boys & Girls Club of Worcester, Friendly House, Girls Inc. of Worcester, YMCA of Central MA, Y.O.U. Inc., YWCA of Central MA, and Worcester Youth Center. Building a high degree of trust, they learn from, share with, and support each other. YouthConnect aligns closely with the five domains within the Greater Worcester Region Community Health Improvement Plan (CHIP) providing physical activity and nutrition education (Domain I), embedded mental health services (Domain II), preventive support (Domain III), violence prevention (Domain IV) and participation in activities to eliminate racism and impact health disparities (Domain V). Each partner brings their particular expertise to the table combined with the collective power of the consortium. We also utilize supports from a widening circle of supporting partners providing expertise to fill identified gaps in services including: mental, physical, and sexual health, college & work readiness, risk behavior & violence prevention, civic engagement & peer leadership, LGBT resources, food & shelter, funding and others.

Measuring the Health Impact of Medical-Legal Interventions on Low-Income Patients

Fri, 11/07/2014 - 11:00am

Research shows that nearly all of the low-income people in the United States have at least one civil legal problem that negatively affects their health. Family Advocates of Central Massachusetts (FACM) is a medical-legal partnership that aims to improve the well-being of vulnerable families by helping patients address legal issues linked to health status, such as access to necessary public benefits, substandard housing, education issues, immigration status, and protection from abusive relationships. The partnership includes Community Legal Aid and its subsidiary, Central West Justice Center, and three medical partners: UMass Medical School, UMass Memorial Children’s Medical Center, and Edward M. Kennedy Community Health Center. Medical providers are the sole community connection for many low-income families. Without legal care that is coordinated with medical care, they face an uphill battle in overcoming the social determinants of health that contribute to pervasive race- and class-based health disparities. When families ask their providers for help with issues that cannot be resolved in an exam room or with a prescription, FACM steps in. The poster will facilitate an interdisciplinary community-research dialogue about evaluating the social determinants of health. We are reassessing our existing outcomes measurement tools to better measure, evaluate, and share the health impact of medical-legal interventions. We welcome input from researchers and community organizations about alternative validated measures that may help us measure and demonstrate the connection between access to legal services and improved health.

Youth Health Benchmarks in the Context of a Regional Health Improvement Plan

Fri, 11/07/2014 - 11:00am

The Greater Worcester Community Health Improvement Plan (CHIP) proposes a set of goals and objectives with the vision of Worcester being the healthiest city in New England by 2020. As a part of the plan, the Worcester Regional Youth Health Survey (RYHS) was conducted by the Worcester Division of Public Health during the 2013-2014 academic years. The RYHS allows the progress toward CHIP goals to be assessed, as well as the identification of additional areas for improvement. Findings will include the results of adolescent health behavior questions from the survey and those CHIP objectives that they inform, which include: healthy eating and active living, behavioral health, primary care and wellness, violence and injury prevention, and health equity and disparities. Progress towards meeting local CHIP goals will be framed by a comparison to national and state-wide data sets. A total of 8,703 youth participated in the survey from grades 9-12. The survey contained standardized questions that were taken from validated national surveys. The survey questions measured the prevalence of health-risk behaviors among youth and the community conditions which provide protective factors as well as the perceived behavioral standards.

Implementation of Health Literacy Practices in Designing a Program for Reduction in Hospital Readmissions from Door to Home

Fri, 11/07/2014 - 11:00am

In collaboration with the Central Mass/MetroWest Transitions in Care Collaborative CMTCC), the Central Mass Health Literacy Project, designed and implemented a training program utilizing plain language to help reduce hospital readmissions. 21 transition care coaches were trained to look for red flags associated with 13 medical conditions responsible for high rates of hospital readmissions. Coaches met eligible Medicare patients in the hospital and followed them in the community for 30 days post discharge. The collaborative was funded by section 3026A of the Affordable Care Act. In 2012, we worked with Elder Services of Worcester, leading agency of CMTCC, to implement the training program. Readmission rates have decreased in the target population and CMTCC received additional 2 years of funding from CMS for their transition care program. Improving transitions from the hospital to other care settings, improving quality care to reduce readmissions for high risk patients and providing measurable savings to Medicare should be our community's goal.

