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1.
Trends Cancer ; 2022 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-35034866

RESUMO

Rising costs of cancer care drive patient financial toxicity (FT) that perpetuates known health disparities in access and quality cancer treatment. This Review discusses how FT is a barrier to cancer research and treatment, and discusses potential solutions to improve affordability and reduce healthcare disparities for our patients.

2.
Braz J Biol ; 84: e254479, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35019105

RESUMO

Earias vittellaFabricius, 1794 (Noctuidae: Lepidoptera) is deliberated to be one of the most destructive pests of cotton and okra vegetation in the world including Asia. The pest has established resistance to various synthetic insecticides. The use of bio-pesticide is one of the unconventional approaches to develop a vigorous ecosystem without harming non- target pests and beneficial natural insect fauna. In the present study, the toxicity levels of Citrullus colocynthis seed extract have been evaluated against the populations of E. vittellaunder standardized laboratory conditions. The toxic effects of C. colocynthis on development periods, protein contents and esterase activity of the life stages of E. vittella were also evaluated. The toxicity levels of methanol, ethanol, hexane, water and profenofos were evaluated on the 1st instar larvae of E. vittella. LC30 and LC80 concentrations exhibited the effectiveness of methanol-based C. colocynthis seed extract against 1st instar larvae of E. vitella. The enhanced larval and pupal periods were revealed in treated samples during the comparison with untreated samples. The intrinsic rate of increase, net reproductive rate in the LC30 and LC80 concentrations exposed larvae remained less than the control treatment. Fecundity, the esterase activity and protein contents were declined in LC30 and LC80 treated samples as compared to the control. The present findings suggest that C. colosynthis extracts based botanical insecticides are beneficial, ecosystem sustainable and can be integrated with insect management programs from environment safety perspective.


Assuntos
Citrullus colocynthis , Inseticidas , Mariposas , Animais , Ecossistema , Larva , Extratos Vegetais/farmacologia
3.
Plant Biol (Stuttg) ; 24(1): 85-94, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34670007

RESUMO

Plant growth and productivity is restricted by a multitude of abiotic stresses. These stresses negatively affect physiological and metabolic pathways, leading to the production of many harmful substances like ROS, lipid peroxides and aldehydes. This study was conducted to investigate the role of Arabidopsis ALDH3I1 gene in multiple abiotic stress tolerance. Transgenic tobacco plants were generated that overexpress the ALDH3I1 gene driven by the CaMV35S promoter and evaluated under different abiotic stresses, namely salt, drought, cold and oxidative stress. Tolerance to stress was evaluated based on responses of various growth and physiological traits under stress condition. Transgenic plants displayed elevated ALDH3I1 transcript levels compared to WT plants. The constitutive ectopic expression of ALDH3I1 conferred increased tolerance to salt, drought, cold and oxidative stresses in transgenic plants, along with improved plant growth. Transgenic plants overexpressing ALDH3I1 had higher chlorophyll content, photosynthesis rate and proline, and less accumulation of ROS and malondialdehyde compared to the WT, which contributed to stress tolerance in transgenic plants. Our results further revealed that ALDH3I1 had a positive effect on CO2 assimilation rate in plants under abiotic stress conditions. Overall, this study revealed that ALDH3I1 positively regulates abiotic stress tolerance in plants, and has future implications in producing transgenic cereal and horticultural plants tolerant to abiotic stresses.


Assuntos
Aldeído Desidrogenase , Regulação da Expressão Gênica de Plantas , Aldeído Desidrogenase/genética , Aldeídos , Secas , Proteínas de Plantas/genética , Proteínas de Plantas/metabolismo , Plantas Geneticamente Modificadas/metabolismo , Estresse Fisiológico/genética
4.
Clin Radiol ; 2021 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-34916046

