RE-AIM analysis of a community-partnered policy, systems, and environment approach to increasing consumption of healthy foods in schools serving low-income populations.

Prevalences of childhood overweight and obesity represent major public health concerns. School-based policy strategies represent one approach to increasing access to healthy foods; however, overall health impact of such initiatives is often overlooked. We undertook program evaluation of a school wellness policy focused approach in low-income, multiracial communities in southeast Los Angeles.

Validation of a Skin-Lesion Image-Matching Algorithm Based on Computer Vision Technology.

Background: Melanoma incidence is increasing globally, but consistently accurate skin-lesion classification methods remain elusive. We developed a simple software system to classify potentially all types of skin lesions. In the current study, we evaluated the system's ability to identify melanomas with a diameter of 10 mm or larger.

Impact of breast cancer subtypes and treatment on survival: an analysis spanning two decades.

Background: We investigated the impact of breast cancer molecular subtypes and treatment on survival in a cohort of medically insured women followed for more than 20 years.

Methods: We examined 934 female members of an integrated health care delivery system newly diagnosed with invasive breast cancer between 1988 and 1995 and followed them through 2008. Tumors were classified into four molecular subtypes on the basis of their expression profile: luminal A; luminal B; basal-like; and HER2-enriched.

Medical history, body size, and cigarette smoking in relation to fatal prostate cancer.

Objectives: Prostate cancer has few known risk factors. As part of a population-based case-control study conducted in four health maintenance organizations, the authors examined the associations between fatal prostate cancer and several medical and behavioral characteristics.

Methods: Cases were 768 health plan members who died of prostate adenocarcinoma during the period 1997-2001.

Racial differences in treatment of early-stage prostate cancer.

Objectives: To determine whether differences existed in prostate cancer treatment received by white and African American men at a health maintenance organization where access to medical care is theoretically equal for all members and, if so, to determine the reasons for these differences.

Methods: We used information from the Kaiser Permanente Northwest Tumor Registry to identify all men diagnosed with local- or regional-stage prostate cancer between 1980 and 2000. We compared the likelihood of treatment with curative intent (TCI) between the two races, adjusting for age, tumor grade, stage, and the presence of comorbid conditions.

Automated inter-rater reliability assessment and electronic data collection in a multi-center breast cancer study.

Background: The choice between paper data collection methods and electronic data collection (EDC) methods has become a key question for clinical researchers. There remains a need to examine potential benefits, efficiencies, and innovations associated with an EDC system in a multi-center medical record review study.

Methods: A computer-based automated menu-driven system with 658 data fields was developed for a cohort study of women aged 65 years or older, diagnosed with invasive histologically confirmed primary breast cancer (N = 1859), at 6 Cancer Research Network sites.

Correlates of screening sigmoidoscopy use among men in a large nonprofit health plan.

Background: As the majority of patients diagnosed with colorectal cancer have no known risk factors, regular screening is strongly recommended. The authors examined factors associated with screening sigmoidoscopy use among participants in the California Men's Health Study (CMHS).

Methods: The authors conducted a cross-sectional study over a 5-year period nested within a prospective cohort study.

Recurrences and second primary breast cancers in older women with initial early-stage disease.

Background: The association between common breast cancer therapies and recurrences and second primary breast cancers in older women is unclear, although older women are less likely to receive common therapies.

Methods: Women aged >or=65 years who were diagnosed with stage I or II breast cancer and who underwent mastectomy or breast-conserving surgery (BCS) from 1990 to 1994 were identified from automated data from 6 healthcare systems and then were followed for 10 years or until breast cancer recurrence, disenrollment, or death. Trained abstractors reviewed medical records to obtain recurrence, tumor, treatment and demographic data.

Breast cancer treatment of older women in integrated health care settings.

Purpose: A substantial literature describes age-dependent variations in breast cancer treatment, showing that older women are less likely to receive standard treatment than younger women. We sought to identify patient and tumor characteristics associated with the nonreceipt of standard primary tumor and systemic adjuvant therapies.

Patients And Methods: We studied 1,859 women age 65 years or older with stage I and II breast cancer diagnosed between 1990 and 1994 who were cared for in six geographically dispersed community-based health care systems.

California Men's Health Study (CMHS): a multiethnic cohort in a managed care setting.

Background: We established a male, multiethnic cohort primarily to study prostate cancer etiology and secondarily to study the etiologies of other cancer and non-cancer conditions.

Methods/design: Eligible participants were 45-to-69 year old males who were members of a large, prepaid health plan in California. Participants completed two surveys on-line or on paper in 2002-2003.

Disparities and survival among breast cancer patients.

Background: Although rates of survival for women with breast cancer have improved, the survival disparity between African American and white women in the United States has increased.

Purpose: To determine whether this survival disparity persists in an insured population with access to medical care.

Methods: In this retrospective cohort study, we extracted data from the tumor registries of six nonprofit, integrated health care delivery systems affiliated with the Cancer Research Network and assessed the survival of African American (n = 2276) and white (n = 18 879) female enrollees who were diagnosed with invasive breast cancer from January 1, 1993, through December 31, 1998.

Screening by prostate-specific antigen and digital rectal examination in relation to prostate cancer mortality: a case-control study.

Background: The potential role of prostate cancer screening in reducing mortality is uncertain. To examine whether screening with the prostate-specific antigen (PSA) test or digital rectal examination is associated with reduced prostate cancer mortality, we conducted a population-based case-control study in 4 health maintenance organizations.

Methods: Cases were 769 health plan members who died because of prostate adenocarcinoma during the years 1997-2001.

Breast cancer risk in a large cohort of female antidepressant medication users.

Paroxetine in particular has been speculated to increase the risk of breast cancer. The aim of this study was to determine if breast cancer risk is elevated among women who used paroxetine relative to those who used other antidepressants. We conducted a retrospective cohort study of 109,004 female health plan members who used various antidepressants between 1995 and 2000 to evaluate breast cancer risk.

Body weight correlates with mortality in early-stage breast cancer.

Hypothesis: Body weight correlates with risk of breast cancer death.

Design: A retrospective cohort study using patient medical records, electronic cancer registry data, and archived tissue specimens.

Setting: A 395-bed, comprehensive community hospital.

Limitations and potential uses of census-based data on ethnicity in a diverse community.

Purpose: Information on ethnicity, socioeconomic status, and social class has value in epidemiologic research and in measurement of the quality of health care but it is difficult to obtain for large populations. This evaluation assessed the potential usefulness of ethnicity data based on address geocoding to the 2000 census.

Methods: We compared ethnicity based on the geocoding data with ethnicity from hospitalization records and birth certificates of a large health maintenance organization.

Does menopausal hormone replacement therapy interact with known factors to increase risk of breast cancer?

Purpose: We and other investigators have previously shown that postmenopausal combined estrogen and progestin replacement therapy (EPRT) increases the risk of breast cancer and that the risk associated with EPRT is substantially higher than for estrogen replacement therapy (ERT) alone. The present study was conducted to determine whether any particular subgroup of women are at particularly high risk of breast cancer if they use EPRT and whether tumor characteristics in women who develop cancer while on ERT or EPRT are different from those in women not using ERT or EPRT.

Patients And Methods: We conducted a population-based case-control study in Los Angeles, CA, with patients diagnosed with breast cancer in the late 1980s and early 1990s.