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Ludvigsson J, von Herrath MG, Mallone R, Buschard K, Cilio C, Craig M, Ilonen J, Leslie D, McGeoch JEM, Schneider D, Skyler JS, Flodström Tullberg M, Hober D. Corona Pandemic: Assisted Isolation and Care to Protect Vulnerable Populations May Allow Us to Shorten the Universal Lock-Down and Gradually Re-open Society. Front Public Health 2020; 8:562901. [PMID: 33102423 PMCID: PMC7555689 DOI: 10.3389/fpubh.2020.562901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/09/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Johnny Ludvigsson
- Department of Biomedical and Clinical Sciences, Crown Princess Victoria Children's Hospital and Division of Pediatrics, Linköping University, Linköping, Sweden
| | | | - Roberto Mallone
- Université de Paris, Institut Cochin, CNRS, INSERM; Assistance Publique Hôpitaux de Paris, Hôpitaux Universitaires de Paris Centre-Université de Paris, Cochin Hospital, Service de Diabétologie et Immunologie Clinique, Paris, France
| | | | - Corrado Cilio
- ImmunoVirology Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Maria Craig
- Children's Hospital at Westmead and University of Sydney, Sydney, NSW, Australia
| | - Jorma Ilonen
- Immunogenetics Laboratory, Institute of Biomedicine, University of Turku, Turku, Finland
| | - David Leslie
- Blizard Institute, Queen Mary, University of London, Whitechapel, United Kingdom
| | - Julie E M McGeoch
- Department of Molecular and Cellular Biology, Harvard University, Cambridge, MA, United States
| | - Darius Schneider
- La Jolla Institute for Allergy and Immunology, La Jolla, CA, United States
| | - Jay S Skyler
- Department of Medicine, Diabetes Research Institute, University of Miami, Miami, FL, United States
| | - Malin Flodström Tullberg
- Department of Medicine Huddinge, The Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Didier Hober
- Université de Lille, CHU Lille, Laboratoire de Virologie-ULR3610, Lille, France
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52
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Kirana C, Smith E, Ngo DT, Trochsler MI, Hewett PJ, Stubbs RS, Hardingham JE, Maddern GJ, Hauben E. High preoperative levels of circulating SFRP5 predict better prognosis in colorectal cancer patients. Future Oncol 2020; 16:2499-2509. [PMID: 33048585 DOI: 10.2217/fon-2020-0356] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The purpose of this research was to investigate the diagnostic and prognostic value of circulating SFRP5 (cSFRP5) in colorectal cancer (CRC). We evaluated preoperative cSFRP5 levels in CRC patients and controls (n = 208). We found significantly higher cSFRP5 levels in CRC patients compared with non-CRC controls (p < 0.001). Levels of cSFRP5 were significantly lower in CRC patients with either vascular invasion (p = 0.001) or liver metastasis (p = 0.016). High cSFRP5 levels were associated with longer disease-free survival in both univariate (p = 0.024) and multivariate (p = 0.015) analyses. Analysis of an independent tissue cohort from The Cancer Genome Atlas database revealed significantly lower SFRP5 RNA expression in CRC tumor tissue compared with adjacent normal mucosa (n = 590 vs 47; p < 0.0001). Our findings confirm the role of cSFRP5 as a physiologic tumor suppressor and demonstrate its potential diagnostic and prognostic value in CRC.
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Affiliation(s)
- Chandra Kirana
- Liver Metastasis Research Group, Discipline of Surgery, The University of Adelaide, The Basil Hetzel Institute for Translational Health Research, Woodville South, South Australia, 5011, Australia.,Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, 5011, Australia
| | - Eric Smith
- Solid Tumour Group, The Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville South, South Australia, 5011, Australia.,Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, 5005, Australia
| | - Doan T Ngo
- School of Biomedical Sciences & Pharmacy, University of Newcastle, New South Wales, 2308, Australia
| | - Markus I Trochsler
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, 5011, Australia
| | - Peter J Hewett
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, 5011, Australia
| | - Richard S Stubbs
- The Wakefield Clinic for Gastrointestinal Diseases, Wellington, 6242, New Zealand
| | - Jennifer E Hardingham
- Solid Tumour Group, The Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville South, South Australia, 5011, Australia.,Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, 5005, Australia
| | - Guy J Maddern
- Liver Metastasis Research Group, Discipline of Surgery, The University of Adelaide, The Basil Hetzel Institute for Translational Health Research, Woodville South, South Australia, 5011, Australia.,Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, 5011, Australia
| | - Ehud Hauben
- Liver Metastasis Research Group, Discipline of Surgery, The University of Adelaide, The Basil Hetzel Institute for Translational Health Research, Woodville South, South Australia, 5011, Australia.,Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, 5011, Australia
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53
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Lu PW, Shabat G, Semeniv S, Fedorkiv M, Fields AC, Lyu HG, Beznosenko A, Davids JS, Melnitchouk N. The Current Landscape of Staging and Treatment of Colorectal Cancer in a Region of Ukraine: a Mixed Methods Study. World J Surg 2020; 45:313-319. [PMID: 32978664 DOI: 10.1007/s00268-020-05796-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND In Ukraine, the 1-year mortality for colorectal cancer is much higher than that seen in high-income countries. We investigated practice patterns of colorectal cancer treatment in a region of Ukraine to account for high mortality rates. METHODS An explanatory sequential mixed methods design was used. Data from patients who underwent surgery for colorectal cancer in Ivano-Frankivsk from 2011 to 2015 were collected via retrospective chart review, and descriptive statistics were calculated. Semi-structured interviews were performed with local practicing surgeons and oncologists until thematic saturation was reached. RESULTS A total of 960 patients who underwent surgery were identified in the Ivano-Frankivsk region with colon (689) or rectal (271) cancer. 11.7% of patients underwent preoperative CT of the abdomen and pelvis, and only 1.7% underwent CT of the chest. 4.1% of patients underwent a complete preoperative colonoscopy, while 31.0% had incomplete colonoscopies. Postoperatively, 31.1% of patients with stage II colon cancer and 43.9% of patients with stage III colon cancer underwent adjuvant chemotherapy. For patients with stage II and III rectal cancers, 20.9% and 33.3% underwent chemotherapy, while 68.4% and 66.7% underwent radiation therapy, respectively. Fifteen physicians completed interviews. Two major themes emerged regarding physician perceptions on providing colorectal cancer care: lack of resources and systems level issues negatively impacting patient care. CONCLUSION In this region in Ukraine, staging practices for colorectal malignancies are inconsistent and inadequate, and adjuvant treatments are varied. This is likely attributable to the lack of resources facing providers and the prohibitively high cost of care to patients.
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Affiliation(s)
- Pamela W Lu
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Galyna Shabat
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Surgery, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Solomiia Semeniv
- National Children's Specialized Hospital "Ohmatdyt", Kyiv, Ukraine
| | - Maryana Fedorkiv
- Department of Surgery, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Adam C Fields
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Heather G Lyu
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Andriy Beznosenko
- Department of Oncocoloproctology, National Cancer Institute, Kyiv, Ukraine
| | - Jennifer S Davids
- Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - Nelya Melnitchouk
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. .,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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54
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Abstract
Ion channels and transporters (ICT) play important roles in almost all basic cellular processes. During last decades, abundant evidences have been provided that ICT (e.g., Ca2+ and K+ channels) are notable for regulating physiological pancreatic duct cellular function and deregulation of ICT is closely associated with the widely accepted hallmarks of pancreatic ductal adenocarcinoma (PDAC) such as proliferation, apoptosis resistance, invasion, and metastasis. Hence this review focuses on the role of ICT malfunctions in context with the hallmarks of PDAC. After briefly introducing epidemiology and history of molecular oncology of PDAC and summarizing the recent studies on molecular classification systems, we focus then on the exocrine pancreas as a very active secretory gland which considerably impacts the changes in the ion transport system (the transportome) upon malignant transformation. We highlight multiplicity of ICT members (H+ transporters, Ca2+, K+, Na+ and Cl- channels) and their functional impact in PDAC. We also present some selective therapeutic options to interfere with transportome functions and thereby with key mechanisms of malignant progression. This will hopefully contribute to a better clinical outcome based on improved therapeutic strategies for this still extremely deadly disease.
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55
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Adnan H, Adnan SM, Deng K, Yang C, Zhao W, Li K. Variation in insurance-mortality relationship amid macroeconomic shifts: a study of SEER female-specific cancer patients in USA. Public Health 2020; 185:130-138. [DOI: 10.1016/j.puhe.2020.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/05/2020] [Accepted: 03/12/2020] [Indexed: 12/25/2022]
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56
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Affiliation(s)
- Bogda Koczwara
- Flinders Medical Centre, Adelaide, SA.,Flinders University, Adelaide, SA
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57
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Sachs E, Jackson V, Sartipy U. Household disposable income and long-term survival after pulmonary resections for lung cancer. Thorax 2020; 75:764-770. [PMID: 32564001 PMCID: PMC7476259 DOI: 10.1136/thoraxjnl-2019-214321] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 04/27/2020] [Accepted: 05/11/2020] [Indexed: 12/25/2022]
Abstract
Introduction Socioeconomic disparities have been linked to survival differences in patients with lung cancer. Swedish healthcare is tax-funded and provides equal access to care, therefore, survival following lung cancer surgery should be unrelated to household income. The aim of this study was to investigate the association between household disposable income and survival following surgery for lung cancer in Sweden. Methods We conducted a nationwide population-based cohort study including all patients who underwent pulmonary resections for lung cancer in Sweden 2008–2017. Individual-level record linkages between national quality and health-data registers were performed to acquire information regarding socioeconomic status and medical history. Cox regression by quintiles of household disposable income was used to estimate the adjusted risk for all-cause mortality. Results We included 5500 patients and the age-adjusted and sex-adjusted incidence rate of death per 100 person-years was 15 and 9.4 in the lowest and highest income quintile, respectively (mean follow-up time 3.2 years). Deprived patients were older, had more comorbidities and were less likely to have preoperative positron emission tomography or minimally invasive surgery, compared with patients with higher income. The adjusted HR for death was 0.77 (95% CI: 0.62 to 0.96) for the highest income quintile compared with the lowest. Conclusions We found an association between household disposable income and survival in patients who underwent surgery for lung cancer in Sweden, despite tax-funded universal health coverage. The association remained after adjustment for differences in baseline characteristics.
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Affiliation(s)
- Erik Sachs
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Veronica Jackson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Ulrik Sartipy
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
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58
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Raymond E, Thieblemont C, Alran S, Faivre S. Impact of the COVID-19 Outbreak on the Management of Patients with Cancer. Target Oncol 2020; 15:249-259. [PMID: 32445083 PMCID: PMC7243433 DOI: 10.1007/s11523-020-00721-1] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The coronavirus SARS-CoV-2 (COVID-19) outbreak is having a profound impact on the management of patients with cancer. In this review, we comprehensively investigate the various aspects of cancer care during the pandemic, taking advantage of data generated in Asia and Europe at the frontline of the COVID-19 pandemic spread. Cancer wards have been subjected to several modifications to protect patients and healthcare professionals from COVID-19 infection, while attempting to maintain cancer diagnosis, therapy, and research. In this setting, the management of COVID-19 infected patients with cancer is particularly challenging. We also discuss the direct and potential remote impacts of the global pandemic on the mortality of patients with cancer. As such, the indirect impact of the pandemic on the global economy and the potential consequences in terms of cancer mortality are discussed. As the infection is spreading worldwide, we are obtaining more knowledge on the COVID-19 pandemic consequences that are currently impacting and may continue to further challenge cancer care in several countries.