RESUMO

AIM: To evaluate utilisation of a medical imaging call centre (MICC) at a multi-site, academic radiology department, focusing on communication of critical, urgent, or significant unexpected findings. MATERIALS AND METHODS: Institutional research ethics board approval was obtained. All calls made to MICC from 1 January to 31 December 2019 were reviewed retrospectively. The total number of calls, date, and reason of each call, level of report alert, and turnaround time (TAT) were recorded. Level 1, 2, and 3 alerts were defined as "potentially life-threatening new/unexpected findings", "could result in morbidity/mortality", or "not immediately life-threatening or urgent", respectively. TAT was defined as the time from alert request received by the MICC until acknowledgement of receipt by the referring physician, with a desired TAT of 60 min, 3 h, and 3 days for each level, respectively. RESULTS: The MICC received 29,799 calls in 2019, on average 2,483 (range 1,989-3,098) calls per month. The most common indications for contacting the MICC were to request imaging reports to be expedited (14,916 calls, 50%) and issuing report alerts to communicate unexpected or urgent findings (7,060 calls, 24%). Average number and range of calls for Level 1, 2, and 3 alerts were 57 (39-80), 345 (307-388), and 187 (127-215) per month, respectively. Average TAT for Level 1, 2, and 3 report alerts were 59 min, 2 h 26 min, and 19 h 39 min, respectively. CONCLUSION: The MICC received a large volume of calls and was a successful method for timely communication of unexpected or urgent imaging findings using a three-tiered alert system.

5.
BMC Fam Pract ; 22(1): 234, 2021 11 18.
Artigo em Inglês | MEDLINE | ID: mdl-34794388

RESUMO

BACKGROUND: As treatments for cancer have improved, more people are surviving cancer. However, compared to people without a history of cancer, cancer survivors are more likely to die of cardiovascular disease (CVD). Increased risk for CVD-related mortality among cancer survivors is partially due to lack of medication adherence and problems that exist in care coordination between cancer specialists, primary care physicians, and cardiologists. METHODS/DESIGN: The Onco-primary care networking to support TEAM-based care (ONE TEAM) study is an 18-month cluster-randomized controlled trial with clustering at the primary care clinic level. ONE TEAM compares the provision of the iGuide intervention to patients and primary care providers versus an education-only control. For phase 1, at the patient level, the intervention includes video vignettes and a live webinar; provider-level interventions include electronic health records-based communication and case-based webinars. Participants will be enrolled from across North Carolina one of their first visits with a cancer specialist (e.g., surgeon, radiation or medical oncologist). We use a sequential multiple assignment randomized trial (SMART) design. Outcomes (measured at the patient level) will include Healthcare Effectiveness Data and Information Set (HEDIS) quality measures of management of three CVD comorbidities using laboratory testing (glycated hemoglobin [A1c], lipid profile) and blood pressure measurements; (2) medication adherence assessed pharmacy refill data using Proportion of Days Covered (PDC); and (3) patient-provider communication (Patient-Centered Communication in Cancer Care, PCC-Ca-36). Primary care clinics in the intervention arm will be considered non-responders if 90% or more of their participating patients do not meet the modified HEDIS quality metrics at the 6-month measurement, assessed once the first enrollee from each practice reaches the 12-month mark. Non-responders will be re-randomized to either continue to receive the iGuide 1 intervention, or to receive the iGuide 2 intervention, which includes tailored videos for participants and specialist consults with primary care providers. DISCUSSION: As the population of cancer survivors grows, ONE TEAM will contribute to closing the CVD outcomes gap among cancer survivors by optimizing and integrating cancer care and primary care teams. ONE TEAM is designed so that it will be possible for others to emulate and implement at scale. TRIAL REGISTRATION: This study (NCT04258813) was registered in clinicaltrals.gov on February 6, 2020.