Familial, Associational, & Incidental Relationships (FAIR)

Fri, 11/07/2014 - 11:00am

Identifying familial linkages in a phenotypic data warehouse can be valuable in cohort identification, and beginning to understand interactions of diseases among families. The goal of the Familial, Associational, & Incidental Relationships (FAIR) system is to identify an index set patients’ relationships through elements in a data warehouse. Using a test set of 500 children, we measured the sensitivity and specificity of available linkage algorithm (e.g.: insurance id and phone numbers) and validated this tool/algorithm through a manual chart audit. Sensitivity varied from 16% to 87%, and specificity from 70% to 100% using various combinations of identifiers. Using the “i2b2” warehouse infrastructure, we have now developed a web app that facilitates FAIR for any index population.

Cancer Surveillance and Outreach in Carlisle, Massachusetts: An Analysis of MDPH Cancer and Environmental Health Data in a Small Town Context

Fri, 11/07/2014 - 11:00am

Introduction: The Carlisle Board of Health (BOH) sought to understand how cancer affects its town (population under 5,000), using data on expected and observed cancer incidence provided by the Massachusetts Cancer Registry (MCR). This project examined cancer incidence data summarized by city/town in five-year intervals, evaluated demographic and environmental factors that could contribute to cancer, and provided recommendations for cancer outreach. Methods: MCR city/town reports from 1995-2009 were examined to identify community cancer trends. A literature review focused on cancers of concern to guide outreach efforts. Data on contributing environmental exposures and health behaviors were explored to identify potential risk factors in Carlisle. Individual- and community-level recommendations were issued based on the data and literature. Results: Observed cases of breast cancer and melanoma in women and colorectal cancer and prostate cancer in men exceeded the number of expected cases. Bladder cancer in men and lung cancer in men and women were somewhat lower than expected. There was insufficient evidence of causation by local environmental exposure. Discussion: Excess cancer cases in Carlisle cannot be interpreted as a cancer cluster. Individuals should be aware of important risk factors and control lifestyle-related factors for common types of cancer. The BOH can monitor data on potential environmental exposures and provide ongoing communication with Carlisle residents about cancer in the community through social media, the local newspaper, and town events. Broad educational outreach on specific risk factors, including sun exposure, arsenic in drinking water, and youth tobacco use should be considered to foster healthy behaviors.

A Nurse Practitioner Model for Delivering Primary and Coordinated Care to Adults with Disabilities - CLASS Inc., Lawrence, MA and Academic Partners, Brandeis University and University of Massachusetts Lowell

Fri, 11/07/2014 - 11:00am

The project will (1) design and plan the implementation of a nurse practitioner model for delivering primary and coordinated care to adults with disabilities who are receiving day habilitation services, and (2) evaluate the design and planning processes using a participatory and iterative approach. The project is a collaborative effort between a university-based research center, provider agencies, a nursing school, and government officials. Products include a logic model of the intervention, materials for training nurses to provide care and service coordination, and an analysis of the process to disseminate lessons learned, support a demonstration project and encourage replication efforts.

Building a Coalition to Promote Health Literacy in Central Massachusetts

Fri, 11/07/2014 - 11:00am

Founded by graduate nursing students at Worcester State University (WSU), the Central Massachusetts Health Literacy Project (CMHLP) is an academic-community partnership with the vision of a healthier Central Massachusetts through health literacy efforts. Current health indicators of the greater Worcester area suggest that there is great need for building health literacy capacity. Although students are considered learners, many WSU graduate nursing students have roots in Central Massachusetts and have years of experience as health care providers. They come from diverse cultural, linguistic, and health care backgrounds. Their combined health care experiences and ability to interpret and perform scholarly work contribute to their ability to assess health literacy needs of local residents, identify the best health literacy practices, and formulate innovative solutions to poor heath literacy. CMHLP members have worked with Worcester Refugee Assistance Program, Elder Services of Worcester, and Central Mass/MetroWest Transitions in Care Collaborative. CMHLP members are not outsiders who come into a community to study and leave. Their commitment to the Worcester area not only helps sustain the collaborative but provides the important everlasting connection between the university and local community.

Leaders Care: Mitigating Violence against Emergency Department Staff

Fri, 11/07/2014 - 11:00am

Engaging Emergency Department clinicians in identifying fears and challenges about safety will support a more secure environment. Identifying staff perceptions regarding safety guided intervention development to maximize security. A survey identified staff perceptions of security, and was repeated after the implementation of mitigation interventions in a New Hampshire community hospital Emergency Department. Staff members, Security Officers, and Patient Registrars were invited to participate in anonymous online surveys pre- and post- mitigation intervention implementation. Data were analyzed for significant differences in responses pre- and post- interventions. Following the initial survey, interventions addressing staff concerns were developed and implemented. In the post-intervention survey, significant differences were noted in 5 of 11 staff concerns. Staff security is a moving target in this environment. Leaders must look at the team as a whole. Interventions designed will drive ongoing educational initiatives, policy revision, and clarification of responsibilities among team members in order to improve safety.

