Maxwell Akonde

Background: Many biomarkers have been evaluated as potential early detection markers for ovarian cancer. Better understanding of factors associated with inter-individual variation in circulating concentrations of these biomarkers is useful for optimizing their clinical utility for early detection. The study objective was to characterize the associations of sociodemographic-, lifestyle-, and health-related factors in relation to circulating ovarian biomarker concentrations in cancer-free women. Methods: The associations between the independent variables and concentrations of 20 biomarkers were examined in a cross-sectional study of 913 women without ovarian cancer who participated in the ovarian cancer screening arm of the Prostate Lung Colorectal and Ovarian (PLCO) Cancer Screening Trial. Results: Older age was significantly associated with trends in concentrations of ten biomarkers, eight that increased with age (human epididymis protein 4 [HE4], beta-2-microglobulin [B2M], epidermal growth factor receptor [EGFR], insulin-like growth factor binding protein 2 [IGFBPII], kallikrein-related peptidase [KLK6], mesothelin [MSLN], matrix metalloproteinase-3 [MMP3], and spondin 2 [SPON2]) and two that decreased with age (insulin-like growth factor 2 [IGFII] and inter-alpha-trypsin inhibitor heavy chain H4 [ITIH4]). Compared to women with no family history of breast or ovarian cancer, those with a positive family history had significantly higher concentrations of B2M, EGFR, and hepcidin and lower concentrations of cancer antigen 125 (CA125) and cancer antigen 72.4 (CA72.4). Post hoc case-control comparisons showed case-control heterogeneity concentrated in specific biomarkers; for example, case-control differences for cancer antigen 15.3 (CA15.3) were statistically significant for all 11 independent variables. Conclusion: Significant trends were observed between age and circulating concentrations of 10 of the 20 biomarkers studied. The strong, consistent findings with age support the need to consider age when assigning thresholds for biomarkers being evaluated for the early detection of ovarian cancer. Integrating data from cancer cases provides valuable context for assessing the generalizability of findings.

Background: Breast and cervical cancer screening uptake remains limited in Ghana despite the public health importance of cancer screening. This study examines factors that influence this behavior. Methods: Secondary analyses of the 2022 Ghana Demographic and Health Survey (GDHS) were conducted. A total of 9,489 women between the ages of 25 to 49 years were evaluated for clinical breast examination (CBE) and cervical cancer screening (CCS) uptakes. Univariable and multivariable logistic regressions were fitted to examine factors that influence women utilization of CBE and CCS. Results: Women in the richer and richest quintiles of wealth index were 40% (AOR=1.40; 95%CI: 1.00 – 1.97) and 118% (AOR=2.18; 95%CI: 1.51 – 3.16) significantly more likely to attain CBE compared to women in the poorest quintile. Women with secondary and higher education were 2.02 times (AOR=2.02; 95%CI: 1.59 – 2.56) and 4.94 times (AOR=4.94; 95%CI: 3.61 – 6.76) as likely to attain CBE compared to women with no education. Women with health insurance were 85% (AOR=1.85; 95%CI: 1.37 – 2.52) more likely to attain CBE compared to women without health insurance. Similar results were found on the associations between wealth index, educational level and health insurance status and CCS uptake. Conclusion: CBE and CCS uptakes were significantly higher in women with higher wealth index, higher education, and health insurance highlighting potential disparities in access to and utilization of preventive services in Ghanaian women. Tailoring policies to address the poverty burden will likely lead to an increase in breast and cervical cancer screening uptakes and potentially better health outcomes. Keywords: Screening; breast; cervical; cancer; Ghana; wealth index.

Cancer screening leads to reduced cancer mortality. Depression and anxiety impact decision-making and may result in less interest in cancer screening (ICS), which is one of the motivators of cancer screening uptake. We examined the association between depression and anxiety and ICS. We analyzed the data of 4,512 respondents in the Health Information National Trend Survey (HINTS) 6 cycle 3. Multivariable logistic regressions were fitted to calculate for the adjusted odds ratios and 95% confidence intervals on the association between depression, anxiety, and respondents’ ICS. Overall, depression and anxiety were not significantly associated (OR=1.17, 95% CI: 0.81-1.70) with interest in cancer screening. However, among people 40 – 60 years of age, those who reported moderate/severe depression and anxiety were 33% (OR=0.67, 95%CI: 0.46-0.99) significantly less likely to be interested in cancer screening compared to those with normal/mild depression and anxiety. The study suggests the need for intentional efforts to improve ICS in people aged 40-60 years who report depression and anxiety.

