A novel vaccine could help prevent middle ear infection in children under two years of age, according to a paper in this week's issue of The Lancet.
Otitis media (middle ear infection) accounts for nearly 20 million visits to a paediatrician every year in the USA. The bacteria Streptococcus pneumoniae and Haemophilus influenzae are the leading causes of infection. Although vaccines against S. pneumoniae exist, they are not effective enough in the age group where the disease is most prevalent--children younger than two years.
Roman Prymula (University of Defence, Hradec Kralove, Czech Republic) and colleagues tested a vaccine containing proteins from 11 different strains of S. pneumoniae attached to a protein derived from H. influenzae. 4968 infants were randomly assigned to receive the pneumococcal protein D vaccine (intervention group) or hepatitis A vaccine (control group) at the ages of 3, 4, 5 and 12-15 months. The investigators followed up the children at the end of their second year of life and found that there were 333 cases of otitis media in the pneumococcal protein D vaccine group and 499 in the control group. They also found that using the vaccine not only protected against pneumocccal otitis media, but also against middle ear infection caused by H. influenzae.
Dr Prymula states: "We found a reduction in ear, nose and throat specialist-confirmed episodes of acute otitis media by about a third in infants in the vaccine group compared with controls."
A novel vaccine could help prevent middle ear infection in children under two years of age, according to a paper in this week's issue of The Lancet.
Otitis media (middle ear infection) accounts for nearly 20 million visits to a paediatrician every year in the USA. The bacteria Streptococcus pneumoniae and Haemophilus influenzae are the leading causes of infection. Although vaccines against S. pneumoniae exist, they are not effective enough in the age group where the disease is most prevalent--children younger than two years.
Roman Prymula (University of Defence, Hradec Kralove, Czech Republic) and colleagues tested a vaccine containing proteins from 11 different strains of S. pneumoniae attached to a protein derived from H. influenzae. 4968 infants were randomly assigned to receive the pneumococcal protein D vaccine (intervention group) or hepatitis A vaccine (control group) at the ages of 3, 4, 5 and 12-15 months. The investigators followed up the children at the end of their second year of life and found that there were 333 cases of otitis media in the pneumococcal protein D vaccine group and 499 in the control group. They also found that using the vaccine not only protected against pneumocccal otitis media, but also against middle ear infection caused by H. influenzae.
Dr Prymula states: "We found a reduction in ear, nose and throat specialist-confirmed episodes of acute otitis media by about a third in infants in the vaccine group compared with controls."
Contact: Roman Prymula, Department of Epidemiology, Faculty of Military Health Sciences, University of Defence, Hradec Kralove, Czech Republic. T) +420 602 488 620 prymulapmfhk.cz
Contact: Joe Santangelo
j.santangeloelsevier
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вторник, 6 сентября 2011 г.
Health Disparities: Genetics, Society And Race Play An Important Role In Access To Healthcare
Minority individuals are much more likely to develop and die from cancer than the general U.S. population. Previous research points to lack of health insurance, poverty, language and cultural barriers, and inadequate access to early detection services and good medical care as causes. Research reported today at the 2007 Annual Meeting of the American Association for Cancer Research (AACR) suggests that genetics, in addition to socioeconomic status, are important factors accounting for the disparity of cancer incidence and mortality between African-Americans, Hispanics and Caucasians.
A survey of stomach and kidney cancer patients in Los Angeles revealed that those who were diagnosed in a late stage of disease when cancer is harder to treat successfully were likely to be older, living in an unsafe neighborhood and traveling at least 45 minutes to get to the doctor.
Researchers at the University of Southern California's Keck School of Medicine cite two general types of personal risk factors associated with late cancer diagnosis: socio-economic, or cultural, factors related to knowledge about the health care system and difficulties accessing it; and individuals' failure to give priority to medical care, despite having access to it.
While minorities have been shown to have higher rates of dying from cancer, it hasn't always been clear why, said Ann Hamilton, Ph.D., assistant professor of preventive medicine at USC. Using proportions of minorities in census tracts or income and education statistics hasn't been totally effective in identifying subgroups at higher risk.
Hamilton and USC colleague Myles Cockburn mailed a questionnaire to patients diagnosed with stomach and kidney cancer between 2000 and 2001 in Los Angeles County, which has a large Hispanic population. It asked about, among other things, access to care, acculturation, neighborhood environment, other diseases and demographic information. The acculturation scale was based on a series of questions, such as, 'What language do you speak primarily at home English, Spanish or both?'
Hamilton and Cockburn also wanted to identify "neighborhood-related" factors that could help predict population subgroups at higher risk for being diagnosed late, in addition to personal risk factors. "I wanted to identify new combinations of individual risk factors as well as ecological factors at the census tract level that could be used to better predict subgroups at higher risk," Hamilton said.
The researchers found that, at the census tract level, the percentage of people who speak a language other than English at home, the percentage of Hispanics 25 or older with less than a ninth grade education, percent unemployed and percent using public transportation were correlated with a higher percentage of cancers being diagnosed at a later stage.
"In using both ecological and personal measures, we were trying to determine how both factors may increase risk. We were assessing the effect of personal risk factors in the context of the neighborhood environment," Hamilton said. "For example, we found an indication that after taking other factors into account, a person with a lower level of acculturation who lived in an area where few others speak English was more likely to be diagnosed at a later stage of disease than the same type of person who lived in an area where most spoke English."
The results, Hamilton said, may help better target disease intervention programs for those most vulnerable and at risk.
Epidemiologists have unexpectedly found that African Americans had a higher rate of recurrence following prostate cancer surgery than did whites, regardless of whether or not patients received surgery at hospitals or by surgeons who performed a high number of such operations.
The findings were surprising as previous research has shown that, in general, patients fare better at hospitals that perform a high volume of surgeries or by surgeons who perform a large number of operations.
According to epidemiologist Kyna Gooden, Ph.D., of Shaw University, previous studies have shown that African Americans have a higher rate of prostate cancer recurrence and a greater likelihood of dying from their cancer following prostate surgery more specifically, total removal of the prostate gland compared to white men.
She and her co-investigators at Shaw University and the University of North Carolina in Chapel Hill, looked at whether the number of prostate cancer surgeries a hospital or a surgeon performed affected this disparity.
