Evaluation of the Global Pattern of Cancer Survival and the Correlation With Healthcare Expenditures

Background: Cancer is a global health burden; the outcome varies widely across all countries. Sharing of experience in setting health policy (including health expenditure) is important. However, there is yet no comprehensive comparison of cancer outcome across all countries. Furthermore, comparison of cost-effectiveness of different systems is especially complex because the incidence of different cancers varies across countries, and their chances of curability differ substantially. Aim: We aims to provide the comparisons using available data and to stimulate global attention to the association of economic parameters with different outcomes. Methods: Cancer statistics from all 184 countries and 27 major cancers listed in GLOBOCAN 2012 were analyzed. The overall outcome of cancer patients was estimated by taking the complement of age-standardized mortality/incidence ratio [1 − (ASM/ASI)] as the proxy relative survival (RS). Taking into account the variation of country-specific cancer pattern, the proxy cancer site-standardized RS (SS-RS) of individual countries were calculated by weighting the proportion of specific cancer sites as compared with the global pattern of incidence. The overall economic parameters of different countries listed by the World Bank were correlated with the corresponding proxy SS-RS. Results: The unadjusted proxy RS among the 184 countries ranged from 0.111 to 0.702 (median = 0.386), the corresponding proxy SS-RS ranged from 0.124 to 0.622 (median = 0.359). The median total health expenditure per capita (HE) increased from US$37 for countries with proxy SS-RS < 0.2, to $4255 for countries with proxy SS-RS ≥ 0.5. Results from logarithmic regression model showed exponential increase in total HE for better outcome. The expenditure varied widely among different strata, but the widest difference was observed among countries with SS-RS ≥ 0.5 (with total HE ranging from US$962 to $9361). Conclusion: Similar to age-standardization, estimation of outcome with adjustment for variation in pattern of cancer incidence is suggested for comparison among different countries, especially for studies related to assessment of health systems. Cancer outcome correlated significantly with economic parameters; the amount of HE escalated exponentially and varied widely among countries with high SS-RS ≥ 0.5. Sharing of experience among different countries will be valuable for developing the most cost-effective health system.

mTOR-dependent phosphorylation controls TFEB nuclear export

During starvation the transcriptional activation of catabolic processes is induced by the nuclear translocation and consequent activation of transcription factor EB (TFEB), a master modulator of autophagy and lysosomal biogenesis. However, how TFEB is inactivated upon nutrient refeeding is currently unknown. Here we show that TFEB subcellular localization is dynamically controlled by its continuous shuttling between the cytosol and the nucleus, with the nuclear export representing a limiting step. TFEB nuclear export is mediated by CRM1 and is modulated by nutrient availability via mTOR-dependent hierarchical multisite phosphorylation of serines S142 and S138, which are localized in proximity of a nuclear export signal (NES). Our data on TFEB nucleo-cytoplasmic shuttling suggest an unpredicted role of mTOR in nuclear export.

Single-Cell, Time-Lapse Reactive Oxygen Species Detection in E. coli

Detection of reactive oxygen species (ROS) in bacteria has been limited to bulk biochemical assays. Although they are powerful and quantitative tools to understand the overall production of ROS in E. coli, such assays provide limited spatial and temporal information when correlating cellular phenotype with perturbations such as antibiotics or other treatments. We have developed single-cell, time-lapse assays to detect ROS in live E. coli. The assays utilize flow systems on a fluorescence microscope to correlate symptoms aroused from biological or chemical perturbations with the in situ detection of ROS. ROS is detected by fluorogenic dyes that accumulate inside the cell, allowing detection of ROS in single cells in both homogeneous and heterogeneous samples using CellROX Green and Amplex® Red/APEX2. © 2018 by John Wiley & Sons, Inc.

Incidence of psoriasiform diseases secondary to tumour necrosis factor antagonists in patients with inflammatory bowel disease: a nationwide population-based cohort study

BACKGROUND

There are increasing reports of paradoxical psoriasiform diseases secondary to anti-tumour necrosis factor (TNF) agents.

AIMS

To determine the risks of paradoxical psoriasiform diseases secondary to anti-TNF agents in patients with inflammatory bowel disease (IBD).

METHODS

A nationwide population study was performed using the Korea National Health Insurance Claim Data. A total of 50 502 patients with IBD were identified between 2007 and 2016. We compared 5428 patients who were treated with any anti-TNF agent for more than 6 months (anti-TNF group) and 10 856 matched controls who had never taken anti-TNF agents (control group).

