The Cost of Lung Cancer Management in France from the Payor’s Perspective

Background

We assessed the average management cost per case of lung cancer in France according to the histological type and stage at diagnosis, together with the cost of each component of different treatment strategies.

Methods

The sample was drawn from public and private hospitals that were treating large numbers of patients. The study covered the period from 1 July 1998 to 30 June 1999 and was based on medical chart review. A Markov model with six decision trees (two for small cell lung cancer [SCLC] and four for non-small cell lung cancer [NSCLC]) was used for the cost analysis. Treatment was broken down into first-line and second-line strategies, surveillance, and terminal care (TC).

Results

The average management costs were €22 006 (€10 631–36 296) for 1 year and €25 643 (€10 631–41 191) for 2 years. The 2-year average costs were €22 420 for disseminated SCLC and €27 098 for localized SCLC. The costs of NSCLC ranged from €19 543 for nonsurgical stages to €30 024 for surgical stages and €24 383 for stage IV. The weight of the different components of each strategy differed markedly according to the diagnostic subgroup: the cost of diagnosis ranged from 7.4% to 14% of total management costs, and that of TC from 11.5% to 31.1%. The principal cost component was first-line chemotherapy (32–58.5%). Sensitivity analyses showed that, whatever the type of lung cancer, the percentage of actively treated patients was the main cost determinant. TC and chemotherapeutic lines also had important economic implications.

Conclusion

The model developed here enables the component costs of different lung cancer management strategies in France to be assessed and the economic consequences of new treatment modalities to be predicted.

     

Consumption of fish and Alzheimer’s Disease

Alzheimer’s Disease (AD) has been described as ‘one of the most disabling and burdensome health conditions worldwide’ and is responsible for approximately 70% of dementia in the elderly. Based on the current prevalence of AD, an aging world population and the associated projected health care requirements, it is estimated that by 2050, the prevalence of AD will reach 104 million with around 43% requiring ongoing health care. If the onset of AD can be reduced by as little as one year, the prevalence could be reduced by 10%. There is substantial commonality in research findings to date around the positive influence of seafood consumption in reducing the risk of dementia and AD. Emerging concern about the sustainability of global fisheries supports the recommendation of selective consumption of sustainable wild caught and increased emphasis on production of farmed fish supplies to meet consumption needs.     

Antipsychotic Use and Risk of Stroke Among Community-Dwelling People With Alzheimer’s Disease

ObjectivesAntipsychotic use for neuropsychiatric symptoms in Alzheimer’s disease (AD) is common despite the increased risk of cardiovascular events and mortality. There is limited and inconsistent evidence on the possible risk of stroke. We assessed whether antipsychotic initiation increases the risk of stroke in people with a verified diagnosis of AD and whether there is a difference in stroke risk between the 2 most commonly used antipsychotics, risperidone and quetiapine.DesignRegister-based exposure-matched cohort study.Setting and ParticipantsThe Medication Use and Alzheimer’s Disease (MEDALZ) cohort included 70,718 community-dwelling people with AD in Finland during 2005-2011. People with previous strokes were excluded.MethodsFor each incident antipsychotic user (n = 20,467), 1 nonuser was matched according to sex, age, and time since AD diagnosis. Analyses were conducted with inverse probability of treatment-weighted (IPTW) Cox proportional hazards models.ResultsCompared with nonuse, antipsychotic use was associated with an increased risk of stroke within 60 days of antipsychotic initiation [IPTW hazard ratio (HR) 1.73, 95% confidence interval (CI) 1.32-2.28]. However, there was no significant overall association between antipsychotic use and the risk of stroke (IPTW HR 1.09, 95% CI 0.98-1.22). There was no difference in stroke risk between risperidone and quetiapine (IPTW HR 1.12, 95% CI 0.91-1.37).Conclusions and ImplicationsStroke risk is increased shortly after antipsychotic initiation in people with AD, suggesting that even short-term use of antipsychotics should be avoided if possible. If antipsychotics are prescribed, effectiveness and safety should be assessed soon after initiation and treatment limited to the shortest possible duration.     