Acceptability of a Novel Smartphone Application for Rhythm Evaluation in Patients with Atrial Fibrillation

Fri, 11/07/2014 - 11:00am

Background: Investigators at UMass Medical School and WPI co-developed a novel smartphone application (app), PULSESMART, that detects atrial fibrillation (AF). AF is the world’s most common, serious heart rhythm problem. In its early stages, most cases of AF are paroxysmal (pAF), making them difficult to identify early in the course of disease. Long-term cardiac monitoring is frequently needed to diagnose and prevent complications from AF, such as stroke. Home monitoring for AF can be clinically impactful but existing technologies have cost or methodological limitations. Data are needed on the potential acceptability and usability of heart rhythm monitoring applications.

Aim: Our aim was to examine patient acceptability of using a pAF detection app.

Methods: 52 patients with pAF underwent rhythm assessment using the app and completed a standardized questionnaire. We looked specifically at responses to 3 questions: 1) how easy was it to use? 2) How important could it be for you? And 3) to what extent does it fit into your daily life?

Results: The mean age was 68.5 years and 69% female. The majority of patients reported the app was easy to use (73%), could be important to them and their health (84%), and would fit into their daily lives (78%).

Conclusions: After use of the pAF detection app, most patients reported positively. The results suggest that older persons with, or at risk for, pAF may benefit from smartphone-based arrhythmia detection platforms. Further work is needed to assess the feasibility of at-home or in-clinic app use.

Symposium Breakout Sessions: 2014 Community Engagement and Research Symposium

Fri, 11/07/2014 - 11:00am

Complete list of Breakout Sessions with descriptions for the 4th annual Community Engagement and Research Symposium, held Friday, November 7, 2014 at the University of Massachusetts Medical School, Worcester, MA.

Symposium Agenda: 2014 Community Engagement and Research Symposium

Fri, 11/07/2014 - 11:00am

Agenda for the 4th annual Community Engagement and Research Symposium, held Friday, November 7, 2014 at the University of Massachusetts Medical School, Worcester, MA.

Symposium Poster Session Presentations: 2014 Community Engagement and Research Symposium

Fri, 11/07/2014 - 10:00am

Complete list of Poster Session presentations with abstracts for the 4th annual Community Engagement and Research Symposium, held Friday, November 7, 2014 at the University of Massachusetts Medical School, Worcester, MA.

Id2 complexes with the SNAG domain of Snai1 inhibiting Snai1-mediated repression of integrin beta4

Tue, 11/04/2014 - 9:56am

The epithelial-mesenchymal transition (EMT) is a fundamental process that underlies development and cancer. Although the EMT involves alterations in the expression of specific integrins that mediate stable adhesion to the basement membrane, such as alpha6beta4, the mechanisms involved are poorly understood. Here, we report that Snai1 inhibits beta4 transcription by increasing repressive histone modification (trimethylation of histone H3 at K27 [H3K27Me3]). Surprisingly, Snai1 is expressed and localized in the nucleus in epithelial cells, but it does not repress beta4. We resolved this paradox by discovering that Id2 complexes with the SNAG domain of Snai1 on the beta4 promoter and constrains the repressive function of Snai1. Disruption of the complex by depleting Id2 resulted in Snai1-mediated beta4 repression with a concomitant increase in H3K27Me3 modification on the beta4 promoter. These findings establish a novel function for Id2 in regulating Snai1 that has significant implications for the regulation of epithelial gene expression.

VEGF targets the tumour cell

Tue, 11/04/2014 - 9:56am

The function of vascular endothelial growth factor (VEGF) in cancer is not limited to angiogenesis and vascular permeability. VEGF-mediated signalling occurs in tumour cells, and this signalling contributes to key aspects of tumorigenesis, including the function of cancer stem cells and tumour initiation. In addition to VEGF receptor tyrosine kinases, the neuropilins are crucial for mediating the effects of VEGF on tumour cells, primarily because of their ability to regulate the function and the trafficking of growth factor receptors and integrins. This has important implications for our understanding of tumour biology and for the development of more effective therapeutic approaches.