6.
Braz J Biol ; 83: e242942, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34468508

RESUMO

Thimerosal is an organomercurial compound, which is used in the preparation of intramuscular immunoglobulin, antivenoms, tattoo inks, skin test antigens, nasal products, ophthalmic drops, and vaccines as a preservative. In most of animal species and humans, the kidney is one of the main sites for mercurial compounds deposition and target organs for toxicity. So, the current research was intended to assess the thimerosal induced nephrotoxicity in male rats. Twenty-four adult male albino rats were categorized into four groups. The first group was a control group. Rats of Group-II, Group-III, and Group-IV were administered with 0.5µg/kg, 10µg/kg, and 50µg/kg of thimerosal once a day, respectively. Thimerosal administration significantly decreased the activities of catalase (CAT), superoxide dismutase (SOD), peroxidase (POD), glutathione reductase (GR), glutathione (GSH), and protein content while increased the thiobarbituric acid reactive substances (TBARS) and hydrogen peroxide (H2O2) levels dose-dependently. Blood urea nitrogen (BUN), creatinine, urobilinogen, urinary proteins, kidney injury molecule-1 (KIM-1), and neutrophil gelatinase-associated lipocalin (NGAL) levels were substantially increased. In contrast, urinary albumin and creatinine clearance was reduced dose-dependently in thimerosal treated groups. The results demonstrated that thimerosal significantly increased the inflammation indicators including nuclear factor kappaB (NF-κB), tumor necrosis factor-α (TNF-α), Interleukin-1ß (IL-1ß), Interleukin-6 (IL-6) levels and cyclooxygenase-2 (COX-2) activities, DNA and histopathological damages dose-dependently. So, the present findings ascertained that thimerosal exerted nephrotoxicity in male albino rats.


Assuntos
Estresse Oxidativo , Timerosal , Animais , Peróxido de Hidrogênio/metabolismo , Rim , Masculino , Ratos , Superóxido Dismutase/metabolismo , Timerosal/metabolismo , Timerosal/toxicidade
7.
Eur Arch Paediatr Dent ; 22(6): 1041-1047, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34059993

RESUMO

PURPOSE: Using software for assessment of restorative work on typodonts in the simulation laboratory may enhance the objective evaluation of student work. The study aimed to evaluate the inter-rater and intra-rater reliability using 3-D scans from the Planmeca Emerald™ intra-oral scanner with Romexis Compare® software for assessing preparations for preformed metal crowns (PMCs). METHODS: Three operators independently recorded 3-D scans and digitally measured the features of 30 PMC preparations on typodont primary teeth (# 75). Using Romexis Compare® software, preparations were measured from mesial, distal and occlusal aspects. Measurements were repeated after 2 weeks. The intraclass correlation coefficient (ICC) was used to measure the reliability of measurements between operators and within the one operator. RESULTS: For measuring the extent of tooth reduction, there was excellent intra-rater reliability for each operator (ICC 0.96-0.99). The highest inter-rater reliability was for measurements of the occlusal surface (0.946 and 0.956), followed by the mesial surface (0.852 and 0.862) and then the distal surface (0.746 and 0.724). CONCLUSION: This method was useful and reliable for measuring features of PMC preparation, but with some limitations. Improving the software to provide specific assistance tools would empower greater uptake of this method as an adjunct to traditional visual grading tool in paediatric dentistry preclinical teaching.

8.
Am Heart J ; 238: 75-84, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33961830

RESUMO

Cardiovascular disease (CVD) is a major source of financial burden and distress, which has 3 main domains: (1) psychological distress; (2) cost-related care non-adherence or medical care deferral, and (3) tradeoffs with basic non-medical needs. We propose 4 ways to reduce financial distress in CVD: (1) policymakers can expand insurance coverage and curtail underinsurance; (2) health systems can limit expenditure on low-benefit, high-cost treatments while developing services for high-risk individuals; (3) physicians can engage in shared-decision-making for high-cost interventions, and (4) community-based initiatives can support patients with system navigation and financial coping. Avenues for research include (1) analysis of how healthcare policies affect financial burden; (2) comparative effectiveness studies examining high and low-cost strategies for CVD management; and (3) studying interventions to reduce financial burden, financial coaching, and community health worker integration.


Assuntos
Doenças Cardiovasculares/economia , Estresse Financeiro/economia , Determinação de Necessidades de Cuidados de Saúde/economia , Doenças Cardiovasculares/psicologia , Agentes Comunitários de Saúde/organização & administração , Pesquisa Comparativa da Efetividade , Tomada de Decisão Compartilhada , Estresse Financeiro/prevenção & controle , Estresse Financeiro/psicologia , Custos de Cuidados de Saúde , Gastos em Saúde , Humanos , Cobertura do Seguro , Resultado do Tratamento
9.
Braz. J. Biol. ; 81(2): 398-405, Mar.-May 2021. tab, graf, ilus
Artigo em Inglês | VETINDEX | ID: vti-762746