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Affiliation(s)
- Eric Raymond
- Department of Medical Oncology, Paris Saint-Joseph Hospital Group, 185 rue Raymond Losserand, 75014, Paris, France.
| | | | - Severine Alran
- Department of Gynecological and Mammary Surgery, Paris Saint-Joseph Hospital Group, Paris, France
| | - Sandrine Faivre
- Medical Oncology, Saint-Louis Hospital, AP-HP, Paris 7 University, Paris, France
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59
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Jia Z, Zhou W, Zhang G, Fu J, Li D, Ren L. CYP3A4 genetic variants are associated with susceptibility of non-small cell lung cancer in a Shaanxi Han population. Genomics 2020; 112:3465-3472. [PMID: 32464168 DOI: 10.1016/j.ygeno.2020.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/06/2020] [Accepted: 05/24/2020] [Indexed: 11/15/2022]
Abstract
PURPOSE Lung cancer (LC) is one of the fastest-growing malignant tumors in the world in terms of morbidity and mortality. CYP3A4 plays a crucial role in the occurrence of LC. Little is known about the contribution of CYP3A4 polymorphisms for non-small cell lung cancer (NSCLC) risk. This study aimed to explore the correlation of CYP3A4 genetic variants (rs3735451, rs4646440, rs35564277, and rs4646437) with NSCLC risk. METHODS Four single nucleotide polymorphisms (SNPs) were genotyped by Agena MassARRAY in this case-control study (507 NSCLC patients and 505 controls) among a Shaanxi Han population. Hardy-Weinberg equilibrium (HWE) of each SNP in controls was evaluated by exact test. The association of CYP3A4 polymorphisms with NSCLC risk was explored by calculating odds ratios (OR) and 95% confidence intervals (CI) using logistic regression analysis with adjustment for age and gender. RESULTS Our research revealed that rs4646440 was significantly associated with an increased risk of NSCLC (OR 2.64, p = .005), while rs4646437 played a protective role in NSCLC risk (OR 0.48, p = 4.00 × 10-7). Stratified analyses indicated that rs4646440 significantly enhanced the susceptibility of NSCLC in BMI > 24 kg/m2, non-smokers and non-drinkers (OR 14.29, p = .012; OR 1.56, p = .023; OR 1.67, p = .031, respectively). Besides, we observed that rs3735451 exhibited an increased risk of NSCLC in BMI > 24 kg/m2 (OR 2.47, p = .030), whereas rs4646437 had a reduced risk of NSCLC in BMI ≤ 24 kg/m2 (OR 0.47, p = 5.17 × 10-5). We also found that rs35564277 was considered as a protective factor of NSCLC in non-smokers (OR 0.50, p = .032). CONCLUSION Our study indicated that CYP3A4 genetic variants were associated with NSCLC susceptibility in a Shaanxi Han population.
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Affiliation(s)
- Zhuoqi Jia
- Department of Thoracic Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Weiru Zhou
- Department of Nuclear Medicine, Xi'an Gaoxin Hospital, Xi'an 710075, Shaanxi, China
| | - Guangjian Zhang
- Department of Thoracic Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Junke Fu
- Department of Thoracic Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Daxu Li
- Department of Stomatology, the First Affiliated Hospital, Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China.
| | - Le Ren
- Department of Stomatology, the First Affiliated Hospital, Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China.
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60
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Watkins J, Wulaningsih W. Three further ways that the COVID-19 pandemic will affect health outcomes. Int J Public Health 2020; 65:519-520. [PMID: 32372270 PMCID: PMC7199867 DOI: 10.1007/s00038-020-01383-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 04/15/2020] [Accepted: 04/27/2020] [Indexed: 12/01/2022] Open
Affiliation(s)
- Johnathan Watkins
- PILAR Research and Education, International House, 24 Holborn Viaduct, London, EC1A 2BN UK
| | - Wahyu Wulaningsih
- PILAR Research and Education, International House, 24 Holborn Viaduct, London, EC1A 2BN UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
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61
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Baddour K, Kudrick LD, Neopaney A, Sabik LM, Peddada SD, Nilsen ML, Johnson JT, Ferris RL, Mady LJ. Potential impact of the COVID-19 pandemic on financial toxicity in cancer survivors. Head Neck 2020; 42:1332-1338. [PMID: 32329924 PMCID: PMC7264615 DOI: 10.1002/hed.26187] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/13/2020] [Indexed: 12/15/2022] Open
Abstract
Background In the context of COVID‐19, cancer survivors represent a particularly vulnerable population that may be “doubly hit” by both costs of cancer treatment and financial strain imposed by the pandemic. Methods We performed a review of the literature pertaining to cancer, financial toxicity, and economic challenges. Results Multiple societies have put forth recommendations to modify delivery of cancer care in order to minimize patient exposure to the virus. Cancer survivors, especially patients with head and neck cancer, have been disproportionately affected by rising unemployment levels and economic recessions in the past, both of which are linked to higher cancer mortality. Patients who rely on employer‐provided insurance and do not qualify for Medicaid may lose access to life‐saving treatments. Conclusions It is essential to implement interventions and policy changes in order to mitigate the effects of this pandemic but also to ensure this becomes a nonissue during the next one.
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Affiliation(s)
- Khalil Baddour
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Lauren D Kudrick
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Department of Medicine, Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Aakriti Neopaney
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Lindsay M Sabik
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA.,University of Pittsburgh Health Policy Institute, Pittsburgh, Pennsylvania, USA.,UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Shyamal D Peddada
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Marci L Nilsen
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
| | - Jonas T Johnson
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Robert L Ferris
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Leila J Mady
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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62
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Pisani P, Airoldi M, Allais A, Aluffi Valletti P, Battista M, Benazzo M, Briatore R, Cacciola S, Cocuzza S, Colombo A, Conti B, Costanzo A, della Vecchia L, Denaro N, Fantozzi C, Galizia D, Garzaro M, Genta I, Iasi GA, Krengli M, Landolfo V, Lanza GV, Magnano M, Mancuso M, Maroldi R, Masini L, Merlano MC, Piemonte M, Pisani S, Prina-Mello A, Prioglio L, Rugiu MG, Scasso F, Serra A, Valente G, Zannetti M, Zigliani A. Metastatic disease in head & neck oncology. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2020; 40:S1-S86. [PMID: 32469009 PMCID: PMC7263073 DOI: 10.14639/0392-100x-suppl.1-40-2020] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The head and neck district represents one of the most frequent sites of cancer, and the percentage of metastases is very high in both loco-regional and distant areas. Prognosis refers to several factors: a) stage of disease; b) loco-regional relapses; c) distant metastasis. At diagnosis, distant metastases of head and neck cancers are present in about 10% of cases with an additional 20-30% developing metastases during the course of their disease. Diagnosis of distant metastases is associated with unfavorable prognosis, with a median survival of about 10 months. The aim of the present review is to provide an update on distant metastasis in head and neck oncology. Recent achievements in molecular profiling, interaction between neoplastic tissue and the tumor microenvironment, oligometastatic disease concepts, and the role of immunotherapy have all deeply changed the therapeutic approach and disease control. Firstly, we approach topics such as natural history, epidemiology of distant metastases and relevant pathological and radiological aspects. Focus is then placed on the most relevant clinical aspects; particular attention is reserved to tumours with distant metastasis and positive for EBV and HPV, and the oligometastatic concept. A substantial part of the review is dedicated to different therapeutic approaches. We highlight the role of immunotherapy and the potential effects of innovative technologies. Lastly, we present ethical and clinical perspectives related to frailty in oncological patients and emerging difficulties in sustainable socio-economical governance.
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Affiliation(s)
- Paolo Pisani
- ENT Unit, ASL AT, “Cardinal Massaja” Hospital, Asti, Italy
| | - Mario Airoldi
- Medical Oncology, Città della Salute e della Scienza, Torino, Italy
| | | | - Paolo Aluffi Valletti
- SCDU Otorinolaringoiatria, AOU Maggiore della Carità di Novara, Università del Piemonte Orientale, Italy
| | | | - Marco Benazzo
- SC Otorinolaringoiatria, Fondazione IRCCS Policlinico “S. Matteo”, Università di Pavia, Italy
| | | | | | - Salvatore Cocuzza
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, Italy
| | - Andrea Colombo
- ENT Unit, ASL AT, “Cardinal Massaja” Hospital, Asti, Italy
| | - Bice Conti
- Department of Drug Sciences, University of Pavia, Italy
- Polymerix S.r.L., Pavia, Italy
| | | | - Laura della Vecchia
- Unit of Otorhinolaryngology General Hospital “Macchi”, ASST dei Settelaghi, Varese, Italy
| | - Nerina Denaro
- Oncology Department A.O.S. Croce & Carle, Cuneo, Italy
| | | | - Danilo Galizia
- Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo,Italy
| | - Massimiliano Garzaro
- SCDU Otorinolaringoiatria, AOU Maggiore della Carità di Novara, Università del Piemonte Orientale, Italy
| | - Ida Genta
- Department of Drug Sciences, University of Pavia, Italy
- Polymerix S.r.L., Pavia, Italy
| | | | - Marco Krengli
- Dipartimento Medico Specialistico ed Oncologico, SC Radioterapia Oncologica, AOU Maggiore della Carità, Novara, Italy
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Novara, Italy
| | | | - Giovanni Vittorio Lanza
- S.O.C. Chirurgia Toracica, Azienda Ospedaliera Nazionale “SS. Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | | | - Maurizio Mancuso
- S.O.C. Chirurgia Toracica, Azienda Ospedaliera Nazionale “SS. Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | - Roberto Maroldi
- Department of Radiology, University of Brescia, ASST Spedali Civili Brescia, Italy
| | - Laura Masini
- Dipartimento Medico Specialistico ed Oncologico, SC Radioterapia Oncologica, AOU Maggiore della Carità, Novara, Italy
| | - Marco Carlo Merlano
- Oncology Department A.O.S. Croce & Carle, Cuneo, Italy
- Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo,Italy
| | - Marco Piemonte
- ENT Unit, University Hospital “Santa Maria della Misericordia”, Udine, Italy
| | - Silvia Pisani
- Immunology and Transplantation Laboratory Fondazione IRCCS Policlinico “S. Matteo”, Pavia, Italy
| | - Adriele Prina-Mello
- LBCAM, Department of Clinical Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin 8, Ireland
- Centre for Research on Adaptive Nanostructures and Nanodevices (CRANN), Trinity College Dublin, Dublin 2, Ireland
| | - Luca Prioglio
- Department of Otorhinolaryngology, ASL 3 “Genovese”, “Padre Antero Micone” Hospital, Genoa, Italy
| | | | - Felice Scasso
- Department of Otorhinolaryngology, ASL 3 “Genovese”, “Padre Antero Micone” Hospital, Genoa, Italy
| | - Agostino Serra
- University of Catania, Italy
- G.B. Morgagni Foundation, Catania, Italy
| | - Guido Valente
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Novara, Italy
| | - Micol Zannetti
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Novara, Italy
| | - Angelo Zigliani
- Department of Radiology, University of Brescia, ASST Spedali Civili Brescia, Italy
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Abstract
The Nutrition Society's 1st Annual Nutrition and Cancer Networking Conference brought together scientists from the fields of Nutrition, Epidemiology, Public Health, Medical Oncology and Surgery with representatives of the public, cancer survivors and cancer charities. Speakers representing these different groups presented the challenges to collaboration, how the needs of patients and the public can be met, and the most promising routes for future research. The conference programme promoted debate on these issues to highlight current gaps in understanding and barriers to generating and implementing evidence-based nutrition advice. The main conclusions were that the fundamental biology of how nutrition influences the complex cancer risk profiles of diverse populations needs to be better understood. Individual and population level genetics interact with the environment over a lifespan to dictate cancer risk. Large charities and government have a role to play in diminishing our current potently obesogenic environment and exploiting nutrition to reduce cancer deaths. Understanding how best to communicate, advise and support individuals wishing to make dietary and lifestyle changes, can reduce cancer risk, enhance recovery and improve the lives of those living with and beyond cancer.
