Hormone therapy – who takes it – the rich or the poor?

Abstract #5093

Introduction: In the UK, hormone therapy is provided to all breast cancer patients for a standard NHS prescription charge (approximately USD13 per month). Previous studies in the USA and the UK have shown that only 60% of patients comply fully with prescribed therapy. This study examines the effects of age, drug type, prognosis and social deprivation on hormone therapy compliance.
 Method: During scheduled outpatient appointments data was collected from patients as part of their routine follow-up. Parameters included: age, name of drug, time on drug, drug compliance (full; deviation – missing <1 pill/week; holiday – missing pills > 1 week; stopped), and side effects (subjective – mild; moderate; severe). Prognostic information was derived using the Nottingham Prognostic Index (NPI). The patients' home postal codes were collected and allocated to the correct electoral ward (small geographical areas with average population of 5500). Using data from the UK National Census in 2000, information on social status was derived from the patients' postal codes and given as the Index of Multiple Deprivation (ID2000). The ID2000 has both an ID2000 score and ID2000 ranking (1 to 8414) for different electoral wards across England & Wales. Low ID2000 scores and high ID2000 rankings correspond to areas of affluence. Patients in ID2000 rankings <4212 were assigned as 'deprived' and >4212 as 'affluent'. The predominant social grade for each ward was recorded (AB, C1, C2, D and E).
 Results: To date, 117 patients have been analysed. The ID2000 ranks ranged from 1033 to 8297. Ninety two (89%) of patients were fully compliant, 5 (5%) deviated, 2 (2%) took a holiday and 4 (4%) stopped taking their hormone treatment. Compliance was significantly better for those taking an aromatase inhibitor (AI) (96.7%) than tamoxifen (80.5%) (Chi2 test Chi2 = 7.147. p = 0.0075). Compliance is unaffected by affluence (92.5%) v deprivation (80.9%) (Chi2 test Chi2 = 2.486, p=0.11). Compliance is also unaffected by NPI (Mann Whitney U test p=0.84) and age (Mann Whitney U test p=0.78).
 Conclusion: These early data suggest that hormone drug compliance in our centre is higher than previously reported. Compliance is significantly higher for aromatase inhibitors than tamoxifen; currently there is no discernable difference between individual AIs. Compliance appears higher in affluent patients; however this is not statistically significant. Compliance appears to be independent of age, duration of therapy and prognosis. This study is ongoing and further work comparing different areas is recommended.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5093.

Public information campaign on aflatoxin contamination of maize grains in market stores in Benin, Ghana and Togo

Rotary International with the International Institute of Tropical Agriculture (IITA) conducted an information campaign from 2000 to 2004 to increase public awareness of aflatoxin in Benin, Ghana and Togo. Key informant interviews with 2416 respondents showed poor baseline knowledge of aflatoxin and its health risks. The campaign included monitoring of aflatoxin contamination in maize grains from market stores in 38 cities and towns. Aflatoxin concentration in contaminated samples ranged from 24 to 117.5 ng g(-1) in Benin, from 0.4 to 490.6 ng g(-1) in Ghana, and from 0.7 to 108.8 ng g(-1) in Togo. The campaign significantly increased public awareness that populations were exposed to high levels of aflatoxin. The number of maize traders who were informed about the toxin increased 10.3 and 3.2 times in Togo and Benin, respectively; at least 33% more traders believed the information in each of Benin and Togo; 11.4 and 28.4% more consumers sorted out and discarded bad grains in Benin and Ghana, respectively. This paper concludes that sustained public education can help reduce aflatoxin contamination.

Computer software tool REALM for sustainable water allocation and management

REALM (REsource ALlocation Model) is a generalised computer simulation package that models harvesting and bulk distribution of water resources within a water supply system. It is a modeling tool, which can be applied to develop specific water allocation models. Like other water resource simulation software tools, REALM uses mass-balance accounting at nodes, while the movement of water within carriers is subject to capacity constraints. It uses a fast network linear programming algorithm to optimise the water allocation within the network during each simulation time step, in accordance with user-defined operating rules. This paper describes the main features of REALM and provides potential users with an appreciation of its capabilities. In particular, it describes two case studies covering major urban and rural water supply systems. These case studies illustrate REALM's capabilities in the use of stochastically generated data in water supply planning and management, modelling of environmental flows, and assessing security of supply issues.