RESUMO

Continuous occurrence of heavy metals is a major cause of environmental pollution due to its toxic effects. At minimum concentrations, these metals are highly reactive and can gather in the food chains and food web, causing major dangers to public health concerns. Soil samples were collected from Paharang drain, Faisalabad. Cadmium tolerant bacteria were isolated and evaluated for their MIC against Cd. The isolated bacterial strain GCFSD01 showed MIC value upto 30 mM/L. The bacterial strain with the highest resistance against Cd was selected for further study. Molecular characterization of bacterial isolate GCFSD01 was performed by 16S rRNA which confirmed it as Bacillus cereus. Optimum growth conditions of bacterial strain were also evaluated. Strain GCFSD01 showed optimum growth at pH 7 and 37 °C temperature. Our result revealed that B. cereus strain GCFSD01 reduced 61.3% Cd after 48 hrs. Multiple metal tolerance and Cd reduction by B. cereus indicate its potential for further use for decontamination of polluted soil.(AU)


A ocorrência contínua de metais pesados é uma das principais causas de poluição ambiental devido aos seus efeitos tóxicos. A contaminação por metais pesados representa um grande risco para todas as formas de vida encontradas no meio ambiente. Em concentrações mínimas, esses metais são altamente reativos e podem se acumular nas cadeias alimentares e na cadeia alimentar, causando grandes perigos às preocupações com a saúde pública. Amostras de solo foram coletadas no esgoto de Paharang, Faisalabad. Bactérias tolerantes ao cádmio foram isoladas da amostra coletada pelo método da placa de ágar. As colônias separadas individuais selecionadas foram avaliadas quanto às suas concentrações inibitórias mínimas contra Cd. A cepa bacteriana isolada GCFSD01 apresentou valores de CIM de 30 mM/L. A colônia bacteriana que apresentou maior resistência contra o Cd foi selecionada para identificação. Após seleção da maior colônia bacteriana resistente ao Cd, coloração de Gram e diferentes testes bioquímicos foram realizados para a caracterização da bactéria isolada. A caracterização molecular do isolado bacteriano GCFSD01 foi realizada por PCR 16S rRNA confirmando a presença de Bacillus cereus. Após a identificação molecular, as condições ótimas de crescimento da cepa bacteriana também foram verificadas. A cepa GCFSD01 apresentou crescimento ótimo em pH 7 e temperatura de 37 °C. Nosso resultado revelou que a cepa de B. cereus GCFSD01 reduziu 61,3% de Cd após 48 horas. A tolerância a múltiplos metais e a redução de Cd por B. cereus indicam seu potencial para uso posterior na descontaminação do solo poluído.(AU)


Assuntos
Bacillus cereus/efeitos dos fármacos , Bacillus cereus/isolamento & purificação , Intoxicação por Cádmio , Análise do Solo
10.
Braz. j. biol ; 81(2): 398-405, Jan.-May 2021. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1153348

RESUMO

Abstract Continuous occurrence of heavy metals is a major cause of environmental pollution due to its toxic effects. At minimum concentrations, these metals are highly reactive and can gather in the food chains and food web, causing major dangers to public health concerns. Soil samples were collected from Paharang drain, Faisalabad. Cadmium tolerant bacteria were isolated and evaluated for their MIC against Cd. The isolated bacterial strain GCFSD01 showed MIC value upto 30 mM/L. The bacterial strain with the highest resistance against Cd was selected for further study. Molecular characterization of bacterial isolate GCFSD01 was performed by 16S rRNA which confirmed it as Bacillus cereus. Optimum growth conditions of bacterial strain were also evaluated. Strain GCFSD01 showed optimum growth at pH 7 and 37 °C temperature. Our result revealed that B. cereus strain GCFSD01 reduced 61.3% Cd after 48 hrs. Multiple metal tolerance and Cd reduction by B. cereus indicate its potential for further use for decontamination of polluted soil.