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64
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Lomia N, Berdzuli N, Pestvenidze E, Sturua L, Sharashidze N, Kereselidze M, Topuridze M, Antelava T, Stray-Pedersen B, Stray-Pedersen A. Socio-Demographic Determinants of Mortality from Chronic Noncommunicable Diseases in Women of Reproductive Age in the Republic of Georgia: Evidence from the National Reproductive Age Mortality Study (2014). Int J Womens Health 2020; 12:89-105. [PMID: 32161506 PMCID: PMC7051896 DOI: 10.2147/ijwh.s235755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/27/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Worldwide, noncommunicable diseases (NCDs) are the leading cause of premature death of women, taking the highest toll in developing countries. This study aimed to identify key socio-demographic determinants of NCD mortality in reproductive-aged women (15-49 years) in Georgia. Materials and Methods The study employed the verbal autopsy data from the second National Reproductive Age Mortality Survey 2014. Univariate and multivariate logistic regression models were fitted to explore the association between each risk factor and NCD mortality, measured by crude and adjusted odds ratio (AOR) with respective 95% confidence intervals (95% CI). Results In the final sample of 843 women, 586 (69.5%) deaths were attributed to NCDs, the majority of which occurred outside a hospital (72.7%) and among women aged 45-49 years (46.8%), ethnic Georgians (85.2%), urban residents (60.1%), those being married (60.6%), unemployed (75.1%) or having secondary and higher education (69.5%), but with nearly equal distribution across the wealth quintiles. After multivariate adjustment, the odds of dying from NCDs were significantly higher in women aged 45-49 years (AOR=17.69, 95% CI= 9.35 to 33.50), those being least educated (AOR=1.55, 95% CI= 1.01 to 2.37) and unemployed (AOR=1.47, 95% CI= 1.01 to 2.14) compared, respectively, to their youngest (15-24 years), more educated and employed counterparts. Strikingly, the adjusted odds were significantly lower in "other" ethnic minorities (AOR=0.29, 95% CI= 0.14 to 0.61) relative to ethnic Georgians. Contrariwise, there were no significant associations between NCD mortality and women's marital or wealth status, place of residence (rural/urban) or place of death. Conclusion Age, ethnicity, education, and employment were found to be strong independent predictors of young women's NCD mortality in Georgia. Further research on root causes of inequalities in mortality across the socioeconomic spectrum is warranted to inform equity- and life course-based multisectoral, integrated policy responses that would be conducive to enhancing women's survival during and beyond reproduction.
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Affiliation(s)
- Nino Lomia
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nino Berdzuli
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ekaterine Pestvenidze
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lela Sturua
- Department of Noncommunicable Diseases, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Nino Sharashidze
- Department of Clinical and Research Skills, Faculty of Medicine, Iv. Javakhishvili Tbilisi State University, Tbilisi, Georgia
| | - Maia Kereselidze
- Department of Medical Statistics, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Marina Topuridze
- Health Promotion Division, Department of Noncommunicable Diseases, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | | | - Babill Stray-Pedersen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Obstetrics and Gynecology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Arne Stray-Pedersen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
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Adnan H, Adnan SM, Deng K, Yang C, Hou Y, Ngo Nkondjock VR, Li K. Macroeconomic environment and insurance-mortality relationship: An analysis of gender-based disparity among non-elderly adult patients of melanoma and lung cancer. Eur J Cancer Care (Engl) 2020; 29:e13229. [PMID: 32011788 DOI: 10.1111/ecc.13229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 12/23/2019] [Accepted: 01/13/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Cancer patients exhibit disparity in mortality risks across demographic divisions as well as insurance groups. The effects of macroeconomic environment also vary for such strata. This study analyses the gaps between mortality risks for male and female cancer patients with and without insurance and examines how such gaps transform over time with macroeconomic shifts. METHODS Demographic, clinical and treatment records of 45,750 melanoma and 91,157 lung cancer patients diagnosed in 2007-2009 and 2011-2013 were extracted from Surveillance, Epidemiology and End Results (SEER) database. Kaplan-Meier test was applied to ascertain survival probability of each insurance group, while Cox proportional hazard model was used to assess relative mortality risk for Medicaid and uninsured patients, for the whole data as well as separately for both time periods and genders. RESULTS Both the hazard ratios and change thereof over time are greater for female patients without insurance, than for male patients. More than any insurance-gender subgroup, uninsured female patients of melanoma have much increased hazard ratios, from 1.41 [95% confidence interval (CI), 1.04-1.92] to 2.22 [95% CI, 1.67-2.94]. CONCLUSION Despite diagnostic improvements and technology advancements, the adverse effects of macroeconomic crisis are associated with increased relative mortality risks for cancer patients without insurance, more for women than men.
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Affiliation(s)
- Humara Adnan
- Harbin Medical University, Harbin, China.,COMSATS University Islamabad, Islamabad, Pakistan
| | | | - Kui Deng
- Harbin Medical University, Harbin, China
| | | | - Yan Hou
- Harbin Medical University, Harbin, China
| | | | - Kang Li
- Harbin Medical University, Harbin, China
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Phillips CM, Parmar A, Guo H, Schwartz D, Isaranuwatchai W, Beca J, Dai W, Arias J, Gavura S, Chan KKW. Assessing the efficacy-effectiveness gap for cancer therapies: A comparison of overall survival and toxicity between clinical trial and population-based, real-world data for contemporary parenteral cancer therapeutics. Cancer 2020; 126:1717-1726. [PMID: 31913522 DOI: 10.1002/cncr.32697] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/29/2019] [Accepted: 12/09/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although increasing evidence has suggested that an efficacy-effectiveness gap exists between clinical trial (CT) and real-world evidence (RWE), to the authors' knowledge, the magnitude of this difference remains undercharacterized. The objective of the current study was to quantify the magnitude of survival and toxicity differences between CT and RWE for contemporary cancer systemic therapies. METHODS Patients receiving cancer therapies funded under Cancer Care Ontario's New Drug Funding Program (NDFP) were identified. Landmark CTs with data regarding survival and adverse events (AEs) for each drug indication were identified. RWE for survival and hospitalization rates during treatment were ascertained through Canadian population-based databases. The efficacy-effectiveness gap for each drug indication was calculated as the difference between RWE and CT data for median overall survival (OS), 1-year OS, and generated hazard ratios (HRs) with 95% CIs from Kaplan-Meier OS curves. Toxicity differences were calculated as the difference between RWE of hospitalization rates and CT serious AE rates. RESULTS Twenty-nine indications from 20 systemic therapies were included. Twenty-eight of 29 indications (97%) demonstrated worse survival in RWE, with a median OS difference of 5.2 months (interquartile range, 3.0-12.1 months). Lower effectiveness in RWE also was demonstrated through a meta-analysis of an OS hazard ratio of 1.58 (95% CI, 1.39-1.80). The median difference between RWE for hospitalization rates and CT serious AEs was 14% (95% CI, 9%-22%). CONCLUSIONS An efficacy-effectiveness gap exists for contemporary cancer systemic therapies, with a 5.2-month lower median OS observed in RWE compared with CT data. These data supports the use of RWE to better inform real-world decision making regarding the use of cancer systemic therapies.
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Affiliation(s)
- Cameron M Phillips
- Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ambica Parmar
- Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Helen Guo
- Cancer Care Ontario, Toronto, Ontario, Canada
| | | | - Wanrudee Isaranuwatchai
- Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada
| | - Jaclyn Beca
- Cancer Care Ontario, Toronto, Ontario, Canada.,Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada
| | - Wei Dai
- Cancer Care Ontario, Toronto, Ontario, Canada.,Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada
| | | | | | - Kelvin K W Chan
- Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Cancer Care Ontario, Toronto, Ontario, Canada.,Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada
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67
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Regidor E, Ronda E, Tapia Granados JA, Pulido J, de la Fuente L, Barrio G. Reversal of Upward Trends in Mortality During the Great Recession by Employment Status at Baseline in a National Longitudinal Study. Am J Epidemiol 2019; 188:2004-2012. [PMID: 31241161 DOI: 10.1093/aje/kwz150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 06/10/2019] [Accepted: 06/13/2019] [Indexed: 12/17/2022] Open
Abstract
Because of the healthy worker effect, mortality rates increased in individuals who were employed and those who were unemployed, and decreased in those economically inactive at baseline in reported studies. To determine if such trends continue during economic recessions, we analyzed mortality rates in Spain before and during the Great Recession in these subgroups. We included 21,933,351 individuals who were employed, unemployed, or inactive in November 2001 and aged 30-64 years in each calendar-year of follow-up (2002-2011). Annual age-adjusted mortality rates were calculated in each group. The annual percentage change in mortality rates adjusted for age and educational level in employed and unemployed persons were also calculated for 2002-2007 and 2008-2011. In employed and unemployed men, mortality rates increased until 2007 and then declined, whereas in employed and unemployed women, mortality rates increased and then stabilized during 2008-2011. The mortality rate among inactive men and women decreased throughout the follow-up. In the employed and the unemployed, the annual percentage change was reversed during 2008-2011 compared with 2002-2007 (-1.2 vs. 3.2 in employed men; -0.3 vs. 4.1 in employed women; -0.8 vs. 2.9 in unemployed men; and -0.6 vs. 1.3 in unemployed women). The upward trends in mortality rates among individuals who were employed or unemployed in 2001 were reversed during the Great Recession (2008-2011).
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68
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Murphy PB, Severance S, Savage S, Obeng-Gyasi S, Timsina LR, Zarzaur BL. Financial toxicity is associated with worse physical and emotional long-term outcomes after traumatic injury. J Trauma Acute Care Surg 2019; 87:1189-1196. [PMID: 31233442 PMCID: PMC6815224 DOI: 10.1097/ta.0000000000002409] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Increasing health care costs and high deductible insurance plans have shifted more responsibility for medical costs to patients. After serious illnesses, financial responsibilities may result in lost wages, forced unemployment, and other financial burdens, collectively described as financial toxicity. Following cancer treatments, financial toxicity is associated with worse long-term health-related quality of life (HRQoL) outcomes. The purpose of this study was to determine the incidence of financial toxicity following injury, factors associated with financial toxicity, and the impact of financial toxicity on long-term HRQoL. METHODS Adult patients with an Injury Severity Score of 10 or greater and without head or spinal cord injury were prospectively followed for 1 year. The Short-Form-36 was used to determine overall quality of life at 1 month, 2 months, 4 months, and 12 months. Screens for depression and posttraumatic stress syndrome were administered. The primary outcome was any financial toxicity. A multivariable generalized estimating equation was used to account for variability over time. RESULTS Five hundred patients were enrolled, and 88% suffered financial toxicity during the year following injury (64% reduced income, 58% unemployment, 85% experienced stress due to financial burden). Financial toxicity remained stable over follow-up (80-85%). Factors independently associated with financial toxicity were lower age (odds ratio [OR], 0.96 [0.94-0.98]), lack of health insurance (OR, 0.28 [0.14-0.56]), and larger household size (OR, 1.37 [1.06-1.77]). After risk adjustment, patients with financial toxicity had worse HRQoL, and more depression and posttraumatic stress syndrome in a stepwise fashion based on severity of financial toxicity. CONCLUSION Financial toxicity following injury is extremely common and is associated with worse psychological and physical outcomes. Age, lack of insurance, and large household size are associated with financial toxicity. Patients at risk for financial toxicity can be identified, and interventions to counteract the negative effects should be developed to improve long-term outcomes. LEVEL OF EVIDENCE Prognostic/epidemiologic study, level III.
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Affiliation(s)
- Patrick B Murphy
- From the Department of Surgery (P.T.M., S.Se., S.O.-G., L.R.T., B.L.Z.), Indiana University School of Medicine, Indianapolis, Indiana; and Department of Surgery (S.Sa.), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Effect of economic recession and impact of health and social protection expenditures on adult mortality: a longitudinal analysis of 5565 Brazilian municipalities. Lancet Glob Health 2019; 7:e1575-e1583. [PMID: 31607469 DOI: 10.1016/s2214-109x(19)30409-7] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/06/2019] [Accepted: 09/11/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND Economic recession might worsen health in low-income and middle-income countries with precarious job markets and weak social protection systems. Between 2014-16, a major economic crisis occurred in Brazil. We aimed to assess the association between economic recession and adult mortality in Brazil and to ascertain whether health and social welfare programmes in the country had a protective effect against the negative impact of this recession. METHODS In this longitudinal analysis, we obtained data from the Brazilian Ministry of Health, the Brazilian Institute for Geography and Statistics, the Ministry of Social Development and Fight Against Hunger, and the Information System for the Public Budget in Health to assess changes in state unemployment level and mortality among adults (aged ≥15 years) in Brazil between 2012 and 2017. Outcomes were municipal all-cause and cause-specific mortality rates for all adults and across population subgroups stratified by age, sex, and race. We used fixed-effect panel regression models with quarterly timepoints to assess the association between recession and changes in mortality. Mortality and unemployment rates were detrended using Hodrick-Prescott filters to assess cyclical variation and control for underlying trends. We tested interactions between unemployment and terciles of municipal social protection and health-care expenditure to assess whether the relationship between unemployment and mortality varied. FINDINGS Between 2012 and 2017, 7 069 242 deaths were recorded among adults (aged ≥15 years) in 5565 municipalities in Brazil. During this time period, the mean crude municipal adult mortality rate increased by 8·0% from 143·1 deaths per 100 000 in 2012 to 154·5 deaths per 100 000 in 2017. An increase in unemployment rate of 1 percentage-point was associated with a 0·50 increase per 100 000 population per rter (95% CI 0·09-0·91) in all-cause mortality, mainly due to cancer and cardiovascular disease. Between 2012 and 2017, higher unemployment accounted for 31 415 excess deaths (95% CI 29 698-33 132). All-cause mortality increased among black or mixed race (pardo) Brazilians (a 0·46 increase [95% CI 0·15-0·80]), men (0·67 [0·22-1·13]), and individuals aged 30-59 years (0·43 [0·16-0·69] per 1 percentage-point increase in the unemployment rate. No significant association was identified between unemployment and all-cause mortality for white Brazilian, women, adolescents (aged 15-29 years), or older and retired individuals (aged ≥60 years). In municipalities with high expenditure on health and social protection programmes, no significant increases in recession-related mortality were observed. INTERPRETATION The Brazilian recession contributed to increases in mortality. However, health and social protection expenditure seemed to mitigate detrimental health effects, especially among vulnerable populations. This evidence provides support for stronger health and social protection systems globally. FUNDING None.