An airport cargo inspection system based on X-ray and thermal neutron analysis (TNA)

A cargo inspection system incorporating a high-resolution X-ray imaging system with a material-specific detection system based on Ancore Corporation's patented thermal neutron analysis (TNA) technology can detect bulk quantities of explosives and drugs concealed in trucks or cargo containers. The TNA process utilises a 252Cf neutron source surrounded by a moderator. The neutron interactions with the inspected object result in strong and unique gamma-ray signals from nitrogen, which is a key ingredient in modern high explosives, and from chlorinated drugs. The TNA computer analyses the gamma-ray signals and automatically determines the presence of explosives or drugs. The radiation source terms and shielding design of the facility are described. For the X-ray generator, the primary beam, leakage radiation, and scattered primary and leakage radiation were considered. For the TNA, the primary neutrons and tunnel scattered neutrons as well as the neutron-capture gamma rays were considered.

Normal tension glaucoma is not associated with the common apolipoprotein E gene polymorphisms

BACKGROUND

/aims: In normal tension glaucoma (NTG) factors other than raised intraocular pressure have a role in the pathogenesis of the optic neuropathy. Because particular apolipoprotein E (ApoE) gene polymorphisms have been associated with cell death and survival in neurological degenerative diseases, the purpose of this study was to determine the ApoE allele frequencies in patients with normal tension glaucoma.

METHODS

The apolipoprotein E genotype of 155 patients with normal tension glaucoma was compared to that of 349 non-affected, control subjects from the same geographical area. A similar comparison was made between 53 patients with normal tension glaucoma who demonstrated progressive visual field loss, and control subjects. The frequencies of genotypes was compared with the chi(2) test and Mantel-Haenszel coefficent.

RESULTS

There was no significant difference in the frequency of ApoE alleles or genotypes in the normal tension glaucoma population compared to the control group. The ApoE alleles and genotypes in NTG patients with progressive disease were not different from the control group.

CONCLUSION

ApoE gene polymorphisms are not linked to normal tension glaucoma, suggesting that this gene does not have a role in the pathogenesis of optic neuropathy in this disease.

Decreased mortality after implementation of a treatment guideline for community-acquired pneumonia

PURPOSE

We developed a pneumonia guideline at Intermountain Health Care that included admission decision support and recommendations for antibiotic timing and selection, based on the 1993 American Thoracic Society guideline. We hypothesized that guideline implementation would decrease mortality.

SUBJECTS AND METHODS

We included all immunocompetent patients > 65 years with community-acquired pneumonia from 1993 through 1997 in Utah; nursing home patients were excluded. We compared 30-day mortality rates among patients before and after the guideline was implemented, as well as among patients treated by physicians who did not participate in the guideline program.

RESULTS

We observed 28,661 cases of pneumonia, including 7,719 (27%) that resulted in hospital admission. Thirty-day mortality was 13.4% (1,037 of 7,719) among admitted patients and 6.3% (1,801 of 28,661) overall. Mortality rates (both overall and among admitted patients) were similar among patients of physicians affiliated and not affiliated with Intermountain Health Care before the guideline was implemented. For episodes that resulted in hospital admission after guideline implementation, 30-day mortality was 11.0% among patients treated by Intermountain Health Care-affiliated physicians compared with 14.2% for other Utah physicians. Analysis that adjusted by logistic regression for age, sex, rural versus urban residences, and year confirmed that 30-day mortality was lower among admitted patients who were treated by Intermountain Health Care-affiliated physicians (odds ratio [OR]: 0.69; 95% confidence interval [CI]: 0.49 to 0.97; P = 0.04) and was somewhat lower among all pneumonia patients (OR: 0.81; 95% CI: 0.63 to 1.03; P = 0.08).

CONCLUSION

Implementation of a pneumonia practice guideline in the Intermountain Health Care system was associated with a reduction in 30-day mortality among elderly patients with pneumonia.

Clinical comparison of frequency doubling technology perimetry and Humphrey perimetry

AIM

To determine the number of missed points on frequency doubling technology (FDT) perimetry that optimise the sensitivity and specificity of the test and to determine the topographical accuracy of the test in a clinical setting.

