Identifying risk factors for disparities in breast cancer mortality among African-American and Hispanic women

BackgroundThis study evaluated the risk factors associated with racial disparities in female breast cancer mortality for African-American and Hispanic women at the census tract level in Texas from 1995 to 2005.MethodsData on female breast cancer cases were obtained from the Texas Cancer Registry. Socioeconomic and demographic data were collected from Census 2000. Network distance and driving times to mammography facilities were estimated using Geographic Information System techniques. Demographic, poverty and spatial accessibility factors were constructed using principal component analysis. Logistic regression models were developed to predict the census tracts with significant racial disparities in breast cancer mortality based on racial disparities in late-stage diagnosis and structured factors from the principal component analysis.ResultsLate-stage diagnosis, poverty factors, and demographic factors were found to be significant predictors of a census tract showing significant racial disparities in breast cancer mortality. Census tracts with higher poverty status were more likely to display significant racial disparities in breast cancer mortality for both African Americans (odds ratio [OR], 2.43; 95% confidence interval [CI], 1.95–3.04) and Hispanics (OR, 5.30; 95% CI, 4.26–6.59). Spatial accessibility was not a consistent predictor of racial disparities in breast cancer mortality for African-American and Hispanic women.ConclusionPhysical access to mammography facilities does not necessarily reflect a greater utilization of mammogram screening, possibly owing to financial constraints. Therefore, a metric measuring access to health care facilities is needed to capture all aspects of access to preventive care. Despite easier physical access to mammography facilities in metropolitan areas, great resources and efforts should also be devoted to these areas where racial disparities in breast cancer mortality are often found.     

少、弱精子症生殖激素水平与染色体核型改变的研究

目的探讨少、弱精子症病人的遗传因素和内分泌因素。方法收集少、弱精子症病例240例,取外周血做染色体核型分析,然后全部病人取血用化学发光法检测血清泌乳素(PRL)、卵泡刺激素(FSH)、黄体生成素(LH)、睾酮(T)水平。结果 240例少、弱精子症患者染色体核型分析中,检出39例异常染色体核型。其中染色体平衡易位3例,罗氏易位3例,随体增加4例,性染色质改变29例。在生殖激素水平的检测中,与201例染色体正常组相比,39例染色体异常组的FSH和LH值均明显升高(P<0.01),而T值明显降低(P<0.01),PRL值差异无统计学意义(P>0.05)。结论染色体异常是导致少、弱精子症发生的一个重要原因,染色体异常可能是通过生殖激素水平的改变起作用。     