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70
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Baek SU, Lim SS, Kim J, Yoon JH. How Does Economic Inequality Affect Infanticide Rates? An Analysis of 15 Years of Death Records and Representative Economic Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193679. [PMID: 31574941 PMCID: PMC6801423 DOI: 10.3390/ijerph16193679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/21/2019] [Accepted: 09/24/2019] [Indexed: 12/01/2022]
Abstract
Background: Is there a relationship between economic inequality and infanticide rates? Few studies have examined the socioeconomic factors that trigger infanticide. This study aims to statistically analyze the effect of these factors on infanticide rates. Methods: This study used infant death records in South Korea from 2003 to 2017 to assess the impact of unemployment rates and various statistical indicators (e.g., GDP and income inequality index) on the rate of infanticide. A generalized additive model and a quasi-Poisson regression were used for statistical analyses. Results: A time-trend analysis shows that the infanticide rate tended to grow despite a decreasing trend in the quarterly infant mortality rate. A 1% increase in the unemployment rate is associated with a significant rise in the relative risk of infanticide after a lag of two quarters. Relative risks increased significantly three and four quarters after a 0.1 rise in the p80/p20 ratio (income inequality index). Conclusions: Policymakers should pay attention to socioeconomic factors while formulating healthcare regulations to protect potential infanticide victims, including vulnerable infants and their parents.
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Affiliation(s)
- Seong-Uk Baek
- College of Medicine, Yonsei University, Seoul 03722, Korea.
| | - Sung-Shil Lim
- The Institute for Occupational Health, Yonsei University College of Medicine, Seoul 03722, Korea.
| | - Jihyun Kim
- The Institute for Occupational Health, Yonsei University College of Medicine, Seoul 03722, Korea.
| | - Jin-Ha Yoon
- The Institute for Occupational Health, Yonsei University College of Medicine, Seoul 03722, Korea.
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul 03722, Korea.
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Li S, Jiang Z, Li Y, Xu Y. Prognostic significance of minichromosome maintenance mRNA expression in human lung adenocarcinoma. Oncol Rep 2019; 42:2279-2292. [PMID: 31545501 PMCID: PMC6826304 DOI: 10.3892/or.2019.7330] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 08/09/2019] [Indexed: 12/21/2022] Open
Abstract
The minichromosome maintenance (MCM) gene family plays an essential role in DNA replication and cell cycle progression. However, MCM gene expression has not been well-studied in lung adenocarcinoma (LUAD). In the present study, the expression, prognostic value and functions of MCMs in LUAD were investigated using several databases and bioinformatic tools, including Oncomine, GEPIA, cBioPortal, CancerSEA and Kaplan-Meier plotter. It was demonstrated that the mRNA expression of MCM2, MCM4 and MCM10 were significantly increased in patients with LUAD. High mRNA expression of MCM2-5, MCM8 and MCM10 were associated with poor overall survival and progression-free survival. High MCM4 expression was associated with adverse post-progression survival. In addition, the Human Protein Atlas database showed that MCM protein expression was consistent with the mRNA expression. These results demonstrate that MCM2, MCM4 and MCM10 are potential prognostic markers and therapeutic targets for LUAD.
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Affiliation(s)
- Shu Li
- Department of Hematology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Zhou Jiang
- Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Yirun Li
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310000, P.R. China
| | - Yang Xu
- Department of Hematology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
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Li Y, Bian X, Wei S, He M, Yang Y. The relationship between pancreatic cancer and type 2 diabetes: cause and consequence. Cancer Manag Res 2019; 11:8257-8268. [PMID: 31571983 PMCID: PMC6750859 DOI: 10.2147/cmar.s211972] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 08/23/2019] [Indexed: 12/12/2022] Open
Abstract
Pancreatic cancer (PC) is a devastating and lethal malignant disease and it is well known that there is a complex bidirectional relationship between PC and type 2 diabetes mellitus (T2DM). In order to more deeply summarize the relationship between them, this article summarizes the epidemiological data on the relationship between PC and T2DM in the past 5 years, and further explains the mechanism of interaction between them. Meanwhile, it also summed up the effects of drug therapy for T2DM on PC and the impact of T2DM on surgical resection of PC. Epidemiological studies clearly indicate that the risk of PC is increased in patients with T2DM. But increasing epidemiological data points out that PC also acts as a cause of T2DM and new-onset T2DM is sign and consequence of PC. Insulin resistance, hyperinsulinemia, hyperglycemia, and chronic inflammation are the mechanisms of T2DM-Associated PC. Metformin decreases the risk of PC, while insulin therapy increases the risk of PC. Besides, studies have shown that T2DM decreases the survival in patients with PC resection.
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Affiliation(s)
- Yan Li
- Department of Gerontology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Xiaohui Bian
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Shuyi Wei
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Meizhi He
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Yuelian Yang
- Department of Gerontology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China
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Shao H, Lin H, Guo Z, Lu J, Jia Y, Ye M, Su F, Niu L, Kang W, Wang S, Hu Y, Huang Y. A multiple signal amplification sandwich-type SERS biosensor for femtomolar detection of miRNA. Biosens Bioelectron 2019; 143:111616. [PMID: 31472412 DOI: 10.1016/j.bios.2019.111616] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/07/2019] [Accepted: 08/19/2019] [Indexed: 12/24/2022]
Abstract
MicroRNAs are widely used as tumor markers for cancer diagnosis and prognosis. Herein, a multiple signal amplification sandwich-type SERS biosensor for femtomolar detection of miRNA is reported. The signal unit consisted of giant Au vesicles, DNA sequences and deposited silver nanoparticles. The giant Au vesicles provided large-volume hot spots because of sharp tips and abundant hotspot gaps, thus enhancing the electromagnetic intensity for the SERS performance. Further silver stain would easily lead to second-stage amplification of Raman signal. In addition, more SERS signal molecules R6G adsorbed on the signal unit with the aid of HCR and the controlled nanogaps between adjacent AgNPs, brought about the third-stage amplification. The capture unit, prepared by immobilizing the capture probe (CP) on the Fe3O4@AuNPs, could easily capture target miRNA and greatly simplify the separation step to improve reproducibility. The higher concentration of target miRNA definitely formed more sandwich-type structures with combination of capture unit and signal unit, resulting in multiple amplification of SERS signals. The proposed multiple signal amplification sandwich-type SERS biosensor could detect miRNA-141 at the femtomolar level with a low detection limit of 0.03 fM. Meanwhile, it exhibited high selectivity and accuracy, even for practical analysis in human serum. Therefore, the designed multiple signal amplification sandwich-type SERS biosensor would be a very promising alternative tool for the detection of miRNA and analogs in the field of biomedical diagnosis.
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Affiliation(s)
- Huili Shao
- State Key Laboratory for Quality and Safety of Agro-products, School of Material Science and Chemical Engineering, Ningbo University, Ningbo, 315211, PR China
| | - Han Lin
- State Key Laboratory for Quality and Safety of Agro-products, School of Material Science and Chemical Engineering, Ningbo University, Ningbo, 315211, PR China; Key Laboratory of Marine Materials and Related Technologies, Zhejiang Key Laboratory of Marine Materials and Protective Technologies, Division of Polymer and Composite Materials, Ningbo Institute of Materials Technology & Engineering, Chinese Academy of Sciences, Ningbo, 315201, PR China
| | - Zhiyong Guo
- State Key Laboratory for Quality and Safety of Agro-products, School of Material Science and Chemical Engineering, Ningbo University, Ningbo, 315211, PR China.
| | - Jing Lu
- State Key Laboratory for Quality and Safety of Agro-products, School of Material Science and Chemical Engineering, Ningbo University, Ningbo, 315211, PR China
| | - Yaru Jia
- State Key Laboratory for Quality and Safety of Agro-products, School of Material Science and Chemical Engineering, Ningbo University, Ningbo, 315211, PR China; Key Laboratory of Marine Materials and Related Technologies, Zhejiang Key Laboratory of Marine Materials and Protective Technologies, Division of Polymer and Composite Materials, Ningbo Institute of Materials Technology & Engineering, Chinese Academy of Sciences, Ningbo, 315201, PR China
| | - Meng Ye
- Department of Medical Oncology, The Affiliated Hospital of Medical School, Ningbo University, Ningbo, 315020, PR China.
| | - Fengmei Su
- National Engineering Research Centre for Advanced Polymer Processing Technology, Key Laboratory of Materials Processing and Mold (Zhengzhou University), Ministry of Education, Zhengzhou University, Zhengzhou, 450002, PR China
| | - Lingmei Niu
- School of Public Health, Hebei Medical University, Shijiazhuang, 050017, PR China
| | - Weijun Kang
- School of Public Health, Hebei Medical University, Shijiazhuang, 050017, PR China
| | - Sui Wang
- State Key Laboratory for Quality and Safety of Agro-products, School of Material Science and Chemical Engineering, Ningbo University, Ningbo, 315211, PR China
| | - Yufang Hu
- State Key Laboratory for Quality and Safety of Agro-products, School of Material Science and Chemical Engineering, Ningbo University, Ningbo, 315211, PR China
| | - Youju Huang
- Key Laboratory of Marine Materials and Related Technologies, Zhejiang Key Laboratory of Marine Materials and Protective Technologies, Division of Polymer and Composite Materials, Ningbo Institute of Materials Technology & Engineering, Chinese Academy of Sciences, Ningbo, 315201, PR China.
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Knight SR, Ots R, Maimbo M, Drake TM, Fairfield CJ, Harrison EM. Systematic review of the use of big data to improve surgery in low- and middle-income countries. Br J Surg 2019; 106:e62-e72. [PMID: 30620075 PMCID: PMC6590290 DOI: 10.1002/bjs.11052] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/08/2018] [Accepted: 10/15/2018] [Indexed: 12/16/2022]
Abstract
Background Technological advances have led to the generation of large amounts of data, both in surgical research and practice. Despite this, it is unclear how much originates in low‐ and middle‐income countries (LMICs) and what barriers exist to the use of such data in improving surgical care. The aim of this review was to capture the extent and impact of programmes that use large volumes of patient data on surgical care in LMICs. Methods A PRISMA‐compliant systematic literature review of PubMed, Embase and Google Scholar was performed in August 2018. Prospective studies collecting large volumes of patient‐level data within LMIC settings were included and evaluated qualitatively. Results A total of 68 studies were included from 71 LMICs, involving 708 032 patients. The number of patients in included studies varied widely (from 335 to 428 346), with 25 reporting data on 3000 or more LMIC patients. Patient inclusion in large‐data studies in LMICs has increased dramatically since 2015. Studies predominantly involved Brazil, China, India and Thailand, with low patient numbers from Africa and Latin America. Outcomes after surgery were commonly the focus (33 studies); very few large studies looked at access to surgical care or patient expenditure. The use of large data sets specifically to improve surgical outcomes in LMICs is currently limited. Conclusion Large volumes of data are becoming more common and provide a strong foundation for continuing investigation. Future studies should address questions more specific to surgery.