Gooden and her team hypothesized that a disproportionate number of African Americans were treated at hospitals or by physicians performing fewer surgeries. The racial differences in the prostate cancer recurrence and mortality following surgery would disappear, they assumed, once they took into account hospital and physician volume.
They examined data from the Surveillance, Epidemiology, and End-Results Medicare database for 962 African American and 7,387 white men diagnosed with prostate cancer between 1993 and 1999 who had received surgery within six months of diagnosis. They controlled for age at diagnosis, cancer stage and grade.
When the researchers looked at the outcomes after surgery in relation to volume, results were similar to previous findings patients who had surgery at high volume hospitals for prostate cancer were less likely to have cancers that returned and less likely to die from prostate cancer. But when they broke down the numbers by race for African Americans and whites, they found that surprisingly, the racial disparities persisted.
"Even for patients who went to high volume hospitals and were seen by high volume physicians, there was still a racial disparity," Gooden said. "We expected that if everyone was treated by similarly experienced doctors or hospitals, they would have had comparable outcomes. But that wasn't the case."
"These results may have less to do with access to clinical care but more to do with lifestyle factors and the physical and genetic characteristics of the tumor itself," Gooden said.
In preliminary findings, researchers have identified differences in the expression of two genes in normal breast tissue from African American and white women that could predispose the former to develop more aggressive tumors and poorer prognoses.
Postdoctoral fellow Lori Field, Ph.D., of the Windber Research Institute, and colleagues at Walter Reed Army Medical Center and Invitrogen Informatics, wanted to understand why breast cancer mortality rates are higher in African American women than in Caucasian, even though the overall incidence in white women is higher. Breast tumors in black women are larger, more aggressive, and more likely to spread to the lymph node than those in white women.
Before comparing breast cancer tumors, the scientists first examined healthy breast tissue. They obtained samples from 26 African American and 22 Caucasian women enrolled in the Clinical Breast Care Project, a federally mandated breast research program with both military and civilian centers.
Using microarray technology to examine large numbers of genes at once, they found differences in the expression of 89 genes among the two groups. Two of these genes PSPH, phosphoserine phosphatase, which is involved in forming serine, and ACSM1, acyl-CoA synthetase medium chain family member 1, which is involved in fatty acid oxidation had a higher expression in the African American women.
Serine is an intermediate in the synthesis of other amino acids, as well as DNA and lipids. If more serine is being shunted into any of these pathways, Field said, it might enhance cellular division and growth. Increased ACSM1 expression could increase the rate of fatty acid oxidation in the cell, resulting in a rise in cellular energy production.
"Both conditions could promote cell growth and could potentially provide greater growth advantage to breast cells in African Americans compared to Caucasians and could increase the likelihood to potential cancer transformation," Field said.
While the researchers continue to validate these initial findings, they currently are comparing breast tumors from African American and Caucasian women to look for differences in gene expression.
"If we see that there are differences in the breast tumors, we may find new molecular targets to which therapy can be tailored specifically to African American women," Field said.
Having a mother or sister with breast cancer significantly increases the risk for young African American women to develop breast cancer, according to the analysis of questionnaires answered by approximately 59,000 African American women enrolled in the Black Women's Health Study.
Beginning in 1995, questionnaires were given every two years to women none of whom knowingly had cancer asking about demographics, reproductive and health history, family history of breast cancer and other factors.
According to principal investigator Julie Palmer, ScD, professor of epidemiology at Boston University, few studies have examined the relationship of family history to breast cancer risk in African American women, and none have done so prospectively.
"We wanted to see if we would confirm what had been shown in white women that having a mother or sister with breast cancer would increase a woman's risk of developing breast cancer," Palmer said.
Analyzing 10 years' worth of follow-up questionnaires found there were 1,050 cases of breast cancer among those who completed questionnaires on family history. The team, found that the incidence rate-ratio for such women was 1.77, meaning that overall, African American women who had a first degree relative either a mother or a sister with breast cancer had 1.77 times the risk of getting breast cancer compared to another woman of the same age who didn't have a family member with breast cancer. Having a family history of breast cancer was a stronger risk factor in women under 35, among whom the relative risk was 2.67.
Palmer said that as the study group ages and the number of women with cancer increases, the team can begin to examine other factors in cancer risk and development. "We'd expect that relative risk of 1.77 to go up quite a bit for women who have two first-degree relatives," she said. In fact, the researchers found that the overall relative risk for breast cancer was 2.58 for having two or more first-degree relatives with breast cancer, but the figure was based on few women.
The researchers plan to examine whether having a family member with other cancers is related to heightened breast cancer risk. Palmer noted that ovarian cancer might be one such cancer because "there are some shared genes," referring to the tumor suppressor gene BRCA1, which when damaged can increase a woman's risk of both breast and ovarian cancers.
In time, Palmer said, the study will have data to report on other cancers, such as colon and lung.
Genetic variations in the body's immune system could play a role in making African Americans more susceptible to developing colon cancer, scientists have found.
Researchers led by Krista Zanetti, Ph.D., a postdoctoral fellow in the National Cancer Institute's Division of Cancer Prevention and Center for Cancer Research, looked at variations in genetic sequences of the gene that makes mannose-binding lectin (MBL), a protein that plays a role in inflammation and innate immunity. They compared 26 MBL variations, or single nucleotide polymorphisms (SNPs), in 261 colon cancer patients and 537 normal controls in the Baltimore area.
Of the 26, four SNPs were associated with a significant increase in colon cancer risk in African Americans, though not in Caucasians. African Americans who carried two copies of all four variants had an approximately six-fold higher risk of colon cancer compared to those without such variants.
The four DNA variants occur in linkage disequilibrium that is, they appear together at a higher frequency than by random chance in both African Americans and Caucasians, though they are more prevalent in the former. "It was surprising," Zanetti said, "because we wouldn't necessarily assume that any one SNP would be linked to one race more than others. It wasn't our hypothesis."
Zanetti and her team currently are attempting to validate the findings with data from the Prostate, Lung, Colorectal and Ovarian (PLCO) trial, a randomized control trial originally designed to test the effectiveness of cancer screening methods. They will screen the colorectal cancer patient subset of the study for the four SNPs, with individuals with colorectal polyps as controls. Both of the latter groups are mostly Caucasian.
