Cervical cancer practice patterns and appropriateness of therapy

OBJECTIVE: This study was undertaken (1) to describe practice patterns for treatment of cervical cancer on a national scale, including patient characteristics associated with receiving appropriate versus inappropriate therapy, and (2) to determine whether mortality rate differences exist between patients who were treated appropriately and those who were treated inappropriately. STUDY DESIGN: We defined treatment appropriateness in cases of cervical cancer according to general recommendations for therapy for each International Federation of Gynecology and Obstetrics stage. In an analysis of data obtained from the Surveillance, Epidemiology, and End Results Program for 1988 through 1994 we determined the associations of patient demographic characteristics and tumor characteristics with treatment appropriateness. The association between treatment appropriateness and overall mortality for as long as 7 years of follow-up was adjusted for age; marital status; Surveillance, Epidemiology, and End Results Program location; International Federation of Gynecology and Obstetrics stage of disease; lymph node status; tumor grade; and histologic classification. RESULTS: Overall 90% of all patients were found to have received appropriate therapy. Important variables significantly associated with being treated inappropriately versus appropriately included age <40 years, positive nodal status, and International Federation of Gynecology and Obstetrics stage IB disease. Important variables significantly associated with receiving no therapy versus receiving appropriate therapy were age >/=60 years, International Federation of Gynecology and Obstetrics stage IV disease, positive nodal status, and unknown nodal status. In a comprehensive model that included demographic factors and tumor characteristics, the adjusted hazard ratio for mortality among patients who were treated inappropriately versus appropriately was 0.87 (95% confidence interval, 0.70-1.09). The adjusted hazard ratio for mortality among patients who did not receive therapy versus those who were treated appropriately was 2.92 (95% confidence interval, 2.44-3.48). CONCLUSIONS: In an analysis of data from a tumor registry, cervical cancer practice patterns were generally found to follow accepted treatment guidelines. Appropriateness of therapy did not vary widely according to demographic variables. Although patients who received no therapy had an elevated risk of death with respect to that of patients who were treated appropriately, patients who were treated inappropriately had a mortality rate similar to that among those who were treated appropriately (perhaps because of limitations in Surveillance, Epidemiology, and End Results Program data). Results of this preliminary study suggest a need for further research on effectiveness of cervical cancer therapies in the general population.     

Socioeconomic differences in lung cancer incidence: a systematic review and meta-analysis

Objective  To investigate the associations between various socioeconomic indicators and lung cancer incidence. Methods  We searched PubMed and EMBASE databases for studies on socioeconomic position (SEP) and lung cancer incidence published through October 2007. Random-effect model was used to pool the risk estimates from the individual studies. We stratified the analysis by adjustment strategy to investigate the influence of smoking on socioeconomic gradient in lung cancer incidence. Results  Out of 3,288 citations, we identified 64 studies eligible for inclusion. Compared to the highest SEP level, we observed an overall increased risk in lung cancer incidence among people with low educational SEP (61%), low occupational SEP (48%), and low income-based SEP (37%). The negative social gradient for lung cancer incidence remained for most of the possible sets of pooled estimates obtained in subgroup analyses for occupational and educational SEP with less consistency for SEP based on income in studies adjusted and unadjusted for smoking. No evidence of publication bias was apparent. Conclusion  Lung cancer incidence was associated with low educational, occupational, and income-based SEP. The association, adjusted or unadjusted for smoking, points out the importance of social position to be addressed in all discussions on cancer preventive measures. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users. This work was performed in the Department of Public Health Sciences, Division of Social Medicine/Epidemiology, Karolinska Institutet, Stockholm, Sweden.     

Quantitative analysis of left ventricular performance from sequences of cardiac magnetic resonance imaging using active mesh model

In this study, the local and global left ventricular function are estimated by fitting three-dimensional active mesh model (3D-AMM) to the initial sparse displacement which is measured from an establishing point correspondence procedure. To evaluate the performance of the algorithm, eight image sequences were used and the results were compared with those reported by other researchers. The findings were consistent with previously published values and the clinical evidence as well. The results demonstrated the superiority of the novel strategy with respect to formerly presented algorithm reported by author et al. Furthermore, the results are comparable to the current state-of-the-art methods.     