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Affiliation(s)
- S R Knight
- Surgical Informatics, Centre for Medical Informatics, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK
| | - R Ots
- Surgical Informatics, Centre for Medical Informatics, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK
| | - M Maimbo
- Department of General Surgery, Kitwe Teaching Hospital, Kitwe, Zambia
| | - T M Drake
- Surgical Informatics, Centre for Medical Informatics, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK
| | - C J Fairfield
- Surgical Informatics, Centre for Medical Informatics, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK
| | - E M Harrison
- Surgical Informatics, Centre for Medical Informatics, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK
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Schleicher SM, Bach PB, Matsoukas K, Korenstein D. Medication overuse in oncology: current trends and future implications for patients and society. Lancet Oncol 2019; 19:e200-e208. [PMID: 29611528 DOI: 10.1016/s1470-2045(18)30099-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 12/04/2017] [Accepted: 12/05/2017] [Indexed: 01/09/2023]
Abstract
The high cost of cancer care worldwide is largely attributable to rising drugs prices. Despite their high costs and potential toxic effects, anticancer treatments could be subject to overuse, which is defined as the provision of medical services that are more likely to harm than to benefit a patient. We found 30 studies documenting medication overuse in cancer, which included 16 examples of supportive medication overuse and 17 examples of antineoplastic medication overuse in oncology. Few specific agents have been assessed, and no studies investigated overuse of the most toxic or expensive medications currently used in cancer treatment. Although financial, psychological, or physical harms of medication overuse in cancer could be substantial, there is little published evidence addressing these harms, so their magnitude is unclear. Further research is needed to better quantify medication overuse, understand its implications, and help protect patients and the health-care system from overuse.
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Affiliation(s)
- Stephen M Schleicher
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peter B Bach
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Konstantina Matsoukas
- Information Systems/Medical Library, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Deborah Korenstein
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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76
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Abstract
Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States and compiles the most recent data on cancer incidence, mortality, and survival. Incidence data, available through 2015, were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data, available through 2016, were collected by the National Center for Health Statistics. In 2019, 1,762,450 new cancer cases and 606,880 cancer deaths are projected to occur in the United States. Over the past decade of data, the cancer incidence rate (2006-2015) was stable in women and declined by approximately 2% per year in men, whereas the cancer death rate (2007-2016) declined annually by 1.4% and 1.8%, respectively. The overall cancer death rate dropped continuously from 1991 to 2016 by a total of 27%, translating into approximately 2,629,200 fewer cancer deaths than would have been expected if death rates had remained at their peak. Although the racial gap in cancer mortality is slowly narrowing, socioeconomic inequalities are widening, with the most notable gaps for the most preventable cancers. For example, compared with the most affluent counties, mortality rates in the poorest counties were 2-fold higher for cervical cancer and 40% higher for male lung and liver cancers during 2012-2016. Some states are home to both the wealthiest and the poorest counties, suggesting the opportunity for more equitable dissemination of effective cancer prevention, early detection, and treatment strategies. A broader application of existing cancer control knowledge with an emphasis on disadvantaged groups would undoubtedly accelerate progress against cancer.
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Affiliation(s)
- Rebecca L Siegel
- Scientific Director, Surveillance Research, American Cancer Society, Atlanta, GA
| | - Kimberly D Miller
- Senior Associate Scientist, Surveillance Research, American Cancer Society, Atlanta, GA
| | - Ahmedin Jemal
- Scientific Vice President, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
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Pedraza CC, Pagano JP, Pescetto C, Prieto L. [Fiscal space for sustainable financing of health systems and universal healthEspaço fiscal para o financiamento sustentável dos sistemas de saúde e saúde universal]. Rev Panam Salud Publica 2018; 42:e197. [PMID: 31093224 PMCID: PMC6386065 DOI: 10.26633/rpsp.2018.197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 12/06/2018] [Indexed: 11/25/2022] Open
Abstract
The articles published in this series show that it is possible to create fiscal space for health in the countries. This requires specific decisions since economic growth is not enough to generate the additional resources needed. The studies analyze the benefit of reviewing the tax expenditures to identify exemptions - generally outdated and of low benefit for the countries -; arguments to increase taxes on products harmful to health; and credits and donations, which do not result in a viable source of income for governments. Fiscal efforts must be accompanied by an improvement in efficiency, and the progressive creation of new revenues is key to improving equity. It is necessary to improve the collection of fiscal resources.To this end, it is necessary to develop a research and action agenda that understands the analysis of the fiscal space inserted in the processes of transformation and reform of health systems, including the technical aspects not yet addressed and studies of the social efficiency of the fiscal space for major development objectives such as the Sustainable Development Goals 2030. In the countries of the Region of the Americas it is essential to have efficient management to do more and better with more resources, even during adverse economic cycles. This should be evident at all levels, including solidarity for achieving better health outcomes, strategic purchase of health goods and services, and strengthening of budget planning systems.
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Affiliation(s)
- Camilo Cid Pedraza
- Departamento de Sistemas y Servicios de Salud. Organización Panamericana de la Salud, Washington D.C., Estados Unidos de América
| | - Juan Pablo Pagano
- Departamento de Sistemas y Servicios de Salud. Organización Panamericana de la Salud, Washington D.C., Estados Unidos de América
| | - Claudia Pescetto
- Departamento de Sistemas y Servicios de Salud. Organización Panamericana de la Salud, Washington D.C., Estados Unidos de América
| | - Lorena Prieto
- Departamento de Sistemas y Servicios de Salud. Organización Panamericana de la Salud, Washington D.C., Estados Unidos de América
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Nolasco A, Pereyra-Zamora P, Sanchis-Matea E, Tamayo-Fonseca N, Caballero P, Melchor I, Moncho J. Economic Crisis and Amenable Mortality in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2298. [PMID: 30347682 PMCID: PMC6211017 DOI: 10.3390/ijerph15102298] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/09/2018] [Accepted: 10/16/2018] [Indexed: 12/24/2022]
Abstract
Background: Both overall mortality and avoidable mortality have decreased in recent years in most European countries. It has become clear that less privileged socioeconomic groups have an increased risk of death. In 2008, most countries went into a severe economic recession, whose effects on the health of the population are still ongoing. While on the one hand, some evidence associates the economic crisis with positive health outcomes (pro-cyclical effect), on the other hand, some other evidence suggests that the economic crisis may pose serious public health problems (counter-cyclical effect), which has given rise to controversy. Objectives: To describe the evolution of overall mortality and amenable mortality in Spain between 2002⁻2007 (before the economic crisis) and 2008⁻2013 (during the economic crisis), nationally and by province, as well as to analyse trends in the risks of death and their association with indicators of the impact of the crisis. Methods: Ecological study of overall mortality and amenable mortality describing the evolution of the risks of death between 2002⁻2007 and 2008⁻2013. Age Standardised Rates were calculated, as well as their percentage change between periods. The association between percentage changes and provincial indicators of the impact of the crisis was analysed. Amenable mortality was studied both overall and categorised into five groups. Results: Amenable mortality represented 8.25% of overall mortality in 2002⁻2007, and 6.93% in 2008⁻2013. Age Standardised Rates for overall mortality and global amenable mortality generally declined, with the sharpest decline in amenable mortality. Decreases in overall mortality and amenable mortality were directly related to vulnerability indicators. The most significant decreases were registered in ischaemic heart disease, cerebrovascular disease, and other amenable causes. The relationship with vulnerability indices varied from direct (cancer) to inverse (hypertensive disease). Conclusions: Amenable mortality shows a more significant decrease than overall mortality between both study periods, albeit unevenly between provinces causes of death. Higher vulnerability indicators entail greater declines, although this trend varied for different causes. Mortality trends and their relationship with socioeconomic indicators in a situation of crisis must be conducted cautiously, taking into consideration a possible pro-cyclical effect.
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Affiliation(s)
- Andreu Nolasco
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, Campus de San Vicente del Raspeig s/n, Ap. 99-03080 Alicante, Spain.
| | - Pamela Pereyra-Zamora
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, Campus de San Vicente del Raspeig s/n, Ap. 99-03080 Alicante, Spain.
| | - Elvira Sanchis-Matea
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, Campus de San Vicente del Raspeig s/n, Ap. 99-03080 Alicante, Spain.
| | - Nayara Tamayo-Fonseca
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, Campus de San Vicente del Raspeig s/n, Ap. 99-03080 Alicante, Spain.
| | - Pablo Caballero
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, Campus de San Vicente del Raspeig s/n, Ap. 99-03080 Alicante, Spain.
| | - Inmaculada Melchor
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, Campus de San Vicente del Raspeig s/n, Ap. 99-03080 Alicante, Spain.
- Mortality Register of the Valencian Community, section of Epidemiological Studies and Health Statistics, General Sub-directorate of Epidemiology and Health Monitoring, General Directorate of Public Health, Health Ministry of the Valencian Government, 03010 Alicante, Spain.
| | - Joaquín Moncho
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, Campus de San Vicente del Raspeig s/n, Ap. 99-03080 Alicante, Spain.
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Krishnasamy R, Gray NA. Low socio-economic status adversely effects dialysis survival in Australia. Nephrology (Carlton) 2018; 23:453-460. [PMID: 28383177 DOI: 10.1111/nep.13053] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 02/15/2017] [Accepted: 03/29/2017] [Indexed: 01/02/2023]
Abstract
AIM Low socio-economic status (SES) is associated with increased incidence of end-stage kidney disease and in the USA, poorer dialysis survival. All Australians have access to a universal healthcare system. METHODS The study included all non-indigenous adult Australians registered with the Australia and New Zealand Dialysis and Transplant Registry who commenced dialysis between 2003 and 2013. SES at dialysis start was classified into quartiles of advantaged through to disadvantaged using Australian Bureau of Statistics socio-economic indexes for areas. The primary outcome was survival assessed using a competing risk regression model with renal transplantation as a competing risk. There was a significant interaction between age and SES, and hence, age-stratified survival analyses were performed. RESULTS A total 20 810 commenced dialysis during the study period. Mortality for the most advantaged quartile was 102.4/1000 person-years (95% confidence interval (CI) 98.0-106.9) compared with 110.7/1000 person-years (95% CI 105.8-115.7) in the disadvantaged quartile. In adjusted analysis, dialysis survival, compared with quartile 1 (advantaged), was inferior in quartile 3 (sub-hazard ratio 1.10, 95% CI 1.03-1.17) and the disadvantaged quartile (sub-hazard ratio 1.09, 85% CI 1.02-1.16) and was significantly modified by age. This disparity in survival outcome between the different SES quartiles was only observed in younger patients but was attenuated in the older ones following an age-stratified analysis. CONCLUSIONS In Australia, low SES has an adverse effect on dialysis patient survival despite universal healthcare. This effect is mainly among younger patients where SES may have a greater proportional impact than co-morbidities.
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Affiliation(s)
- Rathika Krishnasamy
- Department of Nephrology, Nambour General Hospital, Nambour, Queensland, Australia.,The University of Queensland, Sunshine Coast Clinical School, Nambour General Hospital, Nambour, Queensland, Australia.,Australia and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia
| | - Nicholas A Gray
- Department of Nephrology, Nambour General Hospital, Nambour, Queensland, Australia.,The University of Queensland, Sunshine Coast Clinical School, Nambour General Hospital, Nambour, Queensland, Australia.,Australia and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia
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80
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Massuda A, Hone T, Leles FAG, de Castro MC, Atun R. The Brazilian health system at crossroads: progress, crisis and resilience. BMJ Glob Health 2018; 3:e000829. [PMID: 29997906 PMCID: PMC6035510 DOI: 10.1136/bmjgh-2018-000829] [Citation(s) in RCA: 230] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/04/2018] [Accepted: 06/05/2018] [Indexed: 11/03/2022] Open
Abstract
The Unified Health System (Sistema Único de Saúde (SUS)) has enabled substantial progress towards Universal Health Coverage (UHC) in Brazil. However, structural weakness, economic and political crises and austerity policies that have capped public expenditure growth are threatening its sustainability and outcomes. This paper analyses the Brazilian health system progress since 2000 and the current and potential effects of the coalescing economic and political crises and the subsequent austerity policies. We use literature review, policy analysis and secondary data from governmental sources in 2000-2017 to examine changes in political and economic context, health financing, health resources and healthcare service coverage in SUS. We find that, despite a favourable context, which enabled expansion of UHC from 2003 to 2014, structural problems persist in SUS, including gaps in organisation and governance, low public funding and suboptimal resource allocation. Consequently, large regional disparities exist in access to healthcare services and health outcomes, with poorer regions and lower socioeconomic population groups disadvantaged the most. These structural problems and disparities will likely worsen with the austerity measures introduced by the current government, and risk reversing the achievements of SUS in improving population health outcomes. The speed at which adverse effects of the current and political crises are manifested in the Brazilian health system underscores the importance of enhancing health system resilience to counteract external shocks (such as economic and political crises) and internal shocks (such as sector-specific austerity policies and rapid ageing leading to rise in disease burden) to protect hard-achieved progress towards UHC.