"Before we validate these associations in African Americans, we first need to know whether or not they exist in Caucasians that's the number one question we want to answer," Zanetti said. "Is it possible that this is actually an African American risk factor?"
According to Zanetti, the PLCO study gives the researchers the high level of power needed to detect whether these associations really exist in Caucasians. That would then enable the team to design the rest of their study.
Zanetti noted that over the past three decades colon cancer deaths in African Americans have generally been higher than in Caucasians. "We don't know why the decline in death rates has been smaller in African Americans, but we believe it's more than one factor," she said. "These SNPs aren't necessarily the only answer. We need to keep working to uncover all the contributors to this increased risk, whether there are underlying biological issues or social determinants.
"We're doing a multitude of functional studies in the laboratory to see if we can link a phenotype to the genotype we have found," she said. "We're trying to link it to biological function I think there's more to it than just association."
The mission of the American Association for Cancer Research is to prevent and cure cancer. Founded in 1907, AACR is the world's oldest and largest professional organization dedicated to advancing cancer research. The membership includes more than 25,000 basic, translational, and clinical researchers; health care professionals; and cancer survivors and advocates in the United States and more than 70 other countries. AACR marshals the full spectrum of expertise from the cancer community to accelerate progress in the prevention, diagnosis and treatment of cancer through high-quality scientific and educational programs. It funds innovative, meritorious research grants. The AACR Annual Meeting attracts over 17,000 participants who share the latest discoveries and developments in the field. Special Conferences throughout the year present novel data across a wide variety of topics in cancer research, diagnosis and treatment. AACR publishes five major peer-reviewed journals: Cancer Research; Clinical Cancer Research; Molecular Cancer Therapeutics; Molecular Cancer Research; and Cancer Epidemiology, Biomarkers & Prevention. Its most recent publication, CR, is a magazine for cancer survivors, patient advocates, their families, physicians, and scientists. It provides a forum for sharing essential, evidence-based information and perspectives on progress in cancer research, survivorship and advocacy.
American Association for Cancer Research (AACR)
615 Chestnut Street, 17th Floor
Philadelphia, PA 19106
United States
aacr
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A survey of stomach and kidney cancer patients in Los Angeles revealed that those who were diagnosed in a late stage of disease when cancer is harder to treat successfully were likely to be older, living in an unsafe neighborhood and traveling at least 45 minutes to get to the doctor.
Researchers at the University of Southern California's Keck School of Medicine cite two general types of personal risk factors associated with late cancer diagnosis: socio-economic, or cultural, factors related to knowledge about the health care system and difficulties accessing it; and individuals' failure to give priority to medical care, despite having access to it.
While minorities have been shown to have higher rates of dying from cancer, it hasn't always been clear why, said Ann Hamilton, Ph.D., assistant professor of preventive medicine at USC. Using proportions of minorities in census tracts or income and education statistics hasn't been totally effective in identifying subgroups at higher risk.
Hamilton and USC colleague Myles Cockburn mailed a questionnaire to patients diagnosed with stomach and kidney cancer between 2000 and 2001 in Los Angeles County, which has a large Hispanic population. It asked about, among other things, access to care, acculturation, neighborhood environment, other diseases and demographic information. The acculturation scale was based on a series of questions, such as, 'What language do you speak primarily at home English, Spanish or both?'
Hamilton and Cockburn also wanted to identify "neighborhood-related" factors that could help predict population subgroups at higher risk for being diagnosed late, in addition to personal risk factors. "I wanted to identify new combinations of individual risk factors as well as ecological factors at the census tract level that could be used to better predict subgroups at higher risk," Hamilton said.
The researchers found that, at the census tract level, the percentage of people who speak a language other than English at home, the percentage of Hispanics 25 or older with less than a ninth grade education, percent unemployed and percent using public transportation were correlated with a higher percentage of cancers being diagnosed at a later stage.
"In using both ecological and personal measures, we were trying to determine how both factors may increase risk. We were assessing the effect of personal risk factors in the context of the neighborhood environment," Hamilton said. "For example, we found an indication that after taking other factors into account, a person with a lower level of acculturation who lived in an area where few others speak English was more likely to be diagnosed at a later stage of disease than the same type of person who lived in an area where most spoke English."
The results, Hamilton said, may help better target disease intervention programs for those most vulnerable and at risk.
Epidemiologists have unexpectedly found that African Americans had a higher rate of recurrence following prostate cancer surgery than did whites, regardless of whether or not patients received surgery at hospitals or by surgeons who performed a high number of such operations.
The findings were surprising as previous research has shown that, in general, patients fare better at hospitals that perform a high volume of surgeries or by surgeons who perform a large number of operations.
According to epidemiologist Kyna Gooden, Ph.D., of Shaw University, previous studies have shown that African Americans have a higher rate of prostate cancer recurrence and a greater likelihood of dying from their cancer following prostate surgery more specifically, total removal of the prostate gland compared to white men.
She and her co-investigators at Shaw University and the University of North Carolina in Chapel Hill, looked at whether the number of prostate cancer surgeries a hospital or a surgeon performed affected this disparity.
Gooden and her team hypothesized that a disproportionate number of African Americans were treated at hospitals or by physicians performing fewer surgeries. The racial differences in the prostate cancer recurrence and mortality following surgery would disappear, they assumed, once they took into account hospital and physician volume.
They examined data from the Surveillance, Epidemiology, and End-Results Medicare database for 962 African American and 7,387 white men diagnosed with prostate cancer between 1993 and 1999 who had received surgery within six months of diagnosis. They controlled for age at diagnosis, cancer stage and grade.
When the researchers looked at the outcomes after surgery in relation to volume, results were similar to previous findings patients who had surgery at high volume hospitals for prostate cancer were less likely to have cancers that returned and less likely to die from prostate cancer. But when they broke down the numbers by race for African Americans and whites, they found that surprisingly, the racial disparities persisted.
"Even for patients who went to high volume hospitals and were seen by high volume physicians, there was still a racial disparity," Gooden said. "We expected that if everyone was treated by similarly experienced doctors or hospitals, they would have had comparable outcomes. But that wasn't the case."
"These results may have less to do with access to clinical care but more to do with lifestyle factors and the physical and genetic characteristics of the tumor itself," Gooden said.
In preliminary findings, researchers have identified differences in the expression of two genes in normal breast tissue from African American and white women that could predispose the former to develop more aggressive tumors and poorer prognoses.