Electric Blanket Use and Risk of Thyroid Cancer in the Women’s Health Initiative Observational Cohort

Thyroid cancer disproportionally affects more women than men. The aim of this study was to assess whether exposure to extremely low frequency electric magnetic fields from electric blankets (EBs) was associated with the development of thyroid cancer. Data were analyzed from 89,527 women who participated in the Women’s Health Initiative Observational Study and who responded to questions concerning prior use of EBs. During a mean follow-up of 12.2 years, 190 incident cases of thyroid cancer were identified. We estimated the hazard ratio (HR) and 95 percent confidence interval (CI) of incident thyroid cancer associated with EB use by Cox’s proportional hazard model, adjusted for selected covariates. A majority, 57 percent, of the women in the cohort reported the use of EBs while sleeping and/or for warming the bed before sleep. No association was found between use of EBs and subsequent risk of thyroid cancer (HR = 0.98, 95 percent CI 0.72–1.32). Duration of EB use measured in years, months, or hours had no effect on risk. These results did not change when the cases were limited to papillary thyroid cancer, the most frequently occurring histologic type. The results of this study do not support possible health hazards of EBs in regards to thyroid cancer risk.     

Efficacy of a medical food on cognition in Alzheimer’s Disease: Results from secondary analyses of a randomized,controlled trial

Objective  

To investigate the extent that baseline cognitive impairment and intake adherence affected the 13-item Alzheimer’s Disease Assessment Scale — cognitive subscale (ADAS-cog) intervention response of a medical food in Alzheimer’s Disease (AD) patients.     

Alzheimer’s Disease Dietary Supplements in Websites

Consumer demand for health information and health services has rapidly evolved to capture and even propel the movement to online health information seeking. Seventeen percent (52 million) of health information internet users will look for information about memory loss, dementia and Alzheimer’s disease (AD) (Fox Pew Internet & American life project: Online health search. Report. Pew Research Center. http://pewinternet.org/Reports/2006/Online-Health-Search-2006.aspx 2006, Pew Research Center. http://pewinternet.org/Reports/2011/HealthTopics.aspx 2011). We examined the content of the 25 most frequently retrieved websites marketing AD dietary supplements. We found that the majority of websites and their products claimed AD-related benefits, including improvement and enhancement of function, treatment for AD, prevention of AD, maintenance of function, delayed progression of AD, and decreased symptoms. Supplements were described as effective, natural, powerful or strong, dependable and pure or of high quality. Peer reviewed references to proper scientific studies were infrequent on websites. Statements highlighting the risks of dietary supplements were as common as statements mitigating or minimizing these risks. Different strategies were used to promote supplements such as popular appeals and testimonials. Further enforcement of relevant policy is needed and preparation of clinicians to deal with requests of patients and caregivers is indicated.     

Hearing Loss is Associated With Risk of Alzheimer’s Disease: A Case-Control Study in Older People

Background

It remains unknown whether hearing loss increases the risk of Alzheimer’s disease. This study aimed to examine the association between hearing loss and risk of Alzheimer’s disease in older people in Taiwan.

Methods

Analyzing the database from Taiwan’s National Health Insurance Program, this case-control study enrolled 488 subjects ≥65 years old with newly diagnosed Alzheimer’s disease as a case group and 1952 subjects without Alzheimer’s disease as a control group from 1998–2011. Patients with Alzheimer’s disease and other comorbidities were identified by analyzing ICD-9 coding in claims data. The association of hearing loss, other comorbidities, and risk of Alzheimer’s disease were compared between groups.

Results

After controlling for confounders, multivariable logistic regression showed an adjusted odds ratio of Alzheimer’s disease of 1.39 in people with hearing loss (95% CI, 1.05–1.84) versus those without. Parkinson’s disease (OR 4.44; 95% CI, 2.54–7.78), head injury (OR 2.31; 95% CI, 1.46–3.66), depression (OR 1.68; 95% CI, 1.19–2.39), hypertension (OR 1.40; 95% CI, 1.10–1.79), and age (each year, OR 1.03; 95% CI, 1.01–1.05) also showed strong links with Alzheimer’s.

Conclusions

Hearing loss is associated with increased risk of Alzheimer’s disease in older people in Taiwan.Key words: Alzheimer’s disease, head injury, depression, hearing loss, Parkinson’s disease     

Pregnancy Intention and Health Behaviors: Results from the Central Pennsylvania Women’s Health Study Cohort

Objective Our objective was to determine whether intention for future pregnancy affects selected preconception health behaviors that may impact pregnancy outcomes. Methods Analyses are based on data from a population-based cohort study of women ages 18–45 residing in Central Pennsylvania. A subsample of 847 non-pregnant women with reproductive capacity comprise the analytic sample. We determined the associations between intention for future pregnancy and the pattern in the following health behaviors over a 2-year period: nutrition (fruit and vegetable consumption), folic acid supplementation, physical activity, binge drinking, smoking, and vaginal douching. Multivariable analyses controlled for pregnancy-related variables, health status, health care utilization, and sociodemographic variables. Results At baseline, 9% of women were considering pregnancy in the next year, 37% of women were considering pregnancy some other time in the future, and 53% of women were not considering future pregnancy. In multivariable analyses, there were no associations between intention for future pregnancy and maintaining healthy behavior or improving behavior for any of the seven longitudinal health behaviors studied. Conclusions The importance of nutrition, folic acid supplementation, physical activity, avoiding binge drinking, not smoking, and avoiding vaginal douching in the preconception period needs to be emphasized by health care providers and policy makers.     