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Affiliation(s)
- Adriano Massuda
- Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Thomas Hone
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | | | - Marcia C de Castro
- Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Rifat Atun
- Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
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81
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Recent lung cancer mortality trends in Europe: effect of national smoke-free legislation strengthening. Eur J Cancer Prev 2018; 27:296-302. [DOI: 10.1097/cej.0000000000000354] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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82
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Alkire BC, Peters AW, Shrime MG, Meara JG. The Economic Consequences Of Mortality Amenable To High-Quality Health Care In Low- And Middle-Income Countries. Health Aff (Millwood) 2018; 37:988-996. [DOI: 10.1377/hlthaff.2017.1233] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Blake C. Alkire
- Blake C. Alkire is an instructor in the Program in Global Surgery and Social Change, Harvard Medical School, and an instructor in otolaryngology, Massachusetts Eye and Ear Infirmary, both in Boston, Massachusetts. Alkire and Alexander Peters share credit as co–first authors
| | - Alexander W. Peters
- Alexander W. Peters is a research fellow in the Program in Global Surgery and Social Change, Harvard Medical School, and in the Department of Plastic and Oral Surgery, Boston Children’s Hospital, in Boston, Massachusetts; and a resident in surgery at the NewYork-Presbyterian/Weill Cornell Medical Center, in New York City. Peters and Blake Alkire share credit as co–first authors
| | - Mark G. Shrime
- Mark G. Shrime is an assistant professor of global health and social medicine and research director of the Program in Global Surgery and Social Change, Harvard Medical School, and an assistant professor of otolaryngology, Massachusetts Eye and Ear Infirmary
| | - John G. Meara
- John G. Meara is the Kletjian Professor of Global Surgery and director of the Program in Global Surgery and Social Change, Harvard Medical School, and plastic surgeon-in-chief, Department of Plastic and Oral Surgery, Boston Children’s Hospital
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83
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Public Health Care Financing and the Costs of Cancer Care: A Cross-National Analysis. Cancers (Basel) 2018; 10:cancers10040117. [PMID: 29649115 PMCID: PMC5923372 DOI: 10.3390/cancers10040117] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 03/27/2018] [Accepted: 04/08/2018] [Indexed: 12/28/2022] Open
Abstract
Expenditure and financing aspects in the healthcare system in general, and in cancer care in particular, are subjects of increasing concern to the medical community. Nowadays, it is imperative for the healthcare system to respond to the challenge of universal access to quality healthcare, by measuring the financial resources within the healthcare sector. The purpose of this review is to highlight the major gaps in the healthcare expenditures for all types of care, as well as on cancer and anti-cancer drugs across 28 European Union member states. The indicators taken into account are divided into two major groups: (1) healthcare expenditures for all types of care, and (2) healthcare expenditures on cancer and anti-cancer drugs. The programs used for our analysis are SPSS Statistics V20.0 (IBM Corporation, Armonk, NY, USA) and Stat World Explorer. The overall picture confirms that there are considerable disparities between the 28 countries in relation to their expenditures on health. The trend in public expenditures for all types of care, compared to the share of healthcare expenditures as a percentage of the GDP, shows the increase of health expenses between 2010 and 2014, but a lower rise compared to the total GDP increase. Healthcare expenditure on cancer (%THE) is rather low, despite the high cost associated with anti-cancer drugs. New treatments and drugs development will be increasingly difficult to achieve if the share devoted to cancer does not increase, and the lack of funds may act as a barrier in receiving high-quality care.
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84
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Varlotto JM, Voland R, McKie K, Flickinger JC, DeCamp MM, Maddox D, Rava P, Fitzgerald TJ, Graeber G, Rassaei N, Oliveira P, Ali S, Belani C, Glanzman J, Wakelee HA, Patel M, Baima J, Zhang J, Walsh W. Population-based differences in the outcome and presentation of lung cancer patients based upon racial, histologic, and economic factors in all lung patients and those with metastatic disease. Cancer Med 2018. [PMID: 29533006 PMCID: PMC5911616 DOI: 10.1002/cam4.1430] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
To investigate the interrelation between economic, marital, and known histopathologic/therapeutic prognostic factors in presentation and survival of patients with lung cancer in nine different ethnic groups. A retrospective review of the SEER database was conducted through the years 2007–2012. Population differences were assessed via chi‐square testing. Multivariable analyses (MVA) were used to detect overall survival (OS) differences in the total population (TP, N = 153,027) and for those patients presenting with Stage IV (N = 70,968). Compared to Whites, Blacks were more likely to present with younger age, male sex, lower income, no insurance, single/widowed partnership, less squamous cell carcinomas, and advanced stage; and experience less definitive surgery, lower OS, and lung cancer‐specific (LCSS) survival. White Hispanics presented with younger age, higher income, lower rates of insurance, single/widowed partnership status, advanced stage, more adenocarcinomas, and lower rates of definitive surgery, but no difference in OS and LCSS than Whites. In the TP and Stage IV populations, MVAs revealed that OS was better or equivalent to Whites for all other ethnic groups and was positively associated with insurance, marriage, and higher income. Blacks presented with more advanced disease and were more likely to succumb to lung cancer, but when adjusted for prognostic factors, they had a better OS in the TP compared to Whites. Disparities in income, marital status, and insurance rather than race affect OS of patients with lung cancer. Because of their presentation with advanced disease, Black and Hispanics are likely to have increased benefit from lung cancer screening.
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Affiliation(s)
- John Michael Varlotto
- Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts.,University of Massachusetts Medical School, Worcester, Massachusetts
| | - Richard Voland
- School of Nursing, University of Wisconsin, Madison, Wisconsin
| | - Kerrie McKie
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - John C Flickinger
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Malcolm M DeCamp
- Division of Thoracic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Debra Maddox
- Department of Medical Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts
| | - Paul Rava
- Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts.,University of Massachusetts Medical School, Worcester, Massachusetts
| | - Thomas J Fitzgerald
- Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts.,University of Massachusetts Medical School, Worcester, Massachusetts
| | - Geoffrey Graeber
- University of Massachusetts Medical School, Worcester, Massachusetts.,Division of Thoracic Surgery, University of Massachusetts Medical Center, Worcester, Massachusetts
| | - Negar Rassaei
- Department of Pathology, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | - Paulo Oliveira
- University of Massachusetts Medical School, Worcester, Massachusetts.,Division of Pulmonary, University of Massachusetts Medical Center, Allergy and Critical Care Medicine, Worcester, Massachusetts
| | - Suhail Ali
- Penn State Hershey Cancer Institute, Hershey, Pennsylvania
| | - Chandra Belani
- Penn State Hershey Cancer Institute, Hershey, Pennsylvania
| | - Jonathan Glanzman
- Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts.,University of Massachusetts Medical School, Worcester, Massachusetts
| | - Heather A Wakelee
- Division of Medical Oncology, Stanford University, Palo Alto, California
| | - Manali Patel
- Division of Medical Oncology, Stanford University, Palo Alto, California
| | - Jennifer Baima
- Department of Orthopedics and Rehabilitation, University of Massachusetts Medical Center, Worcester, Massachusetts
| | - Jianying Zhang
- Department of Quantitative Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - William Walsh
- University of Massachusetts Medical School, Worcester, Massachusetts.,Department of Medical Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts
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Vignier N, Desgrées du Loû A, Pannetier J, Ravalihasy A, Gosselin A, Lert F, Lydié N, Bouchaud O, Dray Spira R. Access to health insurance coverage among sub-Saharan African migrants living in France: Results of the ANRS-PARCOURS study. PLoS One 2018; 13:e0192916. [PMID: 29447257 PMCID: PMC5814022 DOI: 10.1371/journal.pone.0192916] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 01/20/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Migrants' access to care depends on their health insurance coverage in the host country. We aimed to evaluate in France the dynamic and the determinants of health insurance coverage acquisition among sub-Saharan migrants. METHODS In the PARCOURS life-event retrospective survey conducted in 2012-2013 in health-care facilities in the Paris region, data on health insurance coverage (HIC) each year since arrival in France has been collected among three groups of sub-Saharan migrants recruited in primary care centres (N = 763), centres for HIV care (N = 923) and for chronic hepatitis B care (N = 778). Year to year, the determinants of the acquisition and lapse of HIC were analysed with mixed-effects logistic regression models. RESULTS In the year of arrival, 63.4% of women and 55.3% of men obtained HIC. But three years after arrival, still 14% of women and 19% of men had not obtained HIC. HIC acquisition was accelerated in case of HIV or hepatitis B infection, for migrants arrived after 2000, and for women in case of pregnancy and when they were studying. Conversely, it was slowed down in case of lack of a residency permit and lack of financial resources for men. In addition, women and men without residency permits were more likely to have lost HIC when they had one. CONCLUSION In France, the health insurance system aiming at protecting all, including undocumented migrants, leads to a prompt access to HIC for migrants from sub-Saharan Africa. Nevertheless, this access may be impaired by administrative and social insecurities.
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Affiliation(s)
- Nicolas Vignier
- INSERM, Sorbonne Université, Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, Paris, France
- Groupe hospitalier Sud Ile-de-France, Department of Infectious and Tropical Diseases, Melun, France
| | | | - Julie Pannetier
- Sorbonne Paris Cités, IRD, CEPED, ERL INSERM 1244 SAGESUD, Paris, France
| | | | - Anne Gosselin
- Sorbonne Paris Cités, IRD, CEPED, ERL INSERM 1244 SAGESUD, Paris, France
| | - France Lert
- INSERM, Centre for Research in Epidemiology and Population Health (CESP-U 1018), Villejuif, France
| | - Nathalie Lydié
- Santé Publique France, French National Agency of Public Health, Saint-Maurice, France
| | - Olivier Bouchaud
- Paris 13 University, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Infectious and Tropical diseases, and Laboratoire Educations et Pratiques de Santé (LEPS EA 3412), Bobigny, France
| | - Rosemary Dray Spira
- INSERM, Sorbonne Université, Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, Paris, France
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86
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Sun Y, Bao Y, Jiang X, Tan S, Yin M, Yang C, Zhou L, Zhang Z. pH-sensitive micelles with charge-reversible property for tumor growth inhibition and anti-metastasis. J Mater Chem B 2018; 6:458-468. [DOI: 10.1039/c7tb02439h] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Biocompatible VE-based micelles with charge-reversible property for PTX delivery demonstrating effective antitumor and anti-metastasis effects.