METHODS

In a prospective study, the perimetric data from 99 patients who underwent both FDT perimetry in the screening mode and Humphrey 24-2 (H24-2) were used to determine the sensitivity and specificity of the FDT perimetry compared with the full threshold H24-2 as the gold standard.

RESULTS

Missed points on the FDT perimetry correlated with both the mean deviation and the corrected pattern standard deviation on the Humphrey perimetry. A score assigned to abnormal points on the FDT perimetry and the Humphrey total deviation plot showed a significant correlation for both the location and the depth of the defect. In comparing the Humphrey hemifield test with the FDT perimetry results, if at least one missed point on the frequency doubling test was considered as abnormal then the overall sensitivity of the test was 78.1% and the specificity was 89.1%.

CONCLUSION

FDT perimetry in the screening mode performed in a clinical setting was highly specific, exhibited reasonable sensitivity, and accurately determined the location and depth of scotomas when compared with the full threshold Humphrey 24-2.

Effects on subject response of information brochures and small cash incentives in a mail-based case-control study

PURPOSE

To investigate the impact on subject response of an information brochure and cash incentives included with mailed questionnaires in case-control studies.

METHODS

A randomized trial was carried out within a case-control study investigating cancer in the Province of Ontario. Brochures were included with half of the mailed questionnaires sent to 7487 cases and 2561 controls. Controls were also sent cash incentives of $2, $5, or no money.

RESULTS

With the brochure, response changed from 75.0% to 75.8% in cases, and from 70.3% to 71.1% in controls. Adjusting for differences in age, residence, sex, and cancer site/status, the change was 0.2% [95% confidence interval (CI) = -1.7-2.1] in cases, and 0.6% (95% CI = -3.1-4.3) in controls. The $2 and $5 incentives increased overall response in controls from 61.9% to 72.8% and 77.2%, respectively, i.e., by 10.9% (95% CI = 6.1-15.6) and 15.1% (95% CI = 10.4-19.7), after adjustment. This effect was largely confined to urban areas (for $2 and $5, respectively: 5.5% and 14.2% in Toronto, 15.3% and 20.4% in other urban areas vs. 2.7% and 1.0% in rural areas; p = 0.02). Response time showed little or no improvement when the brochure was included, but was markedly reduced for both the $2 and $5 incentives.

CONCLUSIONS

Cash incentives can improve subject response in epidemiologic studies, whereas information brochures do not appear to have an effect.

Spire contains actin binding domains and is related to ascidian posterior end mark-5

Spire is a maternal effect locus that affects both the dorsal-ventral and anterior-posterior axes of the Drosophila egg and embryo. It is required for localization of determinants within the developing oocyte to the posterior pole and to the dorsal anterior corner. During mid-oogenesis, spire mutants display premature microtubule-dependent cytoplasmic streaming, a phenotype that can be mimicked by pharmacological disruption of the actin cytoskeleton with cytochalasin D. Spire has been cloned by transposon tagging and is related to posterior end mark-5, a gene from sea squirts that encodes a posteriorly localized mRNA. Spire mRNA is not, however, localized to the posterior pole. SPIRE also contains two domains with similarity to the actin monomer-binding WH2 domain, and we demonstrate that SPIRE binds to actin in the interaction trap system and in vitro. In addition, SPIRE interacts with the rho family GTPases RHOA, RAC1 and CDC42 in the interaction trap system. Thus, our evidence supports the model that SPIRE links rho family signaling to the actin cytoskeleton.

First Report of Macrophomina phaseolina Causing Pre-harvest Cassava Root Rot in Benin and Nigeria