A Study of the Relationship between Health and Subjective Well-Being in Parkinson’s Disease Patients

ObjectivesGovernments are turning their attention to evidence on subjective measures of well-being to inform policy decisions. In the context of health, there is, therefore, growing interest in understanding how measures of health-related quality of life relate to subjective well-being and whether subjective well-being could provide a basis for resource allocation decisions in the future. This study investigates the relationship between health-related quality of life, as measured by the EuroQol five-dimensional (EQ-5D) questionnaire, and subjective well-being in Parkinson’s disease.MethodsA paper questionnaire including the EQ-5D questionnaire, four key subjective well-being questions taken from the Integrated Household Survey in England, and other demographic details was distributed to people with Parkinson’s disease in the United Kingdom. Responses were used to estimate multiple regression models explaining subjective well-being using the EQ-5D questionnaire index (UK weights), EQ-5D questionnaire dimensions and the visual analogue scale, and patients’ sociodemographic characteristics.ResultsA total of 199 responses were received. Combining visual analogue scale and EQ-5D questionnaire dimensions, especially anxiety/depression and, to a lesser extent, mobility, yielded the best-fitting models (adjusted R² range 0.36–0.53). Patients with Parkinson’s disease living in care homes report lower levels of subjective well-being than do those living alone. These effects are not captured by the health-related quality-of-life measures in the analysis.ConclusionsUsual health-related quality-of-life measures can partially explain different well-being dimensions, yet they fail to capture part of the broader impact of disease on subjective well-being. Further empirical research into the relationship between subjective well-being and the EQ-5D Parkinson’s disease longitudinally, and in different disease areas, is required, and further standardization of subjective well-being measures is recommended.     

Substance Use and Intimate Partner Violence: Clarifying the Relevance of Women’s Use and Partners’ Use

Research has shown that, when women and/or their partners are involved in substance use, women’s risk for intimate partner violence (IPV) is higher. Prior research has not examined whether substance use by both women and their partners contributes independently or interactively to women’s risk of victimization and has not identified factors moderating the effect of substance use by victim or partner. Mental health and social support are explored as moderators of the association between women’s victimization and substance use by victim or partner in a study of 590 impoverished women residing in the Los Angeles area. This study found that substance use by both the woman and her partner independently predicted IPV and that social support moderated the effect of women’s substance use. These findings clarify the relevance of substance use in the context of intimate relationships and that of social support as a buffer against IPV among impoverished women.     

Multiple Antioxidants in the Prevention and Treatment of Parkinson’s Disease

Parkinson’s disease (PD) is one of the major progressive neurological disorders for which no preventative or long-term effective treatment strategies are available. Epidemiologic studies have failed to identify specific environmental, dietary or lifestyle risk factors for PD except for toxic exposure to manganese, meperidine (Demerol®, the “designer drug” version of which often contains a toxic byproduct of the synthesis, 1-methyl-4-phenyl 1,2,3,6 tetrahydropyridine [MPTP]), and some herbicides and pesticides. The search for genetic risk factors such as mutation, overexpression or underexpression of nuclear genes in DA neurons in idiopathic PD has not been successful as yet. Polymorphism in certain genes appears to be a risk factor, but there is no direct evidence for the causal relationship between polymorphism and increased risk of PD. In familial PD, mutation in the α-synuclein gene is associated with the disease, but a direct role of this gene in degeneration of DA neurons remains to be established. Although mutations in the Parkin gene has been associated with autosomal recessive juvenile Parkinson’s disease, the role of this gene mutation in causing degeneration of DA neurons has not been defined. We have reported that in hereditary PD, a mutation in the α-synuclein gene may increase the sensitivity of DA neurons to neurotoxins. We hypothesize that, in idiopathic PD, epigenetic (mitochondria, membranes, protein modifications) rather than genetic events are primary targets which, when impaired, initiate degeneration in DA neurons, eventually leading to cell death. Although the nature of neurotoxins that cause degeneration in DA neurons in PD is not well understood, oxidative stress is one of the intermediary risk factors that could initiate and/or promote degeneration of DA neurons. Therefore, supplementation with antioxidants may prevent or reduce the rate of progression of this disease. Supplementation with multiple antioxidants at appropriate doses is essential because various types of free radicals are produced, antioxidants vary in their ability to quench different free radicals and cellular environments vary with respect to their lipid and aqueous phases. L-dihydroxyphenylalanine (L-dopa) is one of the agents used in the treatment of PD. Since L-dopa is known to produce free radicals during its normal metabolism, the combination of L-dopa with high levels of multiple antioxidants may improve the efficacy of L-dopa therapy.     