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Affiliation(s)
- Yu Sun
- Tongji School of Pharmacy
- Huazhong University of Science and Technology
- Wuhan 430030
- China
| | - Yuling Bao
- Tongji School of Pharmacy
- Huazhong University of Science and Technology
- Wuhan 430030
- China
- Department of Pharmacy
| | - Xue Jiang
- Tongji School of Pharmacy
- Huazhong University of Science and Technology
- Wuhan 430030
- China
| | - Songwei Tan
- Tongji School of Pharmacy
- Huazhong University of Science and Technology
- Wuhan 430030
- China
- National Engineering Research Centre for Nanomedicine
| | - Mingxing Yin
- Tongji School of Pharmacy
- Huazhong University of Science and Technology
- Wuhan 430030
- China
- Department of Pharmacy
| | - Conglian Yang
- Tongji School of Pharmacy
- Huazhong University of Science and Technology
- Wuhan 430030
- China
| | - Liping Zhou
- Tongji School of Pharmacy
- Huazhong University of Science and Technology
- Wuhan 430030
- China
| | - Zhiping Zhang
- Tongji School of Pharmacy
- Huazhong University of Science and Technology
- Wuhan 430030
- China
- National Engineering Research Centre for Nanomedicine
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87
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Park EC, Kawahara N, Nozaki S, Thabrany H, Yoshimi S, Park S, Lee DH, Akaza H, Roh JK. Joint Symposium of Korean Cancer Association & UICC-ARO-Cross-boundary cancer studies: cancer and Universal Health Coverage (UHC) in Asia. Jpn J Clin Oncol 2017; 47:889-895. [PMID: 28903533 DOI: 10.1093/jjco/hyx074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 06/27/2017] [Indexed: 11/12/2022] Open
Abstract
On 16 June 2016, the Korean Cancer Association (KCA) and Union for International Cancer Control-Asia Regional Office (UICC-ARO) organized a joint symposium as part of the official program of the 42nd Annual Meeting of the Korean Cancer Association to discuss the topic 'Cross-boundary Cancer Studies: Cancer and Universal Health Coverage (UHC) in Asia.' Universal Health Coverage is included in the Sustainable Development Goals adopted by the United Nations as part of the 2030 Agenda for Sustainable Development. The objectives of UHC are to ensure that all people can receive high-quality medical services, are protected from public health risks, and are prevented from falling into poverty due to medical costs or loss of income arising from illness. The participants discussed the growing cost of cancer in the Asian region and the challenges that this poses to the establishment and deployment of UHC in the countries of Asia, all of which face budgetary and other systemic constraints in controlling cancer in the region. Representatives from Korea, Japan and Indonesia reported on the status of UHC in their countries and the challenges that are being faced, many of which are common to other countries in Asia. In addition to country-specific presentations about the progress of and challenges facing UHC, there were also presentations from WHO Kobe Centre concerning advancing UHC in non-communicable diseases and prospects for further collaboration and research on UHC. A presentation from the University of Tokyo also highlighted the need to focus on multidisciplinary studies in an age of globalization and digitization.
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Affiliation(s)
| | | | | | | | | | - Sohee Park
- Graduate School of Public Health, Yonsei University, Korea
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88
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Wulaningsih W, Watkins J, Matsuguchi T, Hardy R. Investigating the associations between adiposity, life course overweight trajectories, and telomere length. Aging (Albany NY) 2017; 8:2689-2701. [PMID: 27650676 PMCID: PMC5191863 DOI: 10.18632/aging.101036] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 08/29/2016] [Indexed: 12/11/2022]
Abstract
Obesity may accelerate ageing through chronic inflammation. To further examine this association, we assessed current adiposity, adiposity at early adulthood and life course overweight trajectories in relation to leukocyte telomere length (LTL). We included a total of 7,008 nationally representative U.S. residents and collected information on objectively measured body mass index (BMI), waist circumference and percent body fat. BMI at age 25 and overweight trajectories were assessed using self-reported history. Leukocyte telomere length (LTL) relative to a standard DNA reference (T/S ratio) was quantified by polymerase chain reaction (PCR). Linear regression models were used to examine the difference in LTL across adiposity measures at examination, BMI at age 25, and overweight trajectories. A 0.2% decrease in telomere length (95% CI:−0.3 to −0.07%) was observed for every kg/m2 increase in BMI, whereas a unit increase in waist circumference (cm) and percent body fat contributed to a 0.09% and 0.01% decrease in LTL, respectively. Higher BMI and being obese at age 25 contributed to lower LTL at older ages. Associations between weight loss through life course and LTL were observed, which further marked the importance of life course adiposity dynamics as a determinant of ageing.
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Affiliation(s)
- Wahyu Wulaningsih
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, University College London, London WC1B 5JU, UK.,Division of Haematology/Oncology, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta 55292, Indonesia.,PILAR Research and Education, Cambridge CB1 2JD, UK
| | | | - Tetsuya Matsuguchi
- Department of Biochemistry and Biophysics, University of California, San Francisco, CA 94158, USA.,Driver Group, L.L.C., San Francisco, CA 94158, USA
| | - Rebecca Hardy
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, University College London, London WC1B 5JU, UK
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89
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Watkins J, Wulaningsih W, Da Zhou C, Marshall DC, Sylianteng GDC, Dela Rosa PG, Miguel VA, Raine R, King LP, Maruthappu M. Effects of health and social care spending constraints on mortality in England: a time trend analysis. BMJ Open 2017; 7:e017722. [PMID: 29141897 PMCID: PMC5719267 DOI: 10.1136/bmjopen-2017-017722] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/10/2017] [Accepted: 08/24/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Since 2010, England has experienced relative constraints in public expenditure on healthcare (PEH) and social care (PES). We sought to determine whether these constraints have affected mortality rates. METHODS We collected data on health and social care resources and finances for England from 2001 to 2014. Time trend analyses were conducted to compare the actual mortality rates in 2011-2014 with the counterfactual rates expected based on trends before spending constraints. Fixed-effects regression analyses were conducted using annual data on PES and PEH with mortality as the outcome, with further adjustments for macroeconomic factors and resources. Analyses were stratified by age group, place of death and lower-tier local authority (n=325). Mortality rates to 2020 were projected based on recent trends. RESULTS Spending constraints between 2010 and 2014 were associated with an estimated 45 368 (95% CI 34 530 to 56 206) higher than expected number of deaths compared with pre-2010 trends. Deaths in those aged ≥60 and in care homes accounted for the majority. PES was more strongly linked with care home and home mortality than PEH, with each £10 per capita decline in real PES associated with an increase of 5.10 (3.65-6.54) (p<0.001) care home deaths per 100 000. These associations persisted in lag analyses and after adjustment for macroeconomic factors. Furthermore, we found that changes in real PES per capita may be linked to mortality mostly via changes in nurse numbers. Projections to 2020 based on 2009-2014 trend was cumulatively linked to an estimated 152 141 (95% CI 134 597 and 169 685) additional deaths. CONCLUSIONS Spending constraints, especially PES, are associated with a substantial mortality gap. We suggest that spending should be targeted on improving care delivered in care homes and at home; and maintaining or increasing nurse numbers.
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Affiliation(s)
- Johnathan Watkins
- Institute for Mathematical and Molecular Biomedicine, King’s College London, London, UK
- PILAR Research and Education, Cambridge, UK
| | - Wahyu Wulaningsih
- PILAR Research and Education, Cambridge, UK
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | | | - Dominic C Marshall
- Oxford University Clinical Academic Graduate School, John Radcliffe Hospital, Oxford, UK
| | - Guia D C Sylianteng
- PILAR Research and Education, Cambridge, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - Phyllis G Dela Rosa
- PILAR Research and Education, Cambridge, UK
- University of the Philippines Manila, Manila, Philippines
| | - Viveka A Miguel
- PILAR Research and Education, Cambridge, UK
- University of the Philippines Diliman, Quezon City, Philippines
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | - Lawrence P King
- Department of Sociology, University of Cambridge, Cambridge, UK
| | - Mahiben Maruthappu
- Department of Applied Health Research, University College London, London, UK
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90
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Galvani AP, Durham DP, Vermund SH, Fitzpatrick MC. California Universal Health Care Bill: an economic stimulus and life-saving proposal. Lancet 2017; 390:2012-2014. [PMID: 28923467 PMCID: PMC5954824 DOI: 10.1016/s0140-6736(17)32148-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 07/16/2017] [Accepted: 07/26/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, USA.
| | - David P Durham
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, USA
| | - Sten H Vermund
- Office of the Dean, Yale School of Public Health, New Haven, CT, USA
| | - Meagan C Fitzpatrick
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, USA
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91
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Waseem M, Ahmad MK, Srivatava VK, Rastogi N, Serajuddin M, Kumar S, Mishra DP, Sankhwar SN, Mahdi AA. Evaluation of miR-711 as Novel Biomarker in Prostate Cancer Progression. Asian Pac J Cancer Prev 2017; 18:2185-2191. [PMID: 28843254 PMCID: PMC5697479 DOI: 10.22034/apjcp.2017.18.8.2185] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objective: MicroRNAs (miRs) are class of small non-coding regulatory RNA aberrantly expressed in various types of malignancies including prostate cancer and serves as potential targets to develop new diagnostic and therapeutic strategies. In this quiet we investigated miRNAs expression profile in benign prostatic hyperplasia (BPH) and prostate cancer (PCa) tissue samples and correlated their expression with clinicopathological parameters. Methodology: The miRNAs expression profile as well as their validation has been done by using Microarray and RT-PCR, respectively. Additionally, we also tried to speculate microRNA-mRNA regulatory module through computational target predictions by using Targetscan, Miranda and MirWalk and obtained results were analysed through DAVID software. Result: We observed that miR-711 is significantly deregulated in BPH and PCa, compared to controls. The lower expression of miR-711 was found to be significantly associated with high Gleason score and metastatic disease. Furthermore, the computational target prediction analysis explored miR-711 association to various cancer cells signalling cascade key molecules associated with cancer cell survival. Conclusion: From our observations we suggest that miR-711 may play a critical role in PCa progression, regulation of various cancer cell survival signalling cascades and that it may be a valuable biomarker for prediction of metastatic disease and poor prognosis in PCa.
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Affiliation(s)
- Mohammad Waseem
- Molecular and Cell Biology, Department of Biochemistry, King George’s Medical University, Lucknow, U.P. India,Department of Urology, King George’s Medical University, Lucknow, U.P. India.
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92
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Ranabhat CL, Kim CB, Park MB, Acharaya S. Multiple disparities in adult mortality in relation to social and health care perspective: results from different data sources. Global Health 2017; 13:57. [PMID: 28789698 PMCID: PMC5549395 DOI: 10.1186/s12992-017-0283-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/28/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Disparity in adult mortality (AM) with reference to social dynamics and health care has not been sufficiently examined. This study aimed to identify the gap in the understanding of AM in relation to religion, political stability, economic level, and universal health coverage (UHC). METHODS A cross-national study was performed with different sources of data, using the administrative record linkage theory. Data was created from the 2013 World Bank data catalogue by region, The Economist (Political instability index 2013), Stuckler David et al. (Universal health coverage, 2010), and religious categories of all UN country members. Descriptive statistics, a t-test, an ANOVA followed by a post hoc test, and a linear regression were used where applicable. RESULT The average AM rate for males and females was 0.20 ± 0.10 and 0.14 ± 0.10, respectively. There was high disparity of AM between countries with and without UHC and between groups with low and high income. UHC and political stability would significantly reduce AMR by >0.41 in both sexes and high economic status would reduce male AMR by 0.44, and female AMR by 0.70. CONCLUSIONS It can be concluded that effective health care; UHC and political stability significantly reduce AM.