Resumo A ocorrência contínua de metais pesados é uma das principais causas de poluição ambiental devido aos seus efeitos tóxicos. A contaminação por metais pesados representa um grande risco para todas as formas de vida encontradas no meio ambiente. Em concentrações mínimas, esses metais são altamente reativos e podem se acumular nas cadeias alimentares e na cadeia alimentar, causando grandes perigos às preocupações com a saúde pública. Amostras de solo foram coletadas no esgoto de Paharang, Faisalabad. Bactérias tolerantes ao cádmio foram isoladas da amostra coletada pelo método da placa de ágar. As colônias separadas individuais selecionadas foram avaliadas quanto às suas concentrações inibitórias mínimas contra Cd. A cepa bacteriana isolada GCFSD01 apresentou valores de CIM de 30 mM/L. A colônia bacteriana que apresentou maior resistência contra o Cd foi selecionada para identificação. Após seleção da maior colônia bacteriana resistente ao Cd, coloração de Gram e diferentes testes bioquímicos foram realizados para a caracterização da bactéria isolada. A caracterização molecular do isolado bacteriano GCFSD01 foi realizada por PCR 16S rRNA confirmando a presença de Bacillus cereus. Após a identificação molecular, as condições ótimas de crescimento da cepa bacteriana também foram verificadas. A cepa GCFSD01 apresentou crescimento ótimo em pH 7 e temperatura de 37 °C. Nosso resultado revelou que a cepa de B. cereus GCFSD01 reduziu 61,3% de Cd após 48 horas. A tolerância a múltiplos metais e a redução de Cd por B. cereus indicam seu potencial para uso posterior na descontaminação do solo poluído.

11.
JCO Oncol Pract ; 17(10): e1440-e1449, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33797952

RESUMO

PURPOSE: Insured patients with cancer face high treatment-related, out-of-pocket (OOP) costs and often cannot access financial assistance. We conducted a randomized, controlled trial of Bridge, a patient-facing app designed to identify eligible financial resources for patients. We hypothesized that patients using Bridge would experience greater OOP cost reduction than controls. METHODS: We enrolled patients with cancer who had OOP expenses from January 2018 to March 2019. We randomly assigned patients 1:1 to intervention (Bridge) versus control (financial assistance educational websites). Primary and secondary outcomes were self-reported OOP costs and subjective financial distress 3 months postenrollment. In post hoc analyses, we analyzed application for and receipt of financial assistance at 3 months postenrollment. We used chi-square, Mann-Whitney tests, and logistic regression to compare study arms. RESULTS: We enrolled 200 patients. The median age was 57 years (IQR, 47.0-63.0). Most patients had private insurance (71%), and the median household income was $62,000 in US dollars (USD) (IQR, $36,000-$100,000 [USD]). Substantial missing data precluded assessment of primary and secondary outcomes. In post hoc analyses, patients in the Bridge arm were more likely than controls to both apply for and receive financial assistance. CONCLUSION: We were unable to test our primary outcome because of excessive missing follow-up survey data. In exploratory post hoc analyses, patients who received a financial assistance app were more likely to apply for and receive financial assistance. Ultimately, our study highlights challenges faced in identifying measurable outcomes and retaining participants in a randomized, controlled trial of a mobile app to alleviate financial toxicity.


Assuntos
Aplicativos Móveis , Neoplasias , Gastos em Saúde , Humanos , Renda , Pessoa de Meia-Idade , Neoplasias/terapia , Inquéritos e Questionários
12.
J Intellect Disabil Res ; 65(6): 561-576, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33764620

RESUMO

BACKGROUND: There is a dearth of literature available on the comparative oral health status of those with Rett syndrome (RTT) despite diurnal bruxism being a supportive diagnostic criterion for the disorder. This study was designed to investigate the dental experiences of individuals with RTT in terms of perceived at-home and professional dental care. METHODS: Using data in the InterRett database, provided by English-speaking families of individuals with a confirmed MECP2 genetic mutation, the study investigated relationships between dental problems, oral care, child factors including bruxism and use of gastrostomy, and socioeconomic indicators. The study also explored relationships between dental presentations and socioeconomic, child, and family-related factors. RESULTS: Individuals with RTT exhibiting bruxism were more likely to access dental treatment. Those who had full oral feeding had a higher incidence rate of dental treatment than those with full tube feeding. A conservative (under) estimation of the overall dental caries progression rate revealed that this may be similar to that of the normal population. CONCLUSIONS: Drivers for dental treatment in RTT include bruxism as well as dental caries. Those who have full oral feeding experience more dental treatment than those with full tube feeding. A higher maternal education level may confer a protective effect for oral health outcomes in those with RTT. Nevertheless, families generally tended to value the importance of oral health despite reported difficulties in day-to-day mouth care.