Postdoctoral fellow Lori Field, Ph.D., of the Windber Research Institute, and colleagues at Walter Reed Army Medical Center and Invitrogen Informatics, wanted to understand why breast cancer mortality rates are higher in African American women than in Caucasian, even though the overall incidence in white women is higher. Breast tumors in black women are larger, more aggressive, and more likely to spread to the lymph node than those in white women.
Before comparing breast cancer tumors, the scientists first examined healthy breast tissue. They obtained samples from 26 African American and 22 Caucasian women enrolled in the Clinical Breast Care Project, a federally mandated breast research program with both military and civilian centers.
Using microarray technology to examine large numbers of genes at once, they found differences in the expression of 89 genes among the two groups. Two of these genes PSPH, phosphoserine phosphatase, which is involved in forming serine, and ACSM1, acyl-CoA synthetase medium chain family member 1, which is involved in fatty acid oxidation had a higher expression in the African American women.
Serine is an intermediate in the synthesis of other amino acids, as well as DNA and lipids. If more serine is being shunted into any of these pathways, Field said, it might enhance cellular division and growth. Increased ACSM1 expression could increase the rate of fatty acid oxidation in the cell, resulting in a rise in cellular energy production.
"Both conditions could promote cell growth and could potentially provide greater growth advantage to breast cells in African Americans compared to Caucasians and could increase the likelihood to potential cancer transformation," Field said.
While the researchers continue to validate these initial findings, they currently are comparing breast tumors from African American and Caucasian women to look for differences in gene expression.
"If we see that there are differences in the breast tumors, we may find new molecular targets to which therapy can be tailored specifically to African American women," Field said.
Having a mother or sister with breast cancer significantly increases the risk for young African American women to develop breast cancer, according to the analysis of questionnaires answered by approximately 59,000 African American women enrolled in the Black Women's Health Study.
Beginning in 1995, questionnaires were given every two years to women none of whom knowingly had cancer asking about demographics, reproductive and health history, family history of breast cancer and other factors.
According to principal investigator Julie Palmer, ScD, professor of epidemiology at Boston University, few studies have examined the relationship of family history to breast cancer risk in African American women, and none have done so prospectively.
"We wanted to see if we would confirm what had been shown in white women that having a mother or sister with breast cancer would increase a woman's risk of developing breast cancer," Palmer said.
Analyzing 10 years' worth of follow-up questionnaires found there were 1,050 cases of breast cancer among those who completed questionnaires on family history. The team, found that the incidence rate-ratio for such women was 1.77, meaning that overall, African American women who had a first degree relative either a mother or a sister with breast cancer had 1.77 times the risk of getting breast cancer compared to another woman of the same age who didn't have a family member with breast cancer. Having a family history of breast cancer was a stronger risk factor in women under 35, among whom the relative risk was 2.67.
Palmer said that as the study group ages and the number of women with cancer increases, the team can begin to examine other factors in cancer risk and development. "We'd expect that relative risk of 1.77 to go up quite a bit for women who have two first-degree relatives," she said. In fact, the researchers found that the overall relative risk for breast cancer was 2.58 for having two or more first-degree relatives with breast cancer, but the figure was based on few women.
The researchers plan to examine whether having a family member with other cancers is related to heightened breast cancer risk. Palmer noted that ovarian cancer might be one such cancer because "there are some shared genes," referring to the tumor suppressor gene BRCA1, which when damaged can increase a woman's risk of both breast and ovarian cancers.
In time, Palmer said, the study will have data to report on other cancers, such as colon and lung.
Genetic variations in the body's immune system could play a role in making African Americans more susceptible to developing colon cancer, scientists have found.
Researchers led by Krista Zanetti, Ph.D., a postdoctoral fellow in the National Cancer Institute's Division of Cancer Prevention and Center for Cancer Research, looked at variations in genetic sequences of the gene that makes mannose-binding lectin (MBL), a protein that plays a role in inflammation and innate immunity. They compared 26 MBL variations, or single nucleotide polymorphisms (SNPs), in 261 colon cancer patients and 537 normal controls in the Baltimore area.
Of the 26, four SNPs were associated with a significant increase in colon cancer risk in African Americans, though not in Caucasians. African Americans who carried two copies of all four variants had an approximately six-fold higher risk of colon cancer compared to those without such variants.
The four DNA variants occur in linkage disequilibrium that is, they appear together at a higher frequency than by random chance in both African Americans and Caucasians, though they are more prevalent in the former. "It was surprising," Zanetti said, "because we wouldn't necessarily assume that any one SNP would be linked to one race more than others. It wasn't our hypothesis."
Zanetti and her team currently are attempting to validate the findings with data from the Prostate, Lung, Colorectal and Ovarian (PLCO) trial, a randomized control trial originally designed to test the effectiveness of cancer screening methods. They will screen the colorectal cancer patient subset of the study for the four SNPs, with individuals with colorectal polyps as controls. Both of the latter groups are mostly Caucasian.
"Before we validate these associations in African Americans, we first need to know whether or not they exist in Caucasians that's the number one question we want to answer," Zanetti said. "Is it possible that this is actually an African American risk factor?"
According to Zanetti, the PLCO study gives the researchers the high level of power needed to detect whether these associations really exist in Caucasians. That would then enable the team to design the rest of their study.
Zanetti noted that over the past three decades colon cancer deaths in African Americans have generally been higher than in Caucasians. "We don't know why the decline in death rates has been smaller in African Americans, but we believe it's more than one factor," she said. "These SNPs aren't necessarily the only answer. We need to keep working to uncover all the contributors to this increased risk, whether there are underlying biological issues or social determinants.
"We're doing a multitude of functional studies in the laboratory to see if we can link a phenotype to the genotype we have found," she said. "We're trying to link it to biological function I think there's more to it than just association."