Memory enhancing drugs and Alzheimer’s Disease: Enhancing the self or preventing the loss of it?

In this paper we analyse some ethical and philosophical questions related to the development of memory enhancing drugs (MEDs) and anti-dementia drugs. The world of memory enhancement is coloured by utopian thinking and by the desire for quicker, sharper, and more reliable memories. Dementia is characterized by decline, fragility, vulnerability, a loss of the most important cognitive functions and even a loss of self. While MEDs are being developed for self-improvement, in Alzheimer’s Disease (AD) the self is being lost. Despite this it is precisely those patients with AD and other forms of dementia that provide the subjects for scientific research on memory improvement. Biomedical research in the field of MEDs and anti-dementia drugs appears to provide a strong impetus for rethinking what we mean by ‚memory’, ‚enhancement’, ‚therapy’, and ‚self’. We conclude (1) that the enhancement of memory is still in its infancy, (2) that current MEDs and anti-dementia drugs are at best partially and minimally effective under specific conditions, (3) that ‚memory’ and ‚enhancement’ are ambiguous terms, (4) that there is no clear-cut distinction between enhancement and therapy, and (5) that the research into MEDs and anti-dementia drugs encourages a reductionistic view of the human mind and of the self.     

Observational and genetic studies of short telomeres and Alzheimer’s disease in 67,000 and 152,000 individuals: a Mendelian randomization study

European Journal of Epidemiology - Short telomeres might lead to increased risk of Alzheimer’s disease, but observational analyses have been inconclusive and potentially confounded by the...     

Promoting Equal Developmental Opportunity and Outcomes Among America’s Children and Youth: Results from the National Promises Study

Building on a developmental framework positing five types of assets or inputs needed for children’s development, referred to as promises, we investigated the extent to which American children and youth experience the five Promises articulated by the America’s Promise Alliance. These are: (1) Caring Adults, (2) Safe Places and Constructive Use of Time, (3) A Healthy Start, (4) Effective Education, and (5) Opportunities to Make a Difference. Data came from a nationally representative poll designed to assess these five resources and involved more than 4,000 teenagers and their parents. Results showed that only a minority of young people experienced rich developmental nourishment (having 4–5 of the Promises). Males, older adolescents, adolescents of color, and adolescents from families with less education and lower parental annual incomes were significantly less likely to experience sufficient developmental opportunities and were also less likely to experience desirable developmental outcomes. However, among those young people who reported experiencing 4–5 Promises, the great majority of demographic differences in developmental outcomes were either eliminated or significantly reduced. The results suggest that increasing children’s experience of these Promises would reduce developmental inequalities among America’s young people. Editors’ Strategic Implications: Longitudinal studies with representative samples will be necessary to further validate this approach and study causal contributions of assets, but this integration of Positive Youth Development frameworks holds great promise for theory, practice, and policy.     

Determinants of Women’s Drug Use During Pregnancy: Perspectives from a Qualitative Study

Maternal and Child Health Journal - Drug use during pregnancy can have negative effects on maternal and child health. However, there is a dearth of data regarding drug use among pregnant women in...     

Ferulic Acid: A Hope for Alzheimer’s Disease Therapy from Plants

Alzheimer’s disease (AD) is a neurodegenerative disorder characterized by the deposition of extracellular amyloid-beta peptide (Aβ) and intracellular neurofibrillar tangles, associated with loss of neurons in the brain and consequent learning and memory deficits. Aβ is the major component of the senile plaques and is believed to play a central role in the development and progress of AD both in oligomer and fibril forms. Inhibition of the formation of Aβ fibrils as well as the destabilization of preformed Aβ in the Central Nervous System (CNS) would be an attractive therapeutic target for the treatment of AD. Moreover, a large number of studies indicate that oxidative stress and mitochondrial dysfunction may play an important role in AD and their suppression or reduction via antioxidant use could be a promising preventive or therapeutic intervention for AD patients. Many antioxidant compounds have been demonstrated to protect the brain from Aβ neurotoxicity. Ferulic acid (FA) is an antioxidant naturally present in plant cell walls with anti-inflammatory activities and it is able to act as a free radical scavenger. Here we present the role of FA as inhibitor or disaggregating agent of amyloid structures as well as its effects on biological models.