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Recent Research Publications and Funding
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March 22, 2015 4:00AM
Triple-negative breast cancer (TNBC) occurs in 10-15% of patients yet accounts for almost half of all breast cancer deaths. TNBCs lack expression of estrogen and progesterone receptors and HER-2 overexpression and cannot be treated with current targeted therapies. TNBCs often occur in African American and younger women. Although initially responsive to some chemotherapies, TNBCs tend to relapse and metastasize. Thus, it is critical to find new therapeutic targets. A second ER gene product, termed ERβ, in the absence of ERα may be such a target. Using human TNBC specimens with known clinical outcomes to assess ERβ expression, we find that ERβ1 associates with significantly worse 5-year overall survival. Further, a panel of TNBC cell lines exhibit significant levels of ERβ protein. To assess ERβ effects on proliferation, ERβ expression in TNBC cells was silenced using shRNA, resulting in a significant reduction in TNBC proliferation. ERβ-specific antagonists similarly suppressed TNBC growth. Growth-stimulating effects of ERβ may be due in part to downstream actions that promote VEGF, amphiregulin, and Wnt-10b secretion, other factors associated with tumor promotion. In vivo, insulin-like growth factor-2 (IGF-2), along with ERβ1, is significantly expressed in TNBC and stimulates high ERβ mRNA in TNBC cells. This work may help elucidate the interplay of metabolic and growth factors in TNBC.
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March 20, 2015 4:00AM
Family efficacy, which refers to a family's belief in its ability to produce a desired outcome, has been shown to protect adolescents from risky health behaviors. Few studies have examined family efficacy within diverse populations, however, and understanding of how efficacy is framed and formed within the context of cultural and familial values is limited. This descriptive qualitative study examined sources of family efficacy within ethnically and socioeconomically diverse families, evaluating how such families develop and exercise family efficacy with the intent to protect adolescents from risky health behaviors (i.e., marijuana and alcohol use and early sexual activity). We collected qualitative data via two semi-structured interviews, 4-6 months apart, with 31 adolescents (ages 12-14) and their parent/s, for total of 148 one-on-one interviews. Thematic analysis identified three distinct domains of family efficacy: relational, pragmatic, and value-laden. Prior experiences and cultural background influenced the domain/s utilized by families. Significantly, families that consistently tapped into all three domains were able to effectively manage personal and family difficulties; these families also had family strategies in place to prevent adolescents from risky behaviors. Health professionals could utilize this concept of multidimensional family efficacy to promote health within culturally diverse families.
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February 27, 2015 6:00AM
Background: Screening measures prior to study enrollment are needed to determine safety and minimize participant burden. Our objective was to determine if functional disability, physical function, cognitive impairment, age or gender were predictive of enrollment in an exercise study. Methods: This observational study used cross-sectional data from 233 stroke survivors with mild-moderate disability, who consented to be screened for potential study enrollment. Results: Participants were on average 68±12 years old (49% women), reported mild-moderate disability (mRS=2.1±0.8), had some impairments in physical functioning (SPPB=6.9 ±2.6), but were without cognitive impairments (MMSE=27.6 ± 3.6). Significant predictors of study enrollment using binary logistic regression included leg strength [X2(1)= 29.17, p<0.01], gait speed [X2(1)= 36.60, p<0.03], and cognitive function [X2(1)= 9.99, p=0.03]. Multiple logistic regression indicated that leg strength, gait speed, and cognitive function together, were predictive of enrollment [X2(3)=14.05, p<0.01]. Conclusions: The Short Physical Performance Battery and Mini-Mental Status Exam are quick and easy to administer; to assess various levels of physical and cognitive function, with minimal risk to participants. Fewer screening tests reduced participant burden and may have encouraged participation in an exercise study, even among stroke survivors with impairments in physical and/or cognitive function.
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February 26, 2015 6:00AM
Adejoke Ayoola, 2012 Cohort, published in the Western Journal of Nursing Research.