The mission of the American Association for Cancer Research is to prevent and cure cancer. Founded in 1907, AACR is the world's oldest and largest professional organization dedicated to advancing cancer research. The membership includes more than 25,000 basic, translational, and clinical researchers; health care professionals; and cancer survivors and advocates in the United States and more than 70 other countries. AACR marshals the full spectrum of expertise from the cancer community to accelerate progress in the prevention, diagnosis and treatment of cancer through high-quality scientific and educational programs. It funds innovative, meritorious research grants. The AACR Annual Meeting attracts over 17,000 participants who share the latest discoveries and developments in the field. Special Conferences throughout the year present novel data across a wide variety of topics in cancer research, diagnosis and treatment. AACR publishes five major peer-reviewed journals: Cancer Research; Clinical Cancer Research; Molecular Cancer Therapeutics; Molecular Cancer Research; and Cancer Epidemiology, Biomarkers & Prevention. Its most recent publication, CR, is a magazine for cancer survivors, patient advocates, their families, physicians, and scientists. It provides a forum for sharing essential, evidence-based information and perspectives on progress in cancer research, survivorship and advocacy.
American Association for Cancer Research (AACR)
615 Chestnut Street, 17th Floor
Philadelphia, PA 19106
United States
aacr
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Differences In Treatments And Outcomes Of Patients With Second Primary Lung Cancers Versus Those With One Primary Lung Identified
Patients with second primary lung cancers (SPLC), when compared to those with one primary lung cancer (OPLC), are more likely to have localized disease at the time of diagnosis and are more likely to receive surgical treatment rather than radiation treatment. However, patients with SPLC have a 12% higher lung cancer specific mortality, Fox Chase Cancer Center researchers reported at the annual meeting of the International Association for the Study of Lung Cancer.
"We want to identify factors that can improve and prolong lung cancer survivorship," says Linna Li, M.D., resident physician in the radiation department at Fox Chase.
It is recognized that patients who were previously treated for lung cancer are at high risk of developing SPLC, but the impact of this second cancer on treatment and lung cancer specific mortality is unknown. With this study Li and her colleagues aimed to uncover some of these unknowns.
The study used the National Cancer Institute Surveillance, Epidemiology and End Results (SEER) database and evaluated the treatment and outcomes of non-small cell lung cancer (NSCLC) survivors with SPLC. Survivors of at least 2 years, over the age of 18 and undergoing active follow-up were included. With a median follow-up of 7 years, 49,577 patient with OPLC and 2,914 patients with SPLC were identified. The incidence, tumor characteristics, treatment, and cause of death in patients with OPLC and SPLC were analyzed.
"By studying a large population database, we can get important information to guide recommendations for treatment and follow up."
The research showed that median time to develop a second cancer is 51 months with 28% diagnosed 5 years after initial diagnosis of lung cancer. When diagnosed with OPLC versus SPLC, localized disease was 45% versus 60%, loco-regional disease was 35% versus 32%, and metastatic disease was 14% versus 5%. The data also showed that treatment of OPLC versus SPLC was 68% versus 87% with surgery, 31% versus 20% with radiation therapy, and 12% versus 12% with both surgery and radiation therapy. At the time of the last follow up, 56% of OPLC and 67% of SPLC were deceased. The leading cause of death in patients with OPLC versus SPLC was 64% versus 76% from lung cancer - showing that those with SPLC have a 12% higher lung cancer specific mortality.
"Curing second primary lung cancers is crucial in the long term care of lung cancer survivors. We should continue to follow lung cancer survivors after 5 years to detect second cancers earlier. It's unclear why SPLC are more likely to die from lung cancer even though they present with earlier disease. Perhaps they have less reserve, limited treatment options for the second treatment, or simply, that they are older. We need to study this more carefully in future clinical trials." adds Li.
Source:
Diana Quattrone
Fox Chase Cancer Center
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"We want to identify factors that can improve and prolong lung cancer survivorship," says Linna Li, M.D., resident physician in the radiation department at Fox Chase.
It is recognized that patients who were previously treated for lung cancer are at high risk of developing SPLC, but the impact of this second cancer on treatment and lung cancer specific mortality is unknown. With this study Li and her colleagues aimed to uncover some of these unknowns.
The study used the National Cancer Institute Surveillance, Epidemiology and End Results (SEER) database and evaluated the treatment and outcomes of non-small cell lung cancer (NSCLC) survivors with SPLC. Survivors of at least 2 years, over the age of 18 and undergoing active follow-up were included. With a median follow-up of 7 years, 49,577 patient with OPLC and 2,914 patients with SPLC were identified. The incidence, tumor characteristics, treatment, and cause of death in patients with OPLC and SPLC were analyzed.
"By studying a large population database, we can get important information to guide recommendations for treatment and follow up."
The research showed that median time to develop a second cancer is 51 months with 28% diagnosed 5 years after initial diagnosis of lung cancer. When diagnosed with OPLC versus SPLC, localized disease was 45% versus 60%, loco-regional disease was 35% versus 32%, and metastatic disease was 14% versus 5%. The data also showed that treatment of OPLC versus SPLC was 68% versus 87% with surgery, 31% versus 20% with radiation therapy, and 12% versus 12% with both surgery and radiation therapy. At the time of the last follow up, 56% of OPLC and 67% of SPLC were deceased. The leading cause of death in patients with OPLC versus SPLC was 64% versus 76% from lung cancer - showing that those with SPLC have a 12% higher lung cancer specific mortality.
"Curing second primary lung cancers is crucial in the long term care of lung cancer survivors. We should continue to follow lung cancer survivors after 5 years to detect second cancers earlier. It's unclear why SPLC are more likely to die from lung cancer even though they present with earlier disease. Perhaps they have less reserve, limited treatment options for the second treatment, or simply, that they are older. We need to study this more carefully in future clinical trials." adds Li.
Source:
Diana Quattrone
Fox Chase Cancer Center
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Altravax, Inc. Awarded $1.2 Million In Federal Funds For Vaccines For HIV/AIDS
Altravax, Inc. announced that it has been awarded two SBIR grants totaling $1.2 million from the NIH's National Institute of Allergy and Infectious Diseases for research on antibody-inducing vaccines for HIV-1. A 2009 report from the United Nations has estimated the total number of people living with AIDS is now at over 30 million. Altravax will use its proprietary MolecularBreeding™ directed evolution technology to create vaccines that provide broad protection against the various strains of HIV-1. The existence of a large number of virus strains and the continued changing nature of the virus is one of the major challenges facing the development of vaccines for HIV/AIDS.