儿童肝母细胞瘤疗效及预后分析

目的探讨儿童肝母细胞瘤(HB)患儿的临床特征、疗效、生存情况、预后相关危险因素及其临床诊治。 方法选择2010年1月至2017年9月,于四川大学华西第二医院儿童血液肿瘤科收治的23例新发HB患儿为研究对象。采用回顾性分析方法,收集其临床病例资料,包括患儿确诊时年龄、性别、首发临床表现、组织病理学类型、治疗前病变范围(PRETEXT)分期、术后儿童肿瘤协作组(COG)分期等临床资料,以及治疗方案、疗效、预后、化疗相关不良反应等。对本组HB患儿的生存分析,如2年总体生存(OS)率、无事件生存(EFS)率,采用Kaplan-Meier法,不同临床特征患儿的生存曲线比较采用log-rank检验。HB患儿接受不同化疗方案治疗的不良反应率比较,采用Fisher确切概率法。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。 结果①本组23例HB患儿确诊时的中位年龄为25.9个月(2.3～155.0个月);男性患儿为12例,女性为11例;腹部肿块为最常见首发临床表现(56.5%,13/23)。其完全缓解(CR)率为65.2%(15/23),部分缓解(PR)率为8.7%(2/23),死亡为5例(21.7%)。②对23例患儿的中位随访时间为21.5个月(7.5～81.4个月),其2年EFS率、OS率分别为60.1%和75.0%。HB患儿预后影响因素的单因素分析结果显示,HB累及血管患儿的2年EFS率为38.9%,显著低于未累及者的81.8%,二者比较,差异有统计学意义(χ²＝4.293,P＝0.038)。HB患儿PRETEXT分期为Ⅳ期者,其2年EFS率为33.3%,显著低于PRETEXT分期为Ⅰ～Ⅲ期者的70.6%,二者比较,差异有统计学意义(χ²＝5.258,P＝0.022)。肺转移HB患儿的2年EFS率、OS率分别为20.0%、30.0%,均显著低于无肺转移者的71.4%、85.7%,二者分别比较,差异均有统计学意义(χ²＝5.491,P＝0.015;χ²＝7.773,P＝0.005)。手术后接受3个疗程化疗,血清甲胎蛋白(AFP)值未恢复正常患儿的2年EFS率、OS率分别为27.2%、37.7%,显著低于手术后接受≤3个疗程化疗即恢复正常者的91.7%、100.0%,二者比较,差异亦均有统计学意义(χ²＝9.837,P＝0.002;χ²＝8.682,P＝0.003)。③严重血液学毒性反应为本组HB患儿最常见化疗相关不良反应,尤其是采取包含多柔比星的联合化疗方案者更严重。本组术后接受化疗的22例HB患儿中,接受联合化疗方案包含多柔比星的14例患儿的3级以上血液学毒性反应、轻度转氨酶升高发生率分别为100.0%(14/14)、64.3%(9/14),显著高于未包含多柔比星患儿的37.8%(3/8)、0(0/8),二者分别比较,差异均有统计学意义(P＝0.002,P＝0.006)。 结论本组儿童HB的临床特征、组织病理学类型与国内外相关临床报道结果基本一致。HB患儿肺转移及手术后接受3个疗程化疗,血清AFP值未恢复正常水平,与该病的不良预后密切相关。     

Prenatal Bisphenol A exposure and early childhood neurodevelopment in Shandong,China

BackgroundSeveral epidemiological studies suggest that prenatal exposure to BPA may interfere with the neurodevelopment of pre-school and school-age children. However, a limited number of studies are available for effects during children at a younger age, especially in China.MethodsBased on Laizhou Wan Birth Cohort (LWBC), BPA concentrations were measured in urine among 506 pregnant women during their hospital admission for delivery and neurodevelopment of their children was assessed using the Gesell Development Schedules at 12 months (n = 368) and 24 months (n = 296). Linear regression and generalized linear models were used to analyze the association between prenatal BPA exposure and the children's developmental quotient scores (DQs).ResultsThe median of maternal BPA concentration was 0.48 μg/L or 1.05 μg/g creatinine. Maternal BPA concentrations were adversely associated with children DQs at 12 months of age, with a 10-fold increase in prenatal BPA concentrations correlated to 1.43-point decrease in DQs in the adaptive domain (β = ?1.43; 95% CI: ?2.30 to ?0.56, p = 0.001). When stratified by gender, prenatal BPA concentrations were adversely associated with the adaptive domain DQs among boys (p-trend = 0.012) and girls (p-trend = 0.028) and the social domain DQs (p-trend = 0.019) only among girls. At 24 months of age, the significant adverse association was only found in the language domain among girls (β = ?1.69; 95% CI: ?3.23 to ?0.15, p = 0.032).ConclusionBased on a Chinese population, we found potential impacts of prenatal BPA exposure on childhood neurodevelopment at 12 and 24 months of age, especially among girls.     

新形势下卫生行业组织治理方法思考

目的：论述通过加强卫生行业组织治理,提高卫生服务质量。方法：对国内外卫生行业组织治理现状进行对比,分析新时代背景下我国卫生行业组织治理的特点和面临的挑战。结果：治理思路是改革传统双重管理体制,以促进行业组织发展为目标。结论：我国卫生行业组织的发展历程和特殊的制度环境决定了我国行业组织仍然由政府为主导,行业的独立性和权威性仍然十分有限。新时代下,面临卫生行业组织改革,政府应根据其特点实行充分授权,提高行业组织的专业化水平。     

Chronic Toxicological Effects of Carbamazepine on Daphnia magna Straus: Effects on Reproduction Traits,Body Length,and Intrinsic Growth

Bulletin of Environmental Contamination and Toxicology - In recent years, pharmaceuticals and personal care products (PPCPs) that remain in the environment have become increasingly important....