In diagnostic surveys conducted in parts of Benin and Nigeria to determine the incidence of pre-harvest cassava root and stem rot during the dry season, Macrophomina phaseolina (Tassi) Goidanich constituted 14.2 and 18.7% of the total fungi (n = 201) associated with cassava root and stem rot from Benin and Nigeria (1). Pathogenicity of M. phaseolina on cassava was tested with cv. Agric. Inocula for pathogenicity tests were prepared by incubating 5-mm-diameter mycelial plugs for each of five isolates (Mp 1 to Mp 5, all collected from Benin) with 500 ml of autoclaved, sterilized, dehusked rice seed for 14 days at 30°C. Five 30-cm-long stem portions per isolate were cut from healthy cassava, surface disinfested in hot water (52°C, 5 min), and planted into 1-liter pots containing autoclaved, sterilized sand mixed with 10 ml of air-dried inoculum. Five plants per isolate similarly treated but not inoculated served as controls. Plants were watered once a week, and maintained in a greenhouse under natural light at 28 to 30°C. Lower leaves of inoculated plants gradually wilted, usually preceded by chlorosis, and brown to black lesions formed on the lower stem portions of some roots. Control plants remained asymptomatic. Plant height and percentage of leaf wilt (determined by counting the number of leaves wilted per plant and dividing by the total number of leaves per plant) were measured on a weekly basis for 8 weeks for each of the control and inoculated plants. At the end of 8 weeks, lesion length on the lower stem was measured. There were significant differences (P < 0.05) in length of the lesions and percentage of leaf wilt induced by the different isolates of M. phaseolina. Isolate Mp 1 induced the longest lesion (7.2 cm), followed by Mp 4 (4.1 cm), Mp 3 and Mp 5 (3.8 cm each), and Mp 2 (1.2 cm). Mp 4 induced the highest percentage of wilted leaves (53%), followed by Mp 1, Mp 3, and Mp 5 (30%), and Mp 2 (10%). All five M. phaseolina isolates (except Mp 3) reduced plant height, compared with control treatments. M. phaseolina was isolated from all infected plants, and the identification was independently confirmed by the International Mycological Institute, Surrey, UK. This is the first report of M. phaseolina causing pre-harvest cassava root rot in Benin and Nigeria. Reference: (1) W. Msikita et. al. Plant Dis. 81:1332, 1997.

White-centred retinal haemorrhages (Roth spots)

Roth spots (white-centred retinal haemorrhages) were classically described as septic emboli lodged in the retina of patients with subacute bacterial endocarditis. Indeed many have considered Roth spots pathognomonic for this condition. More recent histological evidence suggests, however, that they are not foci of bacterial abscess. Instead, they are nonspecific and may be found in many other diseases. A review of the histology and the pathogenesis of these white-centred haemorrhages will be provided, along with the work-up of the differential diagnosis.

Idiopathic intracranial hypertension presenting with gaze-evoked amaurosis

PURPOSE

Gaze-evoked amaurosis is transient monocular visual loss induced by an eccentric position of gaze, most frequently associated with orbital mass lesions. To our knowledge, there has been no reported case of idiopathic intracranial hypertension as a cause of gaze-evoked amaurosis. We present the hypothesis that in an eccentric position of gaze, ischaemic compression of a tense dilated optic nerve sheath results in further elevation of intrasheath pressure compromising blood flow to the retina.

METHOD

We describe a case of unilateral gaze-evoked amaurosis and headaches in a 46 year old man diagnosed with idiopathic intracranial hypertension. He did not respond to medical treatment and had optic nerve sheath decompressions.

RESULT

Following surgery, this patient's visual function improved with resolution of his gaze-evoked amaurosis.

CONCLUSION

Raised intracranial pressure associated with a tense dilated optic nerve sheath should be considered in the differential diagnosis of gaze-evoked amaurosis.

Seasonal affective disorder: some epidemiological findings from a tropical climate

OBJECTIVE

To determine whether a predominantly summer-focussed pattern of seasonal affective disorder (SAD) exists in tropical northern Australia.

METHOD

A mail survey containing a modified form of the Seasonal Pattern Assessment Questionnaire (SPAQ) was administered to 176 households in the city of Townsville (latitude: 19 degrees south).

RESULTS

Using previously reported screening criteria, 9% of respondents reported a degree of summer impairment indicative of SAD, while the incidence rate for winter SAD was 1.7%. This summer-winter ratio is typically reversed in more temperate latitudes.

CONCLUSIONS

Excessive heat and humidity were reported to be the two most influential environmental factors affecting mood and behaviour. It is likely that respondents meeting criteria for summer SAD represent the extreme end of a spectrum of summer-related mood and behaviour change that affects many individuals in northern Australia. Strategies for further clinical and epidemiological research on SAD in tropical climates are proposed.