Abdominal obesity reduction in indigenous men.

OBJECTIVES: To assess the effectiveness of a men's 'waist loss' program over one year in Indigenous men. DESIGN: Pre-and post-test measurements of 47 Indigenous men on four island groups in the Torres Strait region of Northern Australia involved in a version of the 'GutBuster' program, modified by and for Indigenous men. RESULTS: Weight, waist and hip size of 47 men, and body fat estimated from electrical impedence measures of 27 men, were compared at baseline, after approx 2 months, approx 6 months and approx one year. Average weight loss was 3.3 kg (3.5%), and waist loss 4.0 cm (3.5%). The average percentage decrease in fat mass (FM) was 10.8%. An environmental audit technique highlighted modifications needed to the environment to assist behaviour change. CONCLUSIONS: Education-behaviour change interventions of this kind may offer opportunities for health improvements in Indigenous men.     

Budget Impact of Adaptive Abiraterone Therapy for Castration-Resistant Prostate Cancer

BackgroundThe use of a novel strategy known as adaptive abiraterone therapy based on mathematical modeling of evolutionary dynamics of tumor subpopulations was shown in a clinical trial to extend the time to disease progression in patients with metastatic castration-resistant prostate cancer (CRPC) and reduced the use of abiraterone therapy. Although the clinical impact of adaptive abiraterone treatment is clear, the economic impact of this strategy has not been investigated.ObjectiveTo compare the cost of care with adaptive abiraterone therapy versus standard continuous abiraterone therapy in patients with metastatic CRPC, using patient billing data.MethodsWe performed a retrospective review of billing data for patients with metastatic CRPC who received abiraterone treatment at a large cancer center between June 1, 2012, and August 31, 2018. Patients were divided into 2 groups based on whether they received adaptive abiraterone therapy (N = 15) or continuous abiraterone therapy (N = 21). All patients with refractory, metastatic prostate cancer after castration that was indicated for abiraterone therapy were eligible for this study. Each patient in the adaptive abiraterone therapy cohort received abiraterone plus prednisone treatment until the patient reached a target threshold of 50% or more reduction in prostate-specific antigen (PSA) level compared with his PSA level before abiraterone therapy; treatment was then suspended until the PSA level rose above the 50% of PSA before abiraterone therapy target threshold. The continuous therapy cohort received abiraterone plus prednisone daily until radiographic progression. The primary outcomes were the mean annual cost of care per patient, including and excluding the cost of abiraterone, and the cost of care, by clinical category.ResultsThe median time to disease progression was 25.8 months for patients who received adaptive abiraterone therapy compared with 12.1 months for patients who received continuous abiraterone therapy. Overall, the mean total, including the cost of drug, annual cost per patient who received adaptive abiraterone therapy was $79,093 compared with $146,782 for patients who received continuous abiraterone therapy (P <.0001). The annual cost of care per patient, excluding the cost of abiraterone, was $13,883 for those who received adaptive therapy versus $22,322 for those who received continuous abiraterone therapy (P = .2757), which was not statistically significant.ConclusionPractical precision medicine strategies, such as adaptive abiraterone treatment or pharmacogenomics-targeted dosing, can use known biomarkers, such as PSA, to tailor therapy, generate improved outcomes, and reduce costs without the need for novel drug and diagnostic discovery and development. The results of this study suggest that a large clinical study of adaptive abiraterone therapy is warranted to validate the potential of this strategy to extend the time to disease progression and reduce costs of treatment of metastatic CRPC.     

Region-specific and Age-related Decrease of Parvalbumin Gene Expression in the Prefrontal Cortex of Elderly Patients with Schizophrenia

Background: Multiple studies on schizophrenia have suggested a dysfunction of γ-aminobutyric acid (GABA) transmission in the prefrontal cortex (PFC) and some vulnerability of the central nervous system to the aging process. Since one of the calcium-binding proteins, parvalbumin (PV) is a useful marker for a subpopulation of GABAergic local circuit neurons, we determined the PV gene expression in the PFC in schizophrenic brains to study a possible involvement of GABAergic system and its vulnerability, if any, to the aging process.