Dr. Robert Whalen, the Chief Scientific Officer at Altravax, is one of the leaders in the development of the MolecularBreeding™ technology platform for use in the vaccine area. "Our past research activities have made significant progress in developing novel vaccine antigens to broadly target the numerous HIV-1 strains and we are pleased that the NIH is continuing to support our research on HIV vaccines," said Dr. Whalen. "This continued federal support is a critical factor in our program to develop a preventative vaccine to combat the AIDS epidemic."
Altravax also recently received a third NIH SBIR grant for $600,000 to support its research on "Improved Vaccines for Influenza B Virus" to create vaccines that provide broad protection against the two influenza B virus strains that co-circulate each flu season. Including its development of a therapeutic vaccine to treat chronic hepatitis B infection, Altravax is focusing on three areas of major importance for improving human health: hepatitis B, influenza and HIV.
In January 2010, Altravax acquired from Maxygen, Inc. (Nasdaq: MAXY) exclusive rights to the MolecularBreeding™ technology platform for the development of vaccines to infectious diseases.
Source:
Altravax, Inc.
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Dr. Robert Whalen, the Chief Scientific Officer at Altravax, is one of the leaders in the development of the MolecularBreeding™ technology platform for use in the vaccine area. "Our past research activities have made significant progress in developing novel vaccine antigens to broadly target the numerous HIV-1 strains and we are pleased that the NIH is continuing to support our research on HIV vaccines," said Dr. Whalen. "This continued federal support is a critical factor in our program to develop a preventative vaccine to combat the AIDS epidemic."
Altravax also recently received a third NIH SBIR grant for $600,000 to support its research on "Improved Vaccines for Influenza B Virus" to create vaccines that provide broad protection against the two influenza B virus strains that co-circulate each flu season. Including its development of a therapeutic vaccine to treat chronic hepatitis B infection, Altravax is focusing on three areas of major importance for improving human health: hepatitis B, influenza and HIV.
In January 2010, Altravax acquired from Maxygen, Inc. (Nasdaq: MAXY) exclusive rights to the MolecularBreeding™ technology platform for the development of vaccines to infectious diseases.
Source:
Altravax, Inc.
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What We "Know" May Not Be So, When It Comes To The Uninsured And ERs
The 47 million Americans who lack health insurance are the reason emergency departments are crowded all the time right? And only the uninsured visit the emergency department for minor complaints, because it's easier than going to a doctor right?
Not so fast, according to a new study published in the Journal of the American Medical Association by a University of Michigan team. In fact, the reality of what causes ED overcrowding is a lot more complicated, they find. And some widely repeated perceptions about the uninsured and emergency care may be rooted more in assumptions than in solid fact.
Those faulty perceptions, they conclude, may be getting in the way of real efforts to solve both the uninsurance crisis and the crisis in American EDs.
In truth, the uninsured do not make up a disproportionate share of ED patients, because they are the only group that faces the full cost of care, the study shows. It also demonstrates that people who have insurance are more likely to contribute to ED overcrowding and to use the ED for minor complaints or in place of a primary care doctor's visit, because primary care offices are also overcrowded.
The study is based on an exhaustive review of 127 medical research papers, and on detective work to find out whether often-repeated statements about the uninsured and emergency care were actually based in fact. Most of the papers were published in the last decade, when both the plight of the uninsured and the state of the nation's EDs captured the national spotlight.
Although it challenges some of the most-repeated mantras about the uninsured and ED care, the study does confirm that solid evidence exists for many of the things that Americans have come to believe about the uninsured and emergency care.
For instance, the study shows, the number of people without insurance visiting American EDs is rising but less quickly than the numbers of uninsured are rising. Meanwhile, patients with insurance are going to the ED more frequently.
There is also solid evidence that caring for patients insured and uninsured in an ED is more expensive than treating the same complaint in a doctor's office. Uninsured people definitely have a hard time finding primary care doctors who will see them as outpatients, but even insured patients have difficulty finding primary care.
"What we found is that there is a perception that because one of the roles of the emergency room is a safety net for the uninsured it is the uninsured who must be causing all the problems in ED care," says first author and emergency physician Manya Newton, M.D., MPH, M.S., a Robert Wood Johnson Clinical Scholar at the U-M Medical School.
"The crisis in emergency medicine and the problems of the growing uninsured population have been conflated," she adds. "While there's excellent research out there on both issues, the myths about how the uninsured use the emergency department threaten to interfere with the policy-making process. The rise in ED use has much more to do with the aging of the population, the increase in chronic diseases, and the decrease in available primary care than with the uninsured. Policies based on false assumptions risk diverting energy and money from confronting the true drivers of emergency department crowding."
Newton holds positions in internal medicine and emergency medicine at the U-M Medical School, and at the School of Public Health. The study was funded by the RWJ Clinical Scholars Program.
At the least, Newton and her co-authors conclude from their review, ED policy solutions will need to address the lack of timely access to primary care by the uninsured and insured alike.
The uninsured have a nearly impossible task in finding primary care. But both insured and uninsured have trouble getting appointments in less than two to three weeks, or finding primary care after regular business hours and on weekends which leads them to the always-open ED. A reluctance by some physicians to take on the legal liability of counseling a patient over the phone, instead of instructing them to go to the ED, may also contribute, Newton says.
Meanwhile, Newton says the evidence is very strong that the overall cause of ED overcrowding is an "input-throughput-output" problem at American hospitals.
Patients come to the ED for treatment, and under federal law the ED cannot turn them away. Some of them need at least an overnight stay in one of the hospital beds upstairs from the ED. But those beds are often full because of a lack of safe and appropriate places to discharge current patients to so patients get backed up down in the ED, making it more crowded. The closure of hospitals, EDs, and long-term skilled nursing facilities around the country makes the situation worse and worse, the researchers say. Fewer beds plus more patients equals an ED crisis.
Newton and her colleagues embarked on the study after noting a curious phenomenon in the medical literature: many papers whose introductory passages included phrases like "It is well understood that…" and other statements of conventional wisdom about the uninsured and EDs. They often appeared without direct citations of studies that could support such statements.
The researchers set out to find out what those statements, and other assumptions about this issue, were based on. They winnowed an initial pool of 586 papers down to the 127 that most directly pertained to the issue, after excluding papers that looked at children and the elderly (two groups with much different insurance coverage issues than those between the ages of 18 and 65), and papers that looked at emergency psychiatric or dental care (two types of care for which insurance coverage varies greatly even among the insured). They also excluded papers about non-patient care issues.