Background: Early detection of colon cancer leads to better survival outcomes. This can be achieved through colorectal cancer (CRC) screening. People with a family history of cancer (FHC) have increased risk of developing CRC. Increasing screening in this group will reduce CRC mortality. This study evaluated CRC screening in people with FHC. Methods: The study used data from the Health Information National Trends Survey (HINTS) 5, cycle 3. This is an annual cross-sectional survey with a nationally representative sample of American adults. The objective was to study the association between FHC and performing CRC screening. Propensity score matching was used to create a matched population with variables that constituted beliefs in cancer from the survey. Replication procedure, which is based on repeated sampling and allows for accurate computation of standard errors, was used for calculating statistical tests. Multivariable models were fitted in the matched population to assess the association between FHC and performing CRC screening. Results: People with FHC were 14% (OR = 1.14; 95% CI: 0.81–1.60) more likely to perform CRC screening than those without FHC, even though not statistically significant. Age in years (OR = 1.14; 95% CI: 1.12–5.27) had increased likelihood of performing CRC screening, while other races such as American Indians/Alaskan Natives (except African Americans) compared to Caucasians (OR = 0.49; 95% CI: 0.29–0.84) had significantly decreased likelihood of performing CRC screening. Conclusion: FHC was not significantly associated with having a colorectal cancer screening test. Public health advocacy should be directed towards increasing awareness of CRC screening among people with FHC.

The aim of this study was to identify the differences in prevalence and associated factors of underweight and overweight/obesity among Bangladeshi adults (≥18 years) by analyzing the cross-sectional Bangladesh Demographic and Health Survey 2017–2018 data. Multilevel multivariable logistic regression was applied to identify the factors associated with underweight and overweight/obesity in urban and rural areas. The prevalence of underweight was 12.24% and 19.34% in urban and rural areas, respectively. The prevalence of overweight/obesity was 50.23% and 35.96%, respectively, in urban and rural areas. In the final multivariable analysis in both urban and rural areas, 30–49 years of age, female sex, being educated up to college or higher level, living in the wealthiest household, and being currently married or being separated/divorced/widowed had higher odds of being overweight/obese compared to other categories. Residence in the Mymensingh and Sylhet region was associated with decreased odds of overweight/obesity in urban and rural areas. On the other hand, being educated up to college or higher level, living in the wealthiest household, and being married were associated with reduced odds of being underweight in both areas. These high-risk groups should be brought under targeted health promotion programs to curb malnutrition.

Background: Deprivation indices are often used to adjust for socio-economic disparities in health studies. Their role has been partially evaluated for certain population-level cancer outcomes, but examination of their role in ovarian cancer is limited. In this study, we evaluated a range of well-recognized deprivation indices in relation to cancer survival in a cohort of self-identified Black women diagnosed with ovarian cancer. This study aimed to determine if clinical or diagnostic characteristics lie on a mediating pathway between socioeconomic status (SES) and deprivation and ovarian cancer survival in a minority population that experiences worse survival from ovarian cancer. Methods: We used mediation analysis to look at the direct and indirect causal effects of deprivation indices with main mediators of the SEER stage at diagnosis and residual disease. The analysis employed Bayesian structural equation models with variable selection. We applied a joint Bayesian structural model for the mediator, including a Weibull mixed model for the vital outcome with deprivation as exposure. We selected modifiers via a Monte Carlo model selection procedure. Results: The results suggest that high SES-related indices, such as Yost, Kolak urbanicity (URB), mobility (MOB) and SES dimensions, and concentrated disadvantage index (CDI), all have a significant impact on improved survival. In contrast, area deprivation index (ADI)/Singh, and area level poverty (POV) did not have a major impact. In some cases, the indirect effects have very wide credible intervals, so the total effect is not well estimated despite the estimation of the direct effect. Conclusions: First, it is clear that commonly used indices such as Yost, or CDI both significantly impact the survival experience of Black women diagnosed with epithelial ovarian cancer. In addition, the Kolak dimension indices (URB, MOB, mixed immigrant: MICA and SES) also demonstrate a significant association, depending on the mediator. Mediation effects differ according to the mediator chosen.