13.
Clin Radiol ; 76(5): 391.e1-391.e18, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33579517

RESUMO

Non-Hodgkin's lymphoma (NHL) encompasses over 40 different haematological malignancies, including low and high-grade neoplasms, such as follicular lymphoma (FL) and diffuse large B-cell lymphoma (DLBCL) respectively. A key clinical issue in the context of NHL is delayed and inaccurate diagnosis, which contributes adversely to patient morbidity and mortality. This article will address relevant imaging aspects, with particular reference to advancements in NHL imaging, including computed tomography (CT), integrated positron-emission tomography (PET)-CT, and magnetic resonance imaging (MRI). We provide multiparametric (anato-functional) imaging display items, including histological correlation. We will also introduce our original concept of "Specialist Integrated Haematological Malignancy Imaging Reporting" (SIHMIR), a paradigm shift in lymphoma radiology.


Assuntos
Linfoma não Hodgkin/diagnóstico por imagem , Linfoma não Hodgkin/patologia , Imageamento por Ressonância Magnética/métodos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Sistemas de Informação em Radiologia , Tomografia Computadorizada por Raios X/métodos , Humanos , Estadiamento de Neoplasias
14.
Eur Arch Paediatr Dent ; 22(4): 667-674, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33566287

RESUMO

PURPOSE: With the advancements in technology, dental pedagogy has also evolved, and new learning technologies have emerged. Virtual reality (VR) as an education tool in dentistry is underutilised. VR as an adjunct in local anaesthesia (LA) teaching in paediatric dentistry has not been investigated. The study aimed to investigate dental student's perception of dental LA VR simulation on a paediatric patient and to determine whether this can improve students learning experience. METHODS: Seventy-one students participated in a self-administered questionnaire before and after the use of dental LA VR simulator. Descriptive analysis was performed to determine the perceptions of experience gained through VR. The data were tabulated, graphed, and analysed using SPSS and GraphPad Prism software. RESULTS: The study noted that 89.9% of participants perceived that it would improve their LA skills. After using dental LA VR, 83.1% of participants experienced more engaged in the learning activity, and 55.0% of participants agreed/strongly agreed that it improved their understanding of anatomical landmarks. Around 56.4% of participants agreed/strongly agreed that it added value compared with traditional LA teaching methods. CONCLUSION: It can be concluded that the use of VR simulation can enhance students engagement and learning experience in paediatric dentistry settings and can be used as an additional means of LA training.


Assuntos
Realidade Virtual , Anestesia Local , Anestésicos Locais , Criança , Competência Clínica , Educação em Odontologia , Humanos , Odontopediatria
15.
JCO Oncol Pract ; 17(6): e872-e881, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33566677

RESUMO

PURPOSE: Although financial toxicity is a well-documented aspect of cancer care, little is known about how patients narratively characterize financial experiences related to breast cancer treatment. We sought to examine these patient experiences through mixed methods analysis. METHODS: Women (≥ 18 years old) with a history of breast cancer were recruited from the Love Research Army and Sisters Network to complete an 88-item electronic survey including an open-ended response. Quantitative data were used to sort and stratify responses to the open-ended question, which comprised the qualitative data evaluated here. Descriptive statistics and qualitative content analysis were used to evaluate the financial costs and other burdens resulting from breast cancer surgery. RESULTS: In total, 511 respondents completed the survey in its entirety and wrote an open-ended response. Participants reported significant financial burden in different categories including direct payments for medical care and indirect costs such as lost wages and travel expenses. Treatment-related costs burdened participants for years after diagnosis, forming a financial arc for many participants. Discrepancies existed between the degree of financial burden reported on multiple-choice questions and participants' corresponding open-ended descriptions of financial burden. Participants described a lack of communication surrounding costs with their providers and difficulty negotiating payments with insurance. CONCLUSION: Breast cancer care can result in ongoing financial burden years after diagnosis among all patients, even those with adequate insurance patient populations.