The resulting 127 papers received a thorough examination to tally just what they had found and what they were based on, and what types of assumptions about the uninsured they perpetuated or substantiated. One surprising finding, Newton says, is that an often-repeated statement about urban EDs being overwhelmed with uninsured patients appeared to largely stem from a paper by a plastic surgeon who saw three emergency patients in nine months two of whom had no insurance and concluded that two-thirds of all patients in urban EDs are uninsured.
In all, the authors found six commonly repeated assumptions about the uninsured and ERs, which appeared in numerous papers. A number of less common assumptions were also found. But after they had tried to track down the sources of those assumptions, only three of the most common one held any water: the rise in the number of ED visits by uninsured (and insured) people, the higher expense of caring for an uninsured (or insured) person in the ED, and the lack of primary care for uninsured people.
In addition to Newton, the authors of the paper are Carla Keirns, M.D., Ph.D., M.A., M.S., Rebecca Cunningham, M.D., Rodney Hayward, M.D. and Rachel Stanley, M.D., MHSA.
University of Michigan Health System
2901 Hubbard St., Ste. 2400
Ann Arbor, MI 48109-2435
United States
med.umich.edu
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Not so fast, according to a new study published in the Journal of the American Medical Association by a University of Michigan team. In fact, the reality of what causes ED overcrowding is a lot more complicated, they find. And some widely repeated perceptions about the uninsured and emergency care may be rooted more in assumptions than in solid fact.
Those faulty perceptions, they conclude, may be getting in the way of real efforts to solve both the uninsurance crisis and the crisis in American EDs.
In truth, the uninsured do not make up a disproportionate share of ED patients, because they are the only group that faces the full cost of care, the study shows. It also demonstrates that people who have insurance are more likely to contribute to ED overcrowding and to use the ED for minor complaints or in place of a primary care doctor's visit, because primary care offices are also overcrowded.
The study is based on an exhaustive review of 127 medical research papers, and on detective work to find out whether often-repeated statements about the uninsured and emergency care were actually based in fact. Most of the papers were published in the last decade, when both the plight of the uninsured and the state of the nation's EDs captured the national spotlight.
Although it challenges some of the most-repeated mantras about the uninsured and ED care, the study does confirm that solid evidence exists for many of the things that Americans have come to believe about the uninsured and emergency care.
For instance, the study shows, the number of people without insurance visiting American EDs is rising but less quickly than the numbers of uninsured are rising. Meanwhile, patients with insurance are going to the ED more frequently.
There is also solid evidence that caring for patients insured and uninsured in an ED is more expensive than treating the same complaint in a doctor's office. Uninsured people definitely have a hard time finding primary care doctors who will see them as outpatients, but even insured patients have difficulty finding primary care.
"What we found is that there is a perception that because one of the roles of the emergency room is a safety net for the uninsured it is the uninsured who must be causing all the problems in ED care," says first author and emergency physician Manya Newton, M.D., MPH, M.S., a Robert Wood Johnson Clinical Scholar at the U-M Medical School.
"The crisis in emergency medicine and the problems of the growing uninsured population have been conflated," she adds. "While there's excellent research out there on both issues, the myths about how the uninsured use the emergency department threaten to interfere with the policy-making process. The rise in ED use has much more to do with the aging of the population, the increase in chronic diseases, and the decrease in available primary care than with the uninsured. Policies based on false assumptions risk diverting energy and money from confronting the true drivers of emergency department crowding."
Newton holds positions in internal medicine and emergency medicine at the U-M Medical School, and at the School of Public Health. The study was funded by the RWJ Clinical Scholars Program.
At the least, Newton and her co-authors conclude from their review, ED policy solutions will need to address the lack of timely access to primary care by the uninsured and insured alike.
The uninsured have a nearly impossible task in finding primary care. But both insured and uninsured have trouble getting appointments in less than two to three weeks, or finding primary care after regular business hours and on weekends which leads them to the always-open ED. A reluctance by some physicians to take on the legal liability of counseling a patient over the phone, instead of instructing them to go to the ED, may also contribute, Newton says.
Meanwhile, Newton says the evidence is very strong that the overall cause of ED overcrowding is an "input-throughput-output" problem at American hospitals.
Patients come to the ED for treatment, and under federal law the ED cannot turn them away. Some of them need at least an overnight stay in one of the hospital beds upstairs from the ED. But those beds are often full because of a lack of safe and appropriate places to discharge current patients to so patients get backed up down in the ED, making it more crowded. The closure of hospitals, EDs, and long-term skilled nursing facilities around the country makes the situation worse and worse, the researchers say. Fewer beds plus more patients equals an ED crisis.
Newton and her colleagues embarked on the study after noting a curious phenomenon in the medical literature: many papers whose introductory passages included phrases like "It is well understood that…" and other statements of conventional wisdom about the uninsured and EDs. They often appeared without direct citations of studies that could support such statements.
The researchers set out to find out what those statements, and other assumptions about this issue, were based on. They winnowed an initial pool of 586 papers down to the 127 that most directly pertained to the issue, after excluding papers that looked at children and the elderly (two groups with much different insurance coverage issues than those between the ages of 18 and 65), and papers that looked at emergency psychiatric or dental care (two types of care for which insurance coverage varies greatly even among the insured). They also excluded papers about non-patient care issues.
The resulting 127 papers received a thorough examination to tally just what they had found and what they were based on, and what types of assumptions about the uninsured they perpetuated or substantiated. One surprising finding, Newton says, is that an often-repeated statement about urban EDs being overwhelmed with uninsured patients appeared to largely stem from a paper by a plastic surgeon who saw three emergency patients in nine months two of whom had no insurance and concluded that two-thirds of all patients in urban EDs are uninsured.
In all, the authors found six commonly repeated assumptions about the uninsured and ERs, which appeared in numerous papers. A number of less common assumptions were also found. But after they had tried to track down the sources of those assumptions, only three of the most common one held any water: the rise in the number of ED visits by uninsured (and insured) people, the higher expense of caring for an uninsured (or insured) person in the ED, and the lack of primary care for uninsured people.
In addition to Newton, the authors of the paper are Carla Keirns, M.D., Ph.D., M.A., M.S., Rebecca Cunningham, M.D., Rodney Hayward, M.D. and Rachel Stanley, M.D., MHSA.