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February 23, 2015 6:00AM
Preeclampsia is a pregnancy-associated complex condition associated with inflammation, oxidative stress and angiogenic imbalance. Stress sensitive transcription factors nuclear factor-erythroid 2-like 1 (Nrf1) and nuclear factor-erythroid 2-like 2 (Nrf2) are involved in regulation of angiogenic, inflammatory and oxidative stress pathways. Recent evidence suggests a link between Nrf2 and angiogenic factor balance in preeclampsia though the degree to which maternal and placental DNA methylation contributes to disruption of Nrf pathways among women with preeclampsia is unknown. Our central hypothesis is that distinct patterns of DNA methylation in Nrf pathway and angiogenic genes contribute to altered angiogenic balance in preeclampsia. Prospectively, we collected blood in each of three trimesters of pregnancy, maternal white blood cells in the first trimester of pregnancy and placental tissue at delivery from nulliparous women. We analyzed DNA methylation at individual CpG dinucleotides (Illumina Infinium) in Nrf and angiogenic (VEGFA, VEGFB, VEGC, FLT1, KDR, NRF1, PlGF) genes in maternal peripheral blood cells and placenta and circulating angiogenic factors (Millipore Bioplex) from women who developed preeclampsia and normotensive controls (n=6/group). Differences in average methylation beta scores (change in beta score >0.2 indicated significant gain of methylation; >-0.2 indicated significant loss of methylation) determined significant differences between groups. DNA methylation patterns in Nrf and angiogenic genes in maternal white blood cells and placenta were not significantly different in cases/controls. Among women with preeclampsia, PlGF was significantly lower across pregnancy and sFLT1 was significantly higher in the third trimester among women with preeclampsia. DNA methylation in Nrf and angiogenic genes was not associated with altered angiogenic balance in women who developed late onset preeclampsia. Differences in DNA methylation may occur later in pregnancy when circulating factors differed between groups.
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February 17, 2015 6:00AM
Adejoke Ayoola, 2012 Cohort, published in the Wester Journal of Nursing Research.
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February 17, 2015 6:00AM
OBJECTIVES: In collaboration with Public Health Practice-Based Research Networks, we investigated relationships between local health department (LHD) food safety and sanitation expenditures and reported enteric disease rates.
METHODS: We combined annual infection rates for the common notifiable enteric diseases with uniquely detailed, LHD-level food safety and sanitation annual expenditure data obtained from Washington and New York state health departments. We used a multivariate panel time-series design to examine ecologic relationships between 2000-2010 local food safety and sanitation expenditures and enteric diseases. Our study population consisted of 72 LHDs (mostly serving county-level jurisdictions) in Washington and New York.
RESULTS: While controlling for other factors, we found significant associations between higher LHD food and sanitation spending and a lower incidence of salmonellosis in Washington and a lower incidence of cryptosporidiosis in New York.
CONCLUSIONS: Local public health expenditures on food and sanitation services are important because of their association with certain health indicators. Our study supports the need for program-specific LHD service-related data to measure the cost, performance, and outcomes of prevention efforts to inform practice and policymaking.
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February 10, 2015 6:00AM
Background: Adherence to medications is an essential part of heart failure self-care. Poor medication adherence leads to increased rates of exacerbation causing hospitalizations and increased morbidity and mortality.
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February 10, 2015 6:00AM
BACKGROUND: Loneliness is a contributing factor to various health problems in older adults, including complex chronic illness, functional decline, and increased risk of mortality.
OBJECTIVES: A pilot study was conducted to learn more about the prevalence of loneliness in rural older adults with chronic illness and how it affects their quality of life. The purposes of the data analysis reported here were twofold: to describe loneliness, chronic illness diagnoses, chronic illness control measures, prescription medication use, and quality of life in a sample of rural older adults; and to examine the relationships among these elements.
METHODS: A convenience sample of 60 chronically ill older adults who were community dwelling and living in Appalachia was assessed during face-to-face interviews for loneliness and quality of life, using the University of California, Los Angeles (UCLA) Loneliness Scale (version 3) and the CASP-12 quality of life scale. Chronic illness diagnoses, chronic illness control measures, and medication use data were collected through review of participants' electronic medical records.
RESULTS: Overall mean loneliness scores indicated significant loneliness. Participants with a mood disorder such as anxiety or depression had the highest mean loneliness scores, followed by those with lung disease and those with heart disease. Furthermore, participants with mood disorders, lung disease, or heart disease had significantly higher loneliness scores than those without these conditions. Loneliness was significantly related to total number of chronic illnesses and use of benzodiazepines. Use of benzodiazepines, diuretics, nitrates, and bronchodilators were each associated with a lower quality of life.
CONCLUSIONS: Nurses should assess for loneliness as part of their comprehensive assessment of patients with chronic illness. Further research is needed to design and test interventions for loneliness.
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February 5, 2015 6:00AM
Psychotropic medications (antipsychotics, antidepressants, anxiolytics, anticonvulsants, sedative hypnotics) are commonly prescribed for long term care residents with dementia, and have been associated with negative outcome, such as falls, gait impairment, sedation and cognitive decline. The purpose of this study was to describe differences in assisted living versus nursing home residents with moderate to severe cognitive impairment with regard to the use of psychotropic medications. In addition, we considered changes in physical/functional and psychosocial outcomes over the 6 month study period based on setting and use of any psychotropic medication.