Assuntos
Neoplasias da Mama , Adolescente , Neoplasias da Mama/cirurgia , Feminino , Custos de Cuidados de Saúde , Humanos , Mastectomia , Inquéritos e Questionários
16.
N C Med J ; 82(1): 14-20, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33397749

RESUMO

BACKGROUND Patients with cancer are at risk for both objective and subjective financial distress. Financial distress during treatment is adversely associated with physical and mental well-being. Little is known about whether patients' subjective financial distress changes during the course of their treatment.method This is a cross-sectional study of insured adults with solid tumors on anti-cancer therapy for ≥1 month, surveyed at a referral center and three rural oncology clinics. The goal was to investigate how financial distress varies depending on where patients are in the course of cancer therapy. Financial distress (FD) was assessed via a validated measure; out-of-pocket (OOP) costs were estimated and medical records were reviewed for disease/treatment data. Logistic regression was used to evaluate the potential association between treatment length and financial distress.RESULTS Among 300 participants (86% response rate), median age was 60 years (range 27-91), 52.3% were male, 78.3% had stage IV cancer or metastatic recurrence, 36.7% were retired, and 56% had private insurance. Median income was $60,000/year and median OOP costs including insurance premiums were $592/month. Median FD score (7.4/10, SD 2.5) corresponded to low FD with 16.3% reporting high/overwhelming distress. Treatment duration was not associated with the odds of experiencing high/overwhelming FD in single-predictor (OR = 1.01, CI [.93, 1.09], P = .86) or multiple predictor regression models (OR = .98, CI [.86, 1.12], P = .79). Treatment duration was not correlated with FD as a continuous variable (P = .92).LIMITATIONS This study is limited by its cross-sectional design and generalizability to patients with early-stage cancer and those being treated outside of a major referral center.CONCLUSION Severity of cancer treatment-related financial distress did not correlate with time on treatment, indicating that patients are at risk for FD throughout the treatment continuum. Screening for and addressing financial distress should occur throughout the course of cancer therapy.


Assuntos
Gastos em Saúde , Neoplasias , Adulto , Idoso , Idoso de 80 Anos ou mais , Efeitos Psicossociais da Doença , Estudos Transversais , Feminino , Humanos , Renda , Masculino , Pessoa de Meia-Idade , Neoplasias/terapia
17.
Oncologist ; 26(6): 465-e917, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33469991

RESUMO

LESSONS LEARNED: Antitumor activity was observed in the study population. Dose modifications of cabozantinib improve long-term tolerability. Biomarkers are needed to identify patient populations most likely to benefit. Further study of cabozantinib with or without panitumumab in patients with metastatic colorectal cancer is warranted. BACKGROUND: The epidermal growth factor receptor (EGFR) antibody panitumumab is active in patients with RAS wild-type (WT) metastatic colorectal cancer (mCRC), but nearly all patients experience resistance. MET amplification is a driver of panitumumab resistance. Cabozantinib is an inhibitor of multiple kinases, including vascular endothelial growth factor receptor 2 (VEGFR2) and c-MET, and may delay or reverse anti-EGFR resistance. METHODS: In this phase Ib clinical trial, we established the maximum tolerated dose (MTD) and recommended phase II dose (RP2D) of cabozantinib and panitumumab. We then treated an expansion cohort to further describe the tolerability and clinical activity of the RP2D. Eligibility included patients with KRAS WT mCRC (later amended to include only RAS WT mCRC) who had received prior treatment with a fluoropyrimidine, oxaliplatin, irinotecan, and bevacizumab. RESULTS: Twenty-five patients were enrolled and treated. The MTD/RP2D was cabozantinib 60 mg p.o. daily and panitumumab 6 mg/kg I.V. every 2 weeks. The objective response rate (ORR) was 16%. Median progression free survival (PFS) was 3.7 months (90% confidence interval [CI], 2.3-7.1). Median overall survival (OS) was 12.1 months (90% CI, 7.5-14.3). Five patients (20%) discontinued treatment due to toxicity, and 18 patients (72%) required a dose reduction of cabozantinib. CONCLUSION: The combination of cabozantinib and panitumumab has activity. Dose reductions of cabozantinib improve tolerability.