Migration and child health inequities in Nigeria: a multilevel analysis of contextual- and individual-level factors

Objective To assess the role of rural–urban migration in the risks of under‐five death; to identify possible mechanisms through which migration may influence mortality; and to determine individual‐ and community‐level relationships between migration status and under‐five death. Method Multilevel Cox regression analysis was used on a nationally representative sample of 6029 children from 2735 mothers aged 15–49 years and nested within 365 communities from the 2003 Nigeria Demographic and Health Survey. Hazard ratios with 95% confidence intervals were used to express the measures of association between the characteristics, and intra‐class coefficients were used to express the measures of variation. Results Children of rural non‐migrant mothers had significantly lower risks of under‐five death than children of rural–urban migrant mothers. The disruption of family and community ties, low socio‐economic position and vulnerability, and the difficulties migrants face in adapting into the new urban environment, may predispose the children of rural–urban migrants to higher mortality. Conclusion Our results stress the need for community‐level and socio‐economic interventions targeted at migrant groups within urban areas to improve their access to health care services, maternal education, as well as the general socio‐economic situation of women.     

Delayed toxic effects of sulfur mustard on respiratory tract of Iranian veterans

To investigate late toxic effects of sulfur mustard (SM) on the upper and lower respiratory tracts of Iranian veterans, 43 male veterans with more than 25% disability due to SM poisoning in 20-25 years after exposure, were studied. Direct laryngoscopy, pulmonary function tests, arterial blood gasses and pH, computed tomography of sinuses and lungs were investigated. The patients were aged 50.6 (8.9 SD) years with body mass index (BMI) of 26.6 (4.0) and disability of 53.2 (17.0%). The common findings of the upper respiratory tract were dysphonia (79.1%), post-nasal discharge (PND; 41.9%), lower larynx position (30.2%), limitation of vocal cords (25.6%) and mucosal inflammation of larynx (14.8%). The common lower respiratory diseases were diagnosed as chronic obstructive respiratory disease (84%), bronchiectasis (44.1%) and lung fibrosis (7.7%). Severity of disability was negatively correlated with BMI (p = 0.032), spirometric parameters (p < 0.001) and oxygen saturation (p < 0.001), but positively correlated with low-density lipoproteins (LDL <0.010), blood pressure (p = 0.008), diabetes mellitus (p < 0.001), wheezing (p = 0.0043) and bronchiectasis (p < 0.001). Delayed toxic effects of SM in upper and lower respiratory tracts were mostly inflammatory and infectious complications, SM-induced disabilities were significantly correlated with risk factors such as diabetes mellitus, hypertension, LDL and lower-respiratory complications.     

Antihyperglycemic and antihyperlipidemic effect of Rumex patientia seed preparation in streptozotocin-diabetic rats

Background and objective:Rumex patientia (RP) could exert beneficial health effects to ameliorate metabolic diseases. The effect of subchronic feeding of RP seeds was evaluated on serum glucose and lipid profile in streptozotocin (STZ)-diabetic rats. Methods: Wistar rats were divided into control, RP-treated control, diabetic, glibenclamide-treated diabetic, and RP-treated diabetic groups. For induction of diabetes, streptozotcin was administered at a dose of 60 mg/kg. Meanwhile, RP-treated groups received RP seed powder mixed with standard pelleted food at a weight ratio of 6% for 4 weeks. Serum glucose and lipid levels were determined before the study and at 2nd and 4th weeks after the study in addition to the oxidative stress markers in hepatic tissue. Results: Serum glucose was significantly lower in RP-treated diabetic rats at 2nd and 4th weeks as compared to untreated diabetics (p < 0.05 and p < 0.01, respectively). Serum total cholesterol and triglyceride levels did not show significant reductions in RP-treated diabetic rats as compared to untreated diabetics. Serum HDL-cholesterol, however, significantly increased (p < 0.05) and LDL-cholesterol showed a significant reduction (p < 0.05) in RP-treated diabetic rats as compared to untreated diabetics (p < 0.05). RP also attenuated the increased malondialdehyde (MDA) content and reduced activity of superoxide dismutase (SOD) in hepatic tissue. Conclusion: Subchronic treatment of diabetic rats with RP could lessen the abnormal changes in blood glucose level and to improve lipid profile regarding HDL- and LDL-cholesterol in part due to its attenuation of lipid peroxidation in hepatic tissue.