Background: The WHO recommends pregnant women attend antenatal clinic at least three times during pregnancy; during the first, second and third trimesters. During these visits, an array of clinical and laboratory tests is conducted. The information obtained plays an important role not only in the management and care of pregnancy, but also guides policies targeted at addressing pregnancy-induced health challenges. This study therefore presents laboratory and clinical information of pregnant women at their first antenatal visits.Methods: The study was cross-sectional in design which retrospectively reviewed laboratory and clinical data of pregnant women attending their first antenatal clinic (ANC) at the Comboni Hospital, Volta region, Ghana. The data reviewed included information on hemoglobin level, hemoglobin phenotype, malaria diagnostics, Human Immunodeficiency Virus test (HIV), glucose-6-phosphate dehydrogenase (G6PD) deficiency, Hepatitis C Virus (HCV) test, Hepatitis B Virus (HBV) test, Syphilis test, blood pressure, age, urine glucose, and urine protein. The hemoglobin level was assayed with a hemoglobinometer. Qualitative lateral flow chromatographic immunoassay techniques were used to diagnose the HIV, HCV, HBV, syphilis, and malaria status of the pregnant women. Urine dipstick was used assay for the urine protein and urine glucose, whilst the methemoglobin test was used for the G6PD deficiency and alkaline hemoglobin electrophoresis for hemoglobin phenotype. Data on demographic, anthropometric and vital signs such as age, weight and blood pressure were also collected. Descriptive statistics were performed. Frequency and percentages were used to describe the categorical variables and means and standard deviations used to describe the continuous variables.Results: Hemoglobin S(Hb S) was found in 12.8% of the women with 73.4% having hemoglobin levels below 11.5g/dl. On G6PD deficiency, 1.6% and 0.8% were partially and fully defective respectively. Also, urine protein (1.2%) and glucose (0.4%) were detected. The prevalence of HBV, HCV and malaria were 4.4%, 3.6% and 2.4%, respectively.Conclusion: Anemia in pregnancy was high among the study sample. Malaria and hepatitis infections were observed in the study sample. Policies on maternal health should be targeted at providing better nutritional options, that can enhance the hemoglobin level during pregnancy. Pregnant women should benefit from enhanced surveillance for HIV, HBV, HCV, and syphilis.

Purpose: The causes for the survival disparity among Black women with epithelial ovarian cancer (EOC) are likely multi-factorial. Here we describe the African American Cancer Epidemiology Study (AACES), the largest cohort of Black women with EOC. Methods: AACES phase 2 (enrolled 2020 onward) is a multi-site, population-based study focused on overall survival (OS) of EOC. Rapid case ascertainment is used in ongoing patient recruitment in eight U.S. states, both northern and southern. Data collection is composed of a survey, biospecimens, and medical record abstraction. Results characterizing the survival experience of the phase 1 study population (enrolled 2010–2015) are presented. Results: Thus far, ~ 650 patients with EOC have been enrolled in the AACES. The five-year OS of AACES participants approximates those of Black women in the Surveillance Epidemiology and End Results (SEER) registry who survive at least 10-month past diagnosis and is worse compared to white women in SEER, 49 vs. 60%, respectively. A high proportion of women in AACES have low levels of household income (45% < $25,000 annually), education (51% ≤ high school education), and insurance coverage (32% uninsured or Medicaid). Those followed annually differ from those without follow-up with higher levels of localized disease (28 vs 24%) and higher levels of optimal debulking status (73 vs 67%). Conclusion: AACES is well positioned to evaluate the contribution of social determinants of health to the poor survival of Black women with EOC and advance understanding of the multi-factorial causes of the ovarian cancer survival disparity in Black women.

This study aims to find out the prevalence of the American Heart Association’s (AHA)’s cardiovascular health metrics and associated socio-demographic factors. A secondary analysis of the World Health Organization (WHO) STEPwise approach to surveillance survey 2018 (STEPS 2018) data was conducted. Ideal Cardiovascular Health (ICH) was defined as the presence of 5–7 ideal metrics as defined by the AHA. Design-adjusted multivariable logistic regression was used to determine the associated factors of ICH. In total, 5930 respondents were included in our analysis, and 43.1% of the participants had ICH. The odds of ICH decreased with age [compared to 18–29 years old individuals, 30–49 years: AOR (Adjusted Odds Ratio): 0.4; 95% Confidence Interval (CI): 0.4–0.5; 50–69 years: AOR: 0.7; 95% CI: 0.6–0.8], and higher educational attainment (compared to those who received no formal education, being educated up to primary level: AOR:0.7; 95% CI: 0.6–0.8; being educated up to secondary level: AOR: 0.4; 95% CI: 0.4–0.5; being educated up to college and higher: AOR: 0.4; 95% CI: 0.3–0.5). Compared with female and urban residents, the odds were 30% and 40% less among male and rural residents, respectively. The public health promotion programs of Bangladesh should raise awareness among high-risk groups to prevent cardiovascular diseases.