University of Michigan Health System
2901 Hubbard St., Ste. 2400
Ann Arbor, MI 48109-2435
United States
med.umich.edu
Buy Vantin Without Prescription
The Big Gamble - Will Stimulus Dollars Pay Off In Ways Health Information Consumers Can Use?
Shortly after the American Recovery and Reinvestment Act passed in February, there was a government affairs retreat of the eHealth Initiative to discuss concern regarding the $19 billion allocated for health information technology. A feature article in the June issue of the Journal of AHIMA examines conclusions policy makers made about the investment in health IT and how to engage healthcare consumers in productive use of it.
Primarily, the concern is whether the stimulus investment is enough to assist the electronic health records being provided to hospitals and smaller offices, thus meeting the goal of health IT to provide more efficient, less expense, and better quality health and healthcare for consumers.
The Big Gamble discusses legislative language that states one of the key purposes of ARRA is to advance the delivery of patient-centered care, and the decisions the Department of Health and Human Services will make over the next year to achieve consumer's health information needs through several strategies:
- Offer technical assistance and endorse technologies, content and best practices that facilitate proactive delivery of timely information to consumers
- Conduct focus groups and structured interviews with consumers to better understand where health IT can serve their health needs
- Translate medical language into understandable information with the use of text, graphics, audio and video, and
- Design toolkits for consumer outreach
Also discussed are the health IT provisions in ARRA that require physicians to demonstrate meaningful use of electronic health records to qualify for up to $44,000 in adoption incentives. Overall, clinicians should get credit for EHRs that provide meaningful information to consumers, therefore, if health IT tools are not helping consumers make better decisions and manage their health then the tools are not meaningfully changing healthcare.
Read the complete article in the June issue of the Journal of AHIMA or online at journal.ahima.
Source
The American Health Information Management Association
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Primarily, the concern is whether the stimulus investment is enough to assist the electronic health records being provided to hospitals and smaller offices, thus meeting the goal of health IT to provide more efficient, less expense, and better quality health and healthcare for consumers.
The Big Gamble discusses legislative language that states one of the key purposes of ARRA is to advance the delivery of patient-centered care, and the decisions the Department of Health and Human Services will make over the next year to achieve consumer's health information needs through several strategies:
- Offer technical assistance and endorse technologies, content and best practices that facilitate proactive delivery of timely information to consumers
- Conduct focus groups and structured interviews with consumers to better understand where health IT can serve their health needs
- Translate medical language into understandable information with the use of text, graphics, audio and video, and
- Design toolkits for consumer outreach
Also discussed are the health IT provisions in ARRA that require physicians to demonstrate meaningful use of electronic health records to qualify for up to $44,000 in adoption incentives. Overall, clinicians should get credit for EHRs that provide meaningful information to consumers, therefore, if health IT tools are not helping consumers make better decisions and manage their health then the tools are not meaningfully changing healthcare.
Read the complete article in the June issue of the Journal of AHIMA or online at journal.ahima.
Source
The American Health Information Management Association
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Persistent Vaccination Effect Of GRAZAX(R) After Completion Of Treatment
Breakthrough: Results
from the fourth year in a long-term clinical study prove the disease
modifying effect of GRAZAX(R). For the first time ever, it is documented
that the positive clinical effect of the tablet vaccine persists after
completion of treatment.
Today, ALK announces main results from the first follow-up year in a
long-term study (GT-08) with GRAZAX(R), the company's tablet-based vaccine
against grass pollen allergy. The clinical study documents that the effect
of GRAZAX(R) persists following completion of the recommended three-year
treatment regimen. Furthermore, blood samples from patients show a
persistent, positive effect on the immune system indicating a lasting
tolerance to grass pollen.
During the first year after completion of treatment, GRAZAX(R)
continues to provide statistically significant reductions in both hay fever
symptoms and the use of symptom-relieving medication.
In the follow-up year, hay fever symptoms were reduced by 31% while the
use of symptom-relieving medication was reduced by 52%. The reduction of
symptoms and use of medication is measured as median values relative to a
control group in which patients had unrestricted access to
symptom-relieving medication.
The patients in the study have adhered to the recommended three-year
GRAZAX(R) treatment regimen and completed treatment in the autumn of 2007.
The above-mentioned results cover the 2008 pollen season, the first season
in which the patients did not receive active treatment with GRAZAX(R).
The fourth-year results represent a major breakthrough, since ALK is
the first company ever to document a persistent disease modifying
vaccination effect of a tablet-based allergy vaccine. Patients cannot
obtain such a persistent vaccination effect with traditional
symptom-relieving allergy medication.
ALK-Abello A/S
alk-abello/Pages/CorpFrontPage.aspx
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from the fourth year in a long-term clinical study prove the disease
modifying effect of GRAZAX(R). For the first time ever, it is documented
that the positive clinical effect of the tablet vaccine persists after
completion of treatment.
Today, ALK announces main results from the first follow-up year in a
long-term study (GT-08) with GRAZAX(R), the company's tablet-based vaccine
against grass pollen allergy. The clinical study documents that the effect
of GRAZAX(R) persists following completion of the recommended three-year
treatment regimen. Furthermore, blood samples from patients show a
persistent, positive effect on the immune system indicating a lasting
tolerance to grass pollen.
During the first year after completion of treatment, GRAZAX(R)
continues to provide statistically significant reductions in both hay fever
symptoms and the use of symptom-relieving medication.
In the follow-up year, hay fever symptoms were reduced by 31% while the
use of symptom-relieving medication was reduced by 52%. The reduction of
symptoms and use of medication is measured as median values relative to a
control group in which patients had unrestricted access to
symptom-relieving medication.
The patients in the study have adhered to the recommended three-year
GRAZAX(R) treatment regimen and completed treatment in the autumn of 2007.
The above-mentioned results cover the 2008 pollen season, the first season
in which the patients did not receive active treatment with GRAZAX(R).
The fourth-year results represent a major breakthrough, since ALK is
the first company ever to document a persistent disease modifying
vaccination effect of a tablet-based allergy vaccine. Patients cannot
obtain such a persistent vaccination effect with traditional
symptom-relieving allergy medication.
ALK-Abello A/S
alk-abello/Pages/CorpFrontPage.aspx
Buy Armour Without Prescription
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