Assuntos
Neoplasias Colorretais , Fator A de Crescimento do Endotélio Vascular , Anilidas , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/genética , Humanos , Panitumumabe/farmacologia , Panitumumabe/uso terapêutico , Proteínas Proto-Oncogênicas p21(ras) , Piridinas
18.
Braz J Biol ; 81(2): 398-405, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32696847

RESUMO

Continuous occurrence of heavy metals is a major cause of environmental pollution due to its toxic effects. At minimum concentrations, these metals are highly reactive and can gather in the food chains and food web, causing major dangers to public health concerns. Soil samples were collected from Paharang drain, Faisalabad. Cadmium tolerant bacteria were isolated and evaluated for their MIC against Cd. The isolated bacterial strain GCFSD01 showed MIC value upto 30 mM/L. The bacterial strain with the highest resistance against Cd was selected for further study. Molecular characterization of bacterial isolate GCFSD01 was performed by 16S rRNA which confirmed it as Bacillus cereus. Optimum growth conditions of bacterial strain were also evaluated. Strain GCFSD01 showed optimum growth at pH 7 and 37 °C temperature. Our result revealed that B. cereus strain GCFSD01 reduced 61.3% Cd after 48 hrs. Multiple metal tolerance and Cd reduction by B. cereus indicate its potential for further use for decontamination of polluted soil.


Assuntos
Metais Pesados , Poluentes do Solo , Bacillus cereus/genética , Biodegradação Ambiental , Cádmio/toxicidade , Metais Pesados/análise , RNA Ribossômico 16S/genética , Solo , Microbiologia do Solo , Poluentes do Solo/toxicidade
19.
CA Cancer J Clin ; 71(2): 100-106, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33226648

RESUMO

Cancer treatment is associated with financial hardship for many patients and families. Screening for financial hardship and referrals to appropriate resources for mitigation are not currently part of most clinical practices. In fact, discussions regarding the cost of treatment occur infrequently in clinical practice. As the cost of cancer treatment continues to rise, the need to mitigate adverse consequences of financial hardship grows more urgent. The introduction of quality measurement and reporting has been successful in establishing standards of care, reducing disparities in receipt of care, and improving other aspects of cancer care outcomes within and across providers. The authors propose the development and adoption of financial hardship screening and management as an additional quality metric for oncology practices. They suggest relevant stakeholders, conveners, and approaches for developing, testing, and implementing a screening and management tool and advocate for endorsement by organizations such as the National Quality Forum and professional societies for oncology care clinicians. The confluence of increasingly high-cost care and widening disparities in ability to pay because of underinsurance and lack of health insurance coverage makes a strong argument to take steps to mitigate the financial consequences of cancer.


Assuntos
Efeitos Psicossociais da Doença , Estresse Financeiro/epidemiologia , Oncologia/organização & administração , Neoplasias/terapia , Indicadores de Qualidade em Assistência à Saúde , Estresse Financeiro/etiologia , Disparidades em Assistência à Saúde/economia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Oncologia/economia , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Neoplasias/economia
20.
J Interprof Care ; : 1-9, 2020 Dec 08.
Artigo em Inglês | MEDLINE | ID: mdl-33290117

RESUMO

Diabetes mellitus and periodontal disease are among the most frequently occurring conditions that have a substantial effect on the global health economy. The literature regarding medical professionals' knowledge of the bidirectional link between diabetes mellitus and periodontal disease has not been analyzed systematically. The review aimed to investigate the knowledge and understanding of physicians and specialists regarding the two-way relationship between diabetes mellitus and periodontal disease and their approach to referring their patients for a dental consultation. An electronic search of PubMed and Google Scholar databases was conducted to review the studies that assessed knowledge and understanding of medical professionals regarding the relationship between diabetes mellitus and periodontal disease. Data from 13 included studies involved 4,027 participants: 3,256 primary care physicians and 771 medical specialists. Just over 50% of the medical professionals had an understanding of oral health and/or periodontal disease. Over one-third of medical professionals were ignorant of the relationship between oral health and diabetes mellitus. Only 30% reported ever referring their patients for an oral health assessment. Another key finding of the investigation was the absence of interprofessional collaborative care between medical and dental professionals while managing patients with diabetes mellitus. Medical professionals with an integrated knowledge of elementary oral health education and training could play a central role in the timely diagnosis and management of periodontal disease in patients living with diabetes mellitus.

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