Methods:

Methods: We attempted a detailed in situ hybridization to determine the PV gene expression throughout the three PFC subregions (Brodmann areas; BAs 9, 10, and 11) from six elderly patients with schizophrenia and five age-matched normal individuals.

Results:

Results: The regional levels of PV messenger RNA (mRNA) were significantly decreased in BAs 9 and 10 of schizophrenics compared with controls. The cellular levels were significantly decreased in layers III, IV, and V in BAs 9 and 10 of schizophrenics. However, in BA 11 of schizophrenics, the cellular level was significantly decreased in layer in alone. There were significant reverse correlations between the PV mRNA levels in those areas and the age at death in the schizophrenic group, but not in the controls.

Conclusion:

Conclusion: The present results not only provide further evidence of a disturbance in GABA transmission in the PFC of schizophrenics, but also suggest that such dysfunction may be region-specific and vulnerable to the aging process.     

A positive change for a healthier life: Weight reduction strategies for obese people

People who are obese have increased risk of a range of conditions, and also often suffer socially and psychologically. To successfully reduce their weight, they need to make lifelong changes in their eating and exercise habits.     

Avoidable mortality in Victoria between 1979 and 2001

OBJECTIVE: To describe trends in avoidable mortality (AM) in Victoria by sex, degree of socio-economic disadvantage and remoteness. METHODS: The analysis is based on mortality and population data for 1979-2001 supplied by the Australian Bureau of Statistics (ABS) for Victoria. Total and disease-specific AM rates were age standardised using the direct method. For the period between 1997 and 2001, comparisons of total AM rates by sex were made between metropolitan and rural local government areas (LGAs), and between LGAs grouped into quintiles based on socio-economic disadvantage and categories of remoteness. RESULTS: Total AM rates declined significantly (p < 0.05) in both males and females between 1979 and 2001, but were significantly higher in males compared with females. Total AM rates were significantly higher in rural compared with metropolitan LGAs, from 1997 to 2001 in males and in 1998 in females. Total AM rates in the least disadvantaged quintile were significantly lower than those in the most disadvantaged quintile over the entire five-year period in males and in three years in females. Total AM rates were highest in remote LGAs and lowest in highly accessible LGAs. There were significant declines in ischaemic heart disease, stroke and road traffic accident AM rates among males. In females, IHD, stroke, breast and colon cancer AM rates declined significantly. CONCLUSIONS AND IMPLICATIONS: Despite large declines in AM in Victoria, there are significant differences in rates between the sexes and in the population based on socio-economic status or remoteness. These results provide opportunities for policy makers to prioritise public health and health services interventions, targeting population groups and specific disease conditions to reduce health inequalities.     

Regulatory peptides in lower esophageal sphincter of pig and man

Smooth muscle specimens from the lower esophageal sphincter (LES) region of pig and man were analyzed for vasoactive intestinal peptides (VIP), substance P (SP), enkephalin, neuropeptide Y (NPY), gastrin/cholecystokinin (CCK), neurotensin, and somatostatin using immunocytochemistry and radioimmunoassay. VIP-, SP-, enkephalin-, and NPY-immunoreactive nerve fibers were observed in the LES of both species, whereas nerve fibers containing gastrin/CCK, neurotensin, and somatostatin could not be demonstrated. The peptide-containing nerve fibers occurred in the intramural ganglia and in the smooth muscle layers. There was a rich supply of VIP- and NPY-immunoreactive fibers, whereas the supply of SP- and enkephalin-immunoreactive nerve fibers were moderate in number in both species examined. The concentration of VIP, SP, enkephalin, and NPY was comparable in the two species. The present study shows that the pattern of peptidergic innervation of the LES is similar in pig and man. It is proposed that neuronal VIP, SP, enkephalin, and NPY may serve to modulate the motor activity of the LES and that the pig is a suitable experimental animal for the study of regulatory peptides and LES functions.