RESUMEN
PURPOSE: VEGFR-2 gene displays several functional germline polymorphisms with impact on VEGFR-2 mediated angiogenesis. Our purpose was to evaluate VEGFR-2 polymorphisms as prognostic markers for tumor recurrence and overall survival (OS) in non-small-cell lung cancer (NSCLC). METHODS: In total, 209 Caucasian patients who had been surgically treated for NSCLC between 1996 and 2010 were included in this study. Genotyping of peripheral blood cells was performed by TaqMan® genotyping assays or polymerase chain reaction for five VEGFR-2 polymorphisms. Chi- square test, Kaplan-Meier estimator, and Cox regression hazard model were used to assess the prognostic value of VEGFR-2 polymorphisms. RESULTS: VEGFR-2+4422 (AC)10-14 polymorphism was identified as a positive prognostic marker for time to metastasis (11/12 vs. 11/11 (AC) repeats: hazard ratio (HR), 0.28; 95% confidence interval (CI), 0.11-0.75; p=0.012) and OS (11/12 vs. 11/11 (AC) repeats: HR, 0.41; 95% CI, 0.21-0.82; p=0.012) in squamous cell carcinoma. For adenocarcinoma, VEGFR-2-906 C>T (C/T vs. CC: HR, 0.19; 95% CI, 0.43-0.82; p=0.027) and VEGFR-2-271 G>A (G/A vs. G/G: HR, 0.25; 95% CI, 0.07-0.86; p=0.027) predicted longer time to local recurrence and VEGFR-2-906 C>T was a predictor for better OS (T/T vs. C/C: HR, 0.28; 95% CI, 0.09-0.84; p=0.024). CONCLUSIONS: VEGFR2 germline polymorphisms predict tumor recurrence and OS in NSCLC.
Asunto(s)
Biomarcadores de Tumor/genética , Carcinoma de Pulmón de Células no Pequeñas/genética , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Recurrencia Local de Neoplasia/genética , Recurrencia Local de Neoplasia/mortalidad , Polimorfismo Genético/genética , Receptor 2 de Factores de Crecimiento Endotelial Vascular/genética , Adenocarcinoma/genética , Adenocarcinoma/mortalidad , Adenocarcinoma/secundario , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Pulmón de Células no Pequeñas/secundario , Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/secundario , Femenino , Estudios de Seguimiento , Genotipo , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Tasa de SupervivenciaRESUMEN
This article summarizes the published results of the Employment Intervention Demonstration Program (EIDP), a federally-funded, multi-site study examining the effectiveness of supported employment programs for 1273 unemployed individuals with psychiatric disabilities in the U.S. Findings confirm the effectiveness of supported employment across different models, program locations, and participant populations. The study's results are discussed in the context of public policies designed to encourage return to work for those with a severe mental illness.
Asunto(s)
Empleos Subvencionados/estadística & datos numéricos , Empleo/legislación & jurisprudencia , Trastornos Mentales/rehabilitación , Enfermos Mentales/legislación & jurisprudencia , Política Pública , Empleos Subvencionados/legislación & jurisprudencia , Medicina Basada en la Evidencia , Femenino , Humanos , Masculino , Enfermos Mentales/psicología , Evaluación de Resultado en la Atención de Salud , Estados UnidosRESUMEN
Effects of co-occurring disorders on work outcomes were explored among individuals with severe mental illness who were participating in a multisite randomized study of supported employment. At seven sites, 1,273 people were randomly assigned to an experimental supported employment program or a control condition and followed for 2 years. Multivariate regression analysis examined work outcomes including earnings, hours worked, and competitive employment, as well as whether psychiatric disability was disclosed to coworkers and supervisors. Individuals with any comorbidity had lower earnings and were less likely to work competitively. Those with physical comorbidities had lower earnings, worked fewer hours, and were less likely to work competitively. Disclosure was more likely among those with both cognitive and physical comorbidities, as well as those with learning disabilities. Competitive employment was less likely among those with intellectual disability, visual impairment, and human immunodeficiency virus/acquired immuno-deficiency syndrome. The experimental condition was positively related to all outcomes except disclosure. The results suggest that, with some exceptions, comorbidities affect employment outcomes, requiring tailored services and supports to promote vocational success.
Asunto(s)
Evaluación de la Discapacidad , Empleos Subvencionados/métodos , Trastornos Mentales/rehabilitación , Rehabilitación Vocacional/métodos , Educación Vocacional/métodos , Adulto , Atención Ambulatoria , Medicina Basada en la Evidencia/métodos , Femenino , Humanos , Masculino , Trastornos Mentales/complicaciones , Trastornos Mentales/psicología , Evaluación de Resultado en la Atención de Salud , Selección de Paciente , Estados UnidosRESUMEN
KIE: A comparison is made of health care policies and health care delivery systems in the United States, Great Britain, and the U.S.S.R. The differing evolution of the concept of a right to health care in the three countries is traced, and the toleration of unequal distribution of services in the U.S. is attributed to opposition within the medical profession toward the notion of health care as a right and to the inability of federal agencies to develop a comprehensive plan for health care delivery.^ieng