Regulated splicing of the alpha6 integrin cytoplasmic domain determines the fate of breast cancer stem cells

Tue, 11/04/2014 - 9:56am

Although the alpha6beta1 integrin has been implicated in the function of breast and other cancer stem cells (CSCs), little is known about its regulation and relationship to mechanisms involved in the genesis of CSCs. We report that a CD44(high)/CD24(low) population, enriched for CSCs, is comprised of distinct epithelial and mesenchymal populations that differ in expression of the two alpha6 cytoplasmic domain splice variants: alpha6A and alpha6B. alpha6Bbeta1 expression defines the mesenchymal population and is necessary for CSC function, a function that cannot be executed by alpha6A integrins. The generation of alpha6Bbeta1 is tightly controlled and occurs as a consequence of an autocrine vascular endothelial growth factor (VEGF) signaling that culminates in the transcriptional repression of a key RNA-splicing factor. These data alter our understanding of how alpha6beta1 contributes to breast cancer, and they resolve ambiguities regarding the use of total alpha6 (CD49f) expression as a biomarker for CSCs.

IMP3 expression is associated with poor outcome and epigenetic deregulation in intrahepatic cholangiocarcinoma

Tue, 11/04/2014 - 9:56am

IMP3 is a fetal protein not expressed in normal adult tissues. IMP3 is an oncoprotein and a useful biomarker for a variety of malignancies and is associated with reduced overall survival of a number of them. IMP3 expression and its prognostic value for patients with intrahepatic cholangiocarcinoma (ICC) have not been well investigated. The molecular mechanism underlying IMP3 expression in human cancer cells remains to be elucidated. Here we investigated IMP3 expression in ICC and adjacent nonneoplastic liver in 72 unifocal primary ICCs from a single institute by immunohistochemistry, immunoblotting, and real-time polymerase chain reaction. IMP3 was specifically expressed in cancer cells but not in the surrounding normal tissue, and 59 (82%) of 72 ICCs were IMP3 positive by immunohistochemistry. Among 35 cases with lymphovascular invasion, 26 (74%) showed IMP3 positivity in lymph node metastases. IMP3 expression was significantly correlated with tumor size, pathological grade, metastasis, and clinical stage. Kaplan-Meier analysis demonstrated an inverse correlation between IMP3 expression and overall survival rate. Multivariate analysis revealed that IMP3 was the only risk factor associated with survival. To further explore the mechanism of IMP3 expression in cancers, we identified 2 CpG islands at IMP3 proximal promoter. Interestingly, the IMP3 promoter was almost completely demethylated in ICCs in contrast to densely methylated promoter in normal liver tissues. IMP3 expression is a useful biomarker for ICCs and can provide an independent prognostic value for patients with ICC. To our knoweldge, this is the first direct evidence of epigenetic deregulation of IMP3 in human cancer.

Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

Availability of Tanning Beds on US College Campuses

Thu, 10/30/2014 - 7:20am

Importance. Indoor tanning is widespread among young adults in the United States despite evidence establishing it as a risk factor for skin cancer. The availability of tanning salons on or near college campuses has not been formally evaluated.

Objective. To evaluate the availability of indoor tanning facilities on US college and university campuses (colleges) and in off-campus housing surrounding but not owned by the college.

Design, Setting, and Participants. This observational study sampled the top 125 US colleges and universities listed in US News and World Report. Investigators searched websites of the colleges and nearby housing and contacted them by telephone inquiring about tanning services.

Main Outcomes and Measures. Frequency of indoor tanning facilities on college campus and in off-campus housing facilities, as well as payment options for tanning.

Results. Of the 125 colleges, 48.0% had indoor tanning facilities either on campus or in off-campus housing, and 14.4% of colleges allow campus cash cards to be used to pay for tanning. Indoor tanning was available on campus in 12.0% of colleges and in off-campus housing in 42.4% of colleges. Most off-campus housing facilities with indoor tanning (96%) provide it free to tenants. Midwestern colleges had the highest prevalence of indoor tanning on campus (26.9%), whereas Southern colleges had the highest prevalence of indoor tanning in off-campus housing facilities (67.7%). Presence of on-campus tanning facilities was significantly associated with enrollment (P = .01), region (P = .02), and presence of a school of public health (P = .01) but not private vs public status (P = .18) or presence of a tobacco policy (P = .16). Presence of tanning facilities in off-campus housing was significantly associated with region (P = .002) and private vs public status (P = .01) but not enrollment (P = .38), tobacco policy (P = .80), or presence of a school of public health (P = .69).

Conclusions and Relevance. Reducing the availability of indoor tanning on and around college campuses is an important public health target.