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Affiliation(s)
- Chhabi Lal Ranabhat
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do 26426 Republic of Korea
- Institute for Poverty Alleviation and International Development, Yonsei University, Wonju, Ganwon 26493 Republic of Korea
- Health Science Foundations and Study Center, Kathmandu, Nepal
| | - Chun-Bae Kim
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do 26426 Republic of Korea
- Institute for Poverty Alleviation and International Development, Yonsei University, Wonju, Ganwon 26493 Republic of Korea
| | - Myung-Bae Park
- Department of Gerontal Health and Welfare, Pai Chai University, Seo-gu, Daejeon, Republic of Korea
| | - Sambhu Acharaya
- Department of Country Cooperation and Collaboration with the UN System Office of the Director-General, World Health Organization, Geneva, Switzerland
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93
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Xu Z, Liao L, Chai Y, Wang H, Yuan R. Ultrasensitive Electrochemiluminescence Biosensor for MicroRNA Detection by 3D DNA Walking Machine Based Target Conversion and Distance-Controllable Signal Quenching and Enhancing. Anal Chem 2017; 89:8282-8287. [DOI: 10.1021/acs.analchem.7b01409] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Ziqi Xu
- Key Laboratory of Luminescence
and Real-Time Analytical Chemistry (Southwest University), Ministry
of Education, College of Chemistry and Chemical Engineering, Southwest University, Chongqing 400715, People’s Republic of China
| | - Linli Liao
- Key Laboratory of Luminescence
and Real-Time Analytical Chemistry (Southwest University), Ministry
of Education, College of Chemistry and Chemical Engineering, Southwest University, Chongqing 400715, People’s Republic of China
| | - Yaqin Chai
- Key Laboratory of Luminescence
and Real-Time Analytical Chemistry (Southwest University), Ministry
of Education, College of Chemistry and Chemical Engineering, Southwest University, Chongqing 400715, People’s Republic of China
| | - Haijun Wang
- Key Laboratory of Luminescence
and Real-Time Analytical Chemistry (Southwest University), Ministry
of Education, College of Chemistry and Chemical Engineering, Southwest University, Chongqing 400715, People’s Republic of China
| | - Ruo Yuan
- Key Laboratory of Luminescence
and Real-Time Analytical Chemistry (Southwest University), Ministry
of Education, College of Chemistry and Chemical Engineering, Southwest University, Chongqing 400715, People’s Republic of China
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94
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Meneton P, Plessz M, Courtin E, Ribet C, Goldberg M, Zins M. L’impact du chômage sur la santé. Med Sci (Paris) 2017; 33:785-789. [DOI: 10.1051/medsci/20173308025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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95
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Maruthappu M, Watson RA, Watkins J, Zeltner T, Raine R, Atun R. Effects of economic downturns on child mortality: a global economic analysis, 1981-2010. BMJ Glob Health 2017; 2:e000157. [PMID: 28589010 PMCID: PMC5435251 DOI: 10.1136/bmjgh-2016-000157] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 12/28/2016] [Accepted: 12/31/2016] [Indexed: 11/05/2022] Open
Abstract
Objectives To analyse how economic downturns affect child mortality both globally and among subgroups of countries of variable income levels. Design Retrospective observational study using economic data from the World Bank's Development Indicators and Global Development Finance (2013 edition). Child mortality data were sourced from the Institute for Health Metrics and Evaluation. Setting Global. Participants 204 countries between 1981 and 2010. Main outcome measures Child mortality, controlling for country-specific differences in political, healthcare, cultural, structural, educational and economic factors. Results 197 countries experienced at least 1 economic downturn between 1981 and 2010, with a mean of 7.97 downturns per country (range 0–21; SD 0.45). At the global level, downturns were associated with significant (p<0.0001) deteriorations in each child mortality measure, in comparison with non-downturn years: neonatal (coefficient: 1.11, 95% CI 0.855 to 1.37), postneonatal (2.00, 95% CI 1.61 to 2.38), child (2.93, 95% CI 2.26 to 3.60) and under 5 years of age (5.44, 95% CI 4.31 to 6.58) mortality rates. Stronger (larger falls in the growth rate of gross domestic product/capita) and longer (lasting 2 years rather than 1) downturns were associated with larger significant deteriorations (p<0.001). During economic downturns, countries in the poorest quartile experienced ∼1½ times greater deterioration in neonatal mortality, compared with their own baseline; a 3-fold deterioration in postneonatal mortality; a 9-fold deterioration in child mortality and a 3-fold deterioration in under-5 mortality, than countries in the wealthiest quartile (p<0.0005). For 1–5 years after downturns ended, each mortality measure continued to display significant deteriorations (p<0.0001). Conclusions Economic downturns occur frequently and are associated with significant deteriorations in child mortality, with worse declines in lower income countries.
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Affiliation(s)
- Mahiben Maruthappu
- Academic Clinical Fellow & Public Health Registrar, University College London, London, UK
| | - Robert A Watson
- Department of Primary Healthcare and Public Health, Imperial College London, London, UK
| | | | - Thomas Zeltner
- Global Health Centre, Graduate Institute of International and Development Studies, Geneva, Switzerland
| | - Rosalind Raine
- Head of Department of Applied Health Research, University College London, London, UK
| | - Rifat Atun
- Harvard School of Public Health, Harvard University, Cambridge, Massachusetts, USA
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96
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Qixing M, Juqing X, Yajing W, Gaochao D, Wenjie X, Run S, Anpeng W, Lin X, Feng J, Jun W. The expression levels of CYP3A4 and CYP3A5 serve as potential prognostic biomarkers in lung adenocarcinoma. Tumour Biol 2017; 39:1010428317698340. [PMID: 28381170 DOI: 10.1177/1010428317698340] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Lung adenocarcinoma remains to be a high-mortality disease with few effective prognostic biomarkers. Novel biomarkers are urgently demanded to supplement the current prognostic biomarkers. Here, we explored the prognostic value of CYP3A4 and CYP3A5 in lung adenocarcinoma. The tissue microarray was made up of lung adenocarcinoma samples and corresponding normal lung tissues from Nanjing Medical University affiliated Cancer Hospital Tissue Bank. The expression of CYP3A4, together with CYP3A5, was detected by the chip data from Gene Expression Omnibus datasets and immunohistochemistry staining of the tissue microarray. Then, we assessed the relationships between CYP3A4 or CYP3A5 expression level and clinicopathological factors to estimate the clinical significance. Kaplan-Meier curves were applied to analyze the prognosis. Univariate and multivariate Cox analyses were subsequently applied to identify the independent prognostic factors. Immunohistochemistry staining results showed that by comparison with matched normal tissues, CYP3A4 was frequently hyper-expressed in lung adenocarcinoma tissues while CYP3A5 was hypo-expressed, which was consistent with the Gene Expression Omnibus analysis. Kaplan-Meier analysis indicated that high-CYP3A4 or low-CYP3A5 expression level predicted poor survival in lung adenocarcinoma patients. Multivariate Cox analysis found that hypo-expression of CYP3A5 was an independent prognostic factor. Further study revealed that combination of these two markers exhibited a more powerful predictor of poor prognosis, which could target to more accurate survival of lung adenocarcinoma. Our findings indicate that combination of CYP3A4 and CYP3A5 may serve as a novel prognostic biomarker in lung adenocarcinoma, which contribute to the precision of predicting the survival in lung adenocarcinoma.
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Affiliation(s)
- Mao Qixing
- 1 Department of Thoracic Surgery, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, China.,2 The Fourth Clinical College of Nanjing Medical University, Nanjing, China.,3 Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province, Nanjing, China
| | - Xu Juqing
- 4 Department of Oncology, Jiangsu Province Geriatric Hospital, Nanjing, China
| | - Wang Yajing
- 5 Nanjing Medical University, Nanjing, China
| | - Dong Gaochao
- 1 Department of Thoracic Surgery, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, China.,3 Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province, Nanjing, China
| | - Xia Wenjie
- 1 Department of Thoracic Surgery, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, China.,2 The Fourth Clinical College of Nanjing Medical University, Nanjing, China.,3 Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province, Nanjing, China
| | - Shi Run
- 1 Department of Thoracic Surgery, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, China.,2 The Fourth Clinical College of Nanjing Medical University, Nanjing, China.,3 Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province, Nanjing, China
| | - Wang Anpeng
- 1 Department of Thoracic Surgery, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, China.,2 The Fourth Clinical College of Nanjing Medical University, Nanjing, China.,3 Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province, Nanjing, China
| | - Xu Lin
- 1 Department of Thoracic Surgery, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, China.,3 Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province, Nanjing, China
| | - Jiang Feng
- 1 Department of Thoracic Surgery, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, China.,3 Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province, Nanjing, China
| | - Wang Jun
- 4 Department of Oncology, Jiangsu Province Geriatric Hospital, Nanjing, China
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97
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Kumari R, Chouhan S, Singh S, Chhipa RR, Ajay AK, Bhat MK. Constitutively activated ERK sensitizes cancer cells to doxorubicin: Involvement of p53-EGFR-ERK pathway. J Biosci 2017; 42:31-41. [PMID: 28229963 DOI: 10.1007/s12038-017-9667-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The tumour suppressor gene p53 is mutated in approximately 50% of the human cancers. p53 is involved in genotoxic stress-induced cellular responses. The role of EGFR and ERK in DNA-damage-induced apoptosis is well known. We investigated the involvement of activation of ERK signalling as a consequence of non-functional p53, in sensitivity of cells to doxorubicin. We performed cell survival assays in cancer cell lines with varying p53 status: MCF-7 (wild-type p53, WTp53), MDA MB-468 (mutant p53, MUTp53), H1299 (absence of p53, NULLp53) and an isogenic cell line MCF-7As (WTp53 abrogated). Our results indicate that enhanced chemosensitivity of cells lacking wild-type p53 function is because of elevated levels of EGFR which activates ERK. Additionally, we noted that independent of p53 status, pERK contributes to doxorubicin-induced cell death.
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Affiliation(s)
- Ratna Kumari
- National Centre for Cell Science, Savitribai Phule Pune University Campus, Ganeshkhind, Pune 411 007, India
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98
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Hua Z, Zheng X, Xue H, Wang J, Yao J. Long-term trends and survival analysis of esophageal and gastric cancer in Yangzhong, 1991-2013. PLoS One 2017; 12:e0173896. [PMID: 28288195 PMCID: PMC5348038 DOI: 10.1371/journal.pone.0173896] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 02/28/2017] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To describe the long-term trends of the incidence, mortality and survival of upper digestive tract cancers in a high-risk area of China. METHODS We extracted esophageal and gastric cancer cases diagnosed from 1991 to 2013 through the Yangzhong Cancer Registry and calculated the crude and age-standardized incidence and mortality rates. Cancer trends were calculated using the Joinpoint Regression Program and were reported using the annual percentage change (APC). The cancer-specific survival rates were evaluated and compared between groups using the Kaplan-Meier method and log-rank test. RESULTS The age-standardized incidence rate of esophageal cancer declined from 107.06 per 100,000 person-years (male: 118.05 per 100,000 person-years; female: 97.42 per 100,000 person-years) in 1991 to 37.04 per 100,000 person-years (male: 46.43 per 100,000 person-years; female: 27.26 per 100,000 person-years) in 2013, with an APC of -2.5% (95% confidence interval (CI): -3.4%, -1.5%) for males and -4.9% (95% CI:-5.8%, -3.9%) for females. The age-standardized incidence rate of gastric cancer was 165.11 per 100,000 person-years (male: 225.39 per 100,000 person-years; female: 113.34 per 100,000 person-years) in 1991 and 53.46 per 100,000 person-years (male: 76.51 per 100,000 person-years; female: 32.43 per 100,000 person-years) in 2013, with the APC of -3.6% (95% CI: -4.5%, -2.7%) for males and -4.8% (95% CI: -5.7%, -3.9%) for females. The median survival time was 3.0 years for patients with esophageal or gastric cancer. Cancer cases detected after 2004 had a better prognosis. CONCLUSIONS The age-standardized incidence rates of both esophageal and gastric cancer continuously decreased since 1991 through 2013, whereas the mortality rate remained stable before 2004 and significantly declined following the massive endoscopic screening program initiated in 2004. The survival probability of patients with esophageal and gastric cancer has improved obviously in recent decades.
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Affiliation(s)
- Zhaolai Hua
- Department of Epidemiology, Yangzhong Cancer Research Institute, Yangzhong, China
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Xianzhi Zheng
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Hengchuan Xue
- Department of Thoracic Surgery, People’s Hospital of Yangzhong, Yangzhong, China
| | - Jianming Wang
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
- The Innovation Center for Social Risk Governance in Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Jun Yao
- Department of Gastroenterology, Zhenjiang First People’s Hospital, Zhenjiang, China
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99
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Jain V, Alam A. Redefining universal health coverage in the age of global health security. BMJ Glob Health 2017; 2:e000255. [PMID: 28589029 PMCID: PMC5435271 DOI: 10.1136/bmjgh-2016-000255] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/05/2017] [Accepted: 01/22/2017] [Indexed: 02/01/2023] Open
Affiliation(s)
- Vageesh Jain
- King's College London, School of Medicine, London, UK
| | - Azeem Alam
- King's College London, School of Medicine, London, UK
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100
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Policy and priorities for national cancer control planning in low- and middle-income countries: Lessons from the Association of Southeast Asian Nations (ASEAN) Costs in Oncology prospective cohort study. Eur J Cancer 2017; 74:26-37. [DOI: 10.1016/j.ejca.2016.12.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/27/2016] [Accepted: 12/08/2016] [Indexed: 11/23/2022]
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