RESULTS

Incidence of psoriasis was significantly higher in the anti-TNF group (36.8 per 10 000 person-years) compared to the control group (14.5 per 10 000 person-years) (hazard ratio [HR] 2.357, 95% confidence interval [CI] 1.668-3.331). Palmoplantar pustulosis (HR 9.355, 95% CI 2.754-31.780) and psoriatic arthritis (HR 2.926, 95% CI 1.640-5.218) also showed higher risks in the anti-TNF group. In subgroup analyses, HRs for psoriasis by IBD subtype were 2.549 (95% CI 1.658-3.920) in Crohn's disease and 2.105 (95% CI 1.155-3.836) in ulcerative colitis. Interestingly, men and younger (10-39 years) patients have significantly higher risks of palmoplantar pustulosis (HR 19.682 [95% CI 3.867-100.169] and HR 14.318 [95% CI 2.915-70.315], respectively), whereas women and older (≥40 years) patients showed similar rates between the two groups.

CONCLUSIONS

The risks of psoriasiform diseases are increased by anti-TNF agents in patients with IBD. Among psoriasiform diseases, the risk of palmoplantar pustulosis shows the biggest increase particularly in male and younger patients.

Depression and risk of tuberculosis: a nationwide population-based cohort study

BACKGROUND

Studies on the association between depression and risk of tuberculosis (TB) are lacking.

OBJECTIVE

To determine the association between depression and risk of TB.

METHODS

From a nationwide database, patients with depression were identified to form the exposure cohort between 2003 and 2013. The control cohort comprised an equivalent number of subjects without any mood disorders, with each subject age- and sex-matched to a patient in the exposure cohort. The incidence of TB was identified in the exposure cohort and control cohort between 2003 and 2013. A multivariable Cox proportional hazards model was used to estimate the association between depression and the subsequent risk of TB.

RESULTS

A total of 32 372 patients with depression and the same number of controls were identified. The risk of TB in the depression cohort was 2.63-fold (95%CI 1.74-3.96) higher than in the control cohort. When the depression was classified as 'mild' and 'severe', the risk of TB was proportional to depression severity.

CONCLUSIONS

Patients with depression are at a higher risk for TB, and a dose-response relationship exists between depression and the subsequent risk of TB.

Effect of short-term intensive insulin therapy on the incretin response in early type 2 diabetes

AIMS

Short-term intensive insulin therapy (IIT) and gastric bypass surgery are both interventions that can improve beta-cell function, reduce insulin resistance and induce remission of type 2 diabetes. Whereas gastric bypass yields an enhanced glucagon-like peptide-1 (GLP-1) response that may contribute to its metabolic benefits, the effect of short-term IIT on the incretin response is unclear. Thus, we sought to evaluate the impact of IIT on GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) secretion in early type 2 diabetes.

METHODS

In this study, 63 patients (age 59±8.3 years, baseline A1c 6.8±0.7%, diabetes duration 3.0±2.1 years) underwent 4 weeks of IIT (basal insulin detemir and pre-meal insulin aspart). GLP-1, GIP and glucagon responses were assessed by the area-under-the-curve (AUC) of these hormones on oral glucose tolerance tests at baseline and 1-day after the completion of therapy. Beta-cell function was assessed by Insulin Secretion-Sensitivity Index-2 (ISSI-2), with insulin resistance measured by Homeostasis Model Assessment (HOMA-IR).

RESULTS

As expected, comparing the post-therapy oral glucose tolerance test to that at baseline, IIT increased ISSI-2 (P=0.02), decreased HOMA-IR (P<0.001), and reduced AUC_glucagon (P<0.001). Of note, however, IIT had no significant impact on AUC_GLP-1 (P=0.24) and reduced AUC_GIP (P=0.02).

CONCLUSION

Despite improving beta-cell function, insulin resistance and glucagonemia, short-term IIT does not change GLP-1 secretion and decreases the GIP response to an oral glucose challenge in early type 2 diabetes. Thus, the beneficial impact of this therapy on glucose homeostasis is not attributable to its effects on incretin secretion.

The impact of social conditions on patient adherence to pulmonary tuberculosis treatment

SETTING

Tuberculosis (TB) remains one of the main concerns in global health. One of the main threats to treatment success is patient non-adherence to anti-tuberculosis treatment.

OBJECTIVE

To identify the relation between social conditions and treatment adherence in a prospective cohort setting in an intermediate TB burden country.

DESIGN

To identify associations between poor adherence and social conditions, including educational level, type of residence and occupation, we constructed hierarchical logistic regression models.

RESULTS

A total of 551 participants were included in the study. Low educational levels, poor housing and occupations in the construction and manufacturing industries and service sectors were associated with poor adherence; this association was likely to be differentiated by previous history of anti-tuberculosis treatment.

CONCLUSION

Policy making should focus on improving the social conditions of patients by working towards better housing conditions and providing health promoting working conditions to